ANAL FISSURE

Definition-
Anal fissure is a condition where cuts develop in the soft mucosa in the anal region. 

Symptoms-

1. Pain in anal region before, during and after defecation. 
2. Bleeding from anus. 
3. A small lump near fissure. 
4. Itching at anus. 
5. On Examination- Crack at anal region

Cause-

1. Hard and long stool. 
2. Constipation and straining during bowel movements. 
3. Repeated attacks of diarrhoea. 
4. Anal intercourse
5. Child-birth (Because of labour)
6. HIV, Syphilis
7. Anal cancer

Types-

1. Acute- Sudden onset, gets healed in 3-4 days
2. Chronic- Sudden onset, gradually increasing, lasting for days to months due to severe muscle spasm of anal sphincter.
3. Recurring- Acute presentation but happens recurrently due to dietic errors.

Anal fissure is very common complaint in today’s world of fast food and fast life. Working round the clock makes you unaware of your physiological need. We eat wrong food at wrong time and in a wrong way out of habit or out of ignorance. Next day while passing stool there is severe pain in anal region with or without blood streaks in stool. Stool is hard, difficult to pass, person has to strain to get rid of it. This hard stool rubs against delicate mucus membrane of anus which is rich in nerve supply. This rubbing causes abrasion. This abrasion is nothing but fissure.

Treatment-

1. Allopathy-

Applications/medication:
a) Topical ointment- Consisting of anti-inflammatory, antibiotic and anaesthesia. 

1. b) Nitro-glycerine application- To increase blood flow and hasten healing process.
2. c) Botulinum injection- To relax spasm of anal sphincter.   

Surgical-
Lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain; and promote healing.

1. Homoeopathy-

Anal fissure becomes a tendency and recurrence is commonly seen. Here, we treat this acute pain of fissure with acute remedies like Arsenic Album, Ratanhia, Nux vomica, Phosphorus, Nitric acid etc depending on symptom similarities.

Recurrent tendency can be treated with long term constitutional treatment.

Diet Advice in Fissure-in-Ano

1. Lot of fibres in food- 

1. vegetables cooked or raw or sauté, mixed vegetable soup (homemade) 
2. Fruits- 2-3 per day (except apple and pomegranate as it causes constipation most of the time)
3. Soaked raisins (black) – soak 10 pieces of black raisins in half cup of water and have it in the morning, discard the water. Take a glass of water on it
4. Soak 2 pieces of dried fig and consume it in the evening with water
5. Use Oats, barley, Porridge (Daliya) in your diet

1. Reduce spice level in the food (garam masala)
2. Avoid Non-vegetarian food
3. Avoid onion, garlic, coffee, alcohol, tobacco
4. Avoid bakery products – breads, biscuits, toast etc. as they are made of refined wheat flour lacking adequate fibres
5. Take green leafy vegetables+ moong daal (Green gram) khichdi
6. Take plenty of water
7. Take suran (elephant’s foot) in diet- boiled or boiled and fried as a stool softener
8. Use Isabgol husk (Psyllium husk) – 1 spoon soaked for at least an hour in 1 glass of water at bedtime
9. Add ghee (clarified butter) to your food- 1 spoon ghee before food forms coating on entire alimentary canal till anus and helps in smooth bowel movements.
10. Sitz Bath- Take warm (not hot) water in a tub in which you can sit. Add few crystals of Potassium permanganate (buy it from chemist). Adding it is optional. Just water would also suffice. Water turns pink. Sit in this tub in a way that you are immersed in water till waist for 10-12 min. This will relax your rectal muscles and anal sphincter and will give you great relief in pain. There are such tubs- devices available in market which can be fitted on commode whenever you need it. Check online.

DIET IN FISSURE & HAEMORRHOIDS