Some of the common problems occurring at the Anus & Rectum

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SPECIALITY CENTRE FOR ANORECTAL PROBLEMS.

ANAL FISSURE

DEFINITION

An elongated ulcer in the long axis of the lower anal canal.

Causes: Over-stretching and trauma to anal canal by hard fecal matter. During delivery of child, women develop anterior fissure.

Other causes: anal stenosis, venereal diseases, AIDS, IBD.

Types:

Acute: Less than 6 weeks duration.

Chronic: More than 6 weeks with inflammation. At lower end skin tag is present known as sentinel pile. Infection, abscess & fistula in the skin tag is common.

Secondary Chronic fissure - May be due to Crohn's disease, other granulomatous diseases, tuberculosis, AIDS, Venereal diseases.

SYMPTOMS
Occurs at any age, mainly presents in young adults, more in females, may be present in children. Sharp, cutting pain during & after passing stool which may last for hours after passing stool, ceases suddenly & reappears after next stools. Pt. avoids going for stools & develops constipation. Bleeding is usually small, passing few drops. Discharge - small amount.

TREATMENT:
The aim of the treatment is relief of the pain & relaxation of the internal sphincter which will result into healing of the fissure.

General treatment: Sitting in Hot water tub, medicines to control the infection & pain, stool softener & application of the local anaesthetic like xylocaine oint, for relief from the pain.

Dietatory modifications like non spicy, soft, high fiber diet & drinking plenty of water.

Chemical sphincterotomy: Local applications of the drugs to relax the sphincter.
Early or acute fissure may heal with- Conservative management & medicines. Continuing life style management will avoid the recurrence.

Surgical management: Fissure older than 8 weeks or chronic fissure usually requires surgery for the cure. Procedures-Sphincter stretch, Anal dilatation, Fissurectomy (Excision of the fissure) Lateral Internal sphincterotomy, will relax the sphincter & help to heal. Recurrent fissure may require repeat surgery.

Fissures with other anal conditions may require appropriate additional procedure. Secondary fissure may require biopsy to establish the diagnosis & should be treated accordingly.