What is fissure?

An anal fissure or Fissure-in-ano is a tear or cut in the skin of the anal canal. The condition affects men and women equally and can occur at any age ( infants too ). Anal fissures are commonly found in the back part of your anus, in line with the cleft of your buttock.

A fissure which is present for less than 6 weeks is called an Acute fissure. That which is more than 6 weeks old is called a Chronic fissure. The Chronic fissure is usually hard to feel and may have a skin tag like growth called Sentinel Pile.

Causes of Fissure!

Usually trauma to the anal canal causes a fissure.

• Hard stools especially associated with constipation – The increased pressure exerted in an effort to pass the hard stools causes tearing of the delicate perianal skin.
• Diarrhoea – The frequent forceful bowel movement causes tearing of the anal skin.
• Iatrogenic – A tear may occur during insertion of a rectal thermometer, USG probe, endoscope, enema tube.
• Childbirth
• Anal sex – Commonly encountered in homosexuals.
• Rare causes – Crohns disease, leukaemia, tuberculosis, sexually transmitted diseases, viral infections etc

Treatment

PLIS ( Partial Lateral Internal Sphincterotomy )

Done under general anaesthesia, this is a minimally invasive procedure in which a small cut is made in the internal sphincter. Thus straining during defecation is considerably reduced and there is satisfactory relief from pain.

 Laser surgery

The laser is used to perform internal sphincterotomy. This procedure is almost bloodless and the surgeon has good control over the operation site. Additionally, the chronic fibrosed scar is debrided with the laser. This prevents any long term discomfort and enables a quicker recovery.

BOTOX For Fissure

Botulinum Toxin A popularly known by brand name Botox is a neurotoxic protein that produces temporary, localized, flaccid paralysis of muscle. It is used commercially in medicine, cosmetics and research. It is often used to treat Anal Fissure, as an alternative to surgery, especially when medicines have been tried without success.