A fissure literally means a cleft crack. Medically, fissure refers to linear crack in the skin. Skin cracks can arise anywhere in the body. But the cracks are most commonly seen in edges or at the junction of two different types of skins

Causes -

The major causes are supposed to be,

• Physical strain -Pressure exerted while passing stool
• Defecation – Anal fissure is most commonly caused by constipation. The hard, dry stool tears the anus when it stretches the anus forcibly while defecating. It can also be caused by diarrhoea due to sudden purge or straining after enema.
• Foods – Low fibre diet, more spices, alcohol and lesser intake of water can produce hard dry stool, which needs more strain in defecation
• Weakened anus sphincter muscles – due to any diseases
• Dry skin disorders which affect lower part of anus
• Small tight anus – congenitally small or spastic tight anus

Symptoms :

• Cruel pain is the major symptom of fissure – Pain may be burning, stabbing, pricking and a feeling of glass pieces or thorns in the anus. Pain is usually aggravated after defecation. The patients used to suffer with pain for more than half-an-hour after passing stool or for the remaining whole day.
• Bleeding usually occurs at the time of defecation which appears as a streak in the stool. Usually it will be fresh and is supposed to come in drops after defecation but never passes mixed with the faeces.
• Tightness or spasms of the anus usually interrupt in passing the stool
• The fissure is always visible / felt as a swollen traingular (thickened) area with the skin tag in its lower end
• With the fear of pain, patients usually avoid the act of defecation and develop constipation from there which further worsens the condition

Diagnosis – of fissures is easy, since a simple examination with slight stretch of anus can identify the fissure. Digital examination will be very painful in all the case of fissures due to spasm and tightness of anal sphincters, so it is avoided mostly.

Management – Many fissures can be healed with simple management as follows.

• Take plenty of water and fruit juices
• Avoid non-veg and fatty diet
• Take easily digestible, simple food with plenty of vegetables
• Use Indian style toilets since squatting position will be a better position for pain and natural defecation.
• Follow hygienic measures in cleaning and caring
• Pass stool twice a day to avoid dry hard stool and strain to rectum and anus
• * Never suppress an urge. Go for stool whenever there is a call since it will be easy then
• Sitz bath – Before passing stool, sit in a shallow bath tub of warm salt water for 10 – 15 minutes to relax the anal sphincter and to relieve the anal spasm. This technique usually pacifies all the painful anal conditions

Do and Don’t:

• Sporting activities, long-distance walking / travelling / cycling during healing process
• Any friction or injury
• Dry cleaning by toilet papers. Go for wash with warm water which usually soothes
• Scratching, since it may become red, sore and infected.
• Non-veg, fast foods, oily foods, etc.
• Spices and chillies
• Smoking, drinking alcohol and coffee

Prevention – It is well said that prevention is better than cure. Always follow these procedures to avoid anal sufferings

• Take plenty of water for easy defecation and to avoid constipation.
• Follow regular bowel habits
• Take hygeinic measure to keep anus clean and dry
• Treat constipation or diarrhoea immediately

Surgery – Mostly anal fissure heals without surgery, if it is cared for in its initial days itself. But if it becomes chronic and persistent, then, as a last resort, surgery can be opted.

Homeopathy approach : can do wonders when one opts for the treatment in case of fissure. Also, surgery cannot cure all cases of fissure. Even after surgery it can recur if the root cause is not cured. So, Homeopathy treatment is the best way to root out the disease and cure fissure in ano without any side-effects.

Homeopathic medicines : commonly used in case of fissure are -Acid Nit, Bryonia, Calc Flour,

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