Anal Fissure

One of my young patients complained of feeling of “passage of tiny glass pieces” while going to the toilet. This is accompanied with severe burning pain and she had noticed little blood every now and then while passing stools. On examination we found her to have an anal fissure; an ‘acute anal fissure’ to be exact.
So what is an anal fissure or ‘fissure in ano’? This is a split or a wound that occurs in the lining of the anal canal. This can be following passage of hard stools after being constipated or lack of fluids or it may be even after an episode of diarrhoea. This can be seen as a split wound of the anal canal on inspection. This is an extremely painful condition. Classically it starts with burning rectal pain, rectal bleeding which may be noticed as passage of drop or two of blood or a streak of blood on stools or when you clean yourself with toilet tissue on it.
Main reason for this is increased pressure of the anal sphincter(Circular muscle around the anus which control the continence). There is a wishes cycle setting in as this began. Natural tendency is for the sphincter to go into spasm with pain and this will further worsen the pain. Therefore all treatment modalities are based on reduction of sphincter pressure while reducing pain.
Prevention of constipation by taking adequate liquids and high fibre diet, local application of pain releasing applications (local anaesthetics) and muscle relaxing applications (Calcium channel blockers) will help in some patients. If these simple methods fail, injection of botulinum toxin to relax the sphincter for a long period will allow the wounds to heal. Failing all of the above controlled division of the internal sphincter at a surgery will cure this condition.