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Anal Fissure
General Surgery
Anal fissure refers to the condition where there is a crack or tear in the mucous membrane inner layer between the rectum and the anus or in the skin around the anus. Patients often experience intense pain when having a bowel movement due to the stretching and irritation of the fissure.
Symptoms
Common symptoms of an anal fissure include:
- Anal pain
Typically, it is intense and short-lived, especially during bowel movements.
- Bleeding
Noticeable bright red blood may accompany bowel movements, as bleeding caused by the fissure is usually minimal but brightly coloured.
- Tearing sensation
Patients may feel pain or a tearing sensation around the anal area, and it can persist for a while.
Factors
The leading causes of anal fissures are typically related to the following factors:
| Constipation | Constipation is one of the most common causes of anal fissures. Hard stools or straining during bowel movements can lead to anal fissures in the anal mucosa or skin. It is because, during bowel movements, the mucosa or skin is subjected to excessive stretching and pressure, making it prone to injury. |
| Diarrhea | Diarrhea can also lead to anal fissures. During diarrhoea, frequent bowel movements can result in irritation and damage to the mucosa. |
| Overly Soft Stools | Unusually soft stools may not cause fissures by themselves, but they can still irritate the anal mucosa, especially when there's a need to strain during bowel movements. |
| Crohn's Disease | Crohn's disease itself does not directly cause anal fissures, but it can increase the risk of anal fissures. The condition can lead to anal inflammation and ulcers, diarrhoea or constipation, all of which can contribute to the development of anal fissures. |
| Other Factors | Trauma to the area around the anus (e.g., sports injuries) or anal surgery can also lead to the formation of anal fissures. |
Diagnosis and Treaments
Diagnosis
In general, doctors can directly observe anal fissures, and if necessary, they may conduct further examinations and confirm the condition through an anoscopy.
Treatment
The choice of treatment depends on the severity of the anal fissure. Typically, treatment includes the following aspects:
- Non-surgical treatment: For mild anal fissures, non-surgical therapy can be attempted, including improving dietary habits, increasing fibre intake, maintaining adequate hydration, and avoiding constipation. Medications such as anti-inflammatories, pain relievers, or antibiotics can promote healing.
- Surgical treatment: Severe or chronic anal fissures may require surgical intervention. The primary goal of surgery is to remove the fissure and promote healing. Surgical methods include:
- Fissurectomy: This involves removing the tissue around the fissure to clear the area.
- Lateral Internal Sphincterotomy: In this procedure, a small portion of the sphincter muscle is cut to reduce tension and promote healing while relieving pain.
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