| Fissure in ano |
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| What is Fissure in ano
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| It is a condition characterized by a longitudinal crack or slit (ulcer) in the skin of anus. Fissure in ano is observed in children as well as in adults however it is more common amongst middle aged adults, The Posterior midline of the anus is the most common location for Fissure due to low blood supply in this area.
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Symptoms of Fissure
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| Pain while passing stool
Sharp agonizing knife like pain start when the individual passes stool.
The pain may be severe and may persist for an hour or so
It ceases suddenly
If a Fissure become chronic (longstanding) and deep another kind of pain can develop
It is a dull ache in the anus and pelvis that starts a few minutes after the bowel movement and can persist for hours after passing stools, this pain is due to spasm of the internal sphincture muscle and can be quite debilitating.
Blood streaked stool (typically on the side of the stool, which is bright red in color)
Discharge, swelling and itching occur especially with chronic Fissure.
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| Causes
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| Most common cause is CONSTIPATION.
Chronic constipation due to any reason ( such as habitual drug induced, irregular meals or irregular bowel habits) leads to recurring abrasion or forcefully rubbing of the ANAL MUCOSA which leads to Fissure
Other causes- Chronic diarrhea, Multiple pregencies, chronic use of laxative
Incorrectly performing operations for piles.
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| Diagnosis
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Per rectal examination is painful due to
Spasm of internal sphincter, A split or cut on the posterior or anterior midline of the anal verge.
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| Type
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| Acute fissure (Less than 6 weeks), superficial with sharply demarcated edges
Chronic fissure (More than 6 weeks) , usually deeper and may have secondary features including hardening of edge of the fissure, a sentinale pile which looks like small skin tag and hypertrophied anal papillae.
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| Treatment
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| Acute anal fissure – May be cured by regulating dietary habits, exercise, medicines etc.
Chronic fissure- lateral subcutaneous internal sphinctorotomy(by RF) is the best procedure done under short GA or Local Anaesthetia in 2-3 minutes , after which
the patient may be discharged after 2 hrs.
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| Benefits
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No dressing , No bedrest, Office procedure, Immediate relief in pain and burning.
The patient does not realize that he is cured while he is cured. |
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