This is a very common Ano rectal disease causing a lot of suffering to the patient. It consist of a tear or a crack in the skin lined part of the anal canal. It usually found in young and middle age people but some times even in children. Though a small crack, the pain and suffering inflicted by it is of great magnitude. Beside, more often than note, it dose not heal permanently and keeps on showing its effects continually or intermittently.
The crack is usually in the midline posterior i.e. in line with the cleft of the buttocks. Occasionally it may be in the front or sides. Some times a little tag, swelling of the skin develops at the edge of the anus. This is could the sentinel tag or Sentinel Piles. This stays even after the fissure heals unless excised.
Very long standing fissure develops hard fibroid tissue. Later on perennial abscess or a anal fistula may form as a complication. Fissure in Ano is also a common cause of anal stenosis / spasmodic anus.
The causes of fissure are not very clear. Rarely fissure are cause due to some bigger under line problem like chrons, Ulcerative colitis, Tuberculosis, Growths etc. The other main possible region could be trauma to the area due to passage of unusually hard stool. Patients often tend to take laxatives for getting soft watery stool, thinking that this will not cause them pain and will solve the problem. It is true that such patients will note face the problems (Pain, temporarily) avoiding the necessity to expand or starch anal canal / anal orifice, but ultimately this leads to more contractions of the canal. Hence, after some times this patients face difficulty in passing even normally formed stool.
Spasm in the anal sphincter (Valve of the anal canal) and ischemia (insufficient blood supply to the area may be the helping factors in the development of fissure and also in preventing the healing process.
The internal sphincter plays an important role in the development of a fissure. These mussels, controlling the opening of the anus, can not be control voluntarily. Pain due to the fissure will cause spasm of the internal sphincter and not allowed it to relax.
This is the most predominant symptom of fissure in Ano. It is often describe by the patient as of sharp, cutting searing and tearing nature & is of great severity. The pain is usually during defecation and may last up to three to four hours after defecation. The Pain is so agonizing that the patient dreads his visits to the toilet and tends to avoid passing stool, as a result in some cases remains constipated for several days. This further aggravates the symptoms when he eventually has to pass stool.
Some patient s discover that by passing soft watery stool, the pain can be avoided and develop a habit of tacking laxative / purgatives regularly instead of getting proper medical advise. These patents unknowingly are actually aggravating the problem by worsening the condition of the sphincter.
There may be fissures without bleeding but usually the pain is accompanied by bleeding during defecation it is bright red appears as a speak along with the passage of stool. Occasionally it may be profuse-heavy.
Most patients develop a skin tag ( a lump) due to the swelling of the skin at the site of the fissure.
Occur usually in chronic cases and leaves the patient very uncomfortable.
Some long standing cases of painful fissure develop disturbances in passage of urine, some times the frequency to urinate is increased whereas in some cases there is retention.