Gajananam Bhutganadisevitam Kapittha Jamboo Phalcharu Bhakshanam Umasutam Shokvinashkarakam Namami Vighneshwar Padpankajam
Fissure in ano is a troubling and painful condition that affects a great majority of the population world over. The nature and anatomy of fissure in ano is quite clear, and much is known about the various predisposing and contributing factors that lead to initiation and progression of the disease. The preferred method of treating them, one that results in optimal clinical results and the least pain and inconvenience to the patient, however, has been open to debate.
Treatment of Superficial fissures
It has long been recognized that superficial fissures can be cured conservatively2. The following methods are usually advocated for such type of simple fissures.
Warm water sitz bath with or without adding boric powder, povidone iodine solution, or potassium permanganate in the water. This treatment soothes the pain and relaxes the spasm of the internal sphincter for some time 3
Adequate analgesia is necessary to break the vicious cycle of pain viz. avoidance of defecation for prolonged periods leading to hard stools resulting in further tearing of the anoderm and thereby inviting increased pain. A suitable dose of analgesic consumed half an hour before going for defecation gives a good amount of post defecation pain relief.
Stool softening is essential as soft and formed stools negotiate the rectum and anal canal in non-traumatic physiologic maneuver. Plenty of oral fluids also help in keeping the stools soft.
High-fiber-diet and bulk-forming agents such as Isaphgula; green leafy vegetables and fibrous fruits go a long way in increasing the bulk of stool leading to a smooth and swift act of defecation.
Reassurance and encouragement for not resisting the urge for defecation help prevent hard stools. Later the patient could be encouraged to acquire and maintain a regular bowel habit of once or twice a day. Application of local anesthetic cream or gel may help avoid the torture experienced in passage of stools in the patients with acute fissures. Ointments containing opiates, xylocain, amethocain, and cinchocain to relieve pain, belladonna to alleviate sphincter spasm and silver nitrate to promote healing have been in vogue since long. These mixtures are introduced on the finger or a short rectal bogie to ensure a through application over the desired part of the fissure4. The modern practice is to insert the ointment over an anal dilator, which in addition helps relieve sphincter spasm. The possible complication of this treatment includes pruritus due to allergy with the anesthetic agents and loss of anal dilator in the rectum5.
Chronic or complicated fissure in ano
The above mentioned approaches do not prove effective in the chronic variety of fissures in ano. These chronic or complicated fissures are not amicable to the aforesaid simple conservative line of treatment. A definitive therapy is needed to tackle this stubborn malady.