Most of the times seen in posterior aspect because this part is backed by bony hard part.
The main cause for this condition is chronic constipation with hard stools, where this hard stool by constant erosion produces linear ulcer most of the times over post aspect of Anal canal (6 o’ clock position). The other common causes are chronic Amoebiasis, IBS, Inflammatory bowel disease like Crohn’s disease, Ulcerative colitis etc.
Main symptoms are
Painful defecation Pain usually persists for 30 min to 2 hours after defecation and abruptly disappears. If bleeding occurs, seen as a red line on stool. If not treated for long time a flap of skin will cover the fissure which is called as sentinile pile which looks like piles but really not, just a flap of skin to protect the fissure. Many people due to the fear of pain avoid passing stool regularly, they hold it and passes stool whenever they feel relaxed, usually during weekends. This indicates how painful and irritable this condition is.
Specific indication for Conservative management
1.The fissure should be of recent onset
2.There shouldn’t be development of hard granulation tissues over the fissure which prevents normal healing.
Aim of treatment.
Difficulty in treatment is because,
Every time when patient passes stool formation of new abrasion every time is likely which prevents healing Acute spasm of anal sphincter due to which there will be poor blood supply to the fissure area, and because of poor blood supply there will be poor healing. There shouldn’t be formed hard indurated granulation tissue where normal healing is not possible, only by removing indurated portion we can expect healing.
So here aim is
1.Laxatives (anulomana treatment)
2.Herbs which will make the tissues heal fast
3.Antispasmodics and Vedana hara drugs to reduce the sphincteric spasm.
Abhayarista 20 ml bid, T Kankayana vati 400mg 1 bid, T Triphala guggulu 600mg, 1 tid, Avipattikara churna 1 tsp bid continuously for 3-6 months. Sitz bath with Triphala kwatha or just hot water.
We have many success cases with these Rxs, strict diet has to be advised. Rich fiber food, should avoid all spicy and deep fried food.
Just Anal dilatation and removal of indurated tissue gives fast cure that is within 1 week. Really surgery gives complete recovery very fast. Ideal treatment in chronic case is definitely surgery, and recovery is comparatively very fast in surgery for all Fissure in cases. But most of the patients afraid to go for surgery, hence those eligible for conservative management can be treated successfully with medicines.