Symptoms, Causes and Diagnosis Anal Fissure and Haemorroids

Symtoms of Anal Fissure and Haemorroids

Common symptoms include pain that is worse with bowel movements, burning in the anus, bleeding when passing stools, itching and/or a tearing sensation. Patients may try to avoid defecation because of the pain. The pain persists for some time after the passing of stool.

Causes of Anal Fissure and Haemorroids

Hard, dry stool can cause tear in the anal lining. The wound produced by the tear is known as anal fissure. Other causes of a fissure include diarrhoea and inflammation of the anorectal area. 
Anal fissures may be acute (recent onset) or chronic ( present for a long time or recurring frequently ). An acute fissure is usually due to hard stool as discussed above while a chronic fissure may be either due to over-tight or spastic anal sphincter muscles, scarring due to recurrent acute fissure or due to an underlying medical problem. 

Diagnosis of Anal Fissure and Haemorroids

Fissures are diagnosed by simple rectal examination. Additional testing may be recommended if other medical problems such as inflammatory bowel disease or infections are considered as a cause. 

Treatment for Anal Fissure and Haemorroids

The goals of treatment are : 

1. To regulate the consistency of the stools. 
2. Relaxation of the anal sphincter tone. 
3. To avoid discomfort, bleeding and pain. 
4. Healing of the fissure. 

Acute Fissure 

An acute fissure is managed with non-operative treatments and over 90 per cent will heal without surgery. Most acute fissures heal in six weeks. Treatment measures are : 
§ Bowel habits are improved with a high-fibre diet, fibre supplements, stool softeners, and plenty of fluids to avoid constipation and promote the passage of soft stools. 
§ Warm baths for 10-20 minutes several times each day to promote the relaxation of the anal muscles. 
§ Special medicated creams such as lidocaine jelly can be used to control the discomfort. The cream is to be applied in the anal canal before as well as after defecation. 

Chronic Fissure 

A fissure that fails to respond to the above treatment should be re-examined to determine if a definitive reason exists for lack of healing. Such reasons can include scarring or muscle spasm of the internal anal sphincter muscle. Those which continue to cause pain and/or bleeding require surgical treatment. 
Anal sphincter dilatation under anesthesia helps in majority of the cases. Those who do not improve with anal dilatation, require a small operation. A portion of the internal and sphincter muscle is cut. This decreases the pain and spasm. The pain disappears within a few days and complete healing occurs in 3-4 weeks . Chances of recurrence after surgery are less than 10 per cent. 

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