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Anal Fissures and ways to treat 'em

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bikidas2060

Well, in Constipation its causes its side effects and treatment procedures we discussed about constipation. I discussed about anal fissure too. But I believe the problem is sooo big and common that it deserves its own main thread. And hence I am writing a new topic. And I will definitely add new content and some rectifications based upon my experience. So, it’s not going to be the typical copy paste article. 

What’s Anal Fissure

Well, we have sphincters all over our GI tract, urinary tract etc. Sphincter is a round muscle, which acts as a one way valve. When we talk about anus, it has two sphincters, Sympathetic sphincter muscle and Parasympathetic sphincter muscle ones respectively. Inner sphincter is the Sympathetic one and outer sphincter is the Parasympathetic one. So, what do they do? Sympathetic sphincter muscle allows us to control the urge to poop. Anal Fissure occurs when a tear forms on Sympathetic Sphincter Muscle. Our GI tract doesn’t have any pain receptors other than on its both open ends, e.g. mouth and rectum/anus. And the fissure is located on lower third of the anal canal(below Pectinate Line), which contains the two Sphincter Muscles. That’s why we feel the pain. Otherwise it would be rather painless. And that’s why intestinal bleeding can get unnoticed. We are especially at risks as most of us don’t undergo colonoscopy at least once after 40. And colonoscopy is seldomly advised by our doctor as most of us visit a normal Medicine Specialist. And colonoscopy can be expensive as well. As a lot of us don’t have insurance coverage, we just silently watch and observe until it gets severe. 


Causes of Anal Fissure

  1. Number one cause is Constipation. And constipation can be there for a ton of reasons e.g. Junk Food, Food Allergy, Opioid based meds etc.
  2. Some sort of trauma, Foreign Objects, Pregnancy and Childbirth, Straining etc 
  3. Some pre-existing medical condition like tight sphincters.
  4. Irritable bowel syndrome (IBS) and Inflammatory bowel disease (IBD) (Both deserve their own separate threads)
  5. Diseases like Syphilis and Herpes.
  6. Sometimes medical tests like Colonoscopy itself can cause the tear.


How to identify the Anal Fissure? And who can identify? Who is recommended?

If you feel sharp pain during defecation process, see blood smeared stool, then maybe you have anal fissure. A doctor can and will identify the problem. Pain while defecation and blood smeared stool can be misdiagnosed with other diseases like fistula and piles. A Proctologist is the one, who is recommended. They might just either listen to your problem or do a physical examination. They usually do this digital examination. They might suggest for an Anoscopy. In severe cases  Colonoscopy might be recommended. Sometimes the symptoms last for 2-3 hrs or more because of muscle spasm. One might find difficulties in performing regular tasks e.g. walking, squatting, sitting on chair. Please, don’t self diagnose your problem as most of us are not qualified doctors. 

 


Treatment Procedure

Non-surgical treatments

In Non Surgical methods, home remedies for Constipation will be prescribed. We have discussed about them in detail the Constipation thread itself. And for Pain and Inflammation Management NSAIDs e.g. Ketoral-DT can be prescribed. Paracetamol is also seen prescribed. Please be ware if the physician prescribes you Ultracet. It has opioid Tramadol. It will definitely, definitely gonna cause constipation if you are already suffering from the problem. Just notify the doctor but s/he gonna chase you away most probably. So, just find another one. You might be prescribed a Liquid Paraffin based stool softener along with Milk of Magnesia e.g Cremaffin. In extreme cases you might be prescribed a contact stimulant laxative e.g. Sodium Picosulfate e.g. Cremaffin Plus, Mom Plus etc. Demerit of stimulant laxative is it can not be used long term. Both Cremaffin and Cremaffin Plus can’t be use for a long duration and Cremaffin is non habit forming one that’s why it can be availed OTC. But Cremaffin Plus is a habit forming laxative. So, if you are being prescribed for a long duration, share your concern with the physician. If the physician is adamant on giving it to you then share your concern with another physician. Please ask for the exact dosage as they want you to have semi solid stool. You might be prescribed Prucalopride. On the ointment part we have a lot of OTC ointments e.g. Pilex Forte, Pilon. But the doctors seldomly prescribe those OTC ointments. They will rather prescribe a combination of a local anesthetic Lignocaine gel and other protective layer forming agents e.g. Sucralfate. Ex: Sucral Ano. Application method is to either take a pea sized ointment on your rubber gloves covered hands and apply inside the anus or use the applicator tip. You might be prescribed Lignocaine gel, e.g. Lox 2% / Lox 5%. These are usually used while inserting the catheter. Doctors advise to apply it 20 mins before going to toilet. Lox 2% / Lox 5% will numb the area. You will not face any pain. Please check the Adverse Effects of Lignocaine Gel. And share your concerns with your prescribing physician if you find anything similar to those problems. 

If Anal Fissure heals within 4-5 weeks then alright, otherwise it will go to chronic phase. And the usual reason is Constipation but another reason is muscle spasm. Anal Muscle Spasm i.e. Proctalgia does not allow the fissure to heal. So, to relax them they use radical methods 🐒🐒🐒. The ointments contain same active components which are used to treat hypertension. First ointment of choice is Nitroglycerin. It’s a nitro vasodialater. Ex: Rectiv. Other drug of choice is Diltiazem. Ex: Cremagel .  Diltiazem vs Nitroglycerin. Next drug of choice is Nifedipine, ex AnoblissFisofine etc. Nifedipine vs Diltiazem and both of em are Calcium Channel Blockers. Nifedipine is kinda baap of all creams in order to treat rectal muscle spasms. 🙂🙂🙂 And these vasodialators and Calcium Channel Blockers come with a lot of warnings. If overdosed they can lower blood pressure. You might feel dizzy, nauseated. Talk to your Doc for proper guidance. I have seen those creams come with applicators. That’s the problem. The problem is vasodialators and Calcium Channel Blockers don’t act as a healing agent. Their purpose is to relax that stubborn Internal Anal Sphincter. So, direct application on the wound itself is unnecessary.

Just follow the video. And don’t apply a ton of vasodialators and Calcium Channel Blockers creams. Tiny amount is enough. Share your concerns with your prescribing doc. 🙂

Surgical Treatment

They might give you quite some options. One option is Botox injections. It will paralyze the affected area and allow the healing process to be complete. As it’s a quite painful option, I am including it under surgical treatment. Second option is Anal Sphicterotomy. It can be done by a skilled surgeon most preferably by laser. Side effect of Anal Sphicterotomy is Fecal Incontinence. It is what it is. And most probably it will go away after a while.


Some Interesting Bummers One I/ Faces/ed During Healing Process

> Too much fiber intake can make you constipated. They keep on saying take fiber, take fiber supplements. But as always Ati Sarvatra Garhitam (Excess of anything is bad). Check this video.

Basically first part of stool will be very hard and thick. It will just act as a sand paper on the wound. Rest of the stool will be very soft. I have personally felt it. The doctor increased Cremaffin dosage. I had to number 2 twice. First part will be sooo painful. Muscles will spasm like crazy. After 10 mins, I will go again. Soft poop will make the situation very miserable. I was given Cremaffin Plus. I intentionally avoided the same as it is very addictive. 

> Some food will make the issue very worse. They say ripe banana as a source of fiber. Yes, it is true. But it made my case worse. Months after months passed. I gulped bananas day, afternoon and evening. Damn. Even that Anobliss thing did not work. I had that comet poop thing. 40ml of Cremaffin did not work. 

> Opioids will make things worse. Meds like Ultracet will make the similar issues. A good physician will never prescribe it to a constipated person. Stool did not come out. It remained stuck. It was super painful. I had to strain and reopened the fissure. I stopped em. I stopped em all. Anobliss works for me. And for pain management, it is better to bite the bullet and take it like a champ. If you can’t sit lay down on your stomach. WFH saved me, honestly. Otherwise do this 

Just kidding. I listened to a bunch of metal songs like Custer, Walk, The Nameless etc before and after pooping. Man, those helped me a lot. You basically go like a warrior and come back injured. Stupid stuff.

> Flax seeds works. I roasted ’em and ate ’em. Apples worked wonders. 

> If you have IBS then consider this https://www.ibsdiets.org/fodmap-diet/fodmap-foo... list of foods. 

Go follow this Proctologist’s channel Your Friendly Proctologist. He gives good info. Follow your physician. Don’t forget to Google your meds. Know the composition. If doubt arises then go talk to that doctor. You will alienate some doctors as nobody wants to be taught to how to do one’s job. But its your bum in the line, quite literally. And before opting for surgery, ask for for the complications, cost, ask a second opinion. My physician, a medicine specialist, who is a very nice person, charges me 500 bucks per visit. But he also gives free treatments to the needy person. If you say you don’t have any money, he will treat you. If you say that please take fee every alternate visits then also he will agree. And during these visits we have developed this mutual respect for each other. He suggested me to go to a surgeon/proctologist. Surgeon gave me Ultracet. I suffered. I googled and I saw it has a narcotic component. You know, I have this habit of digging around things. It was late but I managed to save myself from further problems. I asked the doc. He confirmed the same. My earlier physician also recommended me to go to a homeopathy doc. That’s strange. Keep your options open. Isobgol/Psyllium is reportedly a good constipation treatment. But as with other laxatives, please don’t over do it.

 Please don’t self treat yourself. I don’t have any meds degree.

    Feel free to share your experience.

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    29 Comments  |  
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    Hunk Hunk
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    B3A5T wrote:

    What are specialist for Anal related called?
    There’s more than one??

    Proctologist. 🙂🙂🙂

    Deal Cadet Deal Cadet
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    B3A5T wrote:

    What are specialist for Anal related called?
    There’s more than one??

    Anal Specialist?

    Deal Lieutenant Deal Lieutenant
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    @bikidas2060 very nice thread. Do u still see blood in your stool? Or its completely cured now? I am suffering from the same. Tried Ayurvedic medicines for 2 months and calcium dobesilate tablets. But still see those bloodline.

    Hunk Hunk
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    RockChap wrote:

    @bikidas2060 very nice thread. Do u still see blood in your stool? Or its completely cured now? I am suffering from the same. Tried Ayurvedic medicines for 2 months and calcium dobesilate tablets. But still see those bloodline.

    Bloodline has disappeared. Actually anal fissures take a long time to heal. They reopen n again heal.

    please check this. And check with your physician for further information. 🙂🙂🙂

    Deal Lieutenant Deal Lieutenant
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    B3A5T wrote:

    What are specialist for Anal related called?
    There’s more than one??

    You can call them Proctologist or Colorectal surgeon, etc.

    But for practical purposes General surgeons deal with these conditions like fissure, fistula, haemorrhoids, etc.

    Deal Subedar Deal Subedar
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    i suffered from anal fissure and piles from last 4 years last year 13 aug docter suggest me surgery after i did surgery it is almost 1 year still i am not feeling too good but yah now i am much better no pain but sometimes still there is bleeding during bowl movement

    Trailblazer Trailblazer
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    Now a days it’s causes bcoz of fast foods, diet n processed foods take more fiber food n fruits r the solution

    Deal Subedar Deal Subedar
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    Dileep_kumar wrote:

    Now a days it’s causes bcoz of fast foods, diet n processed foods take more fiber food n fruits r the solution

    It was biggest problem since pre historic ages and oldies have many stories and treatment to tell .

    Not everything can blamed @ Modern ways of living . 

    Trailblazer Trailblazer
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    saymyname78 wrote:

    It was biggest problem since pre historic ages and oldies have many stories and treatment to tell .

    Not everything can blamed @ Modern ways of living . 

    Ya but now a days many youth r suffering with this constipation is one of the reason bcoz of change in food and sleep habits

    Hunk Hunk
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    P_A_N_K_A_J wrote:

    Content has been removed!

    People don’t discuss about em. That’s the reason. And people have the habit to crack jokes on these things. Discussion is needed.

    Deal Captain Deal Captain
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    How about kshar sutra?

    Entertainer Entertainer
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    bikidas2060 wrote:

    People don’t discuss about em. That’s the reason. And people have the habit to crack jokes on these things. Discussion is needed

    Indeed

    Entertainer Entertainer
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    kartikxxx wrote:

    How about kshar sutra?

    ayurvedic version of allopathic surgical option. 

    people should opt for what can they afford or like

    Deal Captain Deal Captain
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    P_A_N_K_A_J wrote:

    ayurvedic version of allopathic surgical option. 

    people should opt for what can they afford or like

    If u check about the success rate , then in my research i found kshar sutra is a better treatment as compared to other allopathic one.

    Deal Subedar Deal Subedar
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    wayback in 2008, piles problem suddenly started for me in UK. I had normal indian self cooked food only. Still not sure why it caught up. I have undergone surgery and after 1 year same problem. From 2010 onwards, i changed my life style. Started to get up early at 5am and do brisk walk for 30min. Then have warm water of 300ml and then normal water of 600ml before coffee. I continued this for almost 3 months and i see that there is a change & easiness. I continued it and realized it that in hydrated cities like hyderabad this habit is must. But in pune and bangalore, may be due to weather  even if i dont follow the habit, no problem at all. 

    Also i have seen that when i stay in coastal areas where we sweat a lot this problem is not there.

    So for my body type, i have to continue the habit of morning walk, hot water and normal water.

    Weather and water also play role. I always used municipal water in a candle filter and drink. Mineral water is causing me problems. Starange body.

    No doctors visit after 2009 and only observing my body conditions and act accordingly.

    Sometimes take ripen goa, banana helps. 

    yeah, morning walk also helped me fight with dandruff, migrane, teeth color change problem and now gone completely.

    so  just eat & sleep wont suit me. Always physical work. Otherwise my metabolism is also sleeping and causing these problems.

    net net, no maid, no car wash guy, no morning milk delivery by third party 😢 😀

    Deal Captain Deal Captain
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    su_fi wrote:

    i suffered from anal fissure and piles from last 4 years last year 13 aug docter suggest me surgery after i did surgery it is almost 1 year still i am not feeling too good but yah now i am much better no pain but sometimes still there is bleeding during bowl movement

    My neighbour is also suffering from such similar issue…from his 16 years of age…he quit his school and further studies due to this.
    2 years ago, he went for piles surgery (as piles was diagnosed), but the issue of bleeding still remains, after recovery, he again got checked himself and got to know that piles toh tha he nhi, issue kuch or hai..fissure no, piles no, operation galat kar dia, etc etc…
    Now he is eating some rowasa named medicine from past 1.5 years, the medicine basically stopps the blood and the issue is still undiagnosed.. confused

    Hunk Hunk
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    kartikxxx wrote:

    How about kshar sutra?

    Kshar Sutra is used to treat fistula. In Anal Fistula the anal glands get infected. Just like a pimple. But if the infection does not get healed then it gets septic. Sometimes a different narrow path is established from that gland to the outside or not. That condition is called Fistula. And that wound does not gets healed without external intervention. 🙂 Kshar Sutra is used to cut that path open and meds are applied. Kshar Sutra is used to cut off blood supply to grade 1/2 piles. They act like rubber band treatment. That place gets a chance to heal. Kshar Sutra is used to cut off blood supply to grade 1/2 piles. They act like rubber band treatment.

    🙂🙂🙂 In case of anal fissure, kshar is used as there is nothing to cut open.

    Deal Captain Deal Captain
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    people restrict themselves and don’t even talk about their issue…and yes it is very common…
    Good post – kg+

    Deal Lieutenant Deal Lieutenant
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    Drink Plenty of water.
    Eat fibrous foods.
    Avoid tea.
    Avoid spices

    PS: Very brave of you to post this. This too shall pass. Get well soon !

    Deal Newbie Deal Newbie
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    B3A5T wrote:

    What are specialist for Anal related called?
    There’s more than one??

    Johnny sins

    Deal Subedar Deal Subedar
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    its very common piles and fissures,anyone able to fully cure with laser surgery?

    Deal Cadet Deal Cadet
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    Have dealt with this some time ago
    Horrific pain and the image of blood spraying out of you really did a number on me
    When I went to visit the doctor he had prescribed an Indian herb medicine
    For the life of me can’t remember its name.
    Pro tip – Boroline works wonders in healing fissures.I did not use any other cream.
    Basically this heals itself 90% of the time if you can heal your constipation.
    Use Dulcoflex, Gutlooz anything that can make your stool soft.
    Also remember to avoid sugary drinks
    Try to have real coffee (not instant) without milk, it helps immensely too

    Deal Cadet Deal Cadet
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    i faced same issue few months back .it was very disappointing.  But after taking medicine , and most importantly diet , I am eating plain food ,without any spices and , no junk food,, I never saw any blood in stool .  😊

    Pro Shopping Friend Pro Shopping Friend
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    scary problems; feel lucky;

    long back a Maharashtra friend gave green chilli(Techa) and after having that, so much burning in bowels and small lump also bulged out; The end I stopped altogether spicy food; recovered in few days with just coconut oil application

    Anal fissures..piles etc not only very painful but pushes one into very inconvenient position, saw a friend who could not sit properly

    Deal Lieutenant Deal Lieutenant
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    Too much banana can cause bloating and worsen the situation , but fibre rich food / drinks helps .
    Plenty of water or liquid intakes do help. .

    Good topic plus1

    replyuser
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