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What Is The Cause And Treatment For Anal Fissure?

Posted on Sat, 29 Mar 2014

Question: Hi Doctor, I am a 28 year old female. I had relocated to a foreign country exactly 1 month ago from today. The problem started 15 days after relocation. 15 days ago, I wiped some blood on toilet paper after bowel movement. The skin was very dry near anus and i could even see a small cut near mouth of anus with a drop of blood. After 1 day, I started seeing multiple red blood spots over my stool. Also, my stool had dark brown/blackish seed like things in my stool. I felt a very tiny sharp grain just at mouth of anus. In 2 days I developed pain in my hip muscles and muscles near anus. The blood spots and brown/blackish seed like things continued in my stool for a week. The cut near anus healed. Then I started feeling a lump like thing just inside the mouth of anus. There was lot of pain in the muscles near the lump. 3 days ago, the lump (which was actually a ball of pink/white flesh) came out in my bowel. After that, I see pieces of skin, flesh coming out every time in the bowel. Now, I feel no pain after the lump is gone. I do not see blood spots. Problems I currently have see is, 1) brown/blackish seed like things are still seen sometimes but less. 2) Some pain near the mouth of anus when the muscle contracts and expands. 3) The mouth of anus is hard. 4) I sometimes feel tiny stone like thing just at mouth of anus. I eat outside once a day but I try to choose easy digestible food. Other times I cook very simple food. I have increased my intake of fruits, fluids and yoghurt but as mentioned above I still have some issues. I had never had any issues in anus before in life. I have never had anal sex. I am not sure whether it is related but still, I underwent a medicine course for cervical inflammation 1 month ago and it feels like it is fine now looking at symptoms. I have no other problems. I want to know what I am suffering from? What could be the reasons I developed it? I could return to India only after a month and get medical help. Is it something serious and I should immediately see a doctor here and not wait for a month? I am very worried and could not concentrate on work. Please help me.

Answered by Dr. Deepak Kishore Kaltari (50 minutes later)

Brief Answer: It's due to fissure in anus Detailed Answer: Hi Welcome to Healthcare-Magic Namasthe Greetings of the day First and foremost let me reassure it's nothing serious. Do not worry things can be taken care in the foreign location, I do understand your difficulties being in foreign location. From the description given you seem to be suffering from fissure in anus. It usually occurs due to small tear in anal mucosa due to passing of hard stools. Reduced intake of water and diet alteration could have precipitated this episode. It usually causes streaking of blood on stools. Due to presence of ulcer it provokes spasm of both external and internal anal sphincter further aggravating pain and constipation. The mass like thing you notice is sentinel pile ( no way related to piles which we normally speak of) . When the fissure heals it produces over growth of skin and covers and protect the ulcer. This is the mass like thing you are experiencing. Exact diagnosis will depend on visual examination. There is no cause for concern. Follow religiously everything I will be advising you. 1. Ensure good intake of water: 2 to 3 liter of water per day. 2. High fiber diet 3. Syrup Lactulose: 10 ml twice a day. It is laxative and will ensure soft stools and allow complete healing of fissure 4. Hot Seitz bath : Add a handful of common table salt to tub of lukewarm water. Sit in it immersing your anus and bottom. Warm water will reduce the pain and spasm. Sit for 15 minutes thrice a day 5. After Hot seitz bath; after the bath and also before and water going for stools apply Xylocaine Ointment to the anal opening. It will reduce the pain being a local anaesthetic. 6. Nitroglycerine ointment: apply it locally to anus before going to bed. It will relieve the spasm. 7. Tablet Ibuprofen will be helpful to reduce pain. Do get back to me anytime, throughout your stay away from India will be there to assist you. Take care Best Regards Dr Deepak Kishore MBBS, MS, MCH Consultant Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepak Kishore Kaltari (29 hours later)

Thank you so much Doctor for your advice. I have arranged to get these medicines from India as they are not available here. They will arrive in 2 days. My other questions are: 1. I believe Nitroglycerine ointment is only to be applied outside the anus that is at the opening of the anus. Is that correct? 2. How will I know that fissure in anus has healed and I need to discontinue medicines? in other words, how long should I follow this course? 3. I feel very less pain now, even during bowel movement. But, I feel contraction near anus and hardness in anus. Even then do you think it is ok to take the medicines for pain? 4. I used to do power yoga which involves muscle stretch of lower part of body. While doing it in first week of problem, I felt it is causing pain. Since then I only do walking for exercise. Does any exercise having a muscle stretch creates more problem in fissure and should be stopped till fissure heals? Thanks again.

Answered by Dr. Deepak Kishore Kaltari (17 minutes later)

Brief Answer: Fissure will heal in 3 to 4 weeks Detailed Answer: Hi Greetings Dear Ms Let me answer your queries one by one 1. Nitroglycerine ointment only needs to be applied at the anal opening with the dispenser available with the ointment measuring the dosage. 2. Normally the fissure will take 3 to weeks for complete healing. Exact duration will depend on clinical inspection. It would be advisable if you could send clinical photograph for assessment. 3. Pain killers are taken only during 1 St week 4. Power yoga or any exercise will not aggravate the fissure. But it's important to prevent hard stools so that recurrence is avoided. Do get back to me Take care Best Regards Dr Deepak Kishore Consultant Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepak Kishore Kaltari (48 hours later)

Thanks so much Doctor. I have started with the medicines you have advised me from today. I came to know there is a separate hospital for foreigners in most cities in China with English speaking doctors. So, I will go that hospital for an examination in this week. Please tell me anything else you have in mind I should take care for healing of fissure. Thanks again.

Answered by Dr. Deepak Kishore Kaltari (57 minutes later)

Brief Answer: Take care Detailed Answer: That's all madam. Follow the previous advice. Keep me informed about your state. Do let me know if you need any help anytime. Take care Best Regards Deepak

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar