Fissures are often confused with Piles. Anal Fissures are Linear Tears caused in the lining of the anus due to Trauma or injury, which causes the stretching of the Mucosa of the Anal canal. Fissures resemble a paper cut. There are two types of Fissures.
The can either in the Anterior ( 12 O"clock ) or Posterior ( 6 o" clock) areas the Anal opening..
Symptoms of Fissures are similar to that of piles.
The ultimate goal treatment is to relieve the constant pain, lingering discomfort and heal the torn lining. Medicines which speed up the healing of the fissures are prescribed. Nitrate ointment to increase the blood flow and fast track healing. Calcium channel blockers ares also given to reduce the blood pressure.
Two of the most common treatments for Fissures are
Chemical Sphincterotomy:It uses botulinum toxin (BOTOX injection) for therapy. The toxin is directly injected into the internal anal sphincter which part of the the circular internal muscles of the anal sphincter which control the passage of feces. The botox paralyzes the sphincter muscles which restores the blood supply to the anus. The spasming obstructs blood supply and prevents healing of the fissure. The injection prevents spasming and this effect lasts approximately three months. By this time the nerve endings regenerate, the fissure heasl and the symptoms are resolved. This treatment is effective in 80% of the patients. Sometimes the Injection has to be repeated.
Closed Internal Sphincterotomy (LIS):
A Day Care surgical treatment for chronic anal fissure done on the internal anal sphincter muscle which is part of the the circular internal muscles of the anal sphincter which controls the passage of feces. The internal anal sphincter is one of two muscles that form the anal sphincter. The internal anal sphincter is partially divided surgically to reduce spasming and the resting pressure without affecting the use of the sphincter. It improves the blood supply to the fissure area and helps it to heal faster.
Internal Sphincterotomy (LIS) is recommended for its simplicity and causes a smaller wound. It has a high success rate of around 95% and is very effective.It can in inexperienced hands cause loss of control of sphincter tone.
Sphincterometry or Anal Tonometry
Sphincterometry or Anal tonometry used to determine the tone of the anal Sphincter and rule out voluntary contraction. An outpatient procedure which helps to determine the needs for chemical Sphincterometry