A fissure is a small tear in the anal lining. It causes pain out of all proportion to its size, and most heal without an operation.
Also known as: Fissure-in-ano · Anal fissure · Parikartika (Ayurveda)
An anal fissure is a small tear in the lining of the anal canal. It is usually caused by passing a hard or large stool, though it can also follow a bout of diarrhoea, or occur after childbirth.
It is a small injury that produces disproportionate pain, because the anal canal is richly supplied with nerves.
Fissures are unusual in that the condition sustains itself:
Treatment works by breaking this cycle at more than one point at once — softening the stool and relieving the spasm. Treating only the pain leaves the cycle running.
The distinction matters because it changes what is realistic to expect.
Where conservative treatment has been given properly and the fissure has not healed, we discuss procedural options — including Kshara application and, where appropriate, conventional surgical treatment of the sphincter spasm.
This is a decision made after weeks of treatment. Anyone offering fissure surgery at a first consultation, before conservative treatment has been tried, is moving too fast.
The pain usually tells them apart. A fissure causes sharp, tearing pain during and after passing stool, with a small amount of bright red blood. Internal piles typically bleed without pain. That said, the two often occur together, and other conditions can mimic both — an examination settles it in a minute.
An acute fissure — present for under six weeks — usually heals within two to four weeks once the constipation and muscle spasm are treated. A chronic fissure, present longer, has hardened edges and a tighter sphincter, and takes longer. Some chronic fissures need a procedure.
Because of a cycle: the tear causes pain, pain causes the anal muscle to go into spasm, spasm reduces blood supply to the area, and poor blood supply prevents healing. Hard stool then re-tears it. Breaking that cycle — softening stool and relaxing the spasm — is the whole basis of treatment.
Most people do not. The large majority of fissures heal with medication, stool softening and local treatment. Surgery is considered only for chronic fissures that have failed proper conservative treatment, and it is a decision made after weeks of treatment, not at the first visit.
It may ease the pain briefly, but it does not address the constipation or the muscle spasm that keep the fissure open, so the fissure persists and can become chronic. It also risks masking something that is not a fissure. Persistent anal pain and bleeding should be examined.
Proctology & General surgery - (Shalya Tantra)
BAMS, MS(Ayurveda), PhD
Dr. NEELAMBIKA G. B. is an Ayurvedic Surgeon with special emphasis on Management of Surgical conditions through Ayurvedic approach and makes the best use of conventional clinical and diagnostic evaluations for the diagnosis and outcomes assessment.
Reg. 88606/15180 KAUP Board
