ANAL FISSURE

Anal fissure is an elongated ulcer that is a tear or break in the skin of the lower anal canal. Anal fissure is usually notice by blood stained stool or pain during or after defecation. Pain is severe in acute fissure but with chronic fissure intensity of pain is less. Anal fissure is usually occurs in posterior mid line of anus, due to unsupported nature and poor perfusion of anal wall and pelvic floor. In male 90% fissure occur in posterior midline while in female 40% fissures occur in anterior midline particularly in those who have borne children.

 Causes – An anal fissure is caused due to over stretching of anal mucosa due to poor toilet habit in children or constipation or hard stool. Fissure may be superficial or deep enough down to the underlying sphincter muscle. A superficial or a shallow anal fissure may be difficult to see as it is very thin cut and generally heal within a week or two. When anal fissures become deep, they extend to lower end of internal anal sphincter, their margins become hard (indurated) and they do not heal and become chronic. Spasm of internal sphincter muscles contributes to non-healing of chronic fissure. Chronic anal fissure may have a specific cause as infection, Crohn’s disease (multi-systemic inflammatory disease affecting any part of alimentary canal – from mouth to anus) or syphilis. Biopsy can confirm such cause. These fissure are often less painful than the appearance of the lesion.

Symptoms – Anal fissure commonly occurs in persons of age between 15 to 40 years, more in women in meridian of life. It is rare in aged because of muscular atony (relaxation) but not rare in children. Sharp agonizing pain beginning during defecation and lasting for an hour or more is characteristic of fissure. The pain subsides till the next action of bowel but it is severe enough so that the patients become constipated rather than going through the agony of pain. There are periods of remission for days or weeks.

Prevention – Avoiding strain and careful anal hygiene after defecation is the theme of preventing anal fissure. To avoid strain constipation must be prevented by eating enough food and food rich in dietary fibers, drinking sufficient water and avoiding foods causing constipation as foods containing caffeine. Diarrhea can also cause anal strain and should be treated promptly. If toilet paper is used for cleaning it should be soft.

In an infant and child also sufficient fluid intake should be ensured. Frequent change of diaper prevents anal fissure in infants.

In a suspected or preexisting fissure lubricating ointment should be used but hemorrhoid ointment should not be used as they constrict blood vessels and delay healing.

Treatment – Conventional system suggests that beside fiber rich diet and mild laxatives to avoid constipation, a fissure should initially be treated topically and then surgically if required. Locally nitroglycerin or calcium channel blockers or botulinum toxin (botox) is used to relax anal sphincter muscles. While systemic absorption of nitroglycerin (even through the finger used to apply the medicine)causes headache, the botox injection proved to be less and lesser effective after some time and patient need to find some other cure or surgery is performed. Surgery is done to reduce spasm of internal sphincter by anal dilatation or sphincterotomy (incising lateral wall of internal sphincter). The  side effect of surgery, both dilatation and incision, is mainly incontinence of stool which is for sometime immediately after operation and in about 36% cases it persists indefinitely where even solid fecal matter may pass with uncontrolled release of gases. Recurrences are not uncommon.

Homeopathic treatment causes permanent relief from the fissure. One of the following or other homoeopathic medicines can be prescribed as per indications.

RECTUM - FISSURE

Acon-lycoctonum, Aesculus hip., Agnus cast., Allium-cepa, Aloe socotrina, Alumina, Anacardium orien., Antim-crud., Apis mel., Argentum-met., Argentum-nit., Arsenic. alb., Arum-triph., Berberis vul., Bryonia, Calcarea carb., Calcarea-flor., Calcarea-phos., Capsicum, Carbo-animalis, Carbo-veg., Carcinocin., Causticum, Chamomilla, Cimex,  Colchicum, Collinsonia, Cundurango, Curare, Flouric-acid, Graphites, Gratiola, Hamamelis, Hydrastis, Ignatia, Iris versicolor, Kali-brom., Kali-carb.,  Kali-iod., Lacticum-ac., Lachesis, Ledum pal., Medorrhinum, Mercurius sol., Mercurius-dulc., Mercurius-iod.-rubrum, Mezerium, Morganum-gaertner, Morgan-pure, Morphinum, Muriatic-ac., Natrum-mur., Nitric-ac., Nux-vom., Paeonia, Petroleum,  Phosphorus, Phytolacca, Piper-nigrum, Platina, Plumbum met., Plutonium-nit., Podophylum, Ptelea trifol., Ratahnia, Rhus-tox., Sanginaria-nit., Sanicula, Sedum acre, Sepia, Silicea, Spongia, Strontium-carb., Sulphuric-ac., Sulphur, Syphilinum, Thuja occ., Triticum-vulg., Viburnum op.

CASES -

Case – 1. Mr. D B      31 yrs.    male   married     hindu    vegetarian

Diagnosis – Fissure in ano.

The patient has severe burning, cutting and stitching pains for last two weeks. There is a constant sense of plug or a wedge in anus. Aggravated during stool, at night with restlessness cannot lie in any position,. He was better after stool and bleeding from the fissure. There was bleeding after stool. Passes stool of normal consistency.

He was sleepless due to pain in fissure. No relief after Aloe soc. and pothos.

Thirst was increased, three glasses at a time 8 – 10 times a day. He desired salty food and averse pulses, vegetables.

 The patient had appointment for operation on 5^th January and had to get admitted on the 4^th. After taking above mentioned homoeopathic medicines he believed that surgery was the last solution to this pain he came again for homoeopathic medicine as pursued by his family members but on the condition that he should get relief by next day afternoon otherwise he will go for surgery.

03/01/11 Rx Sepia     30 four doses four hourly and report on next day.

04/01/11 Pain was reduced about 20%, there was no bleeding. So patient decided to continue the trial.

                  Rx Sepia     30 dose thrice a day and report after 3 days.

05/01/11 Pain was disappeared since forenoon, patient asked whether to continue with the rest of medicine. Advised to continue treatment but the patient did not as he remained well thereafter.

Case -2. Generally people do not correlate their sickness with life situation, physical strain and mental traumas. The patient in this case suffered for years took many medicines without relief but got prompt relief when he divulged his traumatic experience and physician correlated it to his suffering to mental stress and trauma.

Mr. N.  K.      30 yrs.   male   married    vegetarian      businessman

Diagnosis – Anal fissure, Hemorrhoids (Piles).

The patient presented on 01/10/09 with problem of recurrent anal fissure and piles for last three years. He had burning in fissure during stool, pile swollen and protruded during stool. Stool first hard then soft.

With the above symptoms he was treated with various medicines as Sulphur, Nux vom., Aloe s., Acid Nitricum, Aesculus h., Lycopodium, Hydrastis, Blumia od., Collinsonia, Carica papya Q, Staphysagria,  Thuja oc. etc by myself and other physicians. The patient was repeatedly queried and every time he insisted all is well with him except the above two pathology. Thus we lost one year.

When he visited on 22/11/10, he was asked to describe the happenings from the time he was perfectly well and when and how the trouble started and first occurred. He told that his mother was sick for six months previous to the onset of his trouble. He was emotionally disturbed, stressed and worried due to precarious state of mother who was diagnosed to have Acute Myeloid Leucaemia (AML). He did not get financial help and support from relatives. Mother expired after six months of struggle. Based on his narration he was prescribed –

22/11/10  Rx  1. Ignatia         1M    two doses at 10 minutes interval.

                       2. Graphite      30     two pills thrice a day for 15 days.

                       3. Rubrum       30     two pills once a day for 15 days.

 23/04/11 The patient reported after five months. He was relieved of all symptoms three days after he started the last prescribed medicines. There is recurrence from last few days after his mother died on 09 April. Now  there were swollen piles with mild pain. Bowels were normal. 

                    Rx  1. Ignatia         1M    two doses at 10 minutes interval.

                          2. Graphite       30     two pills thrice a day for 15 days.

                          3. Rubrum        30     two pills once a day for 15 days.

 18/05/11 No pain, No swelling.

                    Rx  1. Nihilum      1M    two doses at 10 minutes interval.

                          2. Graphite     30      two pills thrice a day for 15 days.

                          3. Rubrum     200     two pills once a day for 15 days.

Dr. M. K. Tyagi

D.H.M.S., Dip. N.I.H.

Research Officer, Sewa Mandir.

Mobile" 09829157926
Email: 1.sewamandir@usa.net, 2.manju_mkt2003@yahoo.co.in