Causes and how it happens: It occurs usually due to constipation and application of force to pass motion. It is thought that hard motion tears the anal canal. It occurs less in those who take food containing sufficient amount of fibre. Among fibre containing food are vegetables, raw fruits, isphagula husk etc. It has no relation with consumption of tea, coffee or wine. Frequent passage of motion and diarrhoea increase the likelihood of being attacked with fissure. During the attack it is hard to examine the inside of anus. Scientists have measured the pressure of anal canal and found that the pressure of anal canal does not rise during this period.

Symptoms: Main symptom of anal fissure is pain and bleeding. This kind of pain usually happens after passing motion and it may continue for few minutes to many hours.

'Proctalhgia Fugax' is a disease in which there is pain in anus but it does not have any relation with passing of motion. Patients with thrombosed piles also complain of pain in anus. In this condition they complain of a lump in anus.

In anal fissure bleeding is usually minimal but I have seen patients complaining of profuse bleeding.

People with chronic (long standing) anal fissure complain of a different kind of symptom. They complain of lump, discharge of pus, itching or a protruding skin tag in anus. In this condition there may or may not be any bleeding. Pain is usually minimum or often there is no pain at all except white passing hard motion.

Patients with anal fissure sometimes complains of urinary trouble and female patients occasionally feel pain during sexual intercourse. Though patients realise that this problem had perhaps arise from constipation they don't respond to natures call due to fear of pain. This aggravates the constipation further. There are patients who pass motion on such condition once in seven to ten days.

Acute anal fissure: In this stage there is severe pain and variable bleeding. Anus looks very much contracted. It is not possible to see the fissure inside because of severe pain. It's very hard to introduce any instrument inside.

Chronic anal fissure: Chronic fissure is that when it is limited within a circumscribed margin. In this stage there is a tag of skin which hangs down. Inside the anus also there is a tumour like piece of meat called hypertrophied anal papilla. Many doctors confuse it with a tumour. In this situation interior of the anus and rectum should be testedto clearly identify any tumour or inflammatory cause. This fissure can sometimes get infected and cause abscess which ultimately leads to fistula formation and discharge of pus.

Prevention: One should take care of his bowel so that constipation does not occur and during defecation one should not apply much force. We should give up the habit of going to the toilet frequently. If there is diarrhoea it should be treated immediately.

Treatment: Conservative treatment: If treatment is started soon after the problem starts there is a great chance that the patient will be cured without operation. We prescribe different kind of medicine to make stool softer, fibre-containing diet to increase the volume of stool and some painkiller is used. Sitz bath (Hip bath) is very much helpful. This is done by immersing the hip into a half-filled bowl of warm water containing salt. If this does not cure the condition and if the disease continue for long time then there is less likelihood that the problem will be over without operation.

Surgical Treatment - Dilatation of anal canal: Now a days this operation is not done because of its poor result.

Internal sphincterotomyIn this operation internal sphincter is divided. No need for full anaesthesia. We usually employ spinal anaesthesia in which half of the body below the umbilicus is made senseless. Total two days hospital stay is necessary. The patient can lead normal life after 3-7 days. The success rate of this operation is 95-99 per cent..

Comments: In my view perhaps this is the commonest anal canal problem in our country. If the patient reports early conservative treatment is satisfactory. In chronic cases operative treatment is usually required, result of operation is fairly good. So far I have never had any complications in doing such surgeries.

In last seven years I have seen fifteen thousand patents all having problem in anal canal of these 32% was anal fissure, 18% piles, 15% fistula, 2.6% cancer, 3.3% rectal polyp etc. After operation 96 per cent of the patients were cured successfully.