Fissure

Overview of Fissure

• Commonly it occurs in the midline, posteriorly (more common in males).
• It can also occur in the midline anteriorly (more common in females). [1]
• Although most sufferers are young adults, the condition can affect any age, from infants to the elderly.
• Men and women are affected equally.
• Anterior fissures account for about 10% of those encountered in women but only 1% in men. [2]

Causes of Fissure

• Trauma
• Repeated passage of diarrhoea
• In women- vaginal delivery [2]
• Hemorrhoidectomy
• Crohn’s disease
• Venereal disease
• Ulcerative colitis
• Tuberculosis [1]

Risk factor of Fissure

• Faeces-hard
• Ischemia
• Sphincter hypertonia
• Repeated childbirth
• Enthusiastic usage of ointments and abuse of laxatives. [4]

Classification of Fissure

Acute fissure:

• It is a deep tear in the anal canal with surrounding Oedema also inflammatory induration

Chronic Fissure:

•  When acute fissure fails to heal, it will gradually develop into a deep undermined ulcer with continuing infection and Oedema. [3]

Sign & Symptoms of Fissure

• Pain on defaecation
• Bright-red bleeding
• Mucous discharge
• Constipation [2]

Diagnosis of Fissure

• When the buttocks are spread apart, a longitudinal tear and a hypertrophied, thickened skin is seen near the lower end of fissure-sentinel pile.
• Additionally, Per rectal examination
• Proctoscopy is contraindicated [4]

Differential Diagnosis of Fissure

• Carcinoma anal canal
• Inflammatory bowel disease
• Venereal diseases
• Anal chancre (especially painful)
• Tuberculous ulcer [1]

Treatment of Fissure

Conservative:

• Avoid constipation- e.g. encourage fiber diet, mild laxatives also not to postpone defaecation.
• Surface anesthetic creams: i.e. Lignocaine jelly.
• Metronidazole also antibiotics

Agents which decrease sphincter pressure:

• Glyceryl trinitrate (0.2%)
• Purified botulinum toxin injection into internal sphincter
• Calcium channel blockers: e.g. Nifedipine, Diltiazem

Surgical treatment:

• Lateral anal sphincterotomy of Notaras
• Fissurectomy
• Blunt sphincterotomy [4]

Homeopathic Treatment of Fissure

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Fissure:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Homoeopathic Approach:

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution, family history, presenting symptoms, underlying pathology, possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’. The disease diagnosis is important but in homeopathy, the cause of disease is not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness are also looked for.

Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition. The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology is not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can be greatly improved with homeopathic medicines.

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy.

Medicines:

Aesculus Hip:

• Anus feels raw, soreness, burning, itching also fulness at anus
• In detail, Pain like a knife sawing backward and forward through anus
• Pains in anus about an hour after stool, continuing for some time.
• Aesculus can be of great help if you are experiencing severe pain in the anus following stool passage.
• Either the stool or poop passed is mainly hard and large followed by severe pains.

Graphites:

• Fissures of recent origin, especially in children; varices of rectum and burning rhagades between them.
• Fissures caused by large faecal masses, no irritability, no frequent desire to stool nor spasmodic contraction of sphincter, only some smarting and soreness, aggravation at night and when sitting.

Lachesis:

• Sensation of little hammers pecking away in fissured parts.
• Tormenting urging, but not to stool.
• Itching at anus, aggravation especially after sleep.

Nitric Acid:

• Sharp, splinter-like cutting pains in rectum during also burning after stool.
• Painful prolapses of bowels also sensation of constriction in anus.
• stitching also tearing pains in the anus, or the pain is cutting or stinging in nature.
• All in all, The stool passed is hard, and is accompanied by bright red bleeding from the anus.

Paeonia:

• Ulcerations of mucous membrane of rectum and anus, with fissures, burning and biting some hours after stools.
• Parts swollen and exhaling an offensive odours.
• Furthermore, Anus damp and disagreeable from constant oozing.
• Paeonia is the best remedy for offensive discharge from the anus due to cracks in it.
• Paeonia is also the best medicine for violent pains in the anus during also after passing stool.
• Besides this, The anus is ulcerated and fissured. Itching and burning usually accompany the fissures.
• Help in treatment of Anal Fissures with offensive discharge.

Platina:

• Fissure in ani with crawling and itching in anus every evening; frequent urging with scanty stool
• Painful sensation of weakness.

Ratanhia:

• Ratanhia is an effective medicine for the treatment of Anal Fissures and is particularly beneficial as a remedy for long-lasting pains in the rectum with excessive burning that follows stool passage.
• Patients often describe the pain as being similar to broken glass or a knife piercing in the rectum.
• The stool requires much effort to be passed out due to the constricted anus.
• Ratanhia is the Homeopathic medicine that can work wonders in such a situation.
• Burning in anus like fire, preceding and accompanying defaecation also lasting a long time after, accompanied by prostration of varices.
• Dry heat in anus, with sudden stitches like stabs with a pen-knife. Lastly, Sensation as if the rectum protruded and went back with a jerk, with most horrible pains.

Silicea:

• Long and painful efforts to expel the contents of the rectum but the sphincter ani seems tightly to resist the effort till suddenly the stool passes, sometimes with pain and nervous shuddering
• Stool partly descends and then slips back again.

Sulphur

• Sulphur works well where the stool is hard and dry, causing tears and immense pain in the anus while passage.
• The patient is fearful of even going to the toilet as he thinks of the pain that will accompany the passage of stool.
• Sulphur is of great help in reducing the pain and softening the stool.
• The pain is almost always accompanied by burning.
• Itching in anus due to fissures is best controlled with the use of Sulphur.

Thuja:

• Fissures with edges trimmed with polypoid excrescences or true rectal polypus
• Piles, condylomata, urinary troubles. [5]

Diet & Regimen of Fissure

• 9 foods that may help if you have fissures: Papayas, Lemons, Bananas, Oatmeal, Turmeric, Ghee, Milk, Probiotic-rich foods
• Increasing your fluid intake
• Taking a fiber supplement, such as psyllium husk
• Getting more exercise
• Wearing loose, cotton underwear. [6]

Frequently Asked Questions

What is Fissure?

Fissure is an ulcer in the longitudinal axis of the lower anal canal.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Fissure?

• Aesculus Hip
• Graphites
• Lachesis
• Nitric Acid
• Paeonia
• Platina
• Ratanhia
• Silicea
• Sulphur
• Thuja

What causes Fissure?

• Trauma
• Repeated passage of diarrhoea
• In women- vaginal delivery
• Hemorrhoidectomy
• Crohn’s disease
• Venereal disease
• Ulcerative colitis
• Tuberculosis

What are the symptoms of Fissure?

• Pain on defaecation
• Bright-red bleeding
• Mucous discharge
• Constipation