Rectal and anal pain-Fissue in ano

A fissure in usually posteriorly as a tiny crack in the anal margin.It occurs in an acute form also as a chronic indolent ulcer,but tends to eal more easily in women than in men.Often it is associated whit haemorrhoids.
A fissure is generally caused by the passage of bulky hard stools and commonly develops during the days or weeks after delivery.

Symptoms:
The main complaint is pain during defecation,fallowed by a deep-seated throbbing ache for 2 or 3 hours afterwards.
The aching is caused by rectal spasm and is extremely trying to the sufferer.The fissure often sheds a few drops of blood during defecation but this stops immediately afterwards.

Signs:
The crack or ulcer is visible on careful inspection.The attempt at digital rectal examination causes severe pain and spasm of the sphincters.

Treatment:
Most fissures can be healed by conservative treatment.This consist of:
-keeping the bowels regular and the stool soft by habit,diet and liquid paraffin,and by avoiding straining at stool.
-supporting the anal ring manually during defecation to prevent the crack reopening.
-careful anal hygiene(washing with cotton wool swabs or preferably sitting n warm bath after defecation).
-applying a local anaesthetic ointment before defecation and when this is acting passing an anal dilator which is left in place for a few minutes.This overcome the spasm which is the cause of the pain and the basis for the fissure failing to heal.

If these measures fail more active treatment consists of the fallowing:
-injection of the base of the fissure and of the anal sphincter whit local anaesthetic solution followed by digital dilatation of the anal ring.
-dilatation of the anus under general anesthesia  is probably the most effective of all treatments.
-incision of the internal sphincter.
-excision of the fissure.