What is anal fissure? Anal fissure is a longitudinal cut or tear in the mucosa (soft inner layer) of the anus. The clinical hallmark of fissure is pain during, and several hours after, defecation (passing stool). It usually presents with minimal bright red blood on the poo or toilet tissue.
Acute fissures resolve within 4 to 8 weeks. Chronic fissures persist for 8 to 12 weeks and are characterized by localized swelling and hardening of the tissues in the affected area.
Causes
Upon history taking, patients often report a tearing sensation felt during passage of constipated stool or explosive diarrhea. Other causes of fissure are limited to women – pregnancy and traumatic childbirth. These two conditions pressure in the pelvic area, resulting to the injury.
Diagnosis
There are several conditions that may cause anorectal (anus and rectum) pain and bleeding so it is important to rule out other diagnosis. Anal fissure is confirmed through direct visualization and/or palpation of the cut. The patient is placed in a prone position and the buttocks are spread gently to inspect and palpate for cuts. The procedure can cause extreme discomfort to patients, requiring anesthesia application (lidocaine). For cuts far up the intestinal tract, an anoscope may be used for better visualization.
Treatment
Nonoperative treatment is the first step in the management of fissures. Almost 50% of patients heal with non-operative measures including sitz bath, dietary fiber supplementation and topical anesthetics or anti-inflammatory ointments. Increased water intake should accompany fiber supplementation to facilitate ease in expelling stool.
Fissures that do not heal after 12 weeks of conservative management are candidates for surgical intervention. Lateral internal sphinterotomy promise good results, however, it is the last treatment of choice because of being invasive and of course, the towering cost.
Herbal Remedy
Patients suffering from persistent fissures suffer poor quality of life, which can be significantly improved by the use of the herbal plant Guggul (Commiphora wightii) to treat anal fissure. The use of Guggul achieves the goal of conservative management: fissure healing and pain relief.
Guggul or Commiphora wightii is an herbal plant native to northern India, Central Asia and northern Africa. Traditional Indian Ayurvedic system of medicine has used the extract of the sap (known as gum gugul) to treat arthritis (rheumatoid and osteo), and decrease bad cholesterol levels. The medicinal wonders of Guggul led to its overuse. Now, it is enlisted as an endangered species by the World Conservation Union. Guggul is still being cultivated for medicinal use, but with the aid of the union to promote sustainable harvesting methods and prevent its extinction.
Guggul (Commiphora wightii) to treat anal fissure is manufactured in fixed amount of guggulsterones (50 mg). Two capsules (50 mg) twice daily is the recommended dose to manage fissures. A healthy amount of guggul will help hasten the healing process of the tears and symptomatic relief of pain.
Using Guggul (Commiphora wightii) to treat anal fissure is generally safe. Side effects reported are minimal gastric distress and minor allergic reactions. However, its safety in young children, pregnant and lactating mothers is still not established so physician advice is highly recommended before taking this herbal remedy.
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