Anal fissure is a benign disorder of the anorectal (anus and rectum) that is largely attributed to decreased intake of dietary fiber. It is one of the most common causes of anal pain.
Signs and Symptoms
Patients often seek consultation because they suffer from severe pain immediately after bowel movement that may extend up to several hours after.
Other signs and symptoms include:
- Presence of blood in stool or tissue paper;
- Pain radiating to the buttocks, upper thighs or lower back; and
- Anal spasm.
Causes
Anal fissure is a cut or tear in the mucosa (soft layer) of the anus. Primary anal fissure is usually caused by conditions that increase the pressure in the pelvis such as frequent constipation, diarrhea, pregnancy and traumatic childbirth. Because of the said causes, anal fissures are more commonly observed in women.
Diagnosis
Oftentimes, anal fissure is mistaken for hemorrhoids, also a painful anorectal condition exacerbated by constipation. Only an anal examination can confirm the diagnosis. The patient is placed in prone position then the buttocks are gently spread, easily revealing the tears in the anus. Over tears are not readily visible, which may require palpation of the affected area. This process may cause severe discomfort to the patient so local anesthesia (lidocaine 2% jelly) may be applied to allow for gentle examination.
Treatment
Upon the confirmation of the diagnosis, conservative management is the first line therapy. Around 90% of anal fissures heal on their own; however, symptomatic fissures need treatment.
The most common way to manage and treat anal fissures is to increase dietary fiber intake to prevent constipation and decrease pressure to the affected area during bowel movement. Fiber supplementation may be needed in some patients throughout the course of treatment (3 – 4 weeks). Increasing water intake is a must when taking fiber supplements.
Wiping gently after defecation is also advisable. Use wet wipes instead of dry tissue to prevent aggravation of the tears. Ointments may be prescribed by the physician to address the pain. Also, a regular sitz bath for around 20 minutes may provide relief of pain.
Guarana (Paulinia cupana) to treat anal
An herbal plant from the Amazon can be used as an adjunct therapy for the tears. Using Guarana (Paulinia cupana) to treat anal fissure works by stimulating defecation. Also, Guarana causes vasodilation, which increases the blood flow to the injured anal mucosa, thereby promoting speedy healing.
Generally, using Guarana (Paulinia cupana) to treat anal fissure is safe since the herbal plant is recognized as safe by the US Food and Drug Administration. The recommended dosage is ½ to 1 teaspoon in juice or tea, once to twice a day.
For safety reasons, children and lactating and pregnant women should avoid taking Guarana (Paulinia cupana). Guarana contains caffeine so people who are allergic to the substance and xanthine must also avoid taking this herbal medicine. Excessive intake of caffeine may also induce high blood pressure and other cardiac symptoms. Also, people taking anticoagulants (warfarin) and MAO-inhibitors should avoid this herbal medicine to prevent unwanted drug reactions.
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