Anal fissure is a common condition which causes anorectal pain and bleeding. The pain and bleeding results from longitudinal lacerations in the anus. The cuts and tears result from episodes of passing hardened stools and explosive diarrhea. This is confirmed upon history taking with the patient.
Predisposing factors for anal fissures include frequent constipation and/or diarrhea, pregnancy, difficult childbirth and any other conditions that causes trauma to the anus. These factors increase pressure in the pelvic area, increasing the likelihood of tears during difficult bowel movement.
The fissures can be present without signs and symptoms. Unfortunately, a large number of patients suffer from severe anal pain during and after each bowel movement. The pain may radiate to the upper thighs and buttocks. Fresh blood in stool or toilet tissue may also be present in minimal amounts. These signs and symptoms significantly decrease the quality of life in people with persistent fissures.
Anal fissures are not connected to bowel cancers, but cancer may mimic the presenting signs of a fissure. If not treated, the fissures may develop into:
•Chronic fissures – Tears that fail to heal over 12 weeks. This can cause inflammation and scar formation at the site of tears.
•Anal fistula – The anus may perforate (develop a hole) and connect to surrounding organs or other parts of the bowel.
•Anal stenosis – The anal canal becomes narrowed due to spasm or scar tissue, making the passage of stool more difficult.
A percentage of fissures heal spontaneously. The symptoms, however, especially pain require medical intervention to promote good quality of life. The line of therapy is conservative management through promoting good bowel movement and pain control. Pain is managed by using ointments and anti-inflammatory medications.
Good bowel movement is achieved through:
- •Increasing dietary fiber intake;
- •Increasing oral fluid intake;
- •Fiber supplementation; and
- •Adequate exercise.
Other treatment options include the injection of botulinum toxin in the affected area. Surgical interventions can also be opted to address anal fissures but they come costly and not without side effects.
Another mode of treatment is the use of Gurmar (Gymnema sylvestre) to treat anal fissure. Gurmar is a native herbal plant common in India and Sri Lanka. It has been used since ancient times as a remedy for digestive ailments, appetite suppressant, diuretic, and diabetes or high blood glucose. In fact, chewing the leaves suppresses sweet taste, which can last up to 2 hours.
Gurmar (Gymnema sylvestre) to treat anal fissure works by attracting water into the stools, making them soft and bulky, thus easier and less painful to expel. Its laxative function makes defecating a non-traumatic experience for people suffering from fissures.
Gurmar leaves are made into tea and taken twice a day to relieve constipation. Commercial preparations of Gurmar include 50 mg capsule to be taken twice daily to achieve desired effect. Gurmar (Gymnema sylvestre) to treat anal fissure is generally safe with minimal side effects. Drugs that lower blood glucose may interact with Gurmar, thus appropriate precaution and medical advice must be taken before taking this herbal medicine. Also, pregnant and breastfeeding women as well as young children should seek medical advice before using Gurmar.
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