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Takashshurul Miqad

(Fissure in Ano)
Dr. MSM Shiffa
Fissure is a linear or lngitudinal tear in the anal
canal extending from just below the dentate
line to the anal verge.

Most commonly in young and middle age


The cardinal symptom is pain during and for

minutes to hours following defecation.

Bright red blood is common

Over 90% of anal fissures are located in the
posterior midline.

Almost all the rest located in the anterior


The acute fissure is a "mere crack" in the


Distal sentinel tag, a proximal hypertrophied

anal papilla, fibrotic edges, and exposed internal
sphincter fibres are features of chronicity
Etiology and Pathogenesis

The initiating factor is trauma, typically

overstretching of the anoderm by a large hard

The proposed explanation for the posterior midline

predominance is a lack of tissue support and
maximal stretching at this site.

Failure to heal is secondary to poor perfusion of the

anoderm in the posterior midline.

Posterior midline ischaemia is the result of arterial

anatomy and internal anal sphincter hypertonicity.
Etioloogy / Pathophysiology

Most anal fissures are caused by

stretching of the anal mucosa
beyond its capability. Various causes
of this fissure include:
Straining to defecate, especially if
the stool is hard and dry
Severe and chronic constipation
Severe and chronic diarrhea
Etioloogy / Pathophysiology
Crohn's disease and Ulcerative colitis
Anal sex
Anal stretching
Insertion of foreign objects into the
Tight sphincter muscles
Excessive anal probing
Local trauma
Hard stool
Chron's disease
anal intercourse
Garam masala
Dry food
Mosam garmi
Amraze miq'ad
Safravi ishal
Excessive coldness
Clinical Mainfestations
The symptoms of anal fissure include:
Pain during, and even hours after,
Visible tear in the anus
Blood on the stool or on toilet paper
or toilet bowl
Burning, possibly painful, itch
Jiryane khoon
Shadeed dard
Severe sphincteric spasm
Pruritus ani
Sozish e miq'ad
Sentinel pile/ skin tag
Warm baths and a diet sufficiently high in
fibre to achieve soft bulky stools allows
approximately 50% of acute anal fissures
to heal within three weeks.

Stool softeners and fibre supplements are

reasonable additions.

Recurrence is common, in the range of 30

- 70%, but can be reduced to 15 - 20% by
maintaining a high fibre diet
Chronic Fissure

Are unlikely to heal with warm baths and

a high fibre diet.

Internal Sphincterotomy : Lateral

internal sphincterotomy (LIS) achieves
healing in over 95% within several

Anal Dilatation
Medical Management
Most anal fissures are shallow or
superficial (less than a quarter of inch or
0.64 cm deep). These fissures self-heal
within a couple of weeks. While waiting for
the fissure to heal, topical or suppository
containing anti-inflammatory agents and
local anesthetic can be used. Furthermore,
treatment used for hemorrhoid such as
eating a high-fiber diet, using stool
softener, taking pain killer and having a
sitting bath
Medical Management
Painful deep fissures, on the other
hand cut through the sphincter
muscle thus making it prone to
spasm, which exacerbates the fissure
and aborts the healing process.
Medications such as nitroglycerine
and nifedipine ointments can relax
the sphincter muscle
Medical Management
Surgical intervention may be required for
persisting deep anal fissures unresponsive
to the above conservative measures.
Procedures include:
Internal lateral sphincterotomy or excising
a portion of the sphincter
Anal dilation or stretching of the anal canal
is no longer recommended because of the
unacceptably high incidence of fecal
Digital examination under
Stool softener
Bulking agents
Local anaesthetic gel
Usool e ilaj
Izal e Sabab
Correct the mizaj
Habis ud dam
Daf e tafoon

Hot & dry spicy food
Cold food
Take fibre, mucillagious food and fruit

Nakhuna, baboona, gule teesu

If pain & burning sensations

Aabe kurfa
Aabe kithmi
Apply bone marrow + mom paste
Roghane banafsha
Roghane gul and anabussalab
Qurse kaharuba
Ith zamani
Ith muqil
Habe raswat
Maj muqil
Habe bawasir
Habe muqil
Ith mulayyin
Jawarish e kamooni mushil
Habe tanker
Sharbate anjeer