There can be several causes of painful defaection; the most common condition is what is called fissure-in-ano. Essentially, there develops a fissure in the anal canal.It is commonly seen in women having constipation and passage of hard faecal mass. In men is is the hind part of anus that is affected and in women it is the front side. But, there is no rule in this regard. It can be of any depth and length. A skin tag is seen guarding the fissure near the anal opening; called sentinel pile.
It causes too much pain during defaecation and for a long period after the act. Pain may be so much so that that the suffer fears to go to the latrine. If such a thing develops and the patients defers defaecation for several days; stool constantly accumulate in the rectum and colon to give rise to a large colon; the megacolon; which is acquired one. In many patients bleeding is seen from the sore. Megacolon may end up in gut obstruction; called intestinal obstruction.
The essential cause is diet rich in high animal protein and less fibre. The intrinsic abnormality present in some patient is high resting pressure of the anal muscle; the anal sphincter. Some other diseases like Crohn's disease or anal cancer may present sometimes with fissure-in-ano; and some other are of academic interest
This can easily be diagnosed by viewing the region. The fissure is very much apparent and no further examination may be required. A digital rectal examination is deferred till the pain subsides to diagnose any serious conditions those might be associated with. Routine blood tests are to be conducted and diabetic status must be checked
Treatment is usually conservative;
- Restricting animal protein and adding fibre to diet.
- Plenty of water to drink.
- Some medications;
- Analgesics to relieve pain,
- Antibiotics,
- Anaesthetic creams to be applied before going to toilet,
- Sitting in warm water with some antiseptic, called sitz bath, thereafter,
- Antibiotic ointment to be applied after the sitz bath, and
- Diltiazepam ointment that causes muscle relaxation and increase blood supply; thus helps in healing of the sore.
And perhaps as a last resort surgery is undertaken, to partially cut the sphincter making that less powerful; called lateral sphincterectomy. There is slight risk of the surgery in making the sphincter permanently incompetent, if more is cut; problem of sphincter control.
As per experience, conservative treatment and diet modification gives very good result; nicely avoiding the surgery. There should not be any haste for surgery.
