Anal Fissures in new mothers : A case study

 

Research Study 

 

 

Article by

 

Vimala Ramesh

 

Abstract

Anal fissures is a thin tear in the anal mucosa. Apart from pain from surgical wounds, the most common painful condition faced by women in their confinement period is anal fissures‘. The young mother is frightened by its presence and afraid to go for defecation. Infants also sometimes land up in this condition. The most common causes and effective management of the condition is discussed in detail in the following article.

Discussion

There is a myth that anal fissure is a progressive condition and that it has to be treated surgically alone. But, by a close and detailed case study, various avoidable causes can be elicited and an effective safe and medical management can be worked out.

Conclusion:

Proper life style and food habits can effectively control the anal fissures. An attending physician/ surgeon has to educate the patient about the causes and the complications of the disease.

Introduction

Anal fissures are very common in young mothers and also infants, but can affect people of any age.

Signs and symptoms:

  • Severe excruciating pain during and after passing stools.
  • The person would hesitate to pass stool with a fear of experiencing the pain.
  • Bleeding from anus after passing stool.
  • Tight plug like sensation in the anus.
  • Itching and irritation in the anus making him difficult even to sit.
  • A small protrusion of skin at the point of fissure.
  • A visible crack is also seen at the anus.

 

Causes

Why are first time young mothers more prone to this problem?

The most common cause for this condition is constipation. This condition is related to the type of diet we take and the life style we follow. Pregnancy is an important phase in a woman’s life where the body undergoes various changes to give birth to a baby.

In our society there is a strong belief that new mothers need to follow a particular type of restricted diet post-delivery and the body has to be kept warm (in spite of severe environmental heat). The new mother is not given sufficient water in the belief that it can cause bloating of the stomach or weight gain. Instead of providing the mother with a diet rich in nutrition and fiber, they are served a diet comprising too much garlic, pepper, ginger and methi (fenu greek). Very little or no vegetables and fruits are given, thus denying the new mothers the much needed nutrition.

During this period, the mothers are on medications for wound healing and other supplements which can lead to disruption in the normal defecation process. This leads to hardening of stools and as a consequence strained bowel movement leading to anal fissures.

 

Most common causes:

  1. a) Constipation and straining during bowel movements
  2. b) Passing large or hard stools
  3. c) Chronic diarrhea
  4. d) Inflammation of the anorectal area, caused by Crohn’s disease or another inflammatory bowel disease
  5. e) Childbirth

 

Less common causes:

  • Anal cancer
  • HIV
  • Tuberculosis
  • Syphilis
  • Herpes

Factors that may increase the risk of developing an anal fissure:

  • Aging – Older adults may develop anal fissures partly due to decreased blood circulation, resulting in reduced blood flow to the rectal area.
  • Constipation – Straining during bowel movements and passing hard stools increase the risk of tearing.
  • Childbirth – Anal fissures are more common in women after they give birth.
  • Infants – Children in their 1st year of age are prone to have fissures. Experts are not sure of the cause.
  • Crohn’s disease – This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing.

Lifestyle and home remedies

  • Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences:
  • Adding fiber to the diet – Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. Fiber supplements are also recommended. Adding fiber may cause gas and bloating, so the intake has to be increased gradually.
  • Drinking adequate fluids – Fluids help prevent constipation.
  • Exercising regularly – 30 minutes or more of moderate physical activity, such as walking helps in regular bowel movements and increases blood flow to all parts of the body, which may promote healing of an anal fissure.
  • Avoiding strain during bowel movements – Straining creates pressure, which can open a healing tear or cause a new tear.
  • If an infant has an anal fissure, changing diapers frequently and washing the area gently would help.

Prevention

Anal fissures can be prevented by taking measures to prevent constipation. Eating high-fiber foods, drinking fluids and exercising regularly and avoiding strain during bowel movements help in preventing the onset of constipation.

 

Tests and diagnosis

  • The diagnosis includes capturing a detailed medical history followed by performing an inspection of the anal region and physical examination. Often the tear is visible. Usually a finger or digital exam is conformational test but the doctor avoids it since it is very painful. It may also be diagnosed by inserting a lighted tube (anoscope).
  • The fissure’s location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn’s disease. If an underlying condition is suspected, further testing is recommended.
  • Flexible sigmoidoscopy – A thin, flexible tube with a tiny video camera is inserted into the bottom portion of your colon. This test may be done for patients below 50 years of age and have no risk factors for intestinal diseases or colon cancer.
  • Colonoscopy – A flexible tube is inserted into the rectum to inspect the entire colon. This test may be done if the patient is older than age 50 or have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea.

 

Treatment

Nitroglycerin ointment can be used to relieve pain caused by anal fissures on doctor’s advice. When it is used to treat anal fissure, it is usually applied every 12 hours for up to 3 weeks. If still anal fissure pain persists after using the ointment for 3 weeks doctor should be consulted.

An anal fissure usually heals on its own within four to six weeks. If it doesn’t, medical treatment or surgery usually can relieve discomfort.

 

Homoeopathic Treatment

Homoeopathy has three level of treatment.

  • To reassure the patient and then relieve the pain and discomfort by prescribing an acute remedy.
  • To advice regarding the diet and life style. Once the pain subsides next level treatment should be followed.

In the next level, long acting chronic remedy is selected depending on the totality of the symptoms, duration of complaints, severity of complaints, and the sensitivity and susceptibility of the patient. Depending on the life space investigation, evolution of the disease and a strong family history of major illnesses, a long acting remedy is selected to improve the patient’s overall defense system (Vital force) to lead a better and ailment free life. This medicine is given less frequently.

The most commonly administered medicines for acute remedies include: aesculus, ratanhia, collinsonia, agaricus, nitric acid, sulphur, apis, bryonia, aloes etc. The dosage can be judged after analyzing the case.

 

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