Constipation and Anal Fissure

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Constipation and Anal Fissure Surgeon in Mumbai.

Expert care for constipation and anal fissure in Mumbai. Learn about causes, symptoms, and treatments for constipation and anal fissure. Consult Dr. Husain Gheewala for effective diagnosis and treatment options.

Constipation is very common and it affects people of all ages. Remember, everyone has different bowel habits, for some passing stools, 3 times a day is normal and for some passing stools 3 times a week can be normal. So, if you notice change from your routine bowel habits that would be significant.
Constipation can usually be treated at home with simple changes to your diet and lifestyle.

Constipation

It’s likely to be constipation if:

you have not passed stools for at least 3 times during the last week
the stools are often large and dry, hard or lumpy
you have to strain or give pressure most of the times or there is pain when you have to pass stools
you may also feel bloated or have stomach aches along with hard stools.

Causes

Constipation in adults has many possible causes. Sometimes there’s no obvious reason.

The most common causes include:

not eating enough fibre – such as fruit, vegetables and cereals
not drinking enough fluids
not moving enough and spending long periods sitting or lying-in bed
being less active and not exercising
poor bowel habits such as not passing stools when you feel the need.
changing your diet or daily routine
a side effect of medicine like pain killers
stress, anxiety or depression

Constipation is also common during pregnancy and for 6 weeks after giving birth. Rarely, constipation may be caused by a medical condition

Treatment

Making simple changes to your diet and lifestyle can help you treat constipation.

You may notice a difference within a few days. Sometimes it takes a few weeks before your symptoms improve.

To make your stools softer and easier to pass:

drink plenty of fluids and avoid alcohol
avoid smoking
increase your fibre intake with foods such as wholegrain breads, fresh fruits, prune juice (natural laxative)
add some wheat bran, oats or linseed to your diet
limit intake of junk food

Improve your routine

Keep to a regular time and place and give yourself plenty of time to use the toilet.

Do not delay if you feel the urge to pass stools.

Squatting position (Indian Toilet) is better position to pass stools then Sitting position (western toilets) when the stools are hard and you have to strain.

A daily walk or run can help you pass stools more regularly.

Consult a Specialist if you

are not improving with treatment
are regularly constipated and it lasts a long time
you have severe stomach pains, bloating or swelling
have blood in your stools
have unexpectedly lost weight
feel very tired all the time
your bowel habits change suddenly
are taking medicine that’s causing constipation – such as opioid painkillers

Although people often worry about it, there is no reason to believe that constipation causes a ‘poisoning’ of the system. It can cause feelings of sluggishness and bloating, but there is no evidence that bugs or toxins leak from the bowel into any other part of the body.

Another common idea is that constipation may lead to cancer but there is no evidence that long-term constipation increases the chances of getting bowel cancer.

It is important to remember that the vast majority of cases of constipation are easily resolved with simple diet, lifestyle or medication change. However, if constipation does not respond to different treatments there can be medium to long term effects including:

Haemorrhoids or fissures: bleeding from haemorrhoids, or more rarely a fissure (painful tear) at the anus, is the commonest complication of constipation.
Rectal prolapse: chronic straining can lead to the rectal wall protruding out through the anus.
Diverticular disease: this is where small hard stools lead to increased intestinal contractions, creating pressure which causes the inner section of the intestine to bulge through the protective outer tube of muscle which surrounds it, creating a little pouch of intestine.

Long-term constipation can lead to faecal impaction that is where stools have built up in the last part of the large intestine (rectum).

The main symptom is diarrhoea after a long bout of constipation.

Faecal impaction may be treated with:

stronger laxatives
a suppository – medicine you place in your bottom
a mini enema – where fluid is passed through your bottom, into your bowel
a healthcare professional removing some of the stools – this is not something you should do yourself

Constipation is when you have difficulty passing stools, need to strain when going to the toilet or have infrequent bowel movements.
In most cases constipation can be treated by simple lifestyle changes such as stopping smoking, reducing alcohol intake, increasing exercise and eating a diet rich in fibre.
If symptoms persist, or you notice anything abnormal, please consult a specialist.

Dr. Gheewala has seen and treated numerous patients with constipation with simple and effective techniques.

Anal Fissure

Faeces (stools) is temporarily stored in the rectum and expelled from the body via the anus (back passage). The membranous lining of the anus is called the anal mucosa. An anal fissure is a tear in the anal mucosa.

If you see blood in your stools, or have pain and discomfort in your bottom, you might have an anal fissure. An anal fissure can be very uncomfortable, but it will usually heal if you make some changes to your diet and follow some simple treatments.

Anal fissures are very common and can occur in people of all ages and genders, with around 1 in every 10 people affected at some point in their life.

They affect both sexes equally and people of all ages can get them.

But children and young adults between 10 and 30 years of age are more likely to get anal fissures.

The problem is common in children younger than one year, and affects around eight out of 10 babies. A person’s susceptibility to anal fissures tends to decline with age.

Common causes in adults include constipation and trauma to the anus (such as a difficult childbirth).

Around half of cases heal by themselves with proper self-care and avoidance of constipation. However, healing can be a problem if the pressure of passing bowel motions constantly reopens the fissure. Treatment options include medication and surgery.

Causes

Most anal fissures are caused by trauma to the area, mainly from passing a hard or large stool during a bowel movement. Other causes of anal fissures include:

chronic constipation
rough or excessive wiping of the anus after passing a motion
diarrhoea
inflammation of the anus and rectum
inflammatory bowel disease (IBD), such as Crohn’s disease and Ulcerative Colitis.
scratching (as a reaction to pinworm infection, for example)
anal injury
pregnancy and childbirth
occasionally, a Sexually transmitted infection such as herpes and syphilis.
having unusually tight anal sphincter muscles, which can increase the tension in your anal canal, making it more susceptible to tearing
cancer of the rectum.

Symptoms

An anal fissure can cause signs and symptoms such as:

pain during or after bowel movements, which might last for several hours
a feeling of cramp around the anus
Blood on your stools or toilet paper after wiping your bottom
Itching around the anus
a small crack or tear in the skin around the anus
a small skin tag or lump near the anal fissure

Complications

Anal fissures aren’t associated with more serious diseases, such as bowel cancer, although cancer of the anus may mimic an anal fissure. Some of the possible complications of an anal fissure include:

Chronic anal fissure – the tear fails to heal. Over time, this can cause extensive scar tissue at the site of the fissure (sentinel pile).
Anal fistulas – abnormal ‘tunnels’ join the anal canal to surrounding organs, usually other parts of the bowel.
Anal stenosis – the anal canal becomes abnormally narrowed either due to spasm of the anal sphincter or contraction of the resultant scar tissue.

Diagnosis

An anal fissure is diagnosed using a number of tests including:

physical examination
inspection of the anus and rectum with a slender instrument (anoscope).

Treatment

Conservative treatment usually works, taking 1 to 2 months. It involves:

eating lots of high fibre foods and drinking lots of water to create soft stools, which will ease the pain and muscle spasm around the anus
Warm baths are soothing and they may help the back passage (anus) to relax which may ease the pain.
applying a muscle relaxant cream to the area.
taking pain medication such as paracetamol if you need it
Laxatives for softening of stools

Surgery

An operation is an option if the fissure fails to heal or comes back. The usual operation is to make a small cut in the muscle around the anus (internal sphincterotomy). This permanently reduces the tone (pressure) around the anus and allows the fissure to heal. This is a minor operation which is usually done as day case surgery (you will not usually have to stay overnight in the hospital). The success rate with surgery is very high. At least 9 in 10 cases are cured.Diagnosis

Botox

Botox is a chemical that is injected into the muscles around the anus to help them relax. Botox usually lasts for 2 to 3 months, which allows the fissure to heal.

Many cases of anal fissures are caused by chronic constipation. Suggestions include:

Eat a high-fibre diet.
Drink plenty of water to help soften stools.
Make sure to clean or wipe gently after going to the toilet.

Do not let embarrassment stop you seeking help. Anal fissures are a common problem a colorectal surgeon is used to dealing with.

Most anal fissures get better without treatment, but a specialist will want to rule out other conditions with similar symptoms, such as piles. So, if there is no improvement in 1 to 2 weeks or you feel anything unusual then please see a specialist.

They can also tell you about self-help measures and treatments that can relieve your symptoms and reduce the risk of fissures coming back.

Dr. Gheewala has been dealing with patients of Anal Fissures for years in his practice.

The above measures apply to children who have a fissure as much as to adults. In children, the pain often makes them hold on to their stools which leads to a vicious circle, forming harder stools. These then cause more pain when they are finally passed. Therefore, in addition to the above measures, a short course of laxatives may be prescribed for children with an anal fissure. The aim is to make sure their stools are soft and loose whilst the fissure heals.