PILONIDAL SINUS

 An Anal fissure is a small crack or tear or ulcer (open sore) in your skin in ano-rectal region. Fissures are characterized by extreme Pain, Burning sensation & needle pricking sensation during defecation & in extreme cases throughout the day also. Sometimes fissure causes bleeding also. About one in 10 people get an anal fissure at some point in their life. Anal fissures usually develop at the part of your anus towards your back – in line with the cleft of your buttock or in front of your anus, or even both together. An anal fissure will usually heal within five to six weeks, and it’s called an acute anal fissure. If it lasts for longer than this it’s known as a chronic anal fissure. Anal fissure can come at any age, but it’s most common in people aged 20 to 50. 

☛ A sharp, searing or burning pain in, or around, your bottom, which can last for a couple of hours after you go to the toilet. Some people describe the pain of an anal fissure as like passing broken glass.
☛ Spasms in anus.
☛ Sometimes small Bleeding during defecation.
☛ A sentinel pile. This is a tag of skin that can develop on the edge of your anus below the fissure. This can develop after you get the fissure.

These symptoms may be caused by something other than an anal fissure. One condition they’re often confused with is piles (haemorrhoids), for example. If you have any of these symptoms, contact your Doctor.

Generally an anal fissure will heal within few weeks without any treatment. An anal fissure usually heals if you make some dietary & lifestyle changes along with medicines, or use creams. If it doesn’t get better, generally Doctors advice for surgery.
Fissures Surgery

Surgery may be needed if medicine fails to heal a fissure in the anus. The preferred procedure is an internal anal sphincterotomy. In this procedure Surgeon makes a small incision in the internal anal sphincter, one of two muscles that control the bowels or opening or closing of anus. This will be done under local or general anaesthesia. The internal anal sphincter is always under tension, also known as resting pressure. If that pressure becomes too high, a fissure may form or an existing one may not heal. The incision reduces the resting pressure, allowing the fissure to heal. Even with surgery, an anal fissure must heal on its own. A sphincterotomy involves operating on the sphincter muscles, not closing the actual fissure.

Lateral internal sphincterotomy highly preferred treatment of fissure due to its high success rate (~95%) & easier process. In this treatment the internal anal sphincter is partially divided in order to reduce spasms and thus improve the blood supply to the perianal area.This treatment of fissure improvement in the blood supply helps to heal the fissure.This is a single day &simple surgery. However, this have a number of potential side effects like problems in incision healing and also loss of stool holding capacity and sometimes loss of urination senses also

Anal dilation or stretching of the anal canal also known as Lord’s operation is one of the older treatment of fissure, which is not very common, primarily due to the unacceptably high incidence of fecal incontinence & flatus incontinence.