Holistic Solutions for Anal Fissures: Ayurveda, Diet, & Self-Care

Understanding What Causes Anal Fissures

As the name suggests, the anal fissures are longitudinal tears/breakage of the skin and mucosal lining of the anal region. Anus is the small opening through which we pass the stools. A fissure is an elongated tear leading to the formation of an ulcer.

How is the Tear or Break Formed?

The general causes of the anal fissure are often related to increased pressure at the anal region and increased anal sphincter tone (a group of muscles around your anal canal which, when you squeeze, holds back your stools). Some of the most common causes include:

Exerting Excessive Force While Passing Stools: This may seem exaggerated, but excessive straining while passing stools, often due to constipation or hard stools, can tear the delicate lining of your anus. 

Chronic Constipation: This is the most common cause of anal fissures. Infrequent bowel movements and the passage of large, hard stools can increase the risk of fissures over time. 

Certain foods can worsen constipation, making it harder for your body to move waste through the digestive system. On the other hand, foods rich in fiber can help soften stools and promote regular bowel movements, easing constipation and helping to prevent fissures from forming.
Understanding the role of diet in managing constipation and preventing fissures is crucial. Are you unsure what foods might be causing your constipation and discomfort? 
 

Take our quick quiz to discover personalized recommendations for foods that may be triggering your symptoms and how to improve your gut health.

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Diarrhoea: Like constipation, frequent and watery stools can irritate your anal lining and lead to fissures. 

Anal Trauma: Injuries or trauma to the anal area, such as from anal intercourse, the insertion of foreign objects, or aggressive wiping, can cause fissures. 

Anal Spasms: In some cases, spasms of the anal sphincter muscles can contribute to the development or persistence of fissures by reducing blood flow to the area. 

Inflammatory Bowel Diseases (IBD): Some medical conditions, like Irritable or inflammatory bowel diseases ( Crohn's disease and ulcerative colitis), can increase the risk of anal fissures due to inflammation and ulceration in the digestive tract. 

Childbirth: Most women get anal fissures as a result of childbirth. Childbirth is not indicative of anal fissures. But, anal fissures can occur due to trauma during childbirth, particularly in women who have had a vaginal delivery. 

Anal Infections: Infections in the anal region can cause weakening of the tissue and make it more prone to fissures. 

Anal Conditions: Certain conditions, such as haemorrhoids or anal stenosis (narrowing of the anal canal), can significantly contribute to the development of fissures. 

Signs and Symptoms of Anal Fissures

Anal fissure symptoms can affect the quality of your life. Specifically, passing stools can be severely uncomfortable due to these symptoms. The common symptoms of anal fissure include:

• Experiencing sharp agonising pain during defecation.
   
• Persisting of pain, usually for an hour or more after defecation.
   
• Passing bright streaks of blood along with your stool.
   
• In a chronic fissure, there may be a slight watery or mucous discharge.
   
• Anal itching may also be present.

All these symptoms together can torment you during your restroom visit. These can also affect you mentally and affect the quality of your life.

How long has this issue been troubling you? And what are your symptoms? Depending upon these, anal fissures can be classified into the following:

• Acute Fissures: The fissures of recent origin are called acute fissures.
   
• Chronic Fissures: Those which are of no recent origin and produce symptoms more aggressively are called chronic fissures.

Acute fissures are like any other minor cuts in your body which take no time to heal. The real villain, which keeps tormenting you, is the chronic fissure.

Chronic Anal Fissures: Why They’re Harder to Heal

Did you know that nearly half of the people who suffer from anal fissures develop chronic fissures? This number alone highlights the importance of getting the proper treatment, curing, and preventing anal fissures at the earliest. So what makes the chronic anal fissures a severe problem? Let us have a look.

When fissures become chronic, they do not heal within a reasonable timeframe, usually lasting more than six weeks. Chronic anal fissures can cause significant and prolonged challenges, including:

Persistent Pain: Chronic anal fissures often cause severe pain that occurs during and after bowel movements, which can interfere with daily activities. The pain usually presents as sharp, burning, or throbbing in nature.

Bleeding: Chronic fissures can cause bleeding during or after bowel movements, resulting in blood on toilet paper or the stool.

Discomfort and Itching: People suffering from chronic anal fissures may often experience discomfort, itching and irritation around the anal area.

Skin Tags (Sentinel Pile): Chronic anal fissures often cause skin tags called sentinel piles. They form due to the constant inflammation of the surrounding skin around the fissure. They are often confused with piles or haemorrhoids, but they are more painful than piles during bowel movements.

Impaired Quality of Life: Individuals with chronic anal fissures may experience reduced quality of life due to pain and discomfort. The process may result in avoiding bowel movements, leading to constipation and other related issues.

Psychological Impact: Living with chronic pain can cause anxiety and depression.

Secondary Infections: Prolonged anal fissures can lead to infections by providing a favourable environment for bacteria to grow. 

Challenges in Healing: Chronic fissures can be challenging to heal since they may worsen and develop scar tissue, making them less responsive to conventional treatments and requiring more invasive interventions.

What Makes Chronic Fissures Harder to Heal?

What makes an anal fissure chronic? It occurs due to repeated injury to the lining of the anus caused by constipation, diarrhoea, trauma, childbirth, or other medical conditions. When a fissure becomes chronic or long-standing, it becomes difficult to heal. Let us look at why this happens:

• When a tear occurs, your internal anal sphincter (IAS) muscle contracts or spasms, which causes further tears and reduced blood flow to the affected area.
• Proper healing requires good blood circulation to deliver nutrients and oxygen to the injured tissue. However, in chronic fissures, reduced blood flow to the site of injury delays the healing process.
• Because of poor healing, your bowel movements can cause further irritation and inflammation of the damaged tissue, causing severe pain and spasms of the internal anal sphincter.
• This cycle of pain and muscle spasms keeps repeating, leading to poor blood supply and inflammation, which makes the fissure hard to heal. 

Treating Anal Fissures: An Overview of the Conventional and Holistic Treatment Approaches

Understanding and having a good knowledge of the treatment options you can pursue is essential. What works for you may not work for others because your gut type is different from the others. 

Understanding the role of gut health is critical in managing conditions like anal fissures.

Conventionally, the treatment protocol your doctor will follow includes using ointments, creams, and surgical options like sphincterotomy. Let us look at what these protocols exactly do and the other effective alternatives for these protocols. 

Indeed, there are various conventional medical interventions for anal fissures, ranging from topical treatments to surgical options. Here's an overview of some common approaches: 

Topical Ointments and Creams

Topical Anesthetics: These anaesthetics are applied topically to the affected area for temporary pain relief. Lidocaine is a commonly used anaesthetic.

Nitroglycerin Ointment: Nitroglycerin promotes blood flow, relaxes anal sphincter muscles, and aids in healing.

Calcium Channel Blockers: Medications such as diltiazem and nifedipine can help heal anal fissures by relaxing the anal sphincter.

Fibre Supplements

Dietary changes, such as increasing fibre intake, can help soften stools and reduce strain during bowel movements, which is crucial in preventing further irritation to the fissure.

Stool Softeners and Laxatives

Doctors may suggest over-the-counter stool softeners or prescription laxatives to relieve pain and reduce the risk of recurrent fissures.

Botulinum Toxin Injection

In cases where other treatments have failed, a botulinum toxin injection can relax the anal sphincter, promoting the healing of the fissure.

Surgical Options

Lateral Internal Sphincterotomy (LIS): Lateral Internal Sphincterotomy (LIS) is a surgical method that involves making a small incision in the internal anal sphincter muscle to reduce the pressure on the fissure, which in turn helps it to heal. This procedure is effective for chronic and severe fissures, but it may have a minor side effect of faecal incontinence.

Advancement Flap Surgery: This technique involves creating a flap of healthy tissue near the fissure and positioning it over it to assist in healing. Your healthcare provider will usually consider it when they can't recommend sphincterotomy or when they need to preserve sphincter function.

Fissurectomy: In this procedure, the fissure gets removed. Why? The answer is to allow the healthy tissue to replace it and promote healing. A healthcare provider may recommend it for specific cases.

How Ayurveda Perceives Anal Fissure

Centuries ago, ayurveda textbooks identified and detailed the problem of anal fissures and elaborated the effective treatment plan for the same. These methods are time-tested and still considered the most effective and holistic treatment for anal fissures.

Ayurveda describes an anal fissure as Parikarthika, which translates to a cutting type of pain. It is considered a type of ulcer in the anal region, and the Ayurvedic treatment protocols aim to heal this ulcer. 

Ayurvedic Remedies for Treating Anal Fissures

Here are some of the Ayurvedic remedies for treating anal fissures:

Triphala Powder

If you have ever tried Triphala for anal fissures, then you would agree that it is one of the best medicines out there. It combines three fruits (amalaki, haritaki, and bibhitaki). It has a mild laxative effect. It helps regulate bowel movements and also reduces constipation, which can aggravate anal fissures. Moreover, people use Triphala powder mixed with lukewarm water for taking a sitz bath for anal fissure patients. It gives pain relief as well as helps to heal the fissures.  

Ghee

In Ayurveda, ghee is considered a medicine and dietary staple. Ghee has soothing and healing effects. Daily consumption can help lubricate the anal canal and reduce friction during bowel movements. Medicated ghees help in healing the fissures.

Triphala Ghee

Again, the use of Triphala along with the ghee is a magical remedy for anal fissures. Mixing Triphala powder with ghee creates a topical ointment. It can help reduce inflammation and promote healing when applied to the affected area.

Ayurvedic Herbal Formulations (Ointments or Creams)

Ayurvedic formulations containing herbs like neem, haridra (turmeric), yashtimadhu (liquorice), and manjistha (Indian madder) can be applied topically to alleviate anal discomforts and reduce inflammation and pain.

Buttermilk

Drinking buttermilk helps in balancing digestion and promoting a healthy gut. It is helpful for those with digestive issues contributing to anal fissures.

Castor Oil Packs

They help reduce pain and inflammation associated with anal fissures.

Warm Water or Oil Enema (Basti)

Warm water enemas or oil enemas, also known as basti therapy in Ayurveda, are sometimes recommended to cleanse the colon and alleviate constipation. 

Yoga and Pranayama

Practising gentle yoga postures and pranayama (breathing exercises) can help reduce stress, promote relaxation, and improve overall digestive health.

Dietary Changes

Follow an Ayurvedic diet that emphasises warm, cooked foods and avoids spicy, fried, and processed foods. Incorporate plenty of fruits, vegetables, and fibre-rich foods into your meals.

Hydration

Stay adequately hydrated throughout the day by drinking warm water, herbal teas, or warm ginger water to support digestion and bowel regularity.

The Ayurvedic management protocols for fissure-in-ano include :

• Snehavasthi (oil enema therapy).
   
• Avagaha Swedana (medicated lukewarm water sitz bath).
   
• Lepanam (medicated ointments).
   
• Relief of pain and healing of the fissure is accomplished by correcting the imbalanced Vata and Pitta doshas associated with anal fissures. 
   
• A few of the invasive strategies recommended in Ayurveda include Kshara karma (alkaline paste application), Ksharsutra application (alkali thread therapy), and Agnikarma (cauterisation).

Lifestyle changes to heal anal fissures

Specific changes in our lifestyle can have a huge impact on the healing process of anal fissures and help to prevent them. Follow the following practices:

Maintain Proper Hygiene

After each bowel movement, gently clean the anal area using warm water and mild, unscented soap or use wet wipes designed for sensitive skin.

Pat the area optimally dry using a soft, clean towel rather than rubbing to avoid irritation

Regular Exercise

Make physical activity a routine to aid digestion and weight.

Avoid Straining During Bowel Movements

Respond correctly to the natural urge for a bowel movement. Use a footstool or squatting position to align the colon during bowel movements, making it easier to pass stools. 

Proper Toileting Posture

To ensure a comfortable bowel movement:

1. Sit on the toilet seat in a relaxed and upright posture with your feet flat on the ground or a footstool.
2. Avoid spending too much time on the toilet as it can result in straining and pressure on the rectal area.
3. Remember to take breaks and listen to your body's signals.

Regular Bowel Habits

Establish a consistent daily bowel routine to regulate bowel movements and prevent constipation. Give yourself time for a bowel movement each day, preferably after meals or at a time that suits your body's natural rhythm.

Natural Laxatives (If Needed)

If constipation persists, consider natural laxatives described in Ayurveda. Consult an ayurvedic practitioner to prescribe a laxative after accessing your bowel. 

Avoid Irritants

Avoid using harsh soaps, scented products, or rough toilet paper that may further irritate the anal area.

Regular Health Check-Ups

It is essential to schedule regular medical check-ups with your healthcare provider to monitor your anal health and address any concerns promptly.

Dietary Strategies For Faster Healing: Discover the Signs

Ayurvedic science provides insights into specific dietary strategies that can aid in faster healing. The recommended food plan comprises cow milk, butter, buttermilk, wheat, ghee, rice, green vegetables, and a balanced diet. It's best to avoid consuming chillies, fried foods, and foods that may cause constipation.

Signs of Healing Fissure

• Considerable Degree of Relief in Pain and Discomfort.

• Less Bleeding than earlier.

• Improved Stool Consistency.

• Decreased Itching or Irritation.

• Improved Healing Time.

• Better Comfort During Activities.

• More Regular Bowel Movements.

• Less Sensitivity to Touch.

• Progressive Decrease in Anal Spasms.

• Improved Sleep Patterns.

• More Consistent Relief from Sitz Bath.

Medications for Anal Fissures - How Safe are They?

Over-the-counter medicines are readily available, and people with anal fissures tend to use them more. We have discussed these in the conventional treatment section. These medicines are relatively safe and effective. Let us have a peek through at their benefits.

Topical anaesthetics can provide temporary pain relief by numbing the area. They can also reduce discomfort and pain during bowel movements and throughout the day, as well as ease muscle spasms and promote relaxation of the anal muscles.

Corticosteroid creams or ointments are effective in reducing inflammation and itching in the anal area. They can also soothe and calm irritated skin and mucous membranes and may be effective in healing mild to moderate anal fissures.

Nitroglycerin cream can help relax the anal sphincter muscles, thus improving blood flow to the area and promoting healing. It may also reduce pain and aid in healing chronic anal fissures.

Calcium channel blockers can relax the anal sphincter muscles and help in improving the blood flow to the area and promoting healing. They may be effective in healing chronic anal fissures.

Botulinum toxin (Botox) injections get typically administered by a healthcare professional and are injected into the anal sphincter to relax the muscles, promoting healing and reducing pain. They are helpful for chronic anal fissures that haven't responded to other treatments.

Antibiotic ointments may be prescribed in cases of secondary bacterial infection or inflammation. They can help in preventing or treating infections in the anal area.

Achieving Long-Term Relief and Preventing Future Occurrences

ven though the surgical line of treatment is a fast relief and gives a good grade of healing in anal fissures, it comes with some complications, such as loss of continence ( inability to hold the faeces naturally).

In addition to this, there is no surety that the fissures will not reoccur. 

The best way you can embrace long-term relief is by practising the following : 

• Diet: Diet is vital, and fibre-rich food helps to overcome constipation, so always maintain a high-fibre diet.
   
• Hydration: Stay Hydrated for good bowel movement.
   
• Hygiene: Always follow a good anal hygiene.
   
• Exercise: Regular Exercise helps to keep the pressure at your anal region optimal.
   
• Sitz Bath: Sitz Baths are very effective and provide better relief as well as help to heal the fissures.
   
• Avoid Straining: Always avoid Straining as they cause fissures in the first place.
   
• Laxatives: Use stool softeners or laxatives as required.

When to Consult a Doctor?

Knowing when to seek medical attention for anal fissures is crucial. If you experience severe or persistent symptoms, it is essential to consult a healthcare professional. These are the situations when you should see a doctor:

• Constant pain and discomfort even after medications and treatment.
   
• Excessive bleeding than usual.
   
• Prominent fever and infection signs.
   
• Appearance of more fissures or recurrence of the old ones.
   
• No improvement with home remedies.
   
• Change in bowel habits.
   
• Painful spasms and muscle tightness.
   
• Underlying health conditions.

Conclusion

Knowing your treatment options is essential for a patient. As we discussed, Ayurveda is an experienced veteran in the field of anal fissures and anorectal diseases. Ayurvedic treatment plans and medications are so effective that people choose Ayurveda for anorectal diseases.

If you want to heal and prevent the anal fissures and avoid the recurrence, Ayurveda is the best option. We at Nirva can guide you with the most suitable and effective Ayurveda treatments, along with therapeutic yoga for anal fissures.