HEMORRHOIDS AND ANAL FISSURES: A DETAILED DISCUSSION
- MedReport Foundation
- 38 minutes ago
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UNDERSTANDING THE DIFFERENCE BETWEEN HEMORRHOIDS AND ANAL FISSSURES:
Hemorrhoids, also known as piles, are the lumps formed from swollen veins in the rectum and around the anus. Internal hemorrhoids are developed inside the rectum whereas external hemorrhoids are developed under the skin around the anus. On the other hand, anal fissures are the skin tears resulting in bleeds [1, 2].
Both of them share some common symptoms, that is why most of the times these are confused in diagnosing. The common triggers of both these conditions include [1, 3]:
• Constipation
• Irritation/itching caused due to repeated wiping (in case of diarrhea)
• Sitting for a longer time on the toilet
• Straining and passing hard stools
TABLE-1: DISTINGUISHING FEATURES BETWEEN HEMORRHOIDS AND ANAL FISSURES
FEATURE | HEMORRHOIDS | ANAL FISSURES |
Visible signs | Appears as a lump or swelling near the anus | Tears or cuts around the anal opening |
Pain | Associated with soreness in case of external or prolapsed hemorrhoids | Sharp burning pain during bowel movement which lasts minutes to hours afterward |
Itching | Very common due to skin irritation | Itching may occur as the fissure heals |
DIETARY HABITS AFFECTING THE RECTAL HEALTH:
Diet has direct effect on hemorrhoids and anal fissures. Diet involving adequate fiber and fluid intake avoids constipation which is the primary cause for both these conditions. Soluble fiber intake is advisable as it has a high capacity to hold water eliminating dehydration in large bowel [4].
Two other habits resulting in these conditions are smoking and alcohol consumption. Smoking has a great effect on overall vascular health. Since hemorrhoids are the swollen veins in anal area, smoking causes a direct impact on these.
Excess alcohol consumption causes dehydration which is responsible for passing harder stools ultimately ending up with hemorrhoids and fissures.
DIAGNOSIS:
Diagnosis for external and internal hemorrhoids is different. External hemorrhoids are identified by checking the area around the anus whereas internal hemorrhoids require a digital rectal exam. This procedure helps to look inside the anus and rectum. Medical history also plays an important role as it helps to understand the patient’s eating habits, toilet habits, usage of laxatives or any other existing medical conditions [5].
Anal fissures are diagnosed by looking at the anal region as the tear is often visible. A fresh tear indicates acute anal fissure just like a paper cut. A deeper cut might be due to long-lasting condition (more than eight weeks) and is considered as chronic. In some cases, the location of the fissure provides more details about its cause. Fissure which is present on the side of the anal opening (instead of back or front), is more likely a symptom of Crohn’s disease. This is a chronic inflammatory bowel disease [6].
MEDICAL PROCEDURES:
ANOSCOPY: This is performed by a hollow tube with a light (anoscope) to examine the rectum and anus. Tissue lining the anus and lower rectum are observed for any signs of digestive tract problems or bowel disease [5, 6].
FLEXIBLE SIGMOIDOSCOPY: This is used to examine the rectum and lower colon. The procedure uses a thin, flexible tube (sigmoidoscope) to see the lining of the colon for any growths or inflammation. This test is suggested if there is any rectal bleeding, blood in the poop, ongoing belly pain, constipation or diarrhea [7].
TREATMENT:
If the hemorrhoids are causing a mild discomfort, then a variety of products are available to buy without a prescription like creams, witch hazel pads, suppositories. These help in relieving pain and itching [8].
EXTERNAL HEMORRHOID THROMBECTOMY: If the external hemorrhoid develops a painful clot, then it can be removed to get relief from the pain right away. Most of the times this procedure is done within 72 hours of formation of the clot.
RUBBER BAND LIGATION: This procedure is suggested if the hemorrhoids are associated with continuous bleeding. One or two tiny rubber bands are placed around the base of an internal hemorrhoid to cut off its blood flow. The hemorrhoid falls off within a week. This is an uncomfortable procedure and might cause bleeding after a couple of days.
SURGICAL PROCEDURES:
Though this is rare, hemorrhoidal removal (hemorrhoidectomy), is the most effective way to treat severe and recurring hemorrhoids. The extra tissue that causes bleeding is removed under anesthesia.
Another procedure called hemorrhoid stapling is done generally in case of internal hemorrhoids where the blood flow to the hemorrhoidal tissue is blocked by stapling.
MEDICATIONS FOR ANAL FISSURES:
A variety of medications are available for anal fissures that have lasted for a longer time. Nitroglycerin ointment acts as a vasodilator in restoring the blood flow and helping the anal sphincter relax. Others include diltiazem or nifedipine (calcium channel blockers) which also help in relaxing the blood vessels anal muscles [9].
Sometimes Botox injection is suggested as a last option where it is given into the anal sphincter muscle to help relax it.
Surgical procedure called internal sphincterotomy, in case of chronic anal fissures, is performed by a colorectal surgeon under sedation. A small cut is made into the anal sphincter muscle to release the tension permanently.
HOME REMEDIES [10]:
• Warm water baths play an important role in easing the pain and itching. Sitz bath also help in reducing the inflammation.
• Natural products like coconut oil and aloe vera provide relief from burning, itching and any swelling.
• Using stool softeners prevent hard bowel movements.
• Avoid sitting on the toilet for a longer time. Use fragrance free toilet paper and alcohol free flushable wipes.
WOMEN WITH HEMORRHOIDS AND ANAL FISSURES:
Women experience these conditions especially during pregnancy and after child birth. Hormonal changes during pregnancy i.e. increased progesterone relaxes vein walls resulting in swelling. Some studies suggest that women who give birth naturally are more likely to develop
hemorrhoids and fissures. Natural remedies are suggested initially to provide relief from the symptoms temporarily. No surgical procedures are done until the end of lactation period [11].
REFERENCES:
7. https://my.clevelandclinic.org/health/diagnostics/4953-flexible-sigmoidoscopy 8. https://www.mayoclinic.org/diseases-conditions/hemorrhoids/diagnosis-treatment/drc 20360280
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