When the skin of the anus gets cut or damaged, that is called an anal fissure. It is very similar to what happens when our dry lips get chaffed. Fissures typically bleed and cause pain, which is why they are often confused with haemorrhoids/ piles. When the anal muscles are stretched too far, it usually causes strain on the anus. This can occur to people who suffer from constipation or prolonged diarrhoea. It also occurs for older patients due to decreased blood flow to the anal area. It is not uncommon for women to develop anal fissures after giving birth as well. And it can also happen to people who have Crohn’s disease. With more severe cases of anus tearing, an external lump will form on the anus. These are the sentinel piles tell-tale of chronic fissures. The issue of anal fissures can be solved by medicine or by surgery and also by laparoscopic treatment. Symptoms Some signs and symptoms of anal fissures : Pain during bowel movement Pain after the bowel movements Blood on the stool or toilet paper Anal itching Visible damage to the skin of the anus A small lump that’s close to the anal fissure. Treatments Chemical Sphincterotomy Chemical Sphincterotomy is basically a Botox Injection for anal fissures; it is a very common Treatment for Anal Fissures. If the anal fissure doesn’t heal, it’s usually because of the spasm of the internal anal sphincter muscle which reduces blood supply to that area and further aggravation occurs to the fissure during the passage of motion through a spasmodic anal canal. The Botox is injected into the anal sphincter. This injection is used to prevent spasm and cause temporary paralytic relaxation until the tissues are renewed. The effects last for three months and the anal fissure heals during that time. Percutaneous Closed Lateral Internal Sphincterotomy This surgery, popularly known as CLIS, is a quick minimal invasive surgical method performed by specialized doctors under local anaesthesia that is used to treat chronic anal fissures. It is performed on the internal part of the anal muscle, the internal anal sphincter. The surgical procedure basically lowers the pressure of the internal anal sphincter and the spasm is reduced by dividing this internal anal sphincter. The fissure is healed because anal spasm is lowered and blood flow to the area is improved. Due to the closed technique, the wound is smaller and it heals faster.

An Inguinal Hernia is a gap in the strong tissue in the abdomen which holds the stomach muscles. It occurs in the abdominal muscles and weakens them which cause a bulge in the stomach. Hernia causes discomfort and pain in the stomach. Both men and women can get inguinal hernia. Symptoms of Inguinal Hernia: It can cause a severe pain in abdomen especially in pelvis region. The later symptoms also result in swelling and severe pain in the testicles or groin area. Apart from that the patients who are suffering from inguinal hernia have a problem in walking straight and straining the abdominal muscles by lifting up some things. Diagnosis: The diagnosis of this type of hernia is physical examination as the doctor can see and feel the bulge. For further diagnosis other tests like ultrasound and CT scan is also done. Treatment and Recovery: The surgery of inguinal hernia is done with laparoscopic approach with the help of instrument called laparoscope. Small incisions are made in the abdomen to insert the laparoscope and treat the hernia. This technique is also known as keyhole surgery. Patient takes about 1 to 2 weeks to get properly recover after the surgery. They have to wait atleast for 4 weeks to start exercising after the operation.

Hernias will not go away by themselves. Surgery is the only way to repair a hernia. A hernia repair returns the organ or structure to its proper place and fixes the weakened area of muscle or tissue. Having surgery is a big decision. It can be tempting to put it off, and that may be okay in some cases. Before you decide, make sure you understand the risks and benefits of your decision. Here are some things to consider and discuss with the doctor who is helping you make the decision. How Is the Hernia Affecting You? The first thing to consider is whether or not you are experiencing symptoms. Not everyone has symptoms with a hernia, especially small ones. When symptoms occur, the most common one is pain. Others can include a feeling of heaviness or fullness in the belly or groin. Whether you have symptoms or not, a hernia can also interfere with your leisure activities and your work. So you also need to recognize if you are taking time off from work or interests due to your hernia. Delaying surgery may mean you spend more time away from work and fun instead of returning to activities after recovery. If you have symptoms, especially pain, your doctor is likely to recommend surgery. But what if you don’t have symptoms or they are minimal? In this case, your doctor may recommend watchful waiting. Before you agree to watchful waiting, be sure your doctor knows the whole story. Be honest about any limitations your hernia puts on your time and activities. What Are the Risks of Waiting? 1. Hernias can become incarcerated. One potentially serious risk of not fixing a hernia is that it can become trapped outside the abdominal wall—or incarcerated. This can cut off the blood supply to the hernia and obstruct the bowel, resulting in a strangulated hernia. This requires urgent surgical repair. Not all hernias progress to this point, but it is a risk nonetheless. Avoiding an emergency situation that you can’t control is one reason to consider not delaying surgery. 2. Hernias grow. A more likely scenario is that your hernia will continue to grow and weaken with time. This is likely to increase your symptoms, including pain, and cause more changes to your lifestyle. Surgeons know that smaller hernias are easier to repair than larger hernias. Going ahead with surgery instead of delaying it can prevent your symptoms from getting worse. It can also help you avoid losing work or missing activities. 3. Hernias require surgery eventually. Even if you aren’t having symptoms, you may still want to consider having surgery sooner rather than later. Surgery for a hernia is somewhat inevitable in most cases. Research shows that most people with hernias have surgery within 10 years. Keep in mind that delaying surgery until your hernia is larger and the muscles are weaker may make surgery and recovery more difficult. 4. Your overall health may change. Your age may determine whether waiting is a risk for you. Putting off surgery for years down the road may mean you are not in as good overall health or physical shape. This will also affect your surgery and recovery. So having surgery at a younger age can be beneficial. However, if you are elderly (older than about 75 years of age), not very active, and your hernia isn’t causing problems, it may be better to not fix it. The risks of surgery may outweigh the benefit of repair. Making the Decision Surgery is never convenient and life is always busy. Being in control of when you have surgery is a huge benefit of not delaying your hernia repair. You can schedule your surgery at your convenience. And if you are a candidate for laparoscopic hernia surgery, you’ll be back to life and work sooner than in years past. Surgery should be easier on you and recovery will likely be smoother at a younger age and with a smaller hernia. Ultimately, your doctor is best able to help you decide whether watchful waiting or surgery is the best option for you.

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