Fissures: how to cure them

Fissures are small skin lesions for which, in severe cases, pharmacological or surgical treatment may be necessary.

Fissures are thin cracks or abrasions of a linear type, “cuts” that affect the skin and mucous membrane of different areas of the body. The most frequent cases are localized anally, on the lips or on the sides of the mouth and breasts, usually in breastfeeding women.

Although in most cases the disorder tends to heal spontaneously, for each type of fissure a specific treatment is recommended.

fissures

Causes

The fissure is a more or less deep laceration of the mucosa of the canal caused by a trauma during defecation, frequent in subjects suffering from constipation or emitting hard and voluminous stools.

Among the predisposing factors we also find:

• abuse of laxatives
• the use of digital manoeuvres to facilitate expulsion
• reduced personal hygiene
• diarrhea, characterized by more alkaline stools and therefore more aggressive to the canal.

The contraction and dilation of the canal during the expulsions following the formation of fissures hinder the healing of these small wounds, causing particularly painful pangs due to the abundant presence of nerve endings in this anatomical region.

Due to the increased friction, the pain becomes particularly intense during the passage of hard and voluminous stools, which also leads to an aggravation of the lesion.

As mentioned, constipation, both primary and secondary, is also a determining factor. Many people, in fact, for fear of feeling pain, hold back the defecation going towards constipation and thus making healing difficult.

To favor the chronicization of the disorder also plays an important role an excessive and constant contraction (independent of our control) of the internal sphincter, which determines a microischemia of the canal that slows down the correct healing of the fissure.

Symptoms and diagnosis

The symptomatology of fissures is characteristic and therefore makes it easy to identify the disorder.

They are mainly manifested by pain during defecation, which can be distinguished into three moments. In fact, we speak of “painful syndrome in three stages”, as there is a first acute painful stimulus to the passage of feces, which then subsides for a few minutes, to reappear at different degrees of intensity during the following two or three hours.

Associated with pain, other hallmarks of the presence of fissure are:

• itch
• traces of bright red blood at the time of cleaning with toilet paper, although much less copious than the hemorrhoidal event.

Treatment and prevention

In the presence of superficial lesions, fissures tend to resolve spontaneously in a few days.

In the event that this does not happen, to avoid a worsening it is suggested to use supplements based on fibers or mild natural laxatives such as flax and psyllium seeds, inulin, mallow, plantain or marshmallow thanks to their high content of mucilage with anti-inflammatory and healing action, strictly under the advice of the doctor.

In milder cases, natural remedies based on medicinal plants can also be used. Among the most used we find for example:

• St. John’s wort oil
• Aloe Vera Gel
• The yarrow millefeuille
• The Centella asiatica
• The Rusco
• The butcher’s broom
• Comfrey
• essential oils of lavender, rosemary, cypress, thyme, sage or geranium.

In support are also recommended anesthetic creams for the control of local pain and washes with warm water to be repeated several times a day.

It is essential, in any case, to follow a diet rich in liquids in order to soften the stool and make it smoother.

To treat more intense disorders, a wide range of drugs are available, prescribed by the doctor after an appropriate proctological examination.

Among the most used we find for example:

• lidocaine, local anesthetic also useful in case of hemorrhoids
• nifedipine, diltiazem, nitroglycerin or trinitroglycerin, which belong to the class of muscle relaxants.

Sometimes you can resort to small injections of botulinum toxin always for the purpose of muscle relaxation.

In cases where pharmacological intervention is required, it is important to follow the prescribed treatment in order to avoid chronicization of the disorder.

In any case, both in milder and more severe cases, for a complete resolution of fissures, as well as not to incur relapses, it is important to associate drug therapy with a correct diet by increasing the consumption of fibers, water and vegetable oils, if deficient. On the contrary, it is to reduce the intake of spicy foods or foods containing nerve substances such as tea or coffee.

In the most extreme cases, surgical practice is finally resorted to. Selective cryotherapy is among the most common procedures: it is completely painless and is practiced in case of fissures or hemorrhoids on an outpatient basis. It is based on the removal of the lesion through a probe that operates at low temperature (-100 ° C).

As an alternative to selective cryotherapy, it is possible to perform anuloplasty, which involves the reconstruction of damaged tissue with flaps of skin taken from other areas of the patient’s body.

Complications

In some cases, if not treated correctly, fissures can cause unpleasant complications, among which we find the appearance of fistulas (mainly superficial).

The fistula is a pathological communication between two or more cavities of our body (internal fistula) or between one of them and the outside (external fistula).

It is generally formed due to inflammation that is aggravated following an infection with its abscess. The abscess, once broken, determines the leakage of pus, leaving a tube-shaped space that constitutes the real fistula and which can in turn lead to further infections.

Anorectal fistulas join the anus with the peritoneum or rectal canal and usually form after abscesses in the area of the rectum or anus.

Usually from an fissure originates a fistula called superficial, as it is localized subcutaneously or in the submucosa, not affecting the muscular structures. Oxyuriasis and proctitis are other causes of superficial fistula.

Fissures in the mouth

Causes

The appearance of fissures can also occur on the lips, in particular in that area called labial commissure, which corresponds to the corners of the mouth. In this case it may be angular cheilitis, or a fissure usually caused by a stagnation of saliva that “macerates” the mucous membranes and favors the appearance of fissures.

Angular cheilitis is more frequent in young children or the elderly who use dentures as they produce excess saliva that tends to accumulate at the corners of the mouth.

In addition, especially the little ones, but in some cases also adults, tend to perform automatic gestures, such as licking or biting their lips which, if repeated often throughout the day and for a long time, can lead to inflammation of the lips that favors the formation of fissures. The same can happen in case of contact with cosmetic agents, toothpastes, or other objects that can cause an allergic reaction or irritation of the mouth.

Even those who suffer from a disease such as atopic or seborrheic dermatitis or dry skin are more predisposed to develop lesions in the mouth.

Finally, at the origin of angular cheilitis there may also be a microbial agent, such as Candida albicans or some bacteria (staphylococci, streptococci, enterococci).

Symptoms and diagnosis

As with other types of fissures, even these small cracks involve discomfort, pain and burning more or less intense depending on the extent of the cuts.

The appearance of fissures may be preceded by an erythema in the corners of the mouth, usually accompanied by a peeling of the surrounding skin.

Treatment and prevention

Treatment depends on the cause that determined the fissures which, if possible, should be eliminated. It is therefore necessary to “stay away” from agents that can cause irritation, avoid risky behaviors (such as repeatedly licking the lips) or intervene, under the advice of the family doctor or dermatologist, with pharmacological treatments, for example in case of candidiasis.

However, it is always advisable to apply creams or sticks with an emollient action and that create a protective layer for the lips. For example, products based on natural substances such as olive or sweet almond oil, cocoa butter, beeswax and aloe vera gel can be useful.

Breast fissures

Causes

Also in this case they are small cuts of more or less marked depth located at the level of the nipple and the areola that surrounds it.

They are mainly due to poor hygiene or, during the breastfeeding period, to an incorrect attachment of the baby during feeding.

Symptoms

Similarly to other types of fissures, they cause pain, especially during sucking by the newborn.

Treatment and prevention

Breastfeeding can in some cases cause severe pain to the new mother due to the presence of breast fissures.

To prevent its formation, it is important that the position in which the baby is breastfeeding allows the baby to attach not only to the nipple, but to the entire areola, thus decreasing pressure and rubbing in one place.

For the treatment of breast fissures, the application of soothing pharmaceutical creams or ointments is generally not recommended during breastfeeding as they would not only irritate the skin, particularly sensitive in this area, but also to give breast milk an unpleasant taste also risking being ingested by the newborn.

Instead, natural products based on sweet almonds or St. John’s wort are preferable, even in the prevention phase. Finally, useful is the application of creams based on lanolin, a wax extracted from wool.