The Cause of Anal Fissures

Fissures may be caused due to trauma, and this is usually during bowel movement. This could be hard stool or diarrhea, or in some cases the insertion of items into the anus (such as rectal thermometers, enema tips, or an endoscope) which can cause a fissure. It may also be caused by a tear to the perineum during childbirth (the area between the vagina and anus) which can extend to the anus.

The most common location of anal fissure is the part of the anus closest to the spine. If the fissure does not occur in this area then there may be another underlying cause. This can include anal cancer, leukaemia, Crohn’s disease, viral infections, tuberculosis, gonorrhoea, Chlamydia, human immunodeficiency virus (HIV) and others.

Treatment for Anal Fissures

General treatment can first involve measures such as adding bulk to the stool and softening the stool with certain products. Patients may also alter their diet temporarily, avoiding sharp foods that are harder to digest (popcorn, nuts and so on). Warm baths are encouraged as a way of relaxing spasms within the muscles of the anus.

Further treatment may be needed in some cases where general treatment is not successful. This could include the use of anaesthetics and steroids in order to reduce the pain during bowel movements. There are also several drugs that can help with the symptoms of an anal fissure.

Surgical treatment may be required where the internal anal sphincter is cut and divided. Some fissures may also need to be biopsied. There is a low risk of incontinence following this kind of surgery.

The Test for ANAs

The test for ANAs was developed in the 1950s and it makes use of a blood sample. The antibodies will be tested to determine whether they react with the nucleus of cells or not. The antibodies are detected using fluorescence techniques, which is why the test for ANAs is also sometimes called ‘fluorescent antinuclear antibody test’ or FANA. This test is used to detect autoimmune diseases.

Autoimmune Diseases

Autoimmune diseases are disorders that relate to the immune system. They are characterized by the abnormal production of antibodies which attack the body, and usually feature an inflammation to certain tissues within the body. ANAs are mostly found in patients with autoimmune diseases but may also be found in patients who don’t have conditions relating to an autoimmune disease. This can include chronic infections or even cancer.

Autoimmune diseases can include Hashimoto’s thyroiditis, systemic lupus erythematosus, , juvenile diabetes mellitus, glomerulonephritis, Sjogren’s syndrome, vitiligo, rheumatoid arthritis, polymyositis, scleroderma, Addison disease, pernicious anemia, and pulmonary fibrosis.

Other Reasons for the Production of ANAs

There are many medications that can cause the production of ANAs, when this happens we call it “drug-induced ANAs” and a disease may not necessarily be present. In fact ANAs where no disease is present is found in about 5% of the population.

Diagnosis of Anal Cancer

Once anal cancer has been diagnosed, tests will be carried out to determine whether the cancer cells have spread to other areas of the body. This process is known as staging, and will determine the stage of the disease – helping in the planning of treatment.

Methods used to determine the stage of anal cancer:

- CAT scans make detailed pictures of the inside of the body.
- Chest x-rays show the organs and bones within the chest.
- Endo-anal ultrasound. A probe is inserted into the anus and makes echoes of internal tissues and organs.

The Stages of Anal Cancer

When anal cancer is Stage 0, the cancer is only found in the innermost lining of the anus.

- Stage I means that the tumor is 2 centimetres or smaller.
- Stage II means that the tumor is bigger than 2 centimetres.
- Stage IIIa means that the tumor is any size but has spread to either the lymph nodes nearby the anus, or nearby - organs (vagina, bladder or urethra).
- Stage IIIb means that the tumor is any size and has spread to lymph nodes nearby the anus, the lymph nodes on one side of the pelvis as well as nearby organs, both sets of lymph nodes and on both sides of the pelvis.
- Stage IV means the tumor is any size and may have spread to nearby organs and lymph nodes as well as distant areas of the body.

Treatment for Anal Cancer

The treatment will depend on the stage the anal cancer has reached. In general radiation therapy is used (with high-energy x-rays killing cancer cells); or chemotherapy (using drugs to stop the growth of the cancer cells), and surgery (where the tumor is removed).

If the patient has HIV (human immunodeficiency virus) then treatment will be affected due to the fact the immune system is already weakened. This will mean lower dosages of the anti-cancer drugs.

Anabolic steroids were developed in the 1930s as a way to promote production of testosterone in those who did not have sufficient amounts (a condition known as hypogonadism). It was soon discovered that these steroids could help the growth of muscle, and they started to be used by bodybuilders and weightlifters. Steroid abuse has now become widespread.

Some athletes try to get their hands on illegal steroids due to the fact that they can improve their performance. There are now tests in place to deter professionals and Olympic athletes, though many athletes use certain drugs in order to avoid detection of their steroid abuse.

Others may choose to take steroids as a way to increase their muscle size or to reduce fat, including those who suffer from a condition which leads them to have distorted views of their body (muscle dysmorphia).

Treatment for Anabolic Steroid Abuse

There have not been many studies on the treatment for anabolic steroid abuse. There have been doctors working with patients who experience steroid withdrawal symptoms. Often support is very useful in treating such cases, as well as education to prepare patients for what they may experience. Medications can be used in the case of severe withdrawal symptoms.

Patients may be prescribed antidepressants to treat depression that results from steroid abuse, as well as analgesics for headaches and muscle pains, or medications that can help to restore the hormonal system.

Illnesses that can cause amyloidosis include multiple myeloma, chronic inflammatory diseases and chronic infections. It may also occur in its localised form due to aging, where the localised form will not have implications for other areas of the body.

Types of Amyloidosis

There are three main types of the condition. Primary amyloidosis, also known as AL, is when a cell in bone marrow overproduces a certain protein. It occurs with bone marrow cancer, and is not associated with other diseases. However, it can occur on its own and requires treatment through chemotherapy.

With secondary amyloidosis, or AA, it has resulted from another illness such as those mentioned above. The treatment of this type of amyloidosis will revolve around treatment of the underlying illness that is involved in the individual case.

Familial amyloidosis, or ATTR, is a rare form of amyloidosis that is inherited. In genetics terminology this condition is an inherited autosomal dominant. For anyone who has the condition, their offspring will have a 50% chance of also having it.

Symptoms of Amyloidosis

Amyloidosis will result in abnormal functioning of the organs that are involved. Many organs can be affected, meaning that symptoms can be vague but can include fatigue, weight loss, shortness of breath, tingling, weakness and many more. If it affects the kidney this will result in a swelling of extremities and a severe loss of protein in urine.