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Anal fissure is a longitudinal tear or disruption in the anoderm at the distal end of anal canal. It typically extends from below the dentate line to the anal verge and usually located posteriorly in the midline, probably because of the relatively unsupported nature and poor perfusion of the anal wall in that location. Although it is not a fatal condition, but can significantly influence the quality of life of the affected person due to its troubling symptoms such as severe pain, bleeding per rectum, spasm of the internal sphincter. The pain is so severe that the patient is scared of defecation and therefore he makes an effort to delay the defecation. Despite extensive researches and advancements made in the field of medicine and surgery, exact aetiology of anal fissures is still unknown. Trauma due to the passage of hard stool is thought to be an important initiating factor for the fissure; or less commonly prolonged and repeated passage of diarrhoea. Low fibre diet is also found to be associated with the development of anal fissures. Other causes may include poor toileting habits and poor anal hygiene especially in young children, childbirth trauma in women, Crohn’s disease etc. According to classical Unani literature, anal fissure is termed as shiqaq e miqad and the factors responsible for their development is the passage of dry, hard stool or frequent passage of diarrhoea or akkal khilt (corrosive matter) through the anus or excessive consumption of dry substances. The cause of this dry hard stool as mentioned in the Unani texts is may be the hot and dry temperament of rectum that hardens the stool.
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