Fissures. Prolapsus. Ulceration.
Fissure Of the Anus. — Very pronounced fissures of the anus are frequent in women, the result of accident during labor; such belong to the domain of surgery. But often a fissure or crack in the ring of muscle about the anus may be the result of disease or habit. A small abscess may form and break and be the commencement of a fissure. Constipation and hardened faeces in the rectum may cause great straining in attempts at evacuation and thus lead to fissure. Eczema may also produce the trouble.[1] A "physic" refers to a drug with cathartic or laxative effects.
Symptoms. — Usually the first knowledge of a fissure is after a movement of the bowels — a smarting, stinging sensation being experienced, and a small particle of blood being noticed. In an hour or so after stool a dull pain, and burning and throbbing will be felt. This may continue for hours. Such sensations return as the result of every evacuation of the bowels, causing the sufferer to become negligent through dread, thus producing constipation and aggravating the difficulty. Persons suffering from fissure of the anus soon acquire an anxious, care-worn look and grow despondent, and serious ill health may follow neglect to remedy the trouble.
Treatment. — Cleanliness and regularity in going to stool are of the first importance. Hardened faeces should not be allowed to accumulate in the rectum, and may be prevented by a liberal diet of fruit and succulent vegetables and doses of physic[1]. Small injections of warm water just before going to stool and retained half an hour will soften faeces already hardened. Some fissures will heal of themselves, though the rule is otherwise. Witch hazel ointment[2] is most excellent, and in severe cases a drachm of tannic acid rubbed into an ounce of vaseline will be found serviceable. Some cases will not heal without an operation. The simplest method of restoration is to touch the fissure with lunar caustic[3], though this may leave a scar which feels unpleasant. The usual operation for fissure of the anus is cutting into the fissure and superficial fibres to the depth of one-eighth of an inch and thus denuding the surfaces, when rest in bed for a week or nine days will permit perfect healing and a permanent cure. Oiling the anus or supporting it by pressure of the finger during evacuation will often prevent fissure.
Prolapsus. — This usually occurs during childhood or old age, and is due to a weakened and relaxed condition of the rectum and its mucous membrane. Constipation and irritation of the rectum or urinary organs may lead to it.
Symptoms. — Falling of the bowels (prolapsus) is readily recognized. During straining at evacuation the rectum seems to turn inside out, and form outside a round or pear-shaped tumor, with an opening in the center, the surface being usually dark red from distended venous capillaries. From one to possibly six inches of the rectum may protrude.
Treatment. — First of all return the bowel to its proper position. This can easily be done by placing the child on its back with the knees apart and after oiling the parts protruding, gently manipulating them back to their proper place. Cover the membrane with the ointment of tannin named for fissure. Keep the liver free and the bowels open. Goldenseal is a good tonic. Maintain proper habits, give nourishing food and plenty of fresh air. The use of a bed-pan is beneficial, preventing prolapsus being aided by gravitation.
Ulceration. — It not infrequently happens that ulceration occurs about the anus, and this may prove very annoying if left unattended to. The first symptoms will closely resemble those of piles, followed by a sense of relief when the ulceration becomes marked, although there will be pain during defecation, and the discharges will be found to contain traces of pus.
Treatment consists of keeping the parts thoroughly cleansed by frequent washing with warm water and castile soap and then annointing with equal parts of tincture of myrrh and fluid extract of goldenseal and applying witch hazel ointment.
Piles. — Hemorrhoids. — These are fully considered in the article on Piles.
[2] Witch hazel is an astringent used to treat inflammation.
[3] "Lunar caustic" refers to silver nitrate, which was used to cauterise skin and had antimicrobial properties.