What came first, the egg or the chicken? What came first, constipation or the fissure?

Constipation preceded the fissure. However, there is a big 'but': a chronic fissure will also lead to constipation later on. A fissure is essentially a scratch, a wound, like one we have on a finger, for example, but when this wound is located in the area of the anus, things get a bit complicated... Unlike a scratch on a finger, a scratch in the area of the anus comes into contact with feces daily, which delays its healing because the wound reopens. Additionally, remnants of feces around the internal sphincter do not contribute to the acceleration of healing; therefore, it is very important to thoroughly wash this area in order to promote healing. The reason a fissure that struggles to heal will lead to constipation later on is due to the fact that during the formation of the fissure, there is a strong contraction of the internal sphincter of the anus. If there is no relaxation, then two things happen: one, a delay in healing, because the contraction of this muscle impedes blood flow to the area; and two, the contraction partially obstructs the passage of feces. This can also be seen in the diameter of the feces that come out, and thus starts a process of partial evacuation, which increases the chances of dehydration of the accumulated feces and difficulty in passing it later on. It is essential to understand that the relationship between constipation and fissure is a vicious cycle. Constipation can cause a fissure, and a chronic fissure can, in turn, lead to constipation. Therefore, it is crucial to address both issues simultaneously. A balanced diet rich in fiber, adequate hydration, and regular exercise can help prevent constipation. Additionally, proper anal hygiene, gentle toilet habits, and taking regular breaks to rest and relax can help alleviate the symptoms of a fissure. In conclusion, the debate about what came first, constipation or the fissure, is not as important as understanding the complex relationship between the two. By recognizing the interconnectedness of these issues, we can take proactive steps to prevent and manage them effectively, reducing the risk of further complications and improving overall quality of life.