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  • Anal fissure: symptoms, treatment, surgery, causes

    Recently, the anal fissure has become quite an urgent problem. After hemorrhoids and colitis, the crack takes the third place in terms of frequency of recurrence in the population.

    An anal fissure is a rupture or ulcer between the edge and the dentate line of the anus.

    When positioned on the back, the fracture is located along the semicircle and the middle line of the anus. The crack is a minor defect in the mucosa of the anal canal up to 1 cm long.

    More common in young people, but not excluded at any age. This disease is typical of men with non-traditional sexual orientation. Anal fissure is considered the most common proctologic disease caused by stool disruption.

    Causes of anal fissure


    An anal fissure appears due to a trauma in the mucous membrane of the anal opening due to untimely bowel movement or stool. The main factors of the development of the disease are:

    • constipation;
    • solid feces;
    • diarrhea;
    • hemorrhoids. The nodes of the hemorrhoid easily weaken the walls of the anus. Because of this, the bowel is injured during the act of defecation;

    • proctitis;
    • hard work;
    • sedentary lifestyle, prolonged sitting;
    • injuring the bowel wall with sharp foreign bodies;
    • blood flow in the anus. Characteristic for people who prefer to sit on the toilet for a long time;
    • reception of spicy food or alcohol.
    The causes also include birth injuries, gastrointestinal diseases, weakening of the pelvic muscles, injuries of the rectum. Anal fissure is accompanied by severe pain, this is due to the fact that the wound causes spasm of the muscle - the sphincter holding the stool masses. Spasm prevents the healing of the wound, so the crack is difficult to treat. Often they occur with several provoking factors.

    When passing a hard stool, diarrhea, the mucosa breaks, this leads to the formation of cracks. With the normalization of the stool, the prognosis is quite optimistic. If the disease is started, then the anal canal is inflamed, because due to increased pressure, the crack is not cleared, hiding behind the folds. There are severe pains, as the spasm of the sphincter intensifies.

    Symptoms of anal fissure


    Anal fissure has severe symptoms, which are manifested by pain during defecation. After defecation, pain may stop, but it often happens that the disease becomes chronic and the patient experiences constant pain.

    There is no marked bleeding, on the toilet paper there are traces of blood. Also, as already mentioned above, a spasm of the sphincter is observed.

    The pain after the act of defecation lasts up to several hours.because of what a patient with an anal fissure becomes irritable and nervous. Patients are also afraid of going to the toilet, because of this, the stool masses are even more densified, and the walls of the bowel are injured.

    If a person does not turn to a specialist on time, there is usually no self-healing. A crack may increase in volume, a chronic course of the disease appears.

    Treatment of anal fissure


    Diagnosis is performed when examined by a doctor. Sometimes appoint colonoscopy of the intestine, and the examination is carried out under local anesthesia, in addition you will need blood tests.

    In anal fissure treatment can be conservative or surgical.

    Non-surgical treatment of


    1. 1) Normalization of the stool. For this, the patient is prescribed soft laxatives - Dufalac, Normaise, Forlax, Prelax on the basis of the lactulose component. It is recommended to consume a sufficient amount of fiber and liquid up to 2 liters every day;
    2. 2) Dietotherapy. The patient should be excluded from the diet of spices, spicy foods, alcohol. The food should be regular and balanced. In a day it is necessary to consume up to 200 g.fresh or boiled vegetables, fresh juices and fruits;
    3. 3) Seated baths are effective for relaxing muscles and hygiene. Recommend after a bowel movement to take a bath with a decoction of sage and chamomile. It is obligatory to conduct the procedures before bedtime;
    4. 4) Medication. Patients are assigned 0.2% nitroglycerin ointment or based on diltiazem or nifedipine. After 4-8 weeks, acute cracks successfully heal. Also appoint methyluracil suppositories in the morning and natalside before bedtime;
    5. 5) Injection into the internal sphincter of Botox with local disinfection.
    To ease the patient's condition and normalize the stool can be with the help of enemas. Laxative microclysters based on sunflower oil and water empties the bowels well. After a bowel movement, sedentary baths are recommended, after which it is necessary to inject sea buckthorn candles into the anal canal. If the patient experiences pain, then they make a lidocaine blockade.

    Pain syndrome is stopped, resulting in accelerated wound healing. This procedure has a contraindication - the presence of a hemorrhoidal node.

    In more than 70% of cases, the cure occurs after non-surgical conservative treatment. Therefore, do not rush to lie under the surgeon's knife! For starters, you should adhere to 100% of all doctor's recommendations for hygiene, treatment, and healthy habits.

    It should be noted that during the treatment of anal fissure, it is necessary not to lift the gravity, but also not to succumb to excessive physical exertion. Hot water treatments are not recommended.

    Surgical treatment of anal fissure


    A defect is excised, one part of the anal sphincter of the anal opening is dissected( sphincterotomy).As a result, the sphincter relaxes, obsessive pain disappears, and conditions for successful wound healing are created. Such an operation does not require a long stay in the hospital and the main thing is that dissection of the muscle does not lead to undesirable consequences, i.e.keeping feces is not violated.

    Although complications occur in some cases, since the dissection is almost blind, the sphincter fibers may not be sufficiently incised or traversed.

    Undesirable effects after surgery include hematoma, pain or delayed urination. In the future, there may be fistulas of the intestine or relapse of the disease.

    Currently, there are modern methods of treating spasm with the procedure of pneumodivulsions. The diameter of the anus is measured with a balloon that is opened under pressure for the duration of the operation.

    This helps to remove only the affected areas by radio wave method and the dissection of the sphincter is not required. The wound heals up to 3-4 weeks, the patient is discharged for 2-3 days without any complications.

    Why does the anal fissure hard to heal?


    The crack has a lot of naked nerve endings and at the slightest touch there are severe pains.

    A frequent stool or constipation causes pain, the sphincter spontaneously shrinks. As a result, the fracture is constantly injured, torn and difficult to heal.

    Prognosis and prophylaxis


    Proper treatment contributes to the successful healing of anal cracks. Often patients hesitate to consult a doctor, and for a long time they use all kinds of drugs and candles.

    Development of a chronic form requires surgical intervention. Modern methods of diagnosis and treatment can successfully fight the disease. It is important to carry out preventive measures, the basis of them is the normalization of the stool and a mobile lifestyle.

    The diet should include foods rich in fiber( beets, prunes, melons, dried apricots, kiwi).It is necessary to drink up to 2 liters, which include liquids - juices, compotes, sour-milk products, mineral water.

    Complications of


    The main complication is the inflammatory process of the rectum, paraproctitis. Inflammation occurs as a result of infection of the mucous membrane of the anal canal. In the inner and outer edges of the anal fissures, anal or watchful tubercles quite often appear, because of which a fibrotic polyp may subsequently appear.

    Because the anal fissure can spoil the life of even the most patient person, it is recommended to consult a proctologist physician in time. Be healthy!


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