Anal fissure - Causes, Symptoms and Treatment .MF .
Anal fissure or anal fissure - a linear defect of the anal canal mucosa.Usually, it is located at the rear middle line (6 hours) or anterior midline (12 hours) the anus, in the latter case is more common in women.When combined with chronic anal fissure hemorrhoids may be disposed on the side walls of the anal canal.Anal fissure is an acute, when the disease lasts up to 4 weeks, and chronic when it persists longer.
The figure shows the anatomy of the rectum and its reflex-apparatus.
Causes of anal fissure.
Acute anal fissure may occur during and after a difficult delivery or non-traditional sexual relations.
most common cause of anal fissure is a mechanical injury that occurs as a result of the passage of stool through the tight anal sphincter during defecation.
process of occurrence of anal fissure is as follows.Permanent mechanical trauma rectal mucosa, especially the crypt proof (folds of mucous membrane of the rectum in the anal canal) leads to a linear discontinuities mucosa in most fixed
situation is aggravated by the presence of chronic hemorrhoids.This disease causes poor circulation in the mucous membrane of the anal canal, which reduces its ability to regenerate (healing).
When stool normalization and anesthesia may be remission of the disease, which can last for months or even years, but the first time you have diarrhea or constipation anal fissure may occur again.
symptoms of anal fissure.
clinical picture of anal fissure fairly typical and bright.There are three main features of the disease: pain in the anus, anal sphincter spasm, and bleeding from the anus.
When combined with chronic hemorrhoids to these symptoms is added a prolapsed hemorrhoid and more profuse bleeding.
The main features of anal fissure is a pain in this area.In acute anal fissure pain occurs during or within 20 minutes after defecation, and then passed.Pains have an intense aching or throbbing in nature.Chronic anal fissure pain does not disappear completely, they are most intense during and for 40 minutes after defecation, and may bother with prolonged forced sitting position.Pain causes a spasm of the sphincter muscle of the rectum, and spasm of the sphincter leads to increased pain.
Bleeding from the rectum during anal fissures are scant nature arise during defecation and associated with mechanical trauma mucosal epithelium of the anal canal.
The following figure shows the appearance of anal fissure (a crack is shown by the arrow).
survey of suspected anal fissure.
If you have any of these symptoms should consult a surgeon-proctologist, in the absence of a health facility specialist proctologist, can be examined by a general surgeon's clinic.
Sometimes only a simple inspection of a specialist for the correct diagnosis.Inspection is performed on the gynecological chair or in a knee-elbow position.Dilution of the buttocks can be seen part of the fissure in the form of longitudinal or triangular-shaped red sores, leaving the inside of the anal canal.
Next, if possible conduct a digital rectal examination, allowing to estimate the density of ulcer edges, its length, the presence or absence of spasm of the sphincter of the rectum, which is necessary for a choice of tactics of treatment.Often perform a rectal examination is not possible because of the severe pain syndrome.
in specialized departments of proctology perform sphincterometry, electromyography and elektromanometriyu - studies to using instruments to establish the degree of spasm of the sphincter, which allows to choose the optimal treatment.
for diagnostic comorbidity may often need to perform sigmoidoscopy - endoscopic examination of the rectum for 25 cm, but this research is done only after the self-healing or surgical treatment of anal fissures.
clinical picture of anal fissure is similar to chronic paraproctitis (fistulas of the rectum).However, pain in the rectum fistulas are less pronounced and the fore purulent discharge from the anus.
When proctitis (inflammation of the rectum) Similar symptoms may occur, but the ulcer will not.
Sometimes the appearance of anal fissure is the first manifestation of Crohn's disease.When anal fissure must be tested for syphilis and HIV.Rarely cause of the anus ulcers can become parasitic disease (actinomycosis) or tuberculosis rectum.
Treatment of anal fissures.
treatment of anal fissure should begin with conservative measures, which lasts for an average of 6 weeks.It is necessary to lead an active lifestyle, engage in physical therapy.
The first step is to change the diet.From diet to exclude spicy, fried foods and alcohol.If constipation should eat foods rich in plant fiber - fruits and vegetables raw or cooked.Especially recommended to eat beets, carrots, tomatoes, leaf lettuce, squash, pumpkin, cauliflower.The increased amount should be eaten fresh sweet ripe fruits and berries, especially apples in raw form and as part of meals.Dried fruits and berries should be soaked in food in the form of dishes and, in this case preference is given to prunes.It is necessary to limit the use of rich rolls, white bread, because they contribute to the development of fermentation processes in the intestine.Garnish cereals consumed in limited quantities in the form of friable porridges and casseroles.The most useful buckwheat and oat groats.Of the meat products are suitable lean meats (beef, chicken, rabbit) are used in the form of chops, stew to baked and stewed.Useful soups nenavaristom broth.With good endurance and boiled eggs consumed in the form of omelets to 2 pieces per day.Useful milk, kefir, fermented baked milk, fresh cheese in its natural form, and in the dishes (puddings, cheesecakes).The purpose of the diet - the normalization of stool consistency.In many cases achieving soft stool can achieve healing of acute anal fissure.
In addition to the diet should be used therapeutic candles, of which there are many.For each patient they picked individually.Among the most common can be noted ultraprokt, proctitis-glivenol, gepatrombin.Ointments can also be used, typically they have a special nozzle, allowing them to enter the back pass.Among ointments may be noted Aurobin ointment.Ointments and candles should be used 2 times a day, after the statement of the chair and in front of a candle or the introduction of the ointment requires a warm sitz bath with a weak solution of potassium permanganate or broth chamomile.When applying ointment into the anal canal is administered ointment column 1 cm.
Antibiotic treatment is not indicated.
said treatment has no effect on one of the links in a vicious circle that prevents the healing of anal fissures, namely, the spasm of the sphincter of the rectum.To eliminate currently ointments containing nitroglycerin.Use a 0.4% nitroglycerin ointment, it is most effective, eliminates the sphincter spasm and pain, has a pronounced minimum side effects.Nitroglycerin ointment applied 2 times a day, no more than 8 weeks.A relatively new trend is the use of botulinum toxin injection (Botox) into the region of the anus sphincter, thereby eliminating its spasm.
ineffectiveness of conservative treatment during this period is an indication for surgical treatment, which makes the surgeon-proctologist.
essence of surgical treatment is excision for fracture plane within the healthy mucosa of the anal canal.If there is a spasm of the sphincter produce cut its internal portion - sphincterotomy.Older people do not use sphincterotomy, sphincter relaxation is achieved by using the medication nitroglycerin ointment.Typically, the wound heals by 5-6 days after surgery.Postoperatively needed bandaging a surgeon in the clinic with antiseptic ointment (Levomekol).
Complications of anal fissure.
major complication of anal fissure is the development of acute abscess due to infection through contact with the anal canal mucosa defect adrectal (around the rectum) fiber followed by a purulent inflammation of the latter.Treatment of acute abscess surgery.
often accompanied by anal fissure anal itching and proctitis (inflammation of the rectum).
prevention of anal fissures.
set of rules must be observed.
• Maintain an active lifestyle.
• Compliance with the rules of personal hygiene.After cleaning the act of defecation is necessary.
• Dieting.It should be time to deal with constipation and diarrhea.
• Early treatment of chronic hemorrhoids.
• It is necessary to avoid non-traditional sexual intercourse.
• Do not abuse alcohol.
the words of Al-Samarkand: "If the disease is not defined, it is impossible and treat it."Therefore, in time, please contact a specialist.Be healthy!
Surgeon Thews DS