Anal fissure
Anal fissure is damage to the integrity of the tissues of the mucous membrane of the anal canal. More often, a rupture is formed along the posterior median or anterior line of the anus, on the anterior median line, ruptures usually occur only in women.
The content of the article:
Causes of Anal fissure
Classification of anal fissures
Localization of anal fissures
Symptoms of anal fissure
Diagnosis of anal fissures
Complications of anal fissure
Anal Fissure Treatment
Prevention of the development of anal fissure
Anal crack
Along with chronic hemorrhoids, anal fissure is characterized by formation on the side walls in the anal canal. An acute form of anal fissure develops when the disease lasts up to 4 weeks. The chronic form of anal fissure develops with a longer course.
Causes of Anal fissure
The development of an acute anal fissure is facilitated by severe childbirth in women or sexual contacts of a non-standard nature.
The most common cause of anal fissure is a mechanical injury that occurs during the passage of a tight stool through the sphincter of the anus during defecation. Due to permanent damage to the mucosa of the rectum and the folds of the mucous membrane on part of the anal canal, the formation of linear damage to the mucous membrane occurs in the most sedentary parts, specifically along the posterior or anterior midline. Against this background, sensitive nerve endings open, which provoke a sharp spasm of the anal sphincter and pronounced pain during the process of defecation.
Since the issue of constipation and hard stools continues, due to frequent damage to the mucous membrane, a painful symptom and spasm of the sphincter occur, this slows down the healing process of the resulting crack. Bacteria in the rectum lead to frequent infection of the rupture of the mucous membrane and provoke active inflammation. After a certain period, the edges are compacted and the crack deepens, this makes the nerve endings more unprotected and provokes an increase in pain. At the end of the entire development, the disease flows into a chronic form.
The most dangerous is the presence of chronic hemorrhoids. Such a disease provokes a deterioration in the circulation of blood in the mucous membrane of the anal canal, thereby reducing its ability to heal the wound.
When returning to a normal stool and anesthesia, there is a risk of remission of the disease, the duration of which may be more than one year, but with the first constipation or diarrhea, the anal fissure returns.
Classification of anal fissures
According to the indicators of clinical development, anal fissures are divided into acute and chronic forms. The acute form of anal fissure heals naturally after about two months. The chronic form has a much longer course than the acute one.
The newly formed crack looks outwardly like a mucosal defect, in the depth of which pronounced red fibers of muscle tissue are visible. After a certain period, the deepening of the crack becomes overgrown with granulations or begins to grow with fibrous structure tissues.
A chronic anal fissure is limited to a certain boundary at which scar tissue develops, which rises above the wound, called the “sentinel tubercle”. The upper segment of the anal fissure stretches and breaks all the time, this provokes the formation of a thickened and undercut edge. As a result, a spasm of the sphincter muscles is formed, an excess of blood filling and chronic inflammation forms an extension of the crack in depth, which resists its natural healing. According to this system of development, a transition from an acute form to a chronic anal fissure is formed. The anal fissure that has been flowing for a long time looks like a trophic ulcer.
Classification of anal fissures
According to the indicators of clinical development, anal fissures are divided into acute and chronic forms. The acute form of anal fissure heals naturally after about two months. The chronic form has a much longer course than the acute one.
The newly formed crack looks outwardly like a mucosal defect, in the depth of which pronounced red fibers of muscle tissue are visible. After a certain period, the deepening of the crack becomes overgrown with granulations or begins to grow with fibrous structure tissues.
A chronic anal fissure is limited to a certain boundary at which scar tissue develops, which rises above the wound, called the “sentinel tubercle”. The upper segment of the anal fissure stretches and breaks all the time, this provokes the formation of a thickened and undercut edge. As a result, a spasm of the sphincter muscles is formed, an excess of blood filling and chronic inflammation forms an extension of the crack in depth, which resists its natural healing. According to this system of development, a transition from an acute form to a chronic anal fissure is formed. The anal fissure that has been flowing for a long time looks like a trophic ulcer.
Localization of anal fissures
Cracks of the anal passage are localized mainly in the area of the posterior adhesions, due to the specific construction of the sphincter and anal canal. The high frequency of injuries in this particular area occurs due to the fact that the anal canal is located at an angle to the coccyx and sacrum, and the posterior spike is with a weakened muscular membrane and a thin wall when bypassing the legs of the sphincter, which are combined with the coccyx.
Rare cases that occur in greater numbers in women when anal fissures are localized on the front of the anal canal. In more rare cases, the formation of two anal fissures together, of different locations, is possible. In more frequent cases, cracks are formed, located opposite each other.
Symptoms of anal fissure
With a long period of crack existence, a sufficiently pronounced pain sensation and tonic spasm of the sphincter appear after going to the toilet. By time, the spasm is prolonged to several hours. And sometimes even to the next chair.
Tonic spasm provokes further crack propagation: anal fissure causes persistent spasm, it causes ischemia of the tissues of the walls of the anal canal, slows down the process of tightening the tissues of the anal fissure.
Symptoms of acute anal fissure
The acute form of anal fissure is characterized by spasm of the anal sphincter, painful defecation, blood formations from the anus.
The pain comes at the beginning of defecation, pronounced, and continues for a fairly long period of time. Pain may be felt in the perineum area.
Anal spasm of the sphincter is a reflex phenomenon, it is closely associated with increased pain syndrome, tonic spasm is one of the main components of the pathogenesis of the disease. Spasm provoked by pain reduces blood supply, provokes increased pain and prevents tissue renewal, overgrowth of the crack.
Blood-type secretions from the anal canal are visible as streaks in the stool or traces on paper, they appear when the mucosa is injured during defecation. There may also be profuse bleeding, in which case standard diseases can be implied: hemorrhoids or a tumor.
Symptoms of chronic anal fissure
The acute form of anal canal crack that has been existing for several weeks and does not have the necessary treatment develops into a chronic form.
Pain sensations, unlike acute cracks, are formed after the act of defecation during chronization and disturb much longer. With prolonged sitting in a sitting position, painful sensations increase. The quality of life with the presence of constant pain in the pelvic region is significantly reduced, thus causing a state of irritability, insomnia, neurotic deviations. Often, patients with chronic anal fissure have a fear of the process of defecation, often such patients take strong laxative drugs.
With constipation for a long period, the strenuous act of defecation causes small, bloody outpourings from the anus. Often there is suppuration of the anal fissure, which contributes to the appearance of purulent discharge from the anus.
The chronic form of the crack is associated with a tonic spasm of the sphincter of a less intense nature and it is prolonged for an insignificant period of time. There are frequent complaints of patients with anal itching. Anal fissure with a chronic form is often accompanied by inflammatory processes in the intestine, for example, proctitis.
Diagnosis of anal fissures
He is examined on a special chair or in a kneeling position. When examining the anus, you can see the area of the crack in the anus in the outline of an oblong or triangular ulcer of a bright pink hue, with an elongation deep into the anal canal.
Next, rectal palpation is performed with fingers, this procedure helps to assess the thickening of the edges of the ulcer, its length, the formation of spasm of the sphincter of the rectum; such an analysis will be required to prescribe correct treatment.
In specialized proctology laboratories, sphincterometry, electromyography and electromanometry studies are carried out — special analyzes that help with the help of devices to determine the degree of spasm of the sphincter, such a study allows you to prescribe optimal treatment.
To diagnose concomitant pathology, it is quite often necessary to perform a rectoromanoscopy — an endoscopic examination of the rectum at a distance of 25 cm, but such a study is performed only after natural healing of the crack or surgical treatment of the crack.
With inflammation of the rectum, there is a possibility of similar symptoms, but there will be no defect in the form of an ulcer.
Sometimes the formation of a crack in the anus becomes the first stages of the manifestation of Crohn’s disease. With the development of an anal fissure, tests for syphilis and HIV infection will be required. In rare situations, the appearance of ulcers is associated with a parasitic disease or tuberculosis of the rectum.
Differential diagnosis
The clinical characteristics of anal fissure differ little in the specifics of symptoms. Complications of acute fissure implies differential diagnosis to distinguish it from acute hemorrhoids, paraproctitis, cryptitis or rectal prolapse. It should also be remembered that cryptitis and hemorrhoids very often occur together with an anal fissure. Also, for the application of differential diagnostics, not only a thorough history collection and finger palpation will be required, but also an examination using an anoscope or a rectal mirror.
If a deep crack with roughened edges, similar to an ulcer, is found, it will be necessary to exclude infection of the anal canal with Crohn’s disease, specific sexual infections or the formation of a tumor of the anal canal. In patients who have used sexual anal contact, it will be necessary to exclude traumatization of the sphincter, rectum or the detection of a foreign body. With any treatment of a patient with an anal fissure problem to a therapist, in addition to the usual conservative treatment, you will need a referral to visit a specialist proctologist.
Complications of anal fissure
Complications of anal fissure may be the development of acute paraproctitis, due to infection with rupture of the mucous membrane of the anal canal into the pararectal tissue with further formation of purulent inflammation. The treatment of acute paraproctitis will be surgical intervention.
Often, an anal fissure develops along with proctitis and anal itching is vividly felt.
Anal Fissure Treatment
Treatment of anal fissure classically begins with conservative methods, the use of which lasts up to two months. During this period, more physical therapy classes will be needed.
Special diet
Along with physical education, it is necessary to apply a special diet. Spices, fatty foods and alcoholic beverages should be excluded from the list of consumed products. With constipation, it is useful to include in the diet foods that contain vegetable fiber — raw vegetables and fruits or boiled.
It is useful to eat beets, carrots, tomatoes, lettuce leaves, zucchini, pumpkin. Fresh, sweet and ripe fruits should be included in the diet every day, especially raw apples. Dried fruits should be consumed soaked, prunes are most often used for this purpose. It is necessary to limit the use of muffins, white bread, as they trigger the fermentation process in the stomach. Porridge is eaten in small doses. Buckwheat and oatmeal cereals are relevant in this situation.
Meat should be consumed low-fat varieties, in the form of steamed cutlets, baked or stewed. Broths will also be useful. Dairy products, kefir, fermented baked milk, cottage cheese and milk have useful qualities. The main goal of the diet is to normalize the consistency of the stool. When a soft stool is reached, the percentage of overgrowth of an acute crack of the anus increases.
Medical preparations
You can supplement the diet with the use of medicinal candles, at the moment there are many varieties of them. Each patient should select them individually, do not self—medicate – this is the task of the doctor, only he probably knows how to cure anal fissures. Ointments also give good results, as a rule, they have a special tip with which it becomes easier to inject ointments. Ointments and candles are prescribed to be used several times throughout the day, after defecation. Before the introduction of a candle or ointment, take warm bath procedures using a solution of manganese. A strip of ointment one centimeter long is pressed into the anal canal.
This treatment promotes the healing of anal canal cracks. Ointments are also used, which include nitroglycerin, which eliminates spasm of the sphincter and soreness.
Surgical intervention
If the method of conservative treatment does not bring any results, surgical intervention is prescribed, it is performed by a proctologist surgeon.
The method of surgical intervention consists in excision along the plane of the crack to the limits of the normal mucous membrane of the anal canal. In the presence of spasm of the sphincter, an incision of its internal portion is made by the method of sphincterotomy. As a standard, healing occurs a week after surgery. After the operation, the surgeon performs bandaging with the use of antiseptic ointments.
Prevention of the development of anal fissure
To prevent this disease, you will need to follow only a few simple rules:
You need to love an active sport and include it in your schedule.
It is also important to be more careful about personal hygiene.
After defecation, it is better to wash with water.
It is very important to eat healthy food and include hot, liquid dishes in your daily diet.
Timely fight against the problem of constipation and diarrhea.
Exclude alcohol abuse.
