An anal fissure, or anal fissure, is a rupture of the mucous membrane of the rectum of different depths. Anal fissures occur in those people who lead a sedentary life or suffer from chronic constipation.
Anal fissures are diagnosed in 18% of patients who address issues of discomfort in the rectal area. Occur more frequently in women of reproductive age.
The anal fissure itself, the symptoms and treatment of which we will consider, can be an independent phenomenon arising from the impact of various traumatic factors. However, painful defects of the rectal mucosa and epithelium in the anus are more often associated with various comorbidities (disorders of the gastrointestinal tract, gastric ulcer or duodenal ulcer, internal and external hemorrhoids).
The reasonsCauses of anal fissure are usually associated with injury to the rectum or other diseases, such as hemorrhoids, constipation. The appearance of a mucosal defect in the anus area is facilitated by the same factors as for hemorrhoids:
- Trauma to the mucous membrane of the anal canal, occurring during the passage of hard dry feces during constipation. Prolonged stretching of the anal canal leads to traumatic damage to its posterior wall, especially in men. This zone of the anal canal has anatomical prerequisites for the formation of cracks, since the muscles of the anal beet pulp converge here. In women, the weak point of the anal canal is its anterior part, where the vulva, vagina and the center of the perineum seem to converge. Therefore, cracks in the anterior part of the anal canal are more common in women. On the side walls of the anal canal cracks occur rarely.
- Diseases of the digestive system - various colitis, gastritis, peptic ulcer, hemorrhoids can lead to the formation of anal fissures. Statistics show that anus cracks occur in 95% of patients suffering from inflammation of hemorrhoids.
- Disruption of the cardiovascular system and related diseases (congestion in the pelvic and rectal regions, thrombophlebitis, arteriosclerosis obliterans, aneurysms, vasculitis, etc.).
- Chronic diseases of the upper gastrointestinal tract (gastritis, cholecystitis, gastric ulcer, duodenal ulcer).
- Pregnancy and childbirth - the pressure of the growing uterus on the internal organs, including the large intestine, leads to problems with defecation, as a result of which the expectant mother may experience anal fissures. This pathology is also not uncommon in young mothers - the appearance of fractures of the perineum contributes to the appearance of anal fissures.
You should not hope that the newly formed defect of the mucous membrane will heal by itself, especially if the patient does not completely change anything in his lifestyle and diet. Moreover, a sharp crack (it is considered to be acute the first 4 weeks of its existence) can become chronic, which persists for months and takes the patient out of a state of physical and mental equilibrium.
If a person turned to a specialist in time, then ointment or suppositories are prescribed for the treatment of anal fissure at home, and only in an advanced case is a surgical operation suggested. Microcracks can be a few millimeters, and deep ones reach two centimeters.
Symptoms of anterior fissure
If an anal crack occurs, the most important and main symptom is pain and minor bleeding (see photo). Discomfort persists after stool, with itching and burning. Over time, sphincter spasm can join them. Such signs are observed at any stage of the disease.
However, if an acute wound can heal in a few weeks without special treatment, the chronic fissure does not close for a very long time. Pain during prolonged sitting in a sitting position, constant discomfort causes fear of defecation. As a result, constipation appears, which only worsens the condition of the person. The patient becomes irritable, there are sleep disorders.
Anal fissure in children
Children suffer from cracks to a lesser extent than adults, but similar symptoms can occur even in infants. If a child encounters a disease, it is very important to start treatment in a timely manner so that the fracture does not become chronic, and does not provoke a lot of complications.
It is not necessary to engage in the treatment of the child at home. Folk remedies can only relieve symptoms, unlike medicines.
Over time, the acute form of the disease is able to flow into the chronic stage, especially with inadequate care for injury or the use of incorrect drugs. Most often, an anal fissure in women after labor is permanent, which is also explained by the regular changes in the body of the newly appeared mother.
Pain in the chronic form brings suffering not only during a bowel movement or after a long sitting, but also in case of any forced uncomfortable position, walking. Panic fear of the toilet is added to the itching, discomfort and bleeding.
The patient is increasingly resorting to the help of laxatives, enemas, suppositories, thereby aggravating the process. May develop insomnia and irritability.
Complications of anal fissures include:
- Acute paraproctitis (in case of infection through the defect of the rectal mucosa in the surrounding fatty tissue).
- Severe pain. As a rule, the pronounced pain syndrome in anal fissures is explained by spasm of the anal sphincter.
- Colitis (inflammatory disease of the inner lining of the colon.
- Prostatitis (inflammation of the prostate gland).
- Copious bleeding.
- Fistula rectum.
The proctologist can easily determine the presence of anal fissure even at the stage of a routine examination, since the edematous and mucous membranes are broken. If the chronic rectal fissure is located inside, then a finger scan is performed.
So the proctologist can determine its size, feel the edges. When there are problems with palpation, then the rectoromanoscope is inserted into the anus. This device provides an opportunity to inspect the rectum at a depth of twenty centimeters. If necessary, appointed by colonoscopy, irrigoscopy.
How to treat an anal fissure
If the cause of this problem was any disease, then its treatment is necessary, since it is impossible to cure the anal fissures without eliminating the cause of their occurrence.
In addition, when starting the treatment of anal fissure, it should be clearly recognized that no means will be sufficiently effective if the patient suffers from constipation. Hard stools will traumatize the anus, so it will be difficult to heal the wound, and new cracks may appear periodically. Therefore, all patients need to follow the diet recommended for constipation.
The choice of the method of dealing with such a disease in a particular case is determined by the proctologist after a preliminary examination, depending on the clinical manifestations and nature of the disease.
Anal fissures are treated in the following ways:
- The drug method is the use of drugs to achieve the analgesic effect and the healing of crack passage. The course of treatment depends on the degree of the disease, is carried out by the patient independently at home.
- The minimally invasive method is laser removal of a crack in a hospital.
- The operative method is also carried out in the hospital, performing removal with a laser and sphincterotomy.
Begin, of course, with the conservative. It may include such activities:
- Taking warm baths 2-3 times a day for 10-20 minutes. Thanks to this procedure, the muscles of the anus relax.
- Treatment of the anal area with petroleum jelly.
- Prevention of constipation. To do this, you need to consume more fluids, fruits, vegetables, or after consulting with a doctor to take a laxative.
If these activities do not bring the desired effect or you need to get it faster, you can resort to using ointments and suppositories.
Candles and ointments from cracks in the anus
As a medication, special candles or ointments for cracks in the anus are most often prescribed. They allow you to remove the spasm of the internal anal sphincter.
Pain relief candles:
- Ichtiol candles;
- Glycerin suppositories;
- Calendula Candles;
- Betiol with belladonna;
In their composition usually includes any analgesic, which eases pain in the anus.
Wound healing and anti-inflammatory candles:
- Relief (contain shark liver oil, which has anti-inflammatory, hemostatic and analgesic effect);
- Propolis. To prepare the medication, rub on a fine grater, mix with butter, heat to dissolve. After receiving the liquid solution, the drug is poured into a candle-shaped bath;
- Methyluracil Suppositories with this component have a good wound-healing effect;
- Natalcid - anti-inflammatory drug for the treatment of anal fissures, not containing hormonal components. May be used during pregnancy;
- Posterized This preparation contains inactivated intestinal bacteria, as well as their metabolic products. The tool increases the immune defense and has an anti-inflammatory effect;
- Hepatrombin T - rectal suppositories for stopping rectal bleeding with analgesic and anti-inflammatory effects;
Witch hazel (homeopathic plant-based remedy).
They help treat rectal fissures and prevent the occurrence of complications.
Eliminating constipation and softening feces
By making the stool softer and stool daily, one of the main reasons for the crack around the anus can be eliminated. Medications that facilitate bowel movement are divided into the following groups.
- Means that increase the volume of intestinal contents: plant based on agar or psyllium (Naturolax, Mukofalk, Fayberlex), cellulose based (Fiber, Fibercon).
- Polyhydric alcohols: Duphalac, Normase, Lactulose (standard, non-irritating bowels), Sorbitol, Macrogol, Laktiol (see all laxatives).
- Emollients (vaseline and sea buckthorn oils, Norgalax). At home, for problems with the anal sphincter, counter microclysters are used 10 minutes before emptying (100 ml of pasteurized sunflower oil and 200 ml of boiled water at room temperature).
For the treatment of crack anus at home, you can use some folk remedies. They will help reduce inflammation and reduce the intensity of pain.
- To relieve pain, use a candle made from ordinary potatoes. It is cut in the form of a suppository of a tuber, inserted into the anal canal, kept all night. Then she goes out herself when she has a bowel movement. To enhance its therapeutic effect, you can dip it in honey or oil, for example, sea buckthorn before use. The course is 10 candles.
- If the fissure goes deep into the anal canal, medical microclysters can be used. For example, they mix in 30 ml of sea buckthorn oil and chamomile flower infusion, gently inject the mixture into the anus in the anus with the help of a syringe and hold it until they have enough patience. The procedure must be done before going to bed for 2 weeks.
- Candles. For their preparation you will need hop cones (8 pieces), unsalted lard (0.5 kg), St. John's wort (3/4 cups of grass), 1.5 cups of boiling water. Hops and St. John's wort need to boil, insist 3 hours, wrapped in a warm cloth. Infusion strain.
Sessile baths are also very effective. They help to immediately remove local swelling, pain and help in healing the wound. For these trays need herbal infusions. They take the same for the basis: chamomile, knotweed, calendula, St. John's wort, oak bark, immortelle. Water should be warm, and the duration of the procedure for at least 20 minutes.
Proper nutrition and diet
A diet with an anal fissure should promote regular stools, make the stool soft and not cause stagnation of blood in the rectum.
- A person is recommended to drink daily 1.5 - 2 liters of water, which also makes fecal masses softer. A daily intake of fermented milk products gives a relaxing effect.
- It is necessary to abandon bread made from white flour, since it slags intestines, as well as spicy seasonings, smoked and pickled products, alcohol, especially high-strength.
- It is desirable that the basis of the diet were vegetables and fruits. They contain coarse fiber (dietary fiber), which promotes digestion.
In some cases, extensive and difficult healing anal fissure fissures require surgical intervention for effective treatment. Used several options for exposure. The most common operations are called lateral internal sphincterotomy.
During this procedure, the doctor makes a tiny incision and separates certain layers of sphincter muscles. This helps prevent muscle spasms, which leads to the complete elimination of tension during bowel movements. The method of suturing the walls and excision of mucous membranes, which are affected by scarring and sclerotherapy, is also used.
How long does it take to treat an anal crack?
The duration of treatment of anal fissure in adults depends on the severity of the disease and the chosen treatment regimen.
Non-surgical treatment of cracks with the help of diet, hygiene procedures and medications at home can help alleviate the symptoms of the disease after a few days and lead to full recovery after 4-8 weeks.
The complexity of the surgical treatment of anal fissure and the length of the recovery period after surgery depends on the degree of development of the disease and the type of surgery performed.