Treatment of chronic anal fissure. Anal fissure (anal fissure). Causes, symptoms, diagnosis and treatment of pathology. What suppositories and ointments should be used in treatment? Traditional methods of treating cracks

An anal fissure, or anal fissure, is a rupture of the rectal mucosa of varying depth. 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 present with discomfort in the rectal area. They are more common in women of reproductive age.

By her own anal fissure, the symptoms and treatment of which we will consider, may be an independent phenomenon that arises as a result of the influence of various traumatic factors. However, much more often painful defects in the mucous membrane of the rectum and epithelium in the anus are associated with various concomitant diseases (disturbances in the gastrointestinal tract, gastric or duodenal ulcers, internal and external hemorrhoids).

Causes

The causes of anal fissure are usually associated with injury to the rectum or other diseases such as hemorrhoids and constipation. The appearance of a mucosal defect in the anal area is promoted by the same factors as with hemorrhoids:

1. Trauma to the mucous membrane of the anal canal, which occurs when passing hard, dry feces during constipation. Prolonged stretching of the anal canal leads to traumatic damage to it back wall, especially in men. This area of ​​the anal canal has anatomical prerequisites for the formation of cracks, since the muscles of the anal sphincter converge here. Among women weak point The anal canal is its front part, where the vulva, vagina and center of the perineum seem to converge. Therefore, fissures in the anterior part of the anal canal are more common in women. Cracks rarely occur on the lateral walls of the anal canal.
2. Organ diseases digestive system – various, can lead to the formation of anal fissures. Statistics show that 95% of patients suffering from inflammation have anal fissures hemorrhoids.
3. Disruption of cardio-vascular system and related diseases (congestion in the pelvic and rectal areas, obliterating atherosclerosis, aneurysms, etc.).
4. Chronic diseases of the upper sections gastrointestinal tract (gastritis, stomach ulcer,).
5. Pregnancy and childbirth– pressure of the growing uterus on internal organs, including colon, leads to problems with bowel movements, resulting in expectant mother Anal fissures may appear. It is not uncommon this pathology and in young mothers, the appearance of anal fissures is facilitated by perineal ruptures during childbirth.

You should not hope that the newly formed mucosal defect will heal on its own, especially if the patient does not change anything at all in his lifestyle and diet. Moreover, an acute crack (it is considered acute during the first 4 weeks of its existence) can become chronic, which persists for months and removes the patient from a state of physical and mental balance.

If a person consults a specialist in time, then ointments or suppositories are prescribed to treat anal fissures at home, and only in advanced cases are they offered surgery. Microcracks can be several millimeters wide, while deep cracks can reach two centimeters.

Symptoms of anal fissure

When an anal fissure occurs, the most important and basic symptom is pain and minor bleeding (see photo). Unpleasant sensations persist after defecation, with itching and burning. Over time, sphincter spasm may join them. Such signs are observed at any stage of the disease.

However, if in an acute form the wound can heal in a few weeks without special treatment, then the chronic crack does not close for a very long time. Pain during prolonged sitting, constant discomfort causes fear of defecation. As a result, constipation appears, which only worsens the person’s condition. The patient becomes irritable and sleep disturbances are noted.

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 the disease, it is very important to start treatment in a timely manner so that the crack does not turn into chronic form, and did not provoke a lot of complications.

You should not treat your child at home. Folk remedies can only relieve symptoms, unlike medications.

Chronic fissure

Over time, the acute form of the disease can develop into a chronic stage, especially if the wound is not properly cared for or the wrong products are used. medicines. Most often, an anal fissure in women becomes permanent after labor activity, which is also explained by natural changes in the body of the new mother.

Pain in the chronic form brings suffering not only during bowel movements or after long periods of sitting, but also during any forced uncomfortable position, walking. Added to itching, discomfort and bleeding panic fear in front of the toilet.

The patient increasingly resorts to laxatives, enemas, and suppositories, thereby aggravating the process. Insomnia and increased irritability may develop.

Consequences

Complications of anal fissures include:

1. Acute paraproctitis (when infection enters through a defect in the mucous membrane of the rectum into the surrounding fatty tissue).
2. Severe pain. As a rule, severe pain with anal fissures is explained by spasm anal sphincter.
3. Colitis ( inflammatory disease inner shell large intestine.
4. (inflammatory lesions of the prostate gland).
5. Heavy bleeding.
6. Fistulas of the rectum.

Diagnostics

A proctologist can easily determine the presence of an anal fissure even at the stage of a routine examination, since the areas are swollen and the mucous membranes are damaged. If a chronic rectal fissure is located internally, a digital examination is performed.

So the proctologist can determine its size and feel the edges. When problems with palpation arise, a sigmoidoscope is inserted into the anus. This device makes it possible to examine the rectum at a depth of twenty centimeters. If necessary, colonoscopy and irrigoscopy are prescribed.

How to treat anal fissure

If the cause of this problem is any disease, then its treatment is necessary, since it is impossible to cure anal fissures without eliminating the cause of their appearance.

In addition, when starting treatment for anal fissure, you should be clearly aware that no remedy will be effective enough if the patient suffers from constipation. Hard feces will injure the anus, so it will be difficult to heal the wound, and new cracks may appear periodically. Therefore, all patients should follow the diet recommended for constipation.

The choice of method to combat such a disease in a particular case is determined by the proctologist after a preliminary examination, depending on clinical manifestations and the nature of the disease.

Anal canal fissures are treated in the following ways:

1. Medication method is the use of medications to achieve an analgesic effect and healing of the cracked passage. The course of treatment depends on the degree of the disease and is carried out by the patient independently at home.
2. Minimally invasive method is laser removal of a crack in a hospital setting.
3. Operational method also performed in a hospital, performing laser removal and sphincterotomy.

They start, of course, with the conservative. It may include the following activities:

1. Taking warm baths 2-3 times a day for 10-20 minutes. Thanks to this procedure, the muscles of the anus relax.
2. Treating the anal area with Vaseline.
3. Prevention of constipation. To do this, you need to consume more fluids, fruits, vegetables, or, after consulting a doctor, take a laxative.

If these measures do not bring the desired effect or you need to get it faster, you can resort to the use of ointments and suppositories.

Suppositories and ointments for cracks in the anus

Special suppositories or ointments for cracks in the anus are most often prescribed as medications. They allow you to relieve spasm of the internal anal sphincter.

Pain relieving suppositories:

• Ichthyol candles;
• Proctoglivenol;
• Ultraproct;
• Glycerin suppositories;
• Salofalk;
• Calendula candles;
• Betiol with belladonna;
• Anestezol.

They usually contain some kind of analgesic, which relieves pain in the anus.

Wound healing and anti-inflammatory candles:

1. Relief (contains shark liver oil, which has anti-inflammatory, hemostatic and analgesic effects);
2. Propolis. To prepare the medicine, grate it on a fine grater, mix it with butter, and heat until dissolved. After obtaining a liquid solution, the drug is poured into candle-shaped baths;
3. Methyluracil. Suppositories with this component have a good wound healing effect;
4. Natalsid is an anti-inflammatory drug for the treatment of anal fissures that does not contain hormonal components. Can be used during pregnancy;
5. Posterized. This drug contains inactivated intestinal bacteria, as well as their metabolic products. The product increases immune protection and has an anti-inflammatory effect;
6. Gepatrombin T - rectal suppositories to stop rectal bleeding with analgesic and anti-inflammatory effects;
   Witch hazel (herbal homeopathic remedy).

They help treat rectal fissures and prevent complications.

Relieving constipation and softening stool

By making your stool softer and your bowel movements more frequent every day, you can eliminate one of the main reasons why a fissure occurs around the anus. Medicines that facilitate bowel movements are divided into the following groups.

1. Facilities, increasing the volume of intestinal contents: vegetable based on agar or psyllium (Naturolax, Mucofalk, Fiberlex), based on cellulose (Fiberal, Fibercon).
2. Polyhydric alcohols: Duphalac, Normaze, Lactulose (standard, non-irritating to the intestines), Sorbitol, Macrogol, Lactiol (see all laxatives).
3. Emollients (vaseline and sea buckthorn oils, Norgalax). At home, if there are problems with the anal sphincter, counter microenemas are used 10 minutes before bowel movement (100 ml of pasteurized sunflower oil and 200 ml boiled water room temperature).

Folk remedies

To treat anal fissure at home, you can use some folk remedies. They will help relieve inflammation and reduce the intensity of pain.

1. To relieve pain, use a candle made from ordinary potatoes. It is cut into the shape of a suppository from a tuber, inserted into the anal canal, and left in place all night. Then it comes out on its own when you have a bowel movement. To strengthen it therapeutic effect, can be dipped in honey or oil, such as sea buckthorn, before use. The course is 10 candles.
2. If the crack goes deep into the anal canal, you can use therapeutic microenemas. For example, mix 30 ml sea ​​buckthorn oil and infusion of chamomile flowers, carefully inject the mixture into the anus while warm using a syringe and hold it as long as you have patience. The procedure must be done before bedtime for 2 weeks.
3. Candles. To prepare them you will need hop cones (8 pieces), unsalted lard(0.5 kg), St. John's wort (3/4 cup herb), 1.5 cups boiling water. Hops and St. John's wort must be boiled, left for 3 hours, wrapped in a warm cloth. Strain the infusion.

Sitz baths are also very effective. They help to immediately relieve local swelling, pain and aid in wound healing. For such baths you need herbal infusions. The same ones are used as a basis: chamomile, knotweed, calendula, St. John's wort, oak bark, immortelle. The water should be warm and the procedure should last at least 20 minutes.

Proper nutrition and diet

A diet for anal fissure should promote regular bowel movements, make stool soft and not cause stagnation of blood in the rectum.

1. A person is recommended to drink 1.5 - 2 liters of water daily, which also makes stool softer. A daily intake fermented milk products have a laxative effect.
2. It is necessary to avoid bread made from white flour, as it clogs the intestines, as well as spicy seasonings, smoked and pickled foods, and alcohol, especially high strength ones.
3. It is advisable that the basis of the diet be vegetables and fruits. They contain coarse fiber ( alimentary fiber), which promotes digestion.

Surgery

In some cases, extensive and difficult to heal cracks anal passage require surgery for effective treatment. Several influence options are used. The most common surgery is called lateral internal sphincterotomy.

During this procedure, the doctor makes a tiny incision and separates specific layers of the sphincter muscle. This helps prevent muscle spasms, which leads to complete elimination of tension during bowel movements. The method of suturing the walls and excision of mucous membranes that are affected by scarring and sclerosing is also used.

How long does it take to treat an anal fissure?

The duration of treatment for anal fissure in adults depends on the severity of the disease and the chosen treatment regimen.

Non-surgical treatment of fissures using diet, hygiene procedures and medications, at home can help relieve symptoms of the disease in just a few days and lead to complete recovery in 4-8 weeks.

Complexity surgical treatment anal fissures and the duration of the recovery period after surgery depend on the degree of development of the disease and the type of surgery performed.

Among proctological pathologies, the most common are rectal fissures, the symptoms of which are quite unpleasant. A fissure is a tear (rupture) in the mucous membrane of the rectum, causing severe pain and bleeding. In the absence of appropriate therapy and the process is chronic, pain can persist even at rest. The size of the crack can reach 2 cm, and there is a clear relationship between the size of the tear and the degree of pain.

It is quite natural that the causes of rectal fissures are mainly related to disorders of the gastrointestinal tract. Predisposing factors include frequent constipation, pathologies of the large intestine (polyps), irritable bowel syndrome, vascular changes in the rectum (hemorrhoids). Errors in diet can contribute to the appearance of cracks.

The immediate causes of crack formation are:

• injuries - anal sex, too hard stool, rough medical manipulations;
• increased pressure in the rectum, often observed when lifting heavy objects, strong efforts when trying to empty the intestines;
• congestion in the pelvic organs, associated both with a sedentary lifestyle and with pathologies such as thrombophlebitis, atherosclerosis, vasculitis, etc.;
• childbirth, including unprofessional management postpartum period(the first stool is not caused by the enema/laxative);
• lesions of the anal sphincter (nutritional processes in the rectal area are severely disrupted);
• parakeratosis.

The process of crack formation begins with a small tear in the mucous membrane. After this, the process of exposure of the damaged area to the active microflora of the rectum begins, which contributes to further damage to the mucous membrane and possible infection of the affected area. Cracks of the rectum formed in this way, the treatment of which is not carried out in a timely manner, acquire a chronic, long-term course.

The healing process of a crack is very long, even with adequate treatment. This is due to the fact that the rectum is the place of concentration large number nerve endings and pain cause severe spasm of the sphincter, which leads to disruption of the blood supply (ischemia) to the damaged area of ​​the intestine. Accordingly, tissue healing processes are seriously “inhibited”.

Frightening symptoms of anal fissure

The first and most unpleasant evidence of a rectal fissure is pain. It is sharp, cutting in nature, always appears suddenly and quite frightens a person. The occurrence of pain is accompanied by slight bleeding, which can be detected when examining stool. The blood is fresh, not clotted, in the form of droplets.

After sharp pain there is a short period of rest, after which the pain returns and lasts, as a rule, for several hours. This is the standard flow acute period anal fissure. The fear of experiencing pain again makes a person go to the toilet less often, causing constipation, which only worsens the situation. Therefore, if a rectal fissure is detected, treatment must begin immediately. In its absence, the disease quickly progresses and takes a chronic, intractable course.

Symptoms of the chronic form of rectal fissures are less pronounced than the acute ones. The pain is often dull and aching. With severe irritation of the intestine, pain can radiate to the sacral area, Bladder, causing urinary retention. There are almost constant bloody issues from the rectum, which may not be associated with the act of defecation. Quite often there is severe itching and diaper rash in the anal area, which persists muscle spasm rectum.

Diagnostics – unpleasant, but necessary

The doctor’s experience and qualifications make it possible to accurately identify rectal fissures; diagnosis, in 95% of cases, is not difficult. Main diagnostic measure, in addition to clarifying the patient’s complaints, one can consider finger examination which is carried out with the patient in the gynecological chair or in the knee-elbow position. In some cases, it is advisable to use anesthetics, due to the sharp pain of the crack and severe spasm sphincter.

Laboratory diagnostics includes:

• anoscopy, which allows you to visually examine the rectum and, if necessary, take a smear or piece of tissue for additional research, allows you to carry out some therapeutic measures;
• retroscopy, which helps determine concomitant pathologies of the colon and exclude inflammatory diseases;
• irrigoscopy – x-ray method, using a contrast agent;
• Ultrasound – allows you to diagnose tumors and metastases that grow into the rectum.

Treatment – ​​you shouldn’t count on an immediate effect

For the most part, all rectal fissures can be treated conservatively (more than 70%). The treatment is complex, takes a lot of time and requires a lot of patience from the patient. The main treatment measures are aimed at the following points:

• cupping pain syndrome;
• elimination of spasm of the rectal sphincter;
• normalization of stool;
• impact on the crack itself, promoting healing;
• diet and personal hygiene.

Medicines are used mainly in the form of various creams, ointments and suppositories (suppositories), which are administered directly into the rectum. You should not exceed prescribed by a doctor dosage and frequency of use medicines, and also supplement them, for example, with antibiotics. The diet must be followed quite strictly, since regular bowel movements significantly prevent circulatory problems in the pelvis. Moderate physical activity.

In terms of prevalence, rectal fissure ranks third among intestinal diseases (after hemorrhoids and colitis). It is a longitudinal (ellipsoidal, triangular or linear) tear in the anal mucosa, the size of which can vary from a few millimeters to 1.5-2 cm.

Often the fissure is combined with internal hemorrhoids. Women are most susceptible to the disease due to their anatomical features.

Most often, the disease develops as a result of chronic constipation and trauma to the rectum with solid feces.

Why does it occur?

The appearance of a crack can be caused by several factors.

The most common of them are mechanical injuries and inflammation in any part of the gastrointestinal tract. A combination of both factors is also possible.

Regardless of the specific location of the inflammation, even when located in upper parts Gastrointestinal tract, it significantly increases the risk of developing the disease. This is explained by the fact that all organs of the digestive system communicate with one another, and infectious process in one of the departments leads to the spread of pathology to the entire tract or its individual sections.

In children, a crack often occurs due to a combination of these two factors. This phenomenon is typical for helminthiasis. If there are worms in the lower intestine, swelling and inflammation are observed. Worm eggs lead to the appearance of severe itching, forcing the child to scratch the anus, which leads to mechanical damage to the mucous membrane. The condition is complicated by the passage of feces.

A favorable factor for the appearance of cracks in children is also their immaturity. digestive organs, as a result of which occur frequent disorders stool: diarrhea or constipation. With constipation, the delicate mucous membrane of the rectum is damaged during the passage of solid feces, and with diarrhea, the liquid mass causes irritation and swelling inner surface intestines.

Other possible causes of a crack include:

• weakening of the pelvic floor muscles;
• birth injuries;
• chronic pathologies of the gastrointestinal tract;
• disorders of the digestive system, leading to chronic diarrhea or constipation;
• inflammatory process in one of the intestinal sections;
• laxative abuse;
• rectal injuries (possible during anal sex).

Symptoms

The first sign of a fissure is pain in the anus. The pain can occur unexpectedly, intensifies with bowel movements and resembles the pain of hemorrhoids. Unlike the symptoms of hemorrhoids, with a fissure the pain is much stronger, sharper and longer lasting. It forces a person to delay bowel movements, which leads to the development of constipation and further complicates the situation.

Often there is pain in the perineum and sacral area, which leads to urination disorders and disruption of the rhythm of the menstrual cycle.

The main signs of a crack are:

• sharp pain during and after bowel movements;
• spasm of the anal sphincter as a result severe irritation nerve endings;
• bleeding from the anus - their intensity is less than with hemorrhoids: mainly these are minor traces of blood in the stool or on toilet paper;
• frequent constipation;
• itching, often with perianal eczema;
• burning sensation with diarrhea.

Depending on the complex of symptoms, two forms of the disease are distinguished: acute and chronic.

For acute form There are three main symptoms:

• intense pain during defecation (may persist after it - about 15 minutes);
• bloody discharge from the anus;
• spasm of the anal sphincter.

As a result of incorrect or incomplete treatment the disease enters the chronic stage.

At chronic types of pain are not as severe, but they last much longer. Pain often occurs without defecation. They can be triggered by prolonged sitting. There is often a risk of complications.

Both chronic and acute forms are characterized by difficulty in defecation associated with severe pain. A kind of vicious circle is formed: cracks lead to chronic constipation, and constipation causes complications in the course of the disease

If children have the disease, severe pain during bowel movements causes them to be capricious, cry, and children avoid the potty. Retention of feces in the intestines leads to their compaction. We have to resort to the use of medications.

Diagnosis of rectal fissure

With characteristic clinical picture For rectal fissures, examination and digital examination are performed to confirm the diagnosis.

In case of intense pain, as well as to avoid infection, retromanoscopy is generally not practiced, except in cases where it is necessary to exclude or confirm the presence of a rectal tumor. In this case, anesthesia is certainly performed.

Through examination, a mucosal defect of a linear nature with smooth edges is detected - when acute course diseases, triangular or oval with scar tissue and overgrown granulations - in chronic.

Laboratory tests are also carried out: in adults - for syphilis, HIV, hepatitis, blood sugar, in children - for the presence of worm eggs (stool analysis).

Treatment

Rectal fissure is treated mainly by medication. The goal of therapy is:

1. Eliminating constipation, ensuring regular soft stools.
2. Anesthesia.
3. Healing wounds and relieving possible inflammation.
4. Treatment of concomitant diseases.

To soften stool, patients are prescribed special diet. The diet is based on plant and dairy products. Plant foods contain a large number of fiber, which increases intestinal motility and helps cleanse the body of waste products, and dairy products, by increasing the number of beneficial lactobacilli, help restore normal microflora.

Spicy, salty, flour, and fried foods should be excluded from the menu.

The diet should contain carrots, beets, green apples, prunes, dried apricots, and pumpkin. You can drink kefir at night, and a vegetable salad with olive or other vegetable oil for breakfast will start the gastrointestinal tract and relieve chronic constipation.

If necessary, mild laxatives and cleansing enemas with a weak antiseptic solution are prescribed.

To relieve pain, patients are prescribed warm baths and microenemas. Great for reducing inflammation sea ​​buckthorn candles, as well as suppositories with methyluracil or benzocaine. To heal wounds and facilitate bowel movements, patients are prescribed glycerin suppositories.

Since in many cases the fissure is a consequence of diseases of the gastrointestinal tract, appropriate treatment of the underlying pathology is simultaneously necessary.

Mostly conservative methods give a positive result.

In its absence and the disease progresses to the chronic stage, surgery may be prescribed.

The essence of the surgical intervention is to excise the affected area of ​​the rectum.

Modern medicine offers low-traumatic methods: cryodestruction and laser coagulation.

These methods do not require general anesthesia and long-term hospital stays.

For significant cracks, classical surgery is indicated.

Under general anesthesia sphincterectomy is performed. Its purpose is to weaken the sphincter muscle fibers to relieve spasm. Then the edges of the crack are excised, after which the edges of the wound are sutured.

During the rehabilitation period, which lasts about a month, local anti-inflammatory therapy and strict adherence to a diet are prescribed to prevent constipation.

Traditional medicine tips

Traditional methods can be used rectal suppositories from beeswax. Melt the wax (150 grams), add chamomile, plantain and motherwort (1 pinch each), stir thoroughly, roll up candles and put them in the refrigerator.

Use three times a day.

Another recipe: prepare an ointment based on infusion of chamomile, St. John's wort and calendula. Grind the herbs, pour hot olive oil (ratio – 1:3). Let cool, put in the refrigerator. Use the ointment to lubricate the anus.

Anal fissures are defects in the mucous membrane of the posterior, or less commonly, anterior wall of the colon. Quite rarely, a lateral anal fissure or two anal fissures form together - posterior and anterior. Depending on the duration of the disease, there is a distinction between acute anal fissure and chronic one.

Causes

Rectal fissures appear in women, men, children of different ages. The reasons are as follows:

• constipation for more than 2 – 3 days;
• direct trauma to the mucous membrane;
• prolonged diarrhea;
• alcohol, spicy food;
• Crohn's disease is an inflammatory granulomatous bowel disease;
• instrumental examination of the rectum - sigmoidoscopy, colonoscopy;
• intestinal infectious diseases– dysentery, colitis;
• anal sex.

Risk factors are elderly age, prolapse of the pelvic floor muscles. An anal fissure after childbirth is formed due to pushing or rupture of the perineum.

Symptoms

Anal fissure symptoms may resemble others dangerous diseases- rectal cancer, ulcerative proctitis, internal incomplete ulcerative fistula. Timely contact with a doctor will allow you to differentiate diseases and prescribe correct treatment. Symptoms of a rectal fissure are few, and patients are worried about:

• severe pain during bowel movements caused by spasm of sphincter fibers;
• minor bleeding in the form of a streak of blood on the stool;
• fear of stool associated with the appearance painful sensations during defecation.

An acute anal fissure occurs when the rectal mucosa suddenly ruptures. Burning sharp pain worsens during and after defecation. Then it gradually weakens. Chronic anal fissures are characterized by a wave-like course with periods of remissions and exacerbations.

What does a mucosal defect look like upon examination? It can be a microscopic, barely noticeable wound or a longitudinal slit-like ulcer about 2 cm long, 2-3 mm deep, up to 5 mm wide. Over time, its edges become denser. Thickenings and fibrous nodules appear in the lower and upper parts. Because of severe pain the fibers of the external sphincter spasm, the trophism (nutrition) of the tissues is disrupted. Numerous intestinal microflora contribute to the development of local inflammation. As a result, the anal fissure bleeds and the wound healing time is delayed.

Features of the disease in children

Most often, an anal fissure in a child appears due to constipation. In infants, stool may be delayed for the following reasons:

• intestinal malformation;
• monotonous nutrition during artificial feeding;
• increased content of milk protein (cottage cheese) in food;
• malnutrition - lack of breast milk or complementary foods;
• Breast milk is too fatty.

In older children, habitual constipation and rectal fissures appear due to poor diet, low physical activity, and systematically restraining the urge to defecate during exercise. Holding stool promotes stretching lower section of the large intestine, the tone of its muscles decreases. How to treat constipation to prevent anal fissure from appearing?

Abdominal massage helps babies. In accordance with age, fruit and vegetable juices and purees should be given. It is necessary to teach older children to go to the toilet at the same time. Regular bowel movements contribute to the development of a conditioned reflex.

When a fissure appears in a child’s anus, you should immediately contact a pediatrician to establish and then eliminate the cause of the disease.

Concomitance with hemorrhoids

It is no coincidence that anal fissures are adjacent to hemorrhoids. Their appearance is often associated with constipation. Even though it's two various diseases, at the initial stage of diseases, therapeutic tactics are almost the same. What should be done first to treat hemorrhoids and anal fissures:

• diversify your diet;
• regulate work and rest schedules;
• move more, play sports, gymnastics, spend less time sitting.

When treating hemorrhoids and fissures, the emphasis is on nutrition. In order for the stool to improve, sometimes it is enough to adjust the diet as follows. Include in the daily menu up to 40% plant food. Vegetables and fruits have an alkalizing effect and contain a lot of fiber, which is important for the normal functioning of the digestive system.

The diet for anal fissure is identical. Low-fat recommended dairy products. They gently weaken and contain microorganisms beneficial to the intestines. Bran and black bread enhance peristalsis, vegetable oils– cotton, sunflower, camelina, flaxseed.

Cured hemorrhoids will disappear forever if you listen to the advice of a specialist and streamline your lifestyle. If the above measures do not help, and the rectum becomes cracked, you need to consult a proctologist. The attending physician will prescribe medications for hemorrhoids and fissures.

Initially, both diseases are treated conservatively. For cracks in the anus and hemorrhoids, ointments, tablets, and suppositories are used. To liquefy stool before defecation, it is useful to make a microenema (30 - 40 g) with oils - sea buckthorn, vaseline, propolis. Sea buckthorn and propolis help relieve inflammation and heal wounds. The following medications for hemorrhoids and fissures have a good laxative effect:

• tablets, suppositories "Relief";
• Duphalac – sachets, syrup;
• medicine for hemorrhoids Fitolax - tablets, sachets, bars;
• Lactofiltrum - tablets;
• Phytomucil - sachets.

Constipation medications should not be used continuously. A laxative for hemorrhoids and fissures is effective only at the beginning of the disease, while the causes of constipation are eliminated.

Conservative treatment

Treatment of fissures in the anus for the first month and a half from the onset of the disease is conservative. Patients are recommended:

• laxative diet;
• in the acute stage, exacerbation - rest;
• anal hygiene after defecation;
• warm sitz baths with chamomile, potassium permanganate;
• oil microenemas.

The listed measures are sufficient for the normal well-being of patients. How to cure a fissure in the anus if there is no relief? Antispastic and analgesic suppositories for anal fissures are used as medications:

• with papaverine – relieves intestinal spasms;
• with propolis – relieve pain and eliminate inflammation;
• Anestezin is a local anesthetic;
• Anuzol – contains zinc, dries wounds;
• Neo-Anuzol - contains disinfectants: methylene blue, iodine, resorcinol. Bismuth envelops the crack;
• Proctocort is an anti-inflammatory drug that contains hydrocortisone.

In addition to suppositories, ointments for anal fissures are used: anesthesin, solcoseryl, methyluracil, syntomycin. Sphincter spasms are relieved by:

• 0.2 - 0.5% nitroglycerin ointment, applied 2 - 3 times a day for a period of 1 - 1.5 months;
• nifedipine ointment is applied 2-4 times a day, treatment period is 1-4 weeks;
• administration of small doses of Botax, the effect of the drug lasts up to 3 months.

Constant use of ointments leads to addiction and reduces the effectiveness of treatment. The dosage of the drug has to be increased. Before using ointments, consult your doctor.

Surgery

When conservative treatment does not cause cracks in the anus positive result, surgical intervention is indicated. In modern practice, the following operations are used:

• excision combined with lateral subcutaneous closed sphincterotomy;
• excision of the fissure with posterior sphincterotomy;
• dosed sphincterotomy - partial dissection of the sphincter leads to temporary paresis of the sphincter, sufficient for wound healing;
• minimally invasive surgery using radio waves.

Previously, mechanical divulsion (stretching) of the sphincter was widely used in treatment. Forceful stretching of the anus is accompanied by rupture of part of the sphincter fibers and nerve endings. It can affect the obturator function of the sphincter, leading to incontinence of gases and feces in the intestines.

Russian surgeons practically do not use forced diversion. Instead, dosed stretching of the sphincter using pneumatic balloons and a cone delator has been introduced into practice. With their help, spasms are eliminated in 7 minutes. A rectal fissure heals faster. The patient can start working after a week.

For pneumodivulsion, a separate balloon is selected for each patient. After insertion into the anus, it is gradually inflated to the desired size. At the end of the operation, it is deflated and then removed. The most gentle method of relieving sphincter spasms is cone divulsion with a special cone delator. The procedure is easily tolerated by patients. In most patients, the fissure in the anus finally heals in 1.5 – 2 months.

The prognosis of the disease is favorable. Heal cracks modern methods and by means it is possible. However, in the future, patients will have to avoid constipation, move more, not lift weights, and strengthen the sphincter with simple exercises.

A rectal fissure also corresponds to the following definitions of what is relevant for it: pathological process, like an anal fissure or anal fissure. A rectal fissure, the symptoms of which manifest as a result of a rupture of the rectal mucosa (to a greater or lesser extent), is in most cases diagnosed in those patients for whom the problem of chronic constipation or diarrhea, a preference for anal sex over traditional sex, as well as a sedentary lifestyle are relevant.

general description

An anal fissure acts as a linear defect formed on the mucous membrane of the anal canal. As a rule, the specific area of ​​its location in the anus falls on the posterior line or the anterior midline(in the latter case, this defect is most often observed in women). These types of lesions are associated with exposure of sensitive nerve endings, as a result of which the anal sphincter undergoes sharp spasms, and this, in turn, leads to pain during defecation. All this, first of all, is associated with the patient’s current problem of hard stool or constipation, and if such a problem is not eliminated, then injury to the mucous membrane becomes permanent. Against this background, a persistent pain syndrome appears in combination with spasm from the sphincter. As a result, the possibility of healing of the crack formed in this way is excluded, moreover, due to the presence in the rectum pathogenic microflora, the resulting wound constantly becomes infected.

The listed features of the course of the process relevant for the formation of anal fissure lead to the fact that the active form inflammatory process in the affected area is constantly maintained. Over time, and, accordingly, with the progression of the process, the edges of the crack thicken, and in depth it increases in size. Against the background of these processes, the nerve endings become even less protected against such influence, resulting in the transition of the disease to a chronic form of the course.

If an anal fissure in its appearance is combined with a chronic form of hemorrhoids, then in this case its location may be in the area of ​​the lateral walls of the anal canal. In general, with this variant of the course of the disease, its picture, as can be understood, becomes even more complicated in the features of the actual processes. Hemorrhoids cause deterioration of blood circulation in the mucous membrane of the anal canal, which, in turn, causes a decrease in its ability to regenerate, that is, to heal and restore.

As you might have already guessed from the descriptions of the processes disclosed above, depending on the characteristics of the manifestation, an anal fissure can be acute (in this case, the duration of the disease is no more than 4 weeks), as well as chronic (in this case, accordingly, a longer course is considered ).

Normalization of stool and the use of appropriate pain therapy determines for patients the possibility of remission of the disease, lasting for months, and in some cases for years. However, the onset of the first diarrhea or constipation during the “quiet” period can cause the recurrence of an anal fissure.

Linear break (in some cases, by the way, it may have a triangular or oval shape), relevant for this pathology, otherwise can be defined as cracking of the rectal mucosa. As for the size of this gap, it can reach 2 centimeters in length. It should be noted that rectal fissure is one of the most common diseases diagnosed in the field of proctology, its frequency on average is determined to be 10-20% in the number of existing diseases, relevant to the affected area (i.e. rectum). Regarding the susceptibility to rectal fissures, it can be noted that it occurs in children, men, and women. The factor of susceptibility to the occurrence of anal fissure is considered in conjunction with the reasons that provoke its formation.

Causes of rectal fissure

The appearance of an acute anal fissure may be accompanied by the following reasons:

• Poor blood supply to the anal area. In this case, options are considered in which stagnation of blood occurs in the rectal area against the background of a sedentary lifestyle of patients, characteristics of professional activity (sedentary position), etc.
• Mechanical injury to the anus. In this case, we are talking about damage to the rectal area due to frequent constipation or, conversely, diarrhea. Complications during childbirth in women that provoke such trauma, as well as the preference for non-traditional forms of sexual intercourse (anal sex), are discussed separately.
• Haemorrhoids. As we have already noted above, this disease is characterized by the fact that hemorrhoids lead to weakening of the walls of the anus, easily being injured during defecation. Anal fissures with hemorrhoids are caused by a violation of blood circulation in the anal area (in the form of thrombosis, blood stagnation).
• Disorders associated with the innervation of the rectal area. In this case, a disorder is considered in the form of prolonged spasms of the sphincter, which arose as a result of a central nervous system pathology that is relevant to the patient.
• Anatomical features. The structure of the rectum also determines the possible predisposition to the appearance of a crack in it. A rectal fissure in women, due to those features that are relevant in general in the structure of the female genital organs, occurs on the side of the anterior part of the anus. Taking this into account, accordingly, rectal fissure of the anterior part of the anus is a form of disease in which, due to anatomical features, the predisposition to its occurrence is determined specifically for the corresponding gender of patients.

It should be noted separately that predominantly anal fissure is caused by a combination of the simultaneous influence of several causes or factors.

Rectal fissure: features of acute and chronic forms

As we have already highlighted, anal fissures can, like a number of other diseases, manifest themselves in acute and chronic forms of their own course; the specific form can be determined based on the duration of the manifestations, associated with the disease, we also noted the time intervals above. The acute form of the course is characterized by spontaneity of occurrence as a result of a rupture of the rectal mucosa, which may be accompanied by the process of passage of high-density stool during constipation. Healing of acute anal fissures often occurs within 1-2 days, without the need for any treatment.

A much more serious version of rectal fissure is the chronic form of the disease. Such cracks act as a variant of the continuation of the acute form, against the background of which, in fact, they develop, or more precisely, against the background of cracks that have not completely closed and have been subjected to re-injury due to one or another impact factor. Transformation into a chronic form occurs with even greater expansion and infection by microbes, which are found in abundant quantities on the walls of the rectum. The walls of chronic cracks have high density, the process of their closure (healing) is long and complicated due to the constant impact on the affected area.

Rectal fissure: symptoms

The anal fissure clinic has very characteristic manifestations. The main signs of this disease include a triad of symptoms, in particular: pain in the anus, severe spasm of the anal sphincter, and bleeding, arising directly from the anus. If the course of the disease in combination with hemorrhoids is considered, then the listed signs are also accompanied by a symptom such as prolapse of hemorrhoids in combination with massive bleeding from the anus.

Symptoms of acute anal fissure

Pain in the anus is the leading symptom listed in general description options. In this form of manifestation of the disease, the pain is quite strong, but short-lived. The appearance of pain is noted only during the process of defecation (bowel movement, stool), and also for about 15 minutes after its completion. Basically, the identification of an area of ​​pain occurs with an acute anal fissure in the area of ​​the posterior wall of the rectum.

Spasm of the anus (sphincter) Similar to the pain sensations in this form of the disease, its manifestation is quite intense. The spasm manifests itself in the form of pain, combined with a feeling of difficulty accompanying the process of defecation.

Bleeding from the anus has a slight character of severity. Such bleeding occurs during defecation, which is explained by the passage of feces of a high degree of density.

In addition to the listed symptoms, as their addition stands out difficulty in defecation.

Symptoms of chronic rectal fissure

In this form, the symptoms are similar to the acute form, however, there are some differences. Thus, pain in the anus in this case differs from the case of acute disease. The duration of pain here increases, and it intensifies when forced to take a sitting position for a long period of time. The manifestation of pain in this case determines serious discomfort, as a result of which patients become irritable and have problems sleeping.

In addition to pain, patients also develop a kind of fear regarding bowel movements, often against this background they begin taking laxatives in order to avoid constipation and the symptoms accompanying their condition.

Bleeding arising from the anus also develops here; they are especially relevant for constipation. In addition to blood, pus also begins to be released from the anus. As for sphincter spasms, in this case it is less pronounced than in the acute course of the disease.

Rectal fissure in a child: symptoms

A rectal fissure can develop in a child mainly due to constipation. The disease manifests itself in an acute form, its main symptoms are the appearance of pain during bowel movements, as well as traces of blood that can be found on toilet paper and in stool.

In the vast majority of cases in children, this disease goes away without the need for treatment, that is, on its own, and the only aspect regarding its exclusion is the need to normalize stool.

Rectal fissure during pregnancy

Women are particularly predisposed to problems with bowel movements and constipation in particular, when compared with the male predisposition. And if we consider the period of pregnancy and childbirth, then the risk of such changes is even greater. The appearance of an anal fissure in pregnant women is caused by the influence of a number of specific factors of external and internal scale, we will highlight them below:

• Enlarged uterus. Against the background of this change in the female body during pregnancy, compression of the veins in the pelvic area occurs, and with it, a violation of the outflow of blood from the rectum. Due to stagnation of blood in the veins of the rectum, in turn, with the simultaneous influence of hormones that are relevant during the period under review, tissue swelling develops, which is also accompanied by an increase in their susceptibility to negative effects.
• Hormonal changes. A decrease in uterine tone during pregnancy occurs under the influence of an altered state hormonal levels, along with this, the influence of hormones extends to other smooth muscle organs, these, as you probably already understood, also include the intestines. Due to constipation and weak peristalsis during pregnancy, anal fissures form.
• Food cravings. Due to changes in the diet of pregnant women and the emergence of specific cravings, including those related to sweets and refined foods, digestive disorders develop, which, in turn, increases the risk of developing a rectal fissure.
• Decreased physical activity. It becomes difficult to maintain it properly, especially after the 30th week, which is why corresponding problems arise with the stool, which, as we have noted more than once, lead to the development of the process we are considering.

It should be noted that rectal fissure after childbirth is also an equally common variant of its manifestation. The reasons for the rectal fissure in this case are unclear, however, it is assumed that the process of labor itself, with the accompanying sharp tension of the tissues in this area that occurs during the passage of the fetus and its head through the pelvic floor, plays a significant role here.

In some cases, an anal fissure appears a certain time after the birth of the child. This is due to constipation that often occurs after childbirth, due to the fact that the woman experiences a certain fear of the act of defecation. Subsequent passage of stool increased density leads to damage to already vulnerable tissues.

Complications

Complications that can arise from a rectal fissure, first of all, include the possibility of infection during the development of ascending inflammation, which determines the likelihood of it moving upward through the intestine. In particular, the danger of this process is determined for its mucous membrane in the area of ​​terminal sections, such sections include the sigmoid and rectum, as well as the sphincter. Against the backdrop of the impact caused by the penetration of infection into the environment deep layers, paraproctitis often develops, which, in turn, causes inflammation of the fatty tissue concentrated around the rectum.

Also, complications of anal fissures may include heavy bleeding. In addition, even against the background of minor blood loss, patients develop over time.

A certain danger exists separately for men; it lies in the spread of infection to the prostate gland, against which, accordingly, prostatitis develops.

Diagnostics

It is usually not difficult to identify the presence of a rectal fissure in a patient. It is necessary to differentiate this disease, first of all, from rectal fistula (internal form of manifestation). As part of this pathology, there is no spasm, the intensity of the pain syndrome is not so intense, and the main manifestation of symptoms is the discharge of pus from the anus. When palpating the defect in the mucosal area, slight pain is detected, and in the area of ​​its bottom a fistula cavity is detected in the form of a characteristic depression.

With a suspicious history regarding the possible relevance of HIV infection (against the background of homosexuality, promiscuity and drug addiction), patients may also have diseases that affect the rectum, which in this case is directly related to HIV. Often, in patients with anal fissures, a somewhat unusual picture of their manifestations emerges in this case.

Basic diagnostic methods:

• external examination (in many cases it makes it possible to determine the presence of an anal fissure (part of it); externally, an anal fissure is a longitudinal or triangular red ulcer);
• digital examination of the rectal area (palpation of the intestinal walls, determination of the degree of sphincter spasm);
• sigmoidoscopy (the most reliable method of examining this area with the ability to examine the intestinal mucosa within a distance of up to 30 cm from the anus);
• anoscopy (examination in which the final section of the rectum is examined).

Treatment

In the treatment of anal fissures, the focus is on achieving results in terms of normalizing stool, reducing pain, healing the affected area, and also reducing the increased sphincter tone in this case. Two treatment options are used, surgical treatment and non-surgical treatment.

As part of surgical treatment measures, the method of excision of the fissure, as well as sphincterotomy, is used; the peculiarity of their implementation is actually the dissection of one of the portions of the anal sphincter area. This kind of intervention determines the possibility of achieving the required relaxation of the sphincter, eliminating pain and creating conditions within which healing will be possible. Due to the intersection of this muscle, disturbances in fecal continence do not occur; the patient’s stay in a hospital does not require additional time.

As for non-surgical treatment, it primarily focuses on the following measures: normalization of stool, sitz baths, diet therapy, taking medications to relieve spasm in the specified area. Through measures conservative therapy, applicable in this case, recovery is possible in approximately 70% of cases.

As for such an issue as the prevention of rectal fissures, it consists of patients following the principles proper nutrition and active lifestyle, as well as timely treatment of any type of bowel-related disorders. Eliminating congestion that occurs in the pelvic area is achieved through regular exercise, exercise and walking. Anal sex should be avoided due to the serious risks it poses to this area.