Cracks in the anus, how to treat?

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Cracks in the anus, how to treat?
Cracks in the anus, how to treat?
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Fissures in the anus: symptoms and treatment

Fissures in the anus is the most common complaint that patients make to a proctologist. Not a single person is immune from their appearance, but most often they form in older people. A fissure in the anus can appear both by itself and be the result of other diseases of the digestive system.

The essence of pathology

The essence of pathology
The essence of pathology

A fissure in the anus is a disruption in the normal structure of the rectum, which is the final part of the large intestine. Such a crack, in fact, is a normal rupture of the mucous membranes.

Most often the size of the defect is small. However, this does not prevent him from significantly reducing the quality of life of the patient. If a person suffers from hemorrhoids for a long time, then cracks can even spread to the side walls of the anus.

Like any other disease, fissures can be acute or chronic. With acute fissures, up to 25% of all patients come to the proctologist.

Sharp shape

Main characteristics of acute anal fissure:

  • Severe pain during bowel movements, which subsides on its own after 15-20 minutes. The pain is throbbing.
  • Pain occurs with each contraction of the sphincter.
  • Recurrent bleeding. In this case, the blood will have a bright red light. It can stand out drop by drop, or flow in a jet.
  • During examination, the doctor visualizes an area of inflammation on the intestinal wall. When touched, the patient complains of acute pain.

Chronic form

Characteristics of chronic anal fissure:

  • Mild pain that gets worse after defecation. After a few minutes, they are completely gone. Also, pain will disturb if the stool is disturbed with a diet error and during any straining.
  • Blood seen in stools.
  • Consolidation of the area of the intestinal wall.
  • Normal sphincter tissue is replaced by scar tissue.
  • Symptoms of violation keep repeating.

Predisposing factors

Risk factors for anal fissure:

  • Constipation and diarrhea, that is, any chronic violation of the stool.
  • Diseases of the rectum and large intestine: colitis, hemorrhoids, proctitis, IBS, etc.
  • Crohn's disease.
  • Errors in the diet. The danger is eating s alty and spicy foods, as well as drinking alcohol.
  • Anal sex.

Video: Live He althy “Anus fissure. What causes constipation?:

Causes of anal fissure

The most common causes that can lead to the formation of a crack:

  • Diseases of the gastrointestinal tract:gastric ulcer, gastritis, colitis, hemorrhoids.
  • Anal fissures are found in 95% of patients with inflammation of hemorrhoids.
  • Stool disorders:chronic constipation and diarrhea.
  • Injuries to the rectum. Injury can occur during sigmoidoscopy, anoscopy, colonoscopy, when the doctor inserts the device tube into the intestine with a sharp movement.
  • Other damage to the integrity of the rectum. Most often, such situations occur in people who have anal sex.
  • Pregnancy and childbirth. The growing uterus begins to put pressure on the internal organs that are located below. Under its pressure, the intestines enter, which leads to constipation and increases the likelihood of cracking. Attempts during childbirth also contribute to the violation of the integrity of the anus.
  • Reduced muscle tone of the pelvic floor.
  • Excessive exercise.
  • Diseases such as: anal warts, sphincteritis, dysentery, syphilis, HIV and AIDS, tuberculosis, paraproctitis.

Anal fissure symptoms

Anal fissure symptoms
Anal fissure symptoms

Anal fissure symptoms are as follows:

  • Pain. It will be the more intense, the deeper the defect. At first, pain occurs only during bowel movements, or when it is irritated. As inflammation progresses, pain will be present on an ongoing basis. Pain can have a different character: burning, sharp, pressing, pulling. Spasm of the rectal sphincter often occurs in patients with chronic anal fissure. This leads to increased pain during the act of defecation.
  • Discomfort and itching. Particularly strong discomfort in those patients who wear tight underwear made of non-natural fabrics, as well as in people who sit for a long time, or suffer from stool disorders. The longer the crack, the more itchy.
  • The appearance of scarlet blood. It will be visible on the surface of the feces, and not inside them. Blood is expelled when straining. Venous blood can appear only with a deep lesion of the intestinal wall. In this case, prolonged and massive bleeding may develop.

All of these symptoms can indicate not only an anal fissure, but also much more serious diseases, such as hemorrhoids or even intestinal cancer.

Diagnosis of anal fissure

Diagnosis of anal fissure
Diagnosis of anal fissure

In order to make a correct diagnosis, you will need to undergo the following examinations:

  • Examination of the anus in the doctor's office. Most often, the doctor does not find it difficult to understand that the patient has an anal fissure.
  • Blood test. It is important to evaluate the level of hemoglobin and red blood cells, to exclude anemia, which often develops in patients with anal fissures. This is due to prolonged bleeding.
  • Delivery of feces for a coprogram. This study allows you to exclude inflammation in the intestines, to detect hidden blood in the feces. The Gregersen reaction allows you to clarify whether there is bleeding in the upper intestine.
  • Submission of feces for bacterial culture to detect pathogenic microflora and establish its sensitivity to antibacterial agents.
  • Anoscopy. During the examination, an anoscope is inserted into the anus with which the doctor examines the surface of the intestine.
  • Rectoscopy. A procedure is performed using a proctoscope. It is represented by a tube, which is equipped with a magnifying system and a flashlight. The device is inserted to a depth of up to 35 cm.
  • Irrigoscopy. This is an X-ray examination using a contrast agent.
  • Ultrasound. A device that emits ultrasonic waves is used to assess the condition of the intestine.
  • Detecting the presence of parasite eggs in the feces.

It is important to differentiate anal fissure from pathologies such as:

  • Crohn's disease.
  • AIDS, which can disrupt the condition of any tissues and organs.
  • Hemorrhoidal thrombophlebitis.
  • Fistula in the rectum, which did not lead to its complete perforation.
  • Proctitis and proctosigmoiditis.
  • Actinomycosis (infection of the body with parasites).
  • Gumma (an ulcer that develops against the background of syphilis).
  • Rectal tuberculosis.

To exclude all these diagnoses, a comprehensive examination of the patient is required.

Methods of treating a fissure in the anus

Ways to treat a crack
Ways to treat a crack

The main task facing the doctor is the need to relieve the patient of pain, as well as eliminate the cause of the appearance of anal fissure. This will prevent its reoccurrence.

Methods of treatment that may be indicated for patients with anal fissure:

  • Conservative therapy.
  • Surgical intervention.

Therapy depends on the cause of the cracks and on the intensity of the symptoms of the disorder. Therefore, only a doctor can prescribe treatment after an examination.

Main areas of conservative therapy:

  1. Compliance with dietary nutrition. The diet should include vegetables, fruits, broths, protein foods.
  2. The use of ointments and suppositories, which are aimed at healing tissues and destroying pathogenic flora.
  3. Physiotherapy treatment. Chamomile baths help to cope with anal fissure well.
  4. Taking drugs to relieve constipation and soften stools.

Diet therapy

diet therapy
diet therapy

Patients with anal fissure should avoid eating s alty, spicy, fried, floury, spicy, sour foods and alcoholic beverages. Patients are recommended to eat salads, cereals, fill them with vegetable oil. Useful bran bread (up to 20 g per knock), boiled soups.

To normalize bowel function, you need to include dried apricots, prunes, bananas, figs, boiled carrots, baked apples in the diet. It is also necessary to drink as much water as possible, consume dairy products.

Patients with diarrhea should avoid legumes, cabbage, fresh vegetables and fruits, yeast bread and whole milk.

There are many drugs that can get rid of a fissure in the anus.

Suppositories for anal fissure

Candles for anal fissure
Candles for anal fissure

Suppositories are often prescribed for patients with anal fissure.

The most effective drugs include:

  • Posterized. These suppositories are aimed at increasing immunity, helping to eliminate itching and tissue regeneration.
  • Natalsid. The composition of the drug contains an antimicrobial component. The use of these suppositories allows you to get rid of bleeding.
  • Proctosan. This tool promotes healing of the crack, has a drying effect.
  • Suppositories with propolis. They have an immunomodulatory effect, destroy pathogenic flora, stop the inflammatory response.
  • Ultraproct. These are anti-inflammatory suppositories that quickly stop itching and eliminate pain.

To quickly get rid of the crack, you will need to use candles 2 times a day: in the morning and in the evening.

Ointments for anal fissure

Proctosedyl
Proctosedyl

When the fissure is close to the anus and a person can touch it, doctors recommend using ointments.

The most effective drugs include:

  • Levomekol. This tool allows you to sanitize the affected area from pathogenic flora, eliminate inflammation, restore damaged tissues.
  • Proctosan. This is a drying ointment that helps to stop the inflammatory reaction.
  • Proctosedyl. This drug is prescribed for the relief of inflammation and pain, as well as for tissue regeneration. Its use allows you to relieve itching, reduce swelling and make the patient feel better.
  • Relief. This tool creates a barrier in the form of a film on the surface of the crack. Through it, germs cannot enter an open wound. The use of the ointment can reduce pain, dry the bleeding defect, and accelerate tissue regeneration.
  • Ultraproct. This drug allows you to get rid of pain and itching, promotes tissue repair, eliminates inflammation.
  • Ratovnik. Ointment-balm destroys pathogenic flora, eliminates all discomfort.
  • Nitroglycerin ointment. It promotes healing of the fissure, stops bleeding, improves nutrition of the affected area.
  • Hirudoproct. This ointment strengthens blood vessels, increases local immunity, eliminates inflammation. Thanks to its application, the wounds quickly shrink, they do not suppurate.
  • Bezornil. This is an antimicrobial agent that perfectly disinfects the anus with a fissure. It is also prescribed for the treatment of hemorrhoids.

In addition to the listed ointments, there are other drugs, but the doctor must prescribe them.

Pills and injections for anal fissure

Pills and injections
Pills and injections

If a patient develops sphincter spasm, then Botulinum toxin injections are indicated for him. One injection is enough to relax the muscle. The drug is injected into the lower part of the internal sphincter of the rectum. The dose of the drug should not exceed 20 units.

For the treatment of anal fissure, the patient may be prescribed drugs such as Detralex or Venarus. They are used in both acute and chronic forms of the disease. They help to increase the tone of weak intestinal muscles, relieve swelling and inflammation, and reduce the intensity of pain.

Venarus and Detralex are not prescribed for pregnant and lactating women, as well as the elderly.

Vitamins

Patients with anal fissures are prescribed vitamins A and E. They allow you to restore the damaged mucous membrane of the rectum and improve the condition of the skin.

Laxative

Laxative
Laxative

If a person starts going to the toilet regularly, and his feces are soft, then it will be possible to quickly restore the integrity of the anus and get rid of the crack.

Drugs that help ease bowel movements:

  • Emollients: sea buckthorn oil, vaseline oil, Norgalax. At home, before bowel movements, you can put enemas with sunflower oil and water (100 ml of oil per 200 ml of water). Perform the procedure 10 minutes before the act of defecation.
  • Preparations based on agar or psyllium that increase the volume of feces: Naturolax, Fiberlex, Mucofalk. Preparations containing cellulose: Fibercon, Fiberal.
  • Polyhydric alcohols, which are used more often than others, since they do not irritate the intestinal walls. These are drugs such as: Normaze, Duphalac, Lactulose, Sorbitol, Lactitol, Macrogol.

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Surgical treatment

Indications for surgery for patients with anal fissure:

  • No effect from taking medications (subject to at least 6-8 weeks of therapy).
  • Complaints of the patient about severe discomfort.
  • Complications of anal fissure.
  • Combination of anal fissure and hemorrhoids.
  • Fecal incontinence.

Surgical care for anal fissures can be of the following types:

  • Anal divulsion. This is a kind of "middle" between surgery and conservative therapy. The patient is given anesthesia, after which the sphincter is expanded. This procedure is not prescribed for older people.
  • Cryodestruction. An anal fissure can be treated with liquid nitrogen, but this treatment does not always solve the problem.
  • Sphincterotomy. During the operation, the fissure is excised. If the patient has a spasm of the sphincter in parallel, then it is subject to dissection. Recovery takes up to 6 days. After this time, dressings with Levomekol are required.

The sooner treatment is started, the sooner it will be possible to cope with an anal fissure. If a person does not delay going to the doctor, then it will be possible to get rid of the problem with the help of conservative therapy.

Intestinal ozone therapy - will it help?

Intestinal ozone therapy
Intestinal ozone therapy

Ozone therapy used to be used only in cosmetology, but doctors borrowed this method to treat the intestines. It involves taking 8 ml of blood from a patient, after which it is separated into plasma and erythrocyte mass in a centrifuge. The plasma is additionally enriched with biologically active substances and platelets, after which it is injected into the patient in the area under the anal fissure. This allows tissues to recover faster.

Plasma can be enriched with ozone, which will increase the therapeutic effect and further stimulate the patient's immune system. Ozone therapy for anal fissures is actively used in various countries. In recent years, this method has begun to gain popularity in Russia.

Doctors' opinion

Zagryadsky A. E (Professor, Doctor of Medical Sciences, member of the Russian Academy of Medical Sciences, Head of the Department of Proctology of the MC ON CLINIC): “There are clear protocols for the treatment of anal fissures. Ozone therapy is not included in these protocols. In order for the patient to recover, it will be necessary to normalize the stool, relieve spasm from the sphincter, stimulate tissue healing, and increase blood circulation in the capillaries. To achieve the last goal, phlebotonics are prescribed: Phlebodia or Detralex.”

Lagodich L. G (surgeon, traumatologist, proctologist): “It will not be possible to cope with an anal fissure with one single method. A comprehensive approach is needed.”

Laser and other minimally invasive surgeries

Laser and other minimally invasive surgeries
Laser and other minimally invasive surgeries

Minimally invasive techniques are increasingly being used to treat anal fissures. They are not associated with the risk of complications and allow you to quickly get rid of the existing problem.

Procedures that can be used to treat anal fissure:

  • Laser treatment.
  • Electrocoagulation of cracks.
  • Treatment of cracks with ultrasound.

Laser treatment is used more often than others.

How to cure anal fissure after childbirth?

How to heal a crack
How to heal a crack

Anal fissures often occur in women after childbirth. During attempts, the anus experiences enormous loads, and the perineum is stretched. As a rule, obstetricians do not treat cracks, but after 2 days a woman experiences pain when trying to empty her intestines. To soften the feces, it is required to take drugs that do not penetrate into milk, or do not enter the systemic circulation. You can’t ignore the problem, you need to contact the doctor with it.

Treatment comes down to the use of suppositories with sea buckthorn, Duphalac, Methyluracil. Sometimes doctors prescribe Posterizan suppositories, and for the treatment of the skin around the anus, Emla and Cathejel gel.

It is important to start treatment immediately after delivery. If the defect does not pass for more than 3 months, then the edges of the crack become keratinized, and metabolic processes in the affected tissues slow down. In such a situation, the help of a surgeon may be required.

Anus fissure in a child

Fissure of the anus
Fissure of the anus

Anal fissures are common in children. The child will suffer from acute manifestations of the disease, the process is rarely chronic. Parents should pay attention to the refusal of the baby to go to the toilet, or to his long pastime on the potty. At the same time, he can cry and act up. If adults find an anal fissure in a child, you need to see a doctor.

A child suffering from constipation is prescribed Duphalac (Lactulose). It will be necessary to follow a diet, offer the baby a varied and plentiful drink. Older children should eat soups. If constipation is of a neurological nature, then you need to consult a neurologist. The doctor may prescribe sedatives suitable for children to treat the patient.

In some cases, you need to get rid of worms, treat dysbacteriosis.

If the baby is haunted by diarrhea, then he is prescribed Stop-diar and Ersifuril. Macrophages can also be used. Eubiotics are taken within a month after the completion of the main therapy.

To facilitate the passage of feces, children under one year of age are prescribed suppositories with sea buckthorn oil. They are divided into 2 parts and used 2 times a day. Children older than a year are inserted into a whole candle in the morning and evening. Baths with disinfecting herbs, such as chamomile or calendula, promote the speedy healing of cracks.

Oflokain is prescribed to anesthetize the affected area. It contains an analgesic and an antibiotic. Levomekol is prescribed for up to 7 days, this ointment allows you to accelerate healing. The dose must be strictly observed, as the drug can cause anemia and lead to a decrease in the level of leukocytes in the blood.

Candles or Aurobin ointment can be used for 5 days. Children are inserted by? candles, or apply 0.5 cm of ointment. In addition, drugs such as D-panthenol, Methyluracil, Bepanten can be used in childhood.

Prevention

Prevention
Prevention

To prevent the formation of anal fissures, you need to follow simple recommendations:

  • Empty your bowels on time, get rid of diarrhea or constipation.
  • Play sports, swim, walk as much as possible.
  • Drink at least 2 liters of water a day.
  • Observe the rules of personal hygiene.
  • Treat all diseases of the gastrointestinal tract in time.
  • Don't try to cope with diseases on your own.

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