An anal fissure is an anatomical slit-like defect in the mucous membrane of the anus, usually along the posterior wall.
A crack manifests itself with subjectively unpleasant symptoms, pain, impaired bowel movements and the formation of a fear of the toilet.
Due to the delicacy, the problem is often triggered, leading to complications in the form of chronic ulcers, infection and suppuration.
Among proctological pathologies, anal fissure is one of the most common problems, second only to hemorrhoids. Most often occurs in women between 25 and 45 years old.
Most often, the disease occurs as a result of excessive stress on the sphincter area with frequent diarrhea or constipation, trauma to the sphincter with hemorrhoids, with tension during hard physical work. Also, a provoking factor is sedentary work, alcohol intake, spicy and irritating food, mechanical trauma to the anus with dense feces, foreign objects, anal sex can also lead to the development of anal fissures.
The factors contributing to the development of the process are inflammatory diseases of the colon, the formation of hemorrhoids, proctitis, colitis. In most cases, cracks occur in diseases of the digestive system, from the stomach to the liver and pancreas.
Anal fissures are divided according to the duration of the course into:
- acute, which have recently formed and have a bright clinic,
- chronic, existing for a long time, with periods of exacerbations and remissions.
By localization, they are divided into:
- median, localized along the posterior wall of the anus, along the midline, where blood circulation is weakest and the tension in the wall is strongest during physiological processes.
- mixed, occurring simultaneously in the front and rear walls.
Sharp fissures of the anus are characterized by:
- pain during and after bowel movements;
- the formation of a reflex spasm of the anus;
- the presence of bloody discharge from the anus.
Symptoms of the acute process are quite bright and specific, with the prolonged existence of an anal fissure, severe pain occurs, radiating to the perineum and sacral region, prolonged spasm of the sphincter after emptying the intestines, which in the future can persist for some time, and sometimes until the next stool.
Since the muscles of the sphincter are spasmodic and in good shape, the process is aggravated, since with spasm ischemia occurs (insufficient blood content in the tissue caused by narrowing of the lumen of the artery), which prevents the damaged anus from healing.
Because of the pain, patients often deliberately retain stool, which leads to complications – persistent constipation with very dense feces is formed.
After defecation, blood appears at the site of the crack – scanty discharge with scarlet blood on toilet paper or bloody streaks on the surface of the stool.
Without treatment, within 3-5 weeks, the acute form becomes chronic, there is a thickening and swelling along the edges of the crack, a rough scar and a “sentinel tubercle” are formed along the inner edge.
At the same time, the nature of the pain changes – it occurs after a chair and persists for a long time after it, increasing when a sitting position.
Pain in such a delicate area often leads to problems with sleep and neurosis, there is a fear of the toilet, patients who do not seek treatment constantly take laxatives or refuse to eat.
The spasm of the sphincter during the chronicity of the process will not be very pronounced, it does not persist for a long time, but itching in the anus may occur, inflammatory processes in the rectal region, suppuration and swelling of the fissure, discharge of ichor or pus, blood from it are formed.
Usually, an anal fissure is easily detected by the patient himself or by a doctor when examining the anus. For a detailed examination, it is necessary to push the buttocks apart and examine the area of the anal sphincter, on which, when the walls of the anus are diluted, a defect in the mucous membrane or deeper damage is revealed.
Sometimes a proctologist can conduct a digital rectal examination to determine spasm of the sphincter, but with deep defects such manipulation is not applicable.
Additionally, anoscopy and sigmoidoscopy with anesthesia are used with concomitant bleeding and suspected complications. All instrumental methods are applicable for fracture healing to control the healing and the absence of complications.
It is necessary to distinguish a fissure of the anus from internal fistulas in the rectal region, as well as from specific fissures of syphilitic, tuberculous, parasitic or fungal origin.
The same symptoms can be signs of different diseases, and the disease may not proceed according to the textbook. Do not try to heal yourself – consult your doctor.
Anal fissures are treated by proctologists and surgeons. Therapy can be conservative and operative, depending on the severity and duration of the process. In the acute stage, conservative treatment is carried out to relieve pain and sphincter spasm, and normalize the stool.
First of all, normalization of nutrition is carried out to activate the work of the intestines and soften the stool, establish its regularity – increase the volume of fiber, fermented milk products and activators of peristalsis.
Avoid spicy, salty, bitter foods and annoying condiments, and alcoholic beverages (including beer).
Boiled beets in the amount of 200-300 g, minced or finely chopped and seasoned with vegetable oil or sour cream, give a very good effect in terms of regulating the activity of the intestines.
In addition, it is recommended to eat prunes, apricots, dried apricots and figs, which, after washing, are poured with boiling water and, after swelling, are introduced into the diet 2-3 times a day. A similar diet provides soft stools in most patients. A vinaigrette filled with sunflower oil, containing boiled beets, cabbage, carrots, can give a satisfactory effect.
Local and general therapy is also used. First of all, these are baths with potassium permanganate, nitroglycerin ointment to relax the sphincter, suppositories and ointments with anesthetics (lidocaine, novocaine), sea buckthorn oil or methyluracil.
With old cracks, infrared coagulation, radio frequency or laser coagulation, drug blockade are used, and if ineffective, surgical treatment is used.
Surgery is indicated for deep non-healing defects with cicatricial changes, with significant spasm, with ineffectiveness of conservative methods. Excision of the crack is performed with simultaneous excision of hemorrhoids.
An anal fissure itself is unpleasant, however, complications such as inflammation of the intestine, suppuration and paraproctitis, and bleeding are also dangerous. Therefore, immediate treatment is necessary immediately after the diagnosis is made. On average, the acute phase is cured in 1-2 weeks, the chronic one – up to several months.
For life, the prognosis is favorable, but there may be relapses with constipation or bowel disease.