If there is a fissure in the anus, treatment should begin immediately. This will prevent the defect from increasing in size and becoming infected, which can lead to the development of an inflammatory process. Only a doctor can develop a treatment regimen based on the results of an examination and a complete examination of the patient. In no case should you use medications without consulting a specialist, so as not to provoke serious complications.

Clinical manifestations of pathology

With anal fissure, the symptoms of the disease differ in very specific manifestations. There are 3 main signs, which include the occurrence of severe pain in the rectal area, bleeding and anal spasms.

Cracks in the anus very often appear in parallel with the development of varicose veins of the pelvic organs. Therefore, prolapse of hemorrhoids may additionally be present.

Anal fissure can be acute or chronic. This determines the clinical symptoms of the disease.

An acute fissure is characterized by the appearance of sharp pain in the anus. As a rule, this occurs at the end of a bowel movement. The discomfort disappears quite quickly. Symptoms of an anal fissure include spasm of the rectal sphincter, which manifests itself as difficulty in the free passage of feces. A rather specific sign is the appearance of fresh blood, especially with constipation, when damage to the walls of the defect occurs during the passage of hard feces.

Chronic anal fissure has similar symptoms. The pain is characterized by less intensity and appears periodically. However, the unpleasant sensations persist for quite a long time after defecation, which provides severe discomfort while moving and performing any work. A person tries to prevent constipation from occurring, as this threatens to worsen the disease. Against this background, the patient begins to uncontrollably use various laxatives, long-term use of which can disrupt the normal balance of intestinal microflora.

Principles of therapy

How to cure a fissure in the anus? If unpleasant symptoms occur that indicate a violation of the integrity of the rectal mucosa, you should immediately consult a doctor. This will prevent the progression of the pathology and transition to the chronic stage.

It is not recommended to try to get rid of the problem on your own, since the treatment of an anal fissure must be comprehensive. Only a specialist can develop the necessary therapeutic regimen with which you can get rid of the pathology.

Rectal suppositories are most often used to treat the disease. Thanks to local application, the medicine acts directly on the defect in the rectal mucosa, promoting its speedy healing and restoration of integrity. In complex therapy, ointments are necessarily used, especially when the fissure is localized in the anus.

The use of alternative medicine methods shows good results. However, their use must be agreed upon with a specialist.

How to cure anal fissure? To achieve a quick recovery, you need to follow your doctor's recommendations. Even if you feel better and clinical symptoms weaken, therapy should not be interrupted under any circumstances. This threatens the rapid development of relapse.

The use of rectal suppositories

How to treat anal fissures? The necessary medication must be prescribed by a doctor based on the results of examination and examination of the patient. It is advisable to use suppositories after defecation, so that the drug has an effect directly on the pathological focus, and the active substance does not mix with the feces.

To cleanse the intestines, you can do a cleansing enema. This will ensure the maximum therapeutic effect from the use of rectal suppositories.

Basic remedies for treating anal fissure without surgery:

Application of ointments How to treat an anal fissure in an adult if it is located in the anus?

To treat the defect, it is advisable to use an ointment that has not only anti-inflammatory, but also regenerating properties. The medicine should be applied to the site of injury after defecation and hygiene procedures. The ointment should be used not only externally, but also on the anal sphincter. To do this, you need to apply the medicine to a cotton swab and insert it into the anus to a depth of about 1 cm. Symptoms and treatment of the disease are interconnected. Based clinical picture and the patient’s complaints, the doctor decides on the need to prescribe certain.

For the treatment of anal fissures, the following drugs are mainly used:

1. Aurobin ointment. A combined drug that contains the glucocorticosteroid Prednisolone, the anesthetic Lidocaine and Dexpanthenol. This causes analgesic, anti-inflammatory, antipruritic, regenerating and restorative effects.
2. Cream Bepanten, Pantesol, Dexpanthenol. Used to quickly restore the integrity of the skin and mucous membranes.
3. Solcoseryl. Provides the necessary nutrition to tissues, resulting in rapid healing of the wound.
4. Methyluracil ointment. Reduces the severity of the inflammatory process and has an immunostimulating effect.
5. Emla. A strong pain reliever that contains lidocaine and prilocaine. It is used for severe spasm of the rectal sphincter and the patient’s obvious fear of defecation. At the same time, the ointment has a large number of contraindications for use.

Traditional methods of treating the disease

How to treat anal fissure using alternative medicine? For this purpose, you can use the healing properties medicinal plants and some vegetables.

Good results in treating the disease are shown by candles made independently from propolis. The beekeeping product has unique anti-inflammatory, antiseptic, regenerating and restorative properties. To prepare a suppository, you need to place a small amount of propolis in the freezer, and after completely freezing, grind it using a coffee grinder. Pour the mixture with cold water in a ratio of 1:10 and mix well. Place the product in special molds for making candles or form them yourself and wrap them in parchment paper. Place the finished medicine back in the refrigerator to harden. Before use, the candle should be immersed in warm water for a few seconds to avoid discomfort when the medicine is administered into the rectum. The duration of such therapy is at least 7-10 days.

Beetroot can be used to treat anal fissure. A small piece should be cut out of the vegetable, resembling the shape of a standard suppository. Its length should not exceed 5 cm, and its width should not exceed 1.5 cm. Inject the product into the rectum at night, and in the morning it will come out on its own during bowel movements. After this, you need to carry out hygiene procedures and lubricate the anus area with sea buckthorn oil.

To speed up recovery in complex treatment, you can use sitz baths based on decoctions of medicinal herbs. The collection, which includes chamomile, nettle, plantain and oak, has anti-inflammatory, wound-healing, regenerating and analgesic effects. All components must be mixed in proportions 1:1:3:2, take 2 tbsp. l. mixture and pour 1 liter of boiling water. Leave the mixture for 10-15 minutes, strain and cool slightly. Pour the solution into a basin or other suitable container and use it for sitz baths. It is necessary to ensure that the temperature of the liquid is not too high to prevent skin burns. This type of therapy lasts 7-10 sessions.

Treatment of anal fissure at home should be carried out under the supervision of a specialist. If there is no positive result, you should consult your doctor again to adjust your prescription.

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.

The anal fissure itself, the symptoms and treatment of which we will consider, can be an independent phenomenon that arises as a result of the influence of various traumatic factors. However, much more often painful defects of the rectal mucosa 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

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 its posterior 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. In women, the weak point of the anal canal is its anterior 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. Diseases of the digestive system– various, can lead to the formation of anal fissures. Statistics show that 95% of patients suffering from inflammation of hemorrhoids have anal fissures.
3. Disorders of the cardiovascular system and related diseases (congestion in the pelvic and rectal areas, obliterating atherosclerosis, aneurysms, etc.).
4. Chronic diseases of the upper gastrointestinal tract(gastritis, stomach ulcer,).
5. Pregnancy and childbirth– the pressure of the growing uterus on the internal organs, including the large intestine, leads to problems with bowel movements, resulting in expectant mother Anal fissures may appear. This pathology is not uncommon in young mothers - the appearance of anal fissures is facilitated by perineal ruptures received 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 contacts a specialist in time, then ointments or suppositories are prescribed to treat anal fissure at home, and only in advanced cases is surgery suggested. Microcracks can be several millimeters in size, 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 a 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 is faced with the disease, it is very important to start treatment in a timely manner so that the crack does not become chronic and does 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 after childbirth becomes permanent, 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 or walking. In addition to itching, discomfort and bleeding, panic fear of the toilet is added.

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 of the anal sphincter.
3. Colitis (inflammatory disease of the inner lining of the 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 the clinical manifestations and 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 waste products. The product increases immune defense 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, for problems with the anal sphincter, counter microenemas are used 10 minutes before bowel movement (100 ml of pasteurized sunflower oil and 200 ml of boiled water at 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 enhance its therapeutic effect, you can dip it 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 of sea buckthorn oil and chamomile flower infusion, carefully introduce the mixture into the anus while warm using a syringe and hold it until you have enough 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 of herb), 1.5 cups of 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. And daily intake of fermented milk products gives 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 (dietary fiber), which aids digestion.

Surgery

In some cases, extensive and difficult to heal anal fissures 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 a fissure using diet, hygiene procedures and medications at home can help alleviate the symptoms of the disease within a few days and lead to a complete recovery in 4-8 weeks.

The complexity of surgical treatment of anal fissure and the duration of the recovery period after surgery depend on the degree of development of the disease and the type of operation performed.

Anal fissure is one of the diseases that is not commonly discussed. Indeed, not every person admits that he has problems with the anus. And yet, such a disease exists, and millions of people suffer from it. According to statistics, the disease ranks third among proctological diseases after hemorrhoids and paraproctitis. The disease can affect people of any age and gender. Women get sick somewhat more often than men, and children - less often than adults.

Description of the disease

An anal fissure (anal fissure, rectal fissure) is a narrow and long defect in the mucous membrane of the anus. At this point, the mucous membrane seems to be torn into pieces, exposing the muscle layer. The length of the anal fissure is usually small - no more than 2 cm. The width and depth are several millimeters. Cracks may not form anywhere in the anus, but only on its front and back walls. Anterior localization of the crack is much more common in women than in men, which is associated with biological features body structure of the weaker sex. Rarely, a crack occurs on the lateral surfaces of the anus.

The disease has two main forms - acute and chronic. A crack that has appeared relatively recently is called acute. A sharp crack can heal if conditions are favorable. But without proper treatment, an acute crack can become chronic after a few weeks.

A chronic fissure is characterized by rougher edges and small bumps at the beginning and end. A chronic fissure almost never goes away on its own and requires surgery to treat. Although the disease may experience remissions, one should not hope that they will lead to a complete cure. Under certain circumstances (diet violation, constipation), the disease may return with renewed vigor. In most cases, an anal fissure is accompanied by sphincter spasm, which makes defecation even more difficult, especially during constipation.

Complications

With each act of defecation, an unhealed fissure is exposed to feces. This is especially dangerous with constipation, when the stool is hard. In addition, a huge amount of bacteria settles on the crack (as is known, more than half of human feces consists of bacteria). This leads to even greater inflammation of the wound.

Untreated fissures located in the anus can lead to serious complications - acute purulent paraproctitis, the formation of fistulas, trophic ulcers, massive bleeding, gangrene and sepsis. In men, anal fissures increase the likelihood of prostatitis.

Symptoms

Photo: Brian A Jackson/Shutterstock.com

Cracks in the anus make themselves felt by severe pain that appears after using the toilet or during the act of defecation itself. The pain is usually acute and resembles the sensation of having broken glass in the anus. The pain syndrome associated with a crack can persist for a long time, intensifying with prolonged sitting. It can lead to neurotic states and insanity. The patient may also develop a peculiar fear of defecation. This leads to even more severe constipation, which in turn further aggravates the disease.

Another important sign is bleeding during bowel movements. It can be either minor, consisting of a few drops of blood, or serious, leading to anemia. It all depends on the nature and size of the crack.

The disease can affect a person's lifestyle. The inability to sit painlessly entails the inability, for example, to engage in sedentary work. And the loss of a job already aggravates the patient’s unfavorable mental state.

Causes

The immediate causes of the disease can be divided into mechanical damage to the anal passage and damage to the mucous membrane as a result of sphincter tension.

Mechanical damage can occur:

• during defecation - due to damage to the mucous membrane by solid objects found in the stool
• during anal sex
• during instrumental examinations of the rectum, a crack may appear as a result of unskilled actions of a medical professional

Tears of the mucous membrane due to muscle tension mainly occur when pushing during bowel movements. Also, quite often, rectal fissures can occur in women during childbirth.

It has long been established that the main factor provoking the appearance of a fissure is chronic constipation. Constant efforts during bowel movements lead to increased tension in the muscles of the anus. In addition, hard feces have a negative impact on the condition of the anal mucosa. All this can lead to its rupture and crack formation. Somewhat less often, cracks can form as a result of diarrhea.

Some experts believe that hemorrhoids also contribute to the formation of anal fissures. Although there is another point of view, which is that hemorrhoids do not affect this process in any way. These two diseases have many similar symptoms, but generally different etiologies, and their treatment approaches are also very different. However, it is not uncommon to find both diseases present in one patient.

Factors also contributing to the occurrence of the disease are:

• drinking alcohol, eating too fatty, spicy or salty foods
• sedentary work
• lifting weights
• sedentary lifestyle
• diseases of the lower intestines - colitis, proctitis, irritable bowel syndrome

In addition, diseases of the upper gastrointestinal tract - stomach and duodenal ulcers and gastritis, cholecystitis, blood diseases that lead to impaired coagulation and stagnation in the lower parts of the body - contribute to the formation of cracks, although to a lesser extent.

Separately, it is worth mentioning pregnancy and the birth process. These factors can also contribute to the appearance of fissures in the anal area. In the first case, the reason is an increase in the size of the uterus and the associated difficulty in defecation. This weakens the anal area, and childbirth, accompanied by pushing, can cause damage to the anal mucosa. Of course, in the first days after childbirth little attention is paid to this circumstance, but at the moment of the first bowel movement it will inevitably make itself felt.

Anal fissures in children

This disease is more common in adults, but its occurrence in children cannot be excluded. In this case, it may also be associated with constipation, as well as the fact that in children the excretory organs are not yet fully formed. Therefore, even relatively mild constipation can cause damage to the child's anal area. Symptoms of an anal fissure in young children may include fear of the toilet, blood in the stool.

Photo: filippo giuliani/Shutterstock.com

Diagnostics

When pain occurs in the anus, the patient is naturally unable to determine the cause of the syndrome and make a diagnosis, and, moreover, determine the size and shape of the crack. Therefore, it is recommended to immediately contact a proctologist so that he can analyze the symptoms and prescribe treatment. In most cases, cracks are clearly visible upon visual inspection. In some cases, palpating the anus may be necessary, but this operation may be difficult due to extreme pain for the patient and spasm of the sphincter. Also used for diagnosis are sigmoidoscopy (examination of the anus area 20 cm deep) and colonoscopy. When diagnosing, it is necessary to differentiate a fissure from hemorrhoids, proctitis and paroproctitis, erosions, polyps and tumors.

How to treat the disease

Treating a fissure in the anus, especially one that arose long ago and is large in size, is a difficult task. Nevertheless, a complete cure for the disease is possible, although it requires significant effort, both on the part of the patient and on the part of doctors.

Unlike many other diseases, with anal fissure, the acute form of the disease is treated conservatively, and the chronic form is treated surgically.

If a small anal fissure, a microcrack, occurs, it is better to let it heal on its own. Such cracks can heal in a few days, provided that they do not become re-irritated. This can be achieved if stool does not form and does not come out. That is, you can go on a diet for several days and wait until the crack heals itself.

However, as a rule, the anal fissure is too large and will take too long to heal. In the case of a large crack, a complex treatment method is used, which includes:

• drug treatment
• diet
• lifestyle change

How to treat the disease

Conservative treatment of cracks is carried out using a comprehensive and gradual method. Practice shows that effective treatment diseases can be treated at home. In the presence of severe pain and sphincter spasm, painkillers and antispasmodics are first used, and then wound healing agents are used. In most cases, treatment can be carried out at home and hospitalization is not required. The duration of conservative treatment depends on the severity of the disease and the chosen course of therapy and can take from 2 to 8 weeks. Medicines that are used for fissures can be delivered to the anus either directly or taken in the form of tablets.

Photo: i viewfinder / Shutterstock.com

Of the tablet medications, laxatives should be noted first. These drugs can be prescribed in case of illness caused by constipation. As a rule, senna-based drugs are the most effective, but they are contraindicated for irritable bowel syndrome. In this case, it is best to use preparations based on plantain seeds and artificial cellulose. You can also use laxatives based on polyhydric alcohols, such as Duphalac.

Antispasmodic medications, such as drotaverine, can also be taken in tablet form. Antibiotics in tablets for anal fissures are usually not prescribed, since local remedies are much more effective.

Main forms for rectal treatment:

• baths with bactericidal solutions
• candles (suppositories)
• ointments and creams
• microenemas

The choice of dosage form is dictated by the circumstances of the disease and accompanying symptoms. In case of severe pain, it is difficult to use suppositories, and in case of discharge from the anus - ointments. In some cases, injections of painkillers and antispasmodics are indicated.

An anal fissure, in its etiology, differs little from an ordinary wound, and when treating it, similar principles must be observed. In this case, however, two unfavorable factors should be taken into account that complicate the treatment of the fissure - the sphincter spasm accompanying the disease and the constant infection of the wound area with pathogenic bacteria. Therefore, drugs used in the treatment of cracks must perform two functions - relieve muscle spasms and have strong anti-inflammatory and bactericidal properties.

Ointments

Ointments should usually be applied to the area around the anus once or twice a day after bowel movements. There are antispasmodic ointments and ointments with a predominantly wound-healing effect.

Among local antispasmodics, nitroglycerin ointment 0.2% has proven itself well. This ointment is not sold in a pharmacy in finished form, but is prepared in a pharmacy upon presentation of a doctor's prescription.

Among the new treatment methods, ointments containing botulinum toxin, which relieve vascular spasms, should be noted.

For antiseptic purposes, an ointment for cracks with strong antibiotics is used, for example, Levomikol, containing chloramphenicol. Ointments based on sea buckthorn oil, Relief ointment, and Argosulfan have also proven themselves well. The drugs Actovegin and Solcoseryl, which stimulate healing processes, have shown high effectiveness.

Also worth noting are the ointments Ultraproct, Aurobin, Dexpanthenol, Bepanten, Methyluracil.

Suppositories

Healing suppositories are considered the most effective dosage form for treating cracks. If there are no contraindications for use, then it is preferable to opt for them. Crack suppositories are usually used after bowel movements once or twice a day. Most of them have a wound-healing effect, and many suppositories also have laxative properties. Some drugs may have an effect that stimulates local immunity. For example, Posterizan suppositories contain killed bacteria that cause a response immune system. This drug also has a wound healing and analgesic effect.

Many suppositories also have an analgesic effect. Among them it is worth noting Proctoglivenol, Ultraproct, Anestezol, suppositories with ichthyol, belladonna extract.

Relief suppositories, containing shark liver components, have both anti-inflammatory, analgesic and hemostatic effects.

Not all suppositories are suitable for use in childhood and pregnancy. Anti-inflammatory suppositories Natalsid are among the drugs approved during pregnancy.

You can also note Methyluracil - suppositories that are well suited for wound healing and have immunomodulatory properties, Hepatrombin - suppositories with a hemostatic and healing effect

Baths

For acute cracks, it is recommended to take baths every day, preferably in the evening, with disinfecting solutions, for example, a solution of potassium permanganate. The water temperature should be +40 ºС. Baths with plain warm water can also be performed, which help relieve spasms. The duration of the procedure is 10-20 minutes.

Enemas

For anal fissures, microenemas containing sea buckthorn oil and chamomile decoction help well. This mixture must be injected into the anus in a volume of 50 ml. The procedure is carried out daily for two weeks.

To facilitate stool, you can use counter enemas, administered 10 minutes before. before defecation. They contain 100 ml of pasteurized sunflower oil and 200 ml of boiled water.

Diet

The diet is primarily aimed at eliminating the main cause of the disease – constipation. Indeed, no matter how effective treatment with ointments and suppositories is, it will be completely pointless if the next stool leads to severe tension in the sphincter and an even greater increase in the size of the crack in the anus.

Photo: Barbara Dudzinska / Shutterstock.com

The diet must be selected individually, since different foods have different effects in different cases. However, most experts agree that it is best to remove fatty, fried, pickled and sweet foods, smoked foods from the diet and consume more plant fiber contained in vegetables and fruits, and dairy products. For meat, it is preferable to eat chicken and lean beef. You should also reduce the amount of white bread in your diet, replacing it with bran bread and drink more liquids (except coffee and alcohol).

Lifestyle change

You should give up a sedentary lifestyle and exercise more physical activity to avoid stagnation in the lower part of the body. Even simple walks can have a positive effect on the treatment of the disease.

Surgery

If conservative treatment is ineffective, as well as when the disease enters the chronic stage, which usually occurs a month after the formation of a fissure in the anus, it is indicated surgical treatment. As a rule, the operation consists of removing scars and bumps along the edges of the crack that interfere with its healing. The operation can be performed as traditional way, and with the help of a laser. If sphincter spasm interferes with the treatment of the fissure, then sphincterotomy is performed - partial cutting of the sphincter muscle fibers.

Prevention

Compliance with preventive measures to prevent the disease will be useful not only for those who have already recovered from the disease, but also for those who have never encountered it.

The risk group includes people who lead a sedentary and sedentary lifestyle and suffer from constipation. Prevention of cracks largely coincides with the measures that are used in their treatment. First of all, it is aimed at preventing constipation. It is necessary to be physically active, move more, eat a varied diet, little by little, but as often as possible. Chewing food thoroughly is important, as hard, undigested remains increase the likelihood of injury to the anus. Therefore, it is necessary to treat diseases of teeth and gums in a timely manner. Anal sex should also be avoided.

The incidence of anal fissure in proctology is in 3rd place after hemorrhoids and paraproctitis. The pathology does not lead to death, but is quite capable of worsening the quality of life or even leading to disability.

Rectal fissure (otherwise known as “anal fissure”) has been described in medicine for a very long time; currently there are a huge number of medications for the treatment of this pathology. In the most severe situations, surgical treatment is possible, which, in most cases, eliminates the effect, but does not in any way affect the cause. Rectal fissures are more common in women than in men. The age range is from 18 to 65 years; a fissure in the rectum sometimes develops in infants and children, for which there are reasons, which we will discuss below.

What is a rectal fissure?

An anal fissure is a vertical defect, no more than 2–2.5 cm long, 5 mm wide and 2–3.5 mm deep, although these figures are very average.

Location – mucous membrane of the outer part of the rectal outlet at the border of the skin and mucous membranes.

The erosive surface has a variety of shapes: strip-shaped or rounded.

The appearance of a fissure in the anus in an adult is facilitated by anatomical and physiological features and the structure of the sphincter.

In women, defects in the anterior part of the anus are more common; in advanced stages of the disease, the formation of multiple cracks is possible.

ICD code – K60.0

Causes of formation of rectal fissures

The reasons leading to the formation of anal fissures are very diverse, and are conventionally divided into main and accompanying ones.

The main reasons include:

Mechanical damage.
Influence of infectious factor.
Neuro-reflex.

Mechanical theory

In the basis of the mechanical theory, a key role is assigned to damage to the mucous membrane. This is possible under the following circumstances:

1. Errors in nutrition (passage of bones and seeds through the anus that can injure the mucous membrane during defecation).
2. Tendency to constipation.

Hard stool caused by constipation can seriously injure the rectum.
The mechanical theory explains the causes of anal fissures in children, but is not always a fundamental factor in adults.

Infection theory

An infectious-inflammatory process in the anal canal, with a weakened general status and disruption of the immune system, in 90% of cases will lead to the formation of a defect in the area of ​​the external opening of the rectum.

The appearance of a fissure is also promoted by chronic inflammation in the anal glands, which often results in the replacement of functional tissue with rough tissue that does not have sufficient elasticity.

In this case, for the formation of a rectal fissure, a simple stretching of the anal sphincter with feces is sufficient.

Specific infections of the perianal area (syphilis, gonorrhea, etc.) lead to the replacement of “good” tissue with connective tissue.

Often an anal fissure forms after a rectal abscess or putrefactive paraproctitis.

Neuro-reflex theory

The neuro-reflex theory is based on the hypothesis that the role in the formation of the defect belongs to inflammatory damage to the nerve endings responsible for this area.

Contributing factors:

Constipation,
diarrhea,
iatrogenic damage to the rectum during medical procedures and manipulations,
anal sex.

Favorable background diseases for the appearance of anal fissures

Risk factors for the formation of anal fissures include:

Haemorrhoids,
paraproctitis,
diseases accompanied by itching of the anal area (psoriasis, allergic manifestations, helminthic infestations, etc.),
HPV infections (formation of urogenital papillomas),
colitis (especially ulcerative colitis),
acute intestinal infections accompanied by prolonged diarrhea,
AIDS,
tuberculosis of the intestines,
leukemia,
intestinal diverticula.

What are the types of anal fissures?

By clinical course Anal fissures are divided into acute and chronic.

In a healthy person, an acute fissure can heal on its own within a few weeks, while a chronic fissure can periodically make itself felt, since complete scarring of the defect is impossible.

A chronic crack has clear boundaries with specific ridges. Upon examination, the proctologist sees a tissue defect, in the depths of which the bright red color of the muscle layer is visualized.

During treatment, the bottom of the crack begins to become covered with granulations, which indicates the beginning of the regeneration process.

Due to natural needs, the defect is constantly stretched and torn, sphincter muscles spasm with excessive blood flow and inflammation occurs, this is the main reason for the transition of an acute fissure to a chronic one.

Symptoms of the disease

The symptoms of anal fissure for the acute and chronic stages are similar, but differ in the degree of severity and duration of manifestation.

There are 4 classic signs of an anal fissure:

Pain in the anus.
Spasmodic anal sphincter.
Bleeding from the rectum.
Itching in the anus.

Characteristics of pain in acute and chronic anal fissure

Pain in acute pathology is sharp, severe, concentrated in the area of ​​the external opening of the rectum, tends to intensify during emptying and persists after.
The pain radiates to the perineum, lower abdomen, lumbar region, and sacrum.

Painful sensations are always associated with mechanical impact on the wound. For a chronic course, the intensity of pain is less pronounced; pain can also appear outside the act of bowel movement, for example, after sitting on a chair for a long time.

The pain from a chronic fissure can last for several days and is dull, aching in nature, intensifying at the time of stool passage.

There may be a lull for 20-30 days, then the situation repeats again.

In order to reduce pain, people resort to various measures, for example, taking a forced position, but even this does not always alleviate the suffering of patients.

Some patients, due to constant pain, develop depressive states.

Characteristics of sphincter spasm with anal fissure

Sphincter spasm is caused by pain and is a leading factor in the formation of a “vicious circle”. If you stop the spasms, the pain will decrease.
These factors interfere with self-regeneration processes.

Pain increases contractions of the heart muscle, which further increases spasm.
If the pathology persists for a long time, muscle fibers undergo atrophy and are replaced by non-functional tissue.

Bleeding and itching

The anal fissure is not always accompanied by bleeding. But if the disease is complicated by a ruptured vessel, scarlet blood appears on the stool, napkin, underwear, and toilet.

Some patients clearly say which side of the stool there was blood on, this makes it easier to diagnose an anal fissure.

Other unpleasant symptoms of the disease include debilitating itching of the anus and weeping, which is more typical for a chronic fissure.

What does a rectal fissure lead to without treatment?

If the problem is not given due attention, the consequences can be very disastrous.

Complications of anal fissure are as follows:

Tendency to chronic constipation
irregular menstruation,
formation of a fistula tract.
fibrosis of the anal sphincter.
abscess,
paraproctitis.

If fibrosis has formed, then the most reasonable choice would be to refuse conservative therapy and perform surgery.

Diagnostic measures

Diagnosis is based on medical history, examination and instrumental examination. As a rule, this is enough to establish the correct diagnosis.

The examination is sometimes carried out on a chair, the patient is in a supine position with his legs apart. For better visualization, he is asked to push, since the crack is covered by folds of skin in the perianal area. Some doctors prefer to examine the patient in the knee-elbow position.

If the pain syndrome is severe, any tension in the abdominal wall muscles will lead to increased pain.

Sometimes the patient accurately indicates the time the anal fissure appeared and what contributed to it. The choice of treatment tactics will depend on these aspects.

It is not always possible to easily insert a finger into the rectum; to reduce pain, local anesthesia with anesthetic solutions can be performed.

Differential diagnostics and instrumental examination methods

Differential diagnosis is carried out with diseases that have similar symptoms, such as:

Haemorrhoids,
paraproctitis,
malignant neoplasm of the rectum,
ulcerative-erosive intestinal lesions.

Signs that will help in making a diagnosis:

There is no connection between bowel movements and pain syndrome,
During examination there is no evidence of an anal fissure,
atypical location of pain,
keeping the sphincter in a relaxed state.

Methods of instrumental diagnostics include: sigmoidoscopy, colonoscopy and anoscopy.

During the examination, it is possible to assess the condition of the tissues of the rectum, confirm or refute the presence of tumor formations, determine the boundaries and depth of the crack and decide on the tactics of patient management.

How to treat anal fissure

Depending on the nature of the crack, there are 3 treatment methods:

Operational,
conservative,
combined.

When making a choice, the doctor is guided by the patient’s condition, the size of the crack, the presence of concomitant pathology, and the patient’s financial capabilities.

What you should pay attention to

In this chapter we will talk about nutritional features, what promotes the healing of anal fissures and what treatment is at home.

Basic diet aimed at combating constipation. To do this, the diet includes a sufficient amount of fiber, which contributes to the proper formation of feces. Hot, sour, salty, spices, marinades, alcohol, and fried foods are completely removed from the menu.

What can you eat to make the crack heal faster? In fact, there are still a lot of tasty and healthy products, which will promote wound healing:

Porridge,
salads,
dried fruits,
beet,
carrot,
cucumbers,
lean meats and fish,
chicken,
turkey,
dairy products,
homemade cheese.

Hygiene

Hygiene habits will have to be reconsidered; instead of toilet paper, it is better to use cool water to wash.

Before defecation, if you are prone to constipation, you can do a small enema with boiled cool water or an oil microenema.

After bowel movements, carefully treat the anus with a solution of slightly pink potassium permanganate, this helps heal cracks in the anus.

It is not always possible to get rid of this pathology at home, but there are many recipes traditional medicine, used for rectal fissures.

What are the best candles for cracks?

The choice of suppositories for cracks in the anus is huge, there are inexpensive and effective ones, but for the treatment of pregnant women and children with this pathology, there are fewer suppositories, although it is not at all difficult to buy them in the pharmacy chain.

The most commonly prescribed include:

Methyluracil,
Proctosan neo,
Ultraproct,
Candles with belladonna,
Salofalk,
Natalsid.

Natalsid is approved for use if a rectal fissure develops during pregnancy. In addition, candles with calendula and sea buckthorn will not cause harm.

Anuzol, Neo-Anuzol and Anestezol suppositories will effectively relieve pain.

Microclysters with herbal decoctions

In equal proportions, take crushed oak bark, calendula flowers, chamomile, sage, brew all the ingredients with boiling water and leave for 3 hours.

Strain, pour 50-60 ml of cool broth, to relieve pain you can add 2 ampoules of 2% lidocaine, use a syringe to inject the composition into the rectum, after pre-treating the tip with oil.

A microclyster is done before and after each act of defecation, since even one omission is enough for the edges of the defect to spread again.

Upon completion of treatment, ointment for cracks Levomekol or any other of the above is applied to the area of ​​the external hole, as these ointments contribute to the rapid restoration of damaged tissue.

Note that sometimes hemorrhoids and anal fissures occur simultaneously, but the above method will improve the condition of the rectum and eliminate pain from both inflamed hemorrhoids and anal fissure.

What operations are performed for this pathology and what medications will help with rectal fissures

Proctologists have long and successfully performed the following types of surgical interventions:

Simple excision of an anal defect,
excision of the crack with sutures,
excision of anal fissure in the sphincter area,
combined surgical interventions.

But to achieve a better result, various drugs are prescribed, for example, probiotics and prebiotics to normalize the intestinal microflora, antibacterial drugs to relieve inflammation, drugs that relieve sphincter spasm, analgesics to reduce pain in the acute period, and multivitamins.

There is evidence of the successful use of Botox injections to treat anal fissures, but the administration of this drug does not guarantee that the defect will not reappear.

Indications for surgical treatment:

Sphincter fibrosis,
ineffectiveness of conservative therapy,
combination of a crack with the formation of a fistula,
other concomitant pathology of the rectal fissure requiring surgical intervention.

Sometimes you can get rid of a fissure using minimally invasive manipulation - stretching the sphincter.

If it is not possible to “stretch” the sphincter, excision of scar tissue is performed, which has led to a decrease in the lumen of the outlet of the anal canal.
After the operation, all the above recommendations on diet and hygiene procedures remain relevant.

Fissure in the anus in a child

The main reason is chronic constipation. If such a disaster happens, pay attention to 2 things: whether your baby consumes enough food and whether he has false shyness and a desire to escape the problem when he has the urge to defecate.

Your task is to normalize the child’s diet, hold a conversation about the need and
the importance of visiting the toilet on time and following the doctor’s recommendations for treatment.
If there is no concomitant dysbacteriosis or some other gross pathology, then you can use suppositories with calendula and sea buckthorn, microenemas with natural oils, of course, provided there is no allergic reaction.

In an infant, an anal fissure requires even more attention, because the body’s immune forces are not yet able to independently cope with the aggressive intestinal microflora. The best prevention is to continue breastfeeding.

Anal fissure - what it looks like in acute and chronic form

What does an anal fissure look like?

Anal fissures in most cases appear along the posterior semicircle of the anus. If you imagine it in the form of a dial, the cracks are located at 6 o'clock, in the area of ​​the coccyx, and are small in size - length up to 20 mm, width up to 2 mm, depth no more than 3 mm.

The outer part of the anal fissure is located on the surface of the skin near the anus, the inner part is on the mucous membrane inside the anal canal. The shape of the cracks is elongated (almond-shaped), but can be triangular or round.

The photo above is a schematic representation of an acute anal fissure with pointed upper and lower edges. The edges of the crack are clearly defined, without signs of the formation of connective tissue (it is always lighter than the mucous membrane and has a denser structure).

The contours and appearance of the anal fissure vary depending on the nature of the process and the degree of healing. Along with the appearance of the pathology, the symptoms also change.

What does an acute anal fissure look like?

The photo above shows an acute anal fissure that is bleeding. It is characterized by such features as straight edges and the absence of seals along the edge of the rupture of the mucous membrane. The bottom of cracks in an acute process is clean, without plaque or scar formation.

An anal fissure is very rarely visualized, since it is located between the folds of the anus. During examination, the proctologist carefully moves them apart to determine the exact location of the crack.

Also characteristic of an acute anal fissure is:

• the appearance of streaks of blood in the stool on one side (where the crack is located);
• acute pain in the anus during defecation;
• sphincter spasm.

Going to the toilet with an acute anal fissure becomes painful and sometimes impossible.

A teardrop-shaped or triangular shape of anal fissure is quite common. The outer (lower) edge of such cracks is always wider than the (inner) upper edge.

The photo above shows an anal fissure, along the edges of which connective tissue has formed. This indicates the beginning of healing of the crack. If the disease was treated under the supervision of a proctologist, the likelihood of the crack reoccurring and becoming chronic is reduced.

What does a chronic anal fissure look like?

The photo above shows an anal fissure that has almost completely healed. A scar has formed closer to the sphincter, and the crack itself looks like a round hole in the mucous membrane of the anus.

Such a scar often causes a re-rupture (chronic anal fissure). For example, with constipation, when the mucous membrane cannot stretch to allow the smooth passage of solid feces.

The main external differences between acute and chronic anal fissure are visible in the photo above.

On the left is a photo of an acute anal fissure with smooth edges and a clean bottom, without signs of the formation of a sentinel tubercle.

On the right is an image of a chronic process. The edges of the crack are curved, the bottom is covered with plaque, and a guard tubercle has formed on the outer edge.

For chronic anal fissures (another option appearance in the photo above) ruptures in most cases occur in place of old ones. At the same time, fresh cracks are surrounded by compactions and scars, and therefore have uneven edges, most often zigzig-shaped.

The photo above shows a chronic anal fissure with a sentinel tubercle and an anal polyp. It has several differences from acute:

• the edges of the tear are compacted, they look like a roller framing the crack;
• along the edges of the crack, tubercles of dense connective tissue are visible;
• Bleeding from such fissures is scanty, but blood may remain on toilet paper and stool after bowel movements.

The photo above is an image of an aggravated chronic anal fissure. The bottom of a chronic anal fissure is covered with scar tissue. This is clearly visible in the photo above: the inner surface of the wound is covered with plaque, the edges of the crack are uneven and thickened, and a border tubercle consisting of connective cells is clearly visible on the outer edge.

Anal papillae and sentinel tubercles after fissure healing

After healing of an acute anal fissure, connective tissue also forms on the internal (located inside the anus) part of the fissure. In proctology, such a formation is called the anal papilla. A schematic representation of the anal papillae can be seen in the picture above.

The size of the sentinel (border) tubercles may vary depending on the number of exacerbations of the anal fissure. The more there are, the larger the tubercle becomes.

In the photo above there is a fairly large sentinel tubercle and an anal fissure, which has begun to scar again.

Sometimes such neoplasms are mistaken for papillomas, rectal polyps or condylomas. The anal papillae can become large and at the same time fall out of the anus.

There are no characteristic symptoms during the period of remission. Only in some cases does prolapse of the anal papillae occur. The patient feels a foreign object in the anus.

The only way to remove a chronic anal fissure is surgical excision. During the operation (pictured above), the proctologist removes scar tissue and stitches the edges of the wound. The risk of relapse after surgery is significantly reduced.

The symptomatic manifestations of anal fissure are similar to other diseases, for example, hemorrhoids, and to make a correct diagnosis you need to visit a proctologist.