Anal fissure 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.
An anal fissure is a narrow and long defect in the mucous membrane of the anus. At this point, the mucous membrane is torn apart, exposing the muscle layer. The length of the fissure of the anus is usually small no more than 2 cm. The width and depth are several millimeters. Fissures can form not in any place of the anus, but only on its front and rear walls. Anterior fissure localization is significantly more common in women than in men, which is associated with the biological features of the body structure. Rarely a fissure occurs on the side surfaces of the anus.
The disease has two main forms of the course – acute and chronic. An acute fissure appeared relatively recently. It may be overgrown if conditions are favorable. But without proper treatment, an acute fissure after a few weeks can become chronic.
Chronic fissure is characterized by rougher edges and small tubercles at its beginning and end. It almost never passes itself and requires surgical intervention for treatment. Although remission may occur in the disease, it is not to be hoped that it will lead to a complete cure. Under certain circumstances (violation of the diet, the occurrence of constipation), the disease may return with a new force. In most cases, anal fissure is accompanied by spasm of the sphincter, which makes it more difficult to defecate, especially during constipation.
With each act of defecation, an unhealed fissure is exposed to fecal masses. It is especially dangerous for constipation when the stool is hard. In addition, a huge amount of bacteria is deposited on the fissure (as is known, human feces are more than half of the bacteria). This leads to even greater inflammation of the wound.
Untreated fissures located in the anus can lead to serious complications – acute purulent paraproctitis, fistula formation, trophic ulcers, massive bleeding, gangrene and sepsis. In men, anal fissures increase the likelihood of prostatitis.
Fissures in the anus make themselves felt by severe pain appearing after the toilet or during the act of defecation. The pain, as a rule, is acute and resembles the sensation of the presence of broken glass in the anus area. Pain syndrome with a fissure can persist for a long time, increasing with long sitting. It can lead to neurotic conditions and insomnia. The patient may also form a kind of defecation. This leads to even more severe constipation, which, in turn, further exacerbates the disease.
Also an important sign is bleeding during a bowel movement. It can be as insignificant, and consist of a few drops of blood, and serious, leading to anemia. It all depends on the nature and size of the fissure.
A disease can affect a person’s lifestyle. The inability to sit painlessly entails the impossibility, for example, to engage in sedentary work. And the loss of work exacerbates the adverse mental state of the patient.
The direct causes of the disease can be divided into mechanical damage to the anal passage and damage to the mucous membrane as a result of the tension of the sphincter.
Mechanical damage may occur:
- during bowel movements due to damage to the mucous membrane of solid objects in the fecal masses;
- during instrumental examinations of the rectum, a fracture may appear as a result of unqualified actions of medical staff.
Mucous ruptures due to muscular tensions mainly occur during attempts during defecation. Also, quite often rectal fissures can occur in women during childbirth.
It has long been established that the main factor provoking the appearance of fissures is chronic constipation. Constant attempts during bowel movements lead to increased tension in the muscles of the anus. In addition, hard stools have a negative impact on the condition of the mucous membrane of the anus. All this can lead to its rupture and the formation of fissures. More rarely, they can be formed 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 consists in the fact that hemorrhoids does not affect this process. These two diseases have many similar symptoms, but on the whole there is a different etiology, and the approaches to their treatment are also very different. Nevertheless, it is often possible to find the presence of both diseases at once in one patient.
Factors contributing to the occurrence of the disease are:
- use of alcohol, too fatty, spicy or salty foods;
- sedentary work;
- weight lifting;
- sedentary lifestyle;
- diseases of the lower intestine – colitis, proctitis, irritable bowel syndrome.
Separately it is necessary to say about pregnancy and the process of childbirth. These factors can also contribute to the appearance of fissures in the anus. In the first case, the reason is the increase in the size of the uterus and the associated difficulty in the process of defecation. This weakens the area of the anus, and childbirth, accompanied by attempts, can provoke damage to the mucous membrane of the anus. Of course, in the first days after birth, 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 ruled out. In this case, it can also be associated with constipation, as well as the fact that in children the excretory organs are not yet fully formed. Therefore, even relatively weak constipation can cause damage to the anus area in a child. Symptoms of anal fissure in young children can be a fear of toilet, blood on the feces.
In the event of pain in the anus, the patient is naturally not able to determine the cause of the syndrome and make a diagnosis, and, moreover, to establish the size and shape of the fissure. Therefore, it is recommended to immediately contact the proctologist so that he/she analyzes the symptoms and prescribes treatment. In most cases, fissures are clearly visible upon visual inspection. In some cases, it may be necessary to operate on the anus, but it may be difficult due to extreme pain for the patient and sphincter sphincter. Also, methods of sigmoidoscopy (x-ray examination of the anus by 20 cm in depth) and colonoscopy are used for the diagnosis. When diagnosing, the fracture should be differentiated from hemorrhoids, proctitis and paroproctitis, erosions, polyps and tumors.
How to treat a disease
Treating a fissure in the anus, especially a long-standing and large-sized one, is a difficult task. Nevertheless, a complete recovery from the disease is possible, although it requires considerable effort, both from the patient and from the doctors.
Unlike many other diseases, in case of anal fissure, the acute form of the disease is treated by a conservative method, and chronic – by surgery.
If an anal fissure is small, there are microcracks, it is better to let it heal on its own. Such fissures can heal in a few days, provided that they do not re-irritate. This can be achieved in the event that no fecal masses are formed and they will not go outside. That is, you can sit on a diet for several days and wait until the fissure drags itself.
However, as a rule, the anal fissure is too large, and its overgrowing will take too long. In the case of large fissures using a comprehensive method of treatment, which includes:
- drug treatment;
- lifestyle change.
How to treat the disease
Conservative treatment of fissures is carried out according to a complex and gradual method. Practice shows that effective treatment of the disease can be carried out at home. If there is a strong pain syndrome and sphincter spasm, painkillers and antispasmodics are used first, and then wound heals. In most cases, treatment can be carried out at home, 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 pill form.
In case of acute fissures, it is recommended every day, preferably in the evening, to make baths with disinfecting solutions. The temperature of the water should be + 40ºС. Baths with simple warm water can also be used to help relieve spasms. The duration of the procedure is 10-20 minutes.
Diet is primarily aimed at eliminating the main cause of the disease – constipation. The diet should be chosen 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, smoked meats from the diet and use more of the plant fiber found in vegetables and fruits, dairy products. Meat is preferable to use chicken and lean beef. You should also reduce the amount of white bread in the diet, replacing it with bread and bran and drink more liquids.
It is necessary to refuse a sedentary lifestyle, to show greater physical activity in order to avoid stagnation in the lower part of the body. Even simple walks can have a positive effect on the treatment of the disease.
With the ineffectiveness of conservative treatment, as well as the transition of the disease to the chronic stage, which usually occurs a month after the formation of a fissure in the anus, surgical treatment is indicated. As a rule, the operation is to remove scars and bumps along the edges of the fissures that interfere with its healing.
Compliance with preventive measures to prevent the disease will be useful not only to those who have already recovered from the disease, but also to those who have never encountered it.
The risk group includes people leading a sedentary lifestyle and suffering from constipation. Fissure prevention largely coincides with the measures used in their treatment. First of all, it is aimed at preventing constipation. It is necessary to exercise physical activity, move more, eat a variety of, little by little, but as often as possible. The thorough chewing of food is of great importance, because hard undigested residues increase the likelihood of injury to the anus.