Treatment of anal fissure

Our center specializes in the treatment of anal fissures of all forms. The clinic has advanced technical equipment for comprehensive diagnostics, conservative and surgical treatment of patients. A professional approach to the development of therapeutic regimens, treatment with pain control, reasonable prices and attentive attitude towards clients have ensured the reputation of a highly qualified proctology center of the European level.

Anal fissure is a longitudinal tear in the mucous membrane of the anal canal. The wound occurs due to digestive disorders or impaired blood microcirculation in the pelvic area. The pathological process is activated against the background of injuries to the mucous membrane due to constipation, diarrhea, haemorrhoids, pregnancy, anal sex, and physical overload. People of all ages are susceptible to the disease. The problem is most relevant for people aged 20–60 years, with young women suffering from the pathology 2 times more often than men.

Early treatment and treatment appropriate to the shape of the crack will help achieve healing and reduce pain. A single 98% success rate cannot be generalized to all methods and cases. An anal fissure does not turn into cancer on its own, but tumors and other diseases sometimes produce similar symptoms. Therefore, a long-term non-healing, unusually located or recurring crack requires a full examination, and not just repetition of local treatment.

Symptoms of anal fissure

• Acute cutting or throbbing pain in the anus that accompanies bowel movements, a few minutes after defecation, or prolonged sitting.
• Bloody discharge from the anus. Often scanty, visible only on underwear or in feces. In severe forms of anal fissures, heavy bleeding is possible.
• Burning, itching in the wound area.
• Hypertonicity, sphincter spasms.
• Fear of bowel movements.

Forms of the disease

Classification takes into account the nature of the course, localization and anatomical features of the mucosal rupture. Acute anal fissures appear suddenly and bother the patient for a short period of time. Such wounds are characterized by a smooth surface. In 60% of cases, acute forms of pathology heal without drug treatment when stool returns to normal.

Chronic anal fissures include ruptures that bother the patient for more than a month. Damage to the mucous membrane is accompanied by swelling, thickening of the edges and bulging of the folds of the anal canal, sphincter spasms, and prolonged pain. Negative symptoms force the patient to wait out the urge to defecate and delay visiting the toilet as much as possible. At the same time, the feces become denser, and during bowel movements they injure the mucous membranes more, which aggravates the clinical picture of the pathology. The surface of the wound does not heal, but becomes scarred. The calloused tissue causes constant discomfort and bursts at the slightest overstrain of the anal area. Damage is accompanied by intense bleeding.

By location, the following types of anal fissures are distinguished:

• Posterior – a tear in the intestinal wall from the back. The pathology is typical for men.
• Anterior – anal fissure from the pubic side. Typical for women who anatomically have mucous membranes at the junction of the vagina and anus that are thinner than other tissues of the pelvic area.
• Mirror-like is a pair of symmetrically located breaks on the anterior and posterior walls of the intestine.
• Radial – several wounds around the perimeter of the anus.

Anal fissures require immediate comprehensive treatment. Negligent attitude towards health creates risks for the development of concomitant pathologies.

Possible complications

Frequent bleeding causes anemia and disruption of the cardiovascular system. Chronic ruptures are dangerous for the development of ascending inflammation of the rectum (paraproctitis). Due to tissue scarring, the lumen of the anus narrows. The increase in pathogenesis is accompanied by increased pain and an increase in the frequency of its occurrence. Neglected anal fissures turn into fistulas. These are abnormal channels between the rectum and the pararectal tissue of the perineum. Pus, blood, and feces accumulate in them, which causes a severe abscess.

Chronic anal fissure is not considered a cause of cancer and does not have to become malignant. An ulcer, tumor, infection, or inflammatory bowel disease may look like a crack. If the defect does not heal for a long time, has an unusual location, or is accompanied by other alarming signs, the doctor will clarify the diagnosis and, if necessary, prescribe an additional test or biopsy.

Features of treatment

Therapy is aimed at restoring regular bowel movements, eliminating sphincter hypertonicity, and healing wounds. Treatment of acute anal fissure includes a set of conservative measures. Severe chronic cases additionally require surgical intervention.

Conservative treatment

Assumes:

• Diet. Patients are advised to eat fiber-rich foods, drink plenty of fluids, and fermented milk products. Kefir, boiled beets, and prunes soften stool and activate intestinal peristalsis. Fried foods, confectionery, and alcohol are prohibited. You should also avoid flour, spicy foods, canned food, smoked meats and foods that cause constipation and gas formation. These are bread, pasta, sausages, legumes, nuts, cabbage, rice, bananas.
• Taking laxatives. Systematic use of oral lactulose-based medications is recommended. Constipation is eliminated with the help of pharmaceutical microenemas and suppositories with a laxative effect.
• Use of anti-inflammatory and painkillers. When treating anal fissure, Lidocaine and Dicloberl are prescribed in the form of tablets, suppositories, and injections. The doctor selects the preferred form of medication taking into account the severity of the wound. The drugs relieve itching and burning, help overcome the fear of defecation, and improve the patient’s well-being.
• Treatment of the anal area with healing agents. The category includes drugs in the form of rectal ointments and suppositories. As a rule, the drugs are combined. They combine components with healing, analgesic and anti-inflammatory effects. In the treatment of anal fissures, Procto-Glivenol, Detralex, and sea buckthorn suppositories have proven themselves to be the best.
• Warm sitz baths. The procedures relax the muscles of the anal area and provide the necessary hygiene. Baths are taken daily before bed for 15-20 minutes. The composition of the solution is agreed upon with the doctor.

IMPORTANT! For anal fissure, it is extremely dangerous to use irrigation enemas in the form of syringes or an Esmarch mug. The hard tip of the system can injure the mucous membrane and aggravate the course of the disease!

The duration of conservative treatment is determined individually; healing often requires several weeks and stool monitoring. Chronic fissures may also respond to topical sphincter relaxants or botulinum therapy. Surgery is considered when other methods are unsuitable or insufficiently effective, with an assessment of the risk of continence failure. It cannot be said that any chronic fissure can be cured only by surgery or that one percent success describes all schemes.

Surgical treatment of chronic anal fissure

Involves excision of the damaged area of the intestine and dosed sphincterotomy. The procedure allows you to remove the affected area with minimal trauma to adjacent tissues and restore normal tone of the anal muscle. Complete healing takes several weeks. In this case, the patient must follow the recommendations of the attending physician on diet and use of medications.

The anesthesiologist selects the method of pain relief taking into account the operation, diseases and medications taken. Regional methods, including spinal and epidural anesthesia, can be used as indicated, but have their own risks and do not guarantee complete absence of pain throughout the entire recovery. After the intervention, the patient receives a pain management and care regimen. Medical observation helps to detect complications in a timely manner and adjust treatment.

Prevention of anal fissures

To prevent injuries to the anal canal of the intestine, you should:

• Keep drinking regime. You need to drink 1.5-2 liters of pure still water per day. Juices, tea, compotes are not taken into account.
• Stick to a diet. Give preference to foods high in fiber. There are thermally processed vegetables, fruits, cereals, and lean meats. Include products with a laxative effect, such as prunes, kefir, vegetable oil, seaweed.
• Maintain sufficient physical activity. Do gymnastics regularly, go for walks every day.
• Take measures to prevent constipation. It is important to go to the toilet at the first urge to defecate. After voiding, use soft toilet paper or wet wipes.
• Do not neglect hygiene. It is recommended to wash the anal area with warm soapy water in the morning, evening and after each bowel movement.

If you experience constipation, pain or bleeding in the anal canal area, you should immediately consult a doctor. The center’s proctologists will provide qualified assistance for the surgical treatment of anal fissures of any origin and severity. Call and get a consultation (check the cost when making an appointment) right now!