Anal fissure is a small defect in the mucosa at the very beginning of the anal canal. The length of this defect rarely exceeds 1 cm. The illness is like a “small”, but the problems are quite serious. Indeed, the main symptom of this disease is pain during or after defecation. Its intensity can be very slight in mild cases, but more often the pain is strong enough, continued from several minutes to several hours after stool. Sometimes the pain can be so strong that even makes you “climb the wall”. Fear of the defecation makes by all possible means “to delay” it. There may be small blood smears on paper.
Cause of the severe pain during anal fissure is a small laceration in the anal canal that causes a severe spasm of the anal sphincter (the muscle that holds the stool). The spasm, in it’s turn, causes pain and doesn’t give the fissure time to heal. A so-called “vicious circle” appears. This explains the duration of the disease and difficulty in treatment. For the duration of the disease within a short period of time (usually about 1 month) doctors speak of an acute anal fissure, more than 1 month — a chronic one. Why is it important to know? Because if an acute anal fissure can be cured by conservative methods, to treat the same chronic — is an ungrateful business.
There a lots of causes of anal fissure: constipation, diarrhea, heavy physical work, prolonged sitting, and prolonged standing, intake of spicy foods, alcohol. Sometimes the obvious causes are not detected.
How to treat anal fissure (treatment of anal fissures)
Treatment of acute anal fissures can be conservative, if the pain is not expressed. First exclude spicy foods and alcohol. To ease defecation and reduce injury of anal canal well help counter oil enemas (50 g of sunflower oil + 150 g of warm water in an enema-pear 200 ml). A great help is to have the heat treatments in all types of: warm sitting baths, heating pads in the perineum. Often people use the cold baths that is not quite right, because the cold causes a spasm, and the heat relaxes the muscles thereby decreasing spasm of the sphincter and the pain subside. Suppositories are also used, the choice of which to date is huge. It is important to know the General rule of the insertion of suppositories: before use, preferably is to stretch it in hands and after the insertion into the anus not to push it inside, but to hold it at the level of the anus for 2-3 minutes and only then to push the rest of the suppository into the anal canal. With the insertion of the suppository immediately and “to the limit”, not letting it “to work in the anal canal”, it falls into the ampoule of the rectum.
Severe pain in anal fissure
Well, if the pain is severe, and with a pronounced spasm? In these cases, so-called half-operating method of treatment of anal fissures, is used. Decisive in it is the removal of spasm of the sphincter of rectum, after which the fissure is “automatically” healed. This happens in the following way. An injection of anesthetic is made into the soft tissue between the sacrum and the coccyx. The whole area of the rectum anesthetized and relaxed, and then freely and without pain a special pneumo-balloon is introduced into the anal canal for 5-7 minutes. This is enough to relieve spasm of the anal sphincter. After the manipulation the fissure if self-healed within 7-10 days, thus the nearest defecation is not so painful. Patients go home in 1.5–2 hours after the action of anesthesia is over. The method is easy to undergo, is well established in practice.
Chronic anal fissures
The chronic anal fissures is better to operate right away. Of course you can cure it and stop worsening, but the effect is usually temporary, with the subsequent return of the disease. The surgery itself is not complicated, usually lasts no more than 10 minutes. After the epidural-sacral anesthesia a pneumo-ballon is inserted into the anal canal for 5-7 minutes as described above. Immediately after its removal, a bloodless excision of the fissure is made by the radio wave scalpel (Surgitron). In General, the surgery about anal fissure by this method is relatively easy to undergo. After the surgery, patients stay in the hospital within 2-4 hours under supervision of medical staff and then after an instruction go home. A week after the operation there is a marked clinical improvement with absence of pain and spasm of the anal sphincter. Complete healing of the wound takes place in time of about 20 days. Disability is usually lasts from 0 to 7 days depending on the nature of work and in average is about 3 days.
Anal fissures in combination with the hemorrhoids.
A similar combination in proctology is quite frequent. In ordinary cases internal and external hemorrhoids are removed by the generally accepted rules with subsequent excision of anal fissure as described above. In some cases of the combination of an anal fissure with hemorrhoids, and with severe circular external hemorrhoid nodes, a mixed operation is performed. The postoperative period is not different from such as with hemorrhoids.
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