Anal fissure in an adult

Many patients come to the proctologist with the firm belief that they have hemorrhoids. But already during the survey, before the examination, an experienced doctor may assume the presence of a crack in the anal canal. Alas, in many cases you have to deal with a neglected problem, because at first people consider it too delicate and try to get rid of it themselves. Why is it necessary to consult a doctor in time, what is the danger of anal fissure in adults and its self-treatment? We are dealing with an expert – a coloproctologist at SM-clinics Igor Peresada. 

What is an anal fissure

An anal fissure is a wound, and by the definition of physicians, a violation of the structure of the structure of the mucous membrane of the anus. The size of the anal fissure is from a few millimeters to 2-3 centimeters.

Useful information about anal fissures

Causes of anal fissure in adults

The causes of cracks are varied.

• Chronic constipation or vice versa frequent unformed stools. Both make a person push hard, which increases pressure in the rectum, leads to overstrain of the muscle structures of the anal canal, and injures the mucous and submucosal layers.
• Overvoltage.
• Weight lifting.
• Subcooling.
• The presence of pathogenic flora in the intestine. In addition, such microorganisms support already existing cracks, making treatment much more difficult.
• mechanical injury. They can be caused by various reasons – from an unsuccessful instrumental examination of the rectum to rough anal sex.
• Family activity. With ruptures of the perineum with the transition to the anus and other complications. 
• The cause of an anal fissure can also be insufficient hygiene, impaired blood supply to the anal area (often due to a sedentary lifestyle), infestation of worms and parasites, and the specific structure of the rectum. 

Often there is a combination of several causes¹.

Symptoms of an anal fissure in an adult

Symptoms of anal fissure in the acute stage – a sharp severe pain during defecation and for some time after it; spasm of the anus; slight bleeding during bowel movements.

If the anal fissure is chronic, the pain during bowel movements is not as severe, but more prolonged, and may disturb the person when sitting, walking and during sleep. Chronic anal fissure may be accompanied by constant itching in the anus. There is bloody discharge from the anus, and in especially advanced cases, purulent ones are also possible.

Effective treatment of anal fissure in an adult

How to treat an anal fissure – this is decided by the doctor after the examination and examination. Acute fissures are usually treated with conservative methods, therapy lasts up to 3 weeks. Despite the apparent improvement in the condition, treatment must be persistently continued, achieving a lasting recovery. Treatment of chronic anal fissures is prescribed taking into account the statute of limitations of the problem, the patient’s complaints and the degree of clinical manifestations².

Diagnostics

Diagnosis of cracks, as a rule, is not difficult. The proctologist during examination, rectal examination reveals a sharply compressed anal opening with a mucosal defect. The study is painful, accompanied by the release of a small amount of blood. Often, the so-called “sentinel tubercle” is revealed – a polypoid formation in the area of ​​uXNUMXbuXNUMXbthe crack, the result of improper treatment.

The main examination methods for anal fissures in adults are external examination of the anal region, digital examination, and anoscopy.

If necessary, if there is a suspicion of pathology in the upper intestines, ultrasound, colonoscopy and other examinations are prescribed. 

Ointment

To treat an anal fissure, adults can use ointments and creams with anti-inflammatory, analgesic and antiseptic effects. Popular ointments: Relief Ultra, Hepatrombin G, Proctosan, etc. They are applied both outside and inside the anus sphincter.

After removing the acute phase, healing ointments are used – Methyluracil, Solcoseryl, etc.

With spasms of the anal sphincter, an ointment based on Nifedipine is prescribed, which is made in a pharmacy according to a prescription. There are also ready-made ointments with Nifedipine in the composition (for example, Relifipin).

Candles

For the treatment of anal fissure in adults, multicomponent suppositories are prescribed (Relief, Natalsid, Proctosan, Anuzol, etc.) or plant-based suppositories – with sea buckthorn, propolis, belladonna extract. 

Diet

Treatment of anal fissures begins with the normalization of nutrition and lifestyle. It is necessary to give up physical activity, spicy food, alcohol. For constipation – use a laxative diet, intake of dietary fiber, drink plenty of water to soften the stool.

Botox injections

If conservative treatment of a chronic fissure fails, botulinum toxin may be used. Injections of the drug relieve spasm, relax muscles, thereby improving blood microcirculation. Faster healing of the crack itself³.

Surgical methods

Often, an acute fissure, even with the most intensive treatment, becomes chronic. Its edges become dense, scars form on them. Conservative treatment ceases to help. In such cases, surgical treatment is recommended: excision of a crack with divulsion (stretching) of the anal canal, to relieve spasm.

Excision can be carried out both in the classical way – with a scalpel, and with a laser (with a slight spasm of the sphincter).

Scars form on the affected areas. They can be removed by electrocoagulation.

Prevention of the development of anal fissures in adults at home

Prevention of anal fissures is primarily the normalization of stool, which is achieved by a diet high in fiber, compliance with the drinking water regime (up to 2 liters of water per day).

In addition, it is important:

• give up alcohol and nicotine,
• observe personal hygiene, 
• control physical activity
• try to walk at least half an hour a day,
• minimize the consumption of legumes, pastries, alcohol.

If any symptoms associated with the anal canal occur, you should contact a proctologist in time so that there is a chance to get rid of serious problems in the shortest possible time.

Popular questions and answers

Sources of:

1. V.L. Rivkin. Coloproctology: a guide for physicians. 2011. https://www.mmbook.ru/catalog/gastroenterologija/105758-detail
2. V.S. Groshilin, M.F. Cherkasov. Experience in the application of an integrated approach in the treatment of patients with anal fissures. https://cyberleninka.ru/article/n/opyt-primeneniya-kompleksnogo-podhoda-v-lechenii-bolnyh-s-analnymi-treschinami/viewer
3. I.I. Gribanov. Experience in the treatment of chronic anal fissure with sphincter spasm with drugs of botulinum toxin type A Lantox. Surgery. Journal them. N.I. Pirogov. 2014. https://www.mediasphera.ru/issues/khirurgiya-zhurnal-im-ni-pirogova/2014/2/030023-1207201428