Fissure near the anus treated. Anal fissure (anal fissure)

Treatment for rectal fissure aims to relieve pain, treat constipation, and soften stools. In a chronic fissure of the rectum, when the symptoms of the disease last more than 6 weeks, surgery may be necessary.

Methods for treating an anal fissure

Anal fissure is a very painful and common disease that causes a lot of pain to the patient. Therefore, often people wonder how to cure an anal fissure completely.

Like any tear or cut in the skin, anal fissures often heal on their own within a few weeks. However, a person with this disease should definitely consult a doctor who can advise remedies for treatment that alleviate symptoms and accelerate the healing of an anal fissure.

Treatment of adult patients

It is possible to cure an anal fissure, like many other diseases, at home. However, you should strictly follow the recommendations of the attending physician, which, as a rule, are aimed at eliminating constipation and relieving symptoms.

Eliminating constipation allows the fissure to heal faster and reduces the risk of their occurrence in the future.

Treatment of anal fissures at home includes:

• Increasing your daily fiber intake by including enough fiber-rich foods such as fruits, vegetables, whole grain cereals, and breads in your diet.
• Drinking enough water to avoid dehydration.
• Physical exercise, such as walking or jogging.
• Developing the habit of going to the toilet at the same time.
• You can not postpone going to the toilet when there is an urge to empty the bowels.
• When using wet wipes, avoid those containing fragrances or alcohols, as these can cause discomfort or itching.
• When using toilet paper, preference should be given to its soft types.
• It is necessary to wash the perineum and anus with warm water several times a day, especially after a bowel movement, to relax the muscles of the anus, increase blood flow and clean without rubbing or irritating the skin.

Doctors may also prescribe various medications to treat anal fissures in adults to help relieve symptoms and allow them to heal faster.

Laxatives

These help facilitate bowel movements. In adults, for the purpose of treating anal fissures, laxatives are used to increase the volume of feces. They help retain more fluid in the intestinal lumen, which makes the stool soft and voluminous.

The doctor may recommend a low initial dose of laxative, gradually increasing it over several days until the patient passes soft stools every 1 to 2 days. Cured constipation is the key to getting rid of cracks soon.

Painkillers

If a person feels prolonged pain after a bowel movement, the doctor may prescribe painkillers such as paracetamol or ibuprofen.

Nitroglycerin ointment

If the symptoms of a fissure in the anus do not improve within 1 to 2 weeks, your doctor may treat you with nitroglycerin ointment, which should be applied directly to the anal area, usually twice a day. Nitroglycerin dilates the blood vessels in and around the anus, which helps improve blood flow to the tissues and help the fissure heal faster. It also reduces pressure in the anal canal, which should help relieve pain.

Most acute anal fissures that last less than 6 weeks heal with nitroglycerin ointment. With chronic cracks, the effectiveness of this drug is about 70%.

Since nitroglycerin is absorbed into the systemic circulation through the hemorrhoidal veins when used to treat anal fissures, many patients may develop a headache. Some people may also feel dizzy. In such cases, it is necessary to reduce the amount of ointment applied.

Sometimes using a smaller amount 5-6 times a day is better tolerated than applying a larger amount twice a day.

Local anesthetics

If a patient with a fissure has severe pain in the anus, the doctor may prescribe local anesthetics in the form of ointments or suppositories for treatment. It is recommended to use them immediately before a bowel movement. The ointment should be applied directly to the affected area.

Means used to treat anal fissures are also often prescribed for exacerbation of hemorrhoids. These drugs do not speed up the healing of the fissure, but relieve pain. As a rule, they are used in the first 1-2 weeks.

Sometimes a small amount of a hormonal agent is also added to the ointment with a local anesthetic, which reduces inflammation. The use of such ointments should last no longer than 2 weeks, as they can lead to thinning of the skin in the damaged area.

Calcium channel blockers

Usually used to treat hypertension. However, these medicines applied directly to the anal area are also useful for anal fissures. They relax the sphincter muscles and improve the blood supply to damaged tissues.

Side effects of calcium channel blockers may include headaches, dizziness, itching, or a burning sensation at the application site. They usually disappear within a few days of use, as the patient's body gradually gets used to the treatment.

Topical application of calcium channel blockers is considered to be as effective as nitroglycerin and can heal a rectal fissure if other drugs have failed.

Botulinum toxin injections

This is a relatively new method for the treatment of anal fissures, which, as a rule, is used when all other methods of conservative therapy are ineffective. Botulinum toxin is a very strong poison that can be safely used in small doses.

With a fissure of the anus, its injection causes paralysis of the sphincter muscles. This prevents their spasm, helps reduce pain and speeds up the healing of the crack. The toxin is injected into the external and internal sphincters, as well as into the fissure itself.

Doctors say that botulinum toxin injections help more than half of the patients. Its action lasts 2-3 months, which is enough to heal the crack. The main side effect of this treatment is weakness of the sphincter muscles, which is manifested by fecal incontinence, which is usually temporary.

A person treating anal fissures at home should regularly visit a doctor who will evaluate the progress of recovery. If conservative methods are ineffective, consultation with a proctologist and surgical treatment may be necessary.

Operations are considered the most effective method, according to doctors, they can cure more than 90% of patients with anal fissure. However, like any surgical intervention, these operations are accompanied by a small risk of complications.

With anal fissures, the following operations are performed:

• Lateral sphincterotomy. The procedure consists of making a small incision in the ring of sphincter muscles surrounding the rectum. This helps relieve the pressure inside the anus and allows the anal fissure to heal, as well as reducing the risk of recurrence of the disease. Such an operation does not take long, it is relatively simple and is usually performed under general anesthesia. Lateral sphincterotomy is one of the most effective treatments for anal fissures, with most patients recovering completely within 2-4 weeks. During this operation, due to damage to the anal muscles, 5% of patients may develop temporary fecal incontinence. However, this complication is not severe and lasts only a few weeks.
• Excision of the anal fissure. This technique is used for chronic anal fissures.

Sometimes proctologists close the surface of the crack with a skin flap taken from a healthy area of ​​the patient's body. This improves the blood supply to damaged tissues and promotes healing.

Treatment of anal fissures in children

Fissures of the rectum in children are quite common, so many parents are interested in how to treat them.

As a rule, the treatment of cracks in the anus in children is based on the same principles as in adults. It is also aimed at eliminating constipation and softening the stool. This is achieved by introducing more fiber into the diet (provided that the age of the child allows), increasing water intake.

All tips for non-drug treatment of a fissure in the anus in an adult patient can also be applied to a child. These include baths with warm water, and physical exercise, and developing the habit of going to the toilet at a certain time in a comfortable environment.

Drug treatment of anal fissures in children is carried out only on the recommendations of doctors.

Most often they assign:

• Laxatives. Young children, unlike adults, are more often recommended osmotic laxatives, which increase the amount of fluid in the feces, thereby softening the stool and increasing its volume. The dose of drugs is calculated according to the weight of the baby.
• Nitroglycerin ointment.
• Calcium channel blockers.
• Ointments with local anesthetics.
• Botulinum toxin injections. They are used only in extreme cases, with large and non-healing cracks, since the injection sites and dosage of this drug in children have not yet been precisely established.

With anal fissures in children, surgical interventions are performed very rarely - with the ineffectiveness of conservative treatment and chronic fissures. The most commonly used lateral sphincterotomy and excision of chronic fissures.

Treatment of anal fissures in pregnant women

If cracks in the anus occur during pregnancy, treatment is based on non-drug recommendations. For example, doctors advise these women to eat fiber-rich foods, drink plenty of water, exercise, and take sitz baths.

With insufficient effectiveness of these measures, it is possible to use local anesthetics in the form of ointments, mild laxatives. It is better to refrain from using nitroglycerin ointment during pregnancy.

Surgical treatment of a fissure in the anus is usually carried out after childbirth, if conservative therapy has been ineffective.

Alternative treatment of anal fissures

The most common traditional medicine used to treat rectal fissures:

• Olive oil. Rich in healthy fats that lubricate the surface of the intestines and make it easier to empty. It can be injected directly into the rectum in an amount of 50 ml. Also, a mixture of olive oil, honey and beeswax relieves pain, reduces bleeding and itching in the affected area. To obtain this mixture, its ingredients must be mixed in a bowl in the same proportion, then heated in a microwave oven so that the beeswax completely melts. After the mixture has cooled, it must be applied to the damaged area several times a day.
• Aloe. It has healing and anti-inflammatory properties. It is necessary to cut one leaf from the plant, cut it along the entire length and squeeze out the juice. Then you should apply a small amount of this juice to the affected area several times a day.
• Comfrey. This plant has medicinal properties, promotes healing of anal fissures and relieves pain. Add 1 teaspoon of dried comfrey to 1 cup of hot water, cover and steep for 10-15 minutes, then let cool. This infusion should be used to cleanse the affected area 2-3 times a day.

How to distinguish a fissure from hemorrhoids?

Since hemorrhoids are considered the most common disease of the rectum, many people think that any pain in the anus is caused by them. However, you need to know the differences between hemorrhoids and anal fissure, which is also very common.

It should be noted that with a fissure in the anus, the sharp, cutting pain that appears or intensifies after defecation comes first in the patient's complaints. With ordinary hemorrhoids, people are more likely to complain about the release of blood during bowel movements. Also, with this disease, hemorrhoids often fall out of the anus, which makes it possible to distinguish it from anal fissures.

However, severe pain in hemorrhoids can develop with thrombosis of hemorrhoids. The pain in this case is very strong, is permanent.

A doctor can establish the correct diagnosis and give the right recommendations, to whom you should contact. In addition, it should be remembered that the presence of hemorrhoids does not negate the presence of an anal fissure, but, on the contrary, contributes to its appearance.

Anal fissures are a very common cause of pain in the anus. To treat it, it is necessary to eliminate constipation and reduce pain during bowel movements. In case of failure of conservative treatment, surgical intervention is performed.

Useful video about the causes and treatment of anal fissures

Anal fissure is a proctological disease that occurs in 20-30 people. out of 1000. Areas of its location: anterior commissure and coccygeal wall of the anal canal, possible sizes - up to 1.5 cm.

The mechanism of its formation is as follows: due to mechanical damage or vascular changes, a mucosal tear occurs, which is immediately “attacked” by highly active rectal microorganisms, deepening and damaging it even more. If left untreated, the edges of a linear or elliptical fissure thicken, which is fraught with infection and relaxation of the sphincter. A characteristic feature of the formation of a defect (and its injury) is a vivid pain syndrome. Its nature is in the anatomical features of the structure of the posterior wall of the rectum. There are many nerve endings here.

Symptoms

The manifestations of the problem (those that are visible visually) are similar to the symptoms of a number of other proctological diseases. However, doctors identify three main symptoms.

They are the same for acute, subacute and chronic fissures, and differ only in the degree of severity. So, in acute they are very pronounced, in chronic - less, but disturb for a long time. It:

• Pain. Occurs both during defecation and after it (sometimes when urging to stool). It has an acute, pulsating character, can “give” along the back of the legs, lasts from 5 minutes. up to several hours. It can cause the development of stool fear.
• Sphincter spasm.
• Isolation of blood from the rectum. Scanty, with an admixture of mucus. In the chronic form of the disease, bleeding may be associated with a violation of the stool (diarrhea or constipation), while pain is rare. Explicit bleeding develops with concomitant hemorrhoids.

The reasons

Cracks can be located both on the back (80% of cases) and on the front wall of the canal mucosa (about 10-12%). When defecating, they remain practically motionless, while the rest move down and then come back. If we imagine the mucous membrane of the anal passage on a conditional dial, then at 6 and 12 o'clock the fixed walls are just the areas with insufficient blood circulation and the risk of trauma during defecation.

Proctologists believe that one of the factors in the formation of trauma is the inflammatory process in the pockets of Morgani's crypts. It develops when excrement accumulates in them. Due to inflammation, the mucosa first loses its elasticity, and then is injured and torn. Thus, the main causes of mucosal tear are:

• Damage to the canal with a "heavy" rough stool, which is provoked by excessive consumption of coarse fiber and insufficient fluid.
• Great straining during stool.
• Rupture of the passage during childbirth. It is observed in nulliparous women, it provokes excessive tension in the anus.
• Associated diseases: irritable bowel syndrome, ulcerative colitis, proctitis, Crohn's disease, pancreatitis.
• Damage to the mucosa associated with the anatomical features of the structure of the intestinal canal (sacrococcygeal curvature).
• Damage to the canal with proctological instruments during diagnostic measures, anal sex, trauma by foreign objects contained in the feces.
• Violation of blood flow and stagnation of blood caused by thrombophlebitis, aneurysm, hemorrhoids, atherosclerosis.
• Pressure surges in the rectum. They can be caused by heavy lifting.
• neurocirculatory disorders. Contribute to the development of spasm of the sphincter.

The study of the mechanisms of occurrence of problems continues today. So, thanks to research, doctors were able to relieve spasm of the sphincter with nitro drugs, which significantly improved the effectiveness of treatment.

Types of anal fissures

Diagnosis is possible only after a rectal examination. It can be finger or instrumental. Its implementation allows you to determine the localization of the problem and identify the presence or absence of sphincter spasm.

In addition, the proctologist is required to indicate the nature of the course of the disease by adding the words "acute" or "chronic". Let's see how these diagnoses differ.

• The acute form is a recently developed defect, which is characterized by severe but short-term pain (during bowel movements and 10-15 minutes after it), minimal bleeding and a pronounced spasm of the sphincter. This type of injury has smooth, polished edges, and its bottom is lined with muscle fibers.
• The chronic form is an acute defect that has transformed into a chronic one. Prolonged painful sensations are characteristic, which are caused not only by the act of defecation, but also by an uncomfortable posture, urge to go to the toilet; a slight discharge of scarlet blood caused by problems with the stool. The edges of such an injury do not heal on their own, they only thicken and become dense. At the base, a sentinel tubercle is formed - a polyp of connective tissue.

In chronic forms of the disease, long periods of remission (up to 20 days or more) are possible, when the symptoms cease to bother. Defects seem to heal, but it must be remembered: a connective tissue scar tends to develop into a malignant tumor.

Methods of treatment at home

Treatment of anal fissure depends on the duration of its existence. Fresh injuries are quickly healed through conservative therapy: the use of stool normalizers, suppositories and ointments that relieve pain, spasm, inflammation, etc.

If more than 3 weeks have passed since the formation, its edges have become dense, then in most cases it is impossible to do without surgical intervention. It is no longer possible to cope with such a problem at home.

Rectal suppositories

Candles, the main purpose of which is to eliminate discomfort (itching, soreness) and accelerate the healing of the mucosa, tend to be quickly absorbed and have a therapeutic effect. Allergic reactions with their use are rare.

• Suppositories with sea buckthorn oil. Herbal suppositories that increase local immunity and accelerate regeneration processes. They have little antimicrobial activity. Allowed for children and pregnant women. The course of treatment is 7 days, 1 candle per day.
• Hepatrombin G. Candles and ointment, which have analgesic, anti-allergic effects, relieve itching, burning, and swelling.
• Proctosan. A four-component drug that has an astringent, anti-inflammatory, analgesic and wound healing effect. The course of treatment is up to 7 days. Suppositories are administered twice a day, one at a time. Contraindicated during pregnancy.
• Relief Advance. It has a fast analgesic and powerful regenerating effect due to the content of benzocaine and shark liver oil. Candles and Relief ointment are allowed to be used in the rehabilitation period (from 3 to 5 rubles per day), during pregnancy and immediately before defecation to facilitate the passage of feces. Adverse reactions rarely develop.
• Natalsid. Suppositories contain sodium alginate, a polysaccharide from algae. They speed up the healing process, have an anti-inflammatory effect. Suppositories are placed twice a day from 1 to 2 weeks.
• Anestezol. Contains zinc and benzocaine. These components anesthetize, dry the wound, accelerate the regeneration of the mucosa. Contraindications: hypersensitivity to the components of suppositories.
• Ultraproject. Combined drug, the components of which promote rapid wound healing (hormone fluocortolone) and relieve pain (cinchocaine). The course of treatment is no more than 1 month. Contraindicated in the first trimester of pregnancy.

Any suppositories from this list are administered as follows: empty the intestines, in the supine position on the side (the leg should be bent at the knee), a candle is inserted and the buttocks are squeezed; lie down for at least 5 minutes.

Ointments

If a person is worried about severe pain, then the use of suppositories is not possible. Then the proctologist prescribes ointment (or cream) drugs. They have a greasy texture, are easy to apply, relieving pain and inflammation, and also contribute to the healing of damaged tissues of the anus.

• Posterized forte. It contains a suspension of the cell membrane of a strain of Escherichia coli, which activates local immunity, starts the process of formation of immunoglobulin A, which forms a thin protective film on the mucous membrane, as well as hydrocortisone, which relieves inflammation. The ointment is administered with a special applicator twice a day (or after each stool) for a maximum of 3 weeks.
• Solcoseryl. Means for restoring the damaged wall of the anus. It is applied only after the crack has dried. Not . Apply a thin layer 2 p. in a day.
  Aurobin. Ointment with anti-inflammatory and antibacterial effect. Contains prednisone and
• D-panthenol. Relieves itching and swelling, relieves pain well, stimulates tissue regeneration. It can suppress adrenal function, therefore it is not prescribed in childhood and during pregnancy.
• Nitroglycerin ointment. Promotes relaxation of the sphincter, which has a beneficial effect on the process of wound healing. She processes the anorectal zone, the rectum (using a cotton swab). The course of treatment is up to a month, 3-4 times a day.
• Levomikol. Antibacterial ointment that accelerates the healing of the skin. It is prescribed if the wound is affected by bacteria and becomes inflamed. The ointment is applied for 7-10 days in the morning and evening.
• Ichthyol ointment. Relieves pain and inflammation.
• Ratovnik. Fights inflammation, accelerates regeneration processes, kills microbes living on the mucosa. It is allowed to apply after each bowel movement.

The rules for applying the ointment are as follows: the anus is washed with warm water and soap, after drying, the ointment is applied to the affected area with a thin layer 2-3 times a day (unless otherwise indicated in the instructions).

Folk remedies

Despite the huge number of drugs for anal fissure, the desire to try to be cured with folk remedies remains. We list easy-to-make and safe recipes from folk healers.

• Herbal candles. Dry raw materials of plantain, chamomile and motherwort taken in equal parts are added to melted beeswax. 10 suppositories are formed, and after solidification, they are used to relieve swelling and itching.
• Propolis suppositories with the addition of . A mixture of 70% alcohol, fat and, taken in 40 grams each, is prepared, insisted for 3 days, after which a stick cut from potatoes is dipped into it and inserted into the anus. The procedure is repeated until complete recovery every evening.
• Ice candles. Dry raw materials of chamomile, oak bark and calendula (in equal proportions) are boiled in a liter of water for 5 minutes. After cooling, the broth is poured into molds (you can use fingers from medical gloves) and frozen.
• Compress of bile and vegetables. Carrots and beets, grated, combined with bile (pork or bovine), taken in a ratio of 3:1. The composition is spread on the tissue and applied to the rupture of the mucosa, hold for 15-20 minutes.
• Infusion for sitz baths. Mix taken 20 gr. calendula, sage, chamomile and St. John's wort. Pour 1.5 liters. boiling water, filter and dilute to an acceptable temperature with warm water. A sitz bath is taken for 15-20 minutes.
• Decoctions for microclysters. In a glass of boiling water, brew 1 tbsp. l. chamomile (or yarrow, St. John's wort). In a warm form, it is injected into the anus with a microclyster with a volume of 30-50 ml. After the introduction, it is recommended to lie on the left side. Duration of application - 1 p. per day for three consecutive weeks.
• Spruce resin ointment. Take 4 tbsp. spruce resin, boil it, filter and add 2 tbsp. sheep fat and boil again. Wax is introduced. Apply chilled 2 p. in a day.

Keep in mind: it will not work to cure a chronic crack with folk remedies. The above means can only speed up the healing process of the operated wound.

Dietary nutrition in case of illness

Dietary nutrition is aimed at facilitating the process of defecation and reducing pain. It involves minimal heat treatment of vegetables, the inclusion of probiotics and natural yoghurts in the diet. With symptoms of anal fissure and other proctological diseases, it is recommended:

• Include in the diet: whole grain cereals, dried fruits, vegetable broth soups, vegetable salads (including boiled or baked beets), rosehip broth.
• Exclude from the diet: seasonings, alcohol (including beer), spicy, salty, fatty protein foods (meat, high-fat dairy products, rich broths, eggs), citrus juices, fresh wheat bread, foods rich in starch.
• Observe the drinking regime. To soften the feces, you need to drink 2.5-3 liters per day. water.
• Include bran in the diet, take enzyme preparations Mezim, Gestal, Panzinorm, which facilitate digestion.
• Stick to fractional meals (5-7 times a day).
• To stimulate bowel contraction, add vegetable oil to salads. Sometimes it is allowed to drink vaseline oil.

It is worth adhering to the diet in the period after the refusal of cleansing enemas, as well as after surgery to prevent injury to the wound surface. During the period of remission, it is allowed to diversify the diet with "harmful" foods in minimal quantities.

Operative methods of treatment

Surgical treatment is indicated for the chronic course of the disease, when there is no positive effect from the use of ointments, suppositories, physiotherapy or the condition improves only for a short time.

Excision of the anal fissure can be performed in a hospital or clinic, under general anesthesia or local anesthesia (without hospitalization). When choosing the type of anesthesia and the location of the operation, the proctologist is guided by the presence of factors such as sphincter spasm, the presence of scar tissue and the location of the wound.

Operation types

Surgical treatment involves excision of the wound within healthy tissue with "sentinel tubercles". There are several types of operations to excise a mucosal defect:

• Classic sphincterotomy. It is necessary to eliminate the spasm of the internal sphincter. It is carried out in open (with a dissection of the mucosa) and closed (with penetration through the intersphincter groove without damaging the mucosa) options. It is performed after excision of the crack and fibrous tissue. Lasts no more than 30 minutes. After 2-6 weeks after sphincterotomy, recovery is noted in 73-100% of patients. Possible complications: pain syndrome, bleeding, prolonged wound healing, abscess, fecal incontinence.
• Pneumodivulsion of the anal sphincter. Surgical stretching of the rectal canal by forcing air with a pneumoballoon. The duration of the manipulation is 7 minutes. Contraindications: surgery on the canal in history, hemorrhoids (internal and external) 3-4 degrees, fistulas.
• Excision of the defect in combination with medical relaxation of the sphincter. An incision of the mucosa with an electrocoagulator and a "triangular" excision of the wound with a hypertrophied papilla, crypt and sentinel tubercle. The final stage of the operation is drug applications with nifidipine, nitroglycerin ointment or an injection of Botox (botulinum toxin).
• laser surgery. Cauterization of deep tissues with decontamination of the wound. It is indicated for fissures and hemorrhoidal bands, not accompanied by spasm of the sphincter. Duration - from 10 to 30 minutes.
• Electrocoagulation. Impact on the problem area with a high frequency current. At the same time, the tissues are excised and cauterized, blood loss is minimal. A scab is formed, falling off in 8-12 days. Disadvantages: prolonged pain, the inability to relieve spasm of the sphincter.
• Electroradiosurgical coagulation. Bloodless excision with high-frequency radio waves, in which the scars "melt". The operation is painless. nerve endings are not stimulated. It is rarely used, because. complications often occur.
• Ultrasonic treatment. The latest method, which involves the impact only on altered tissues (without damage to nerves and blood vessels). There is no bleeding and pain, no need for hospitalization.

The duration of disability depends on the type of intervention and the rate of healing of the submucosa. With sphincterotomy - the most practiced operation with low recurrence rates - it is 3-4 weeks.

Preparing for the operation

The success of the surgical intervention largely depends on the preparatory measures. In the preoperative period, the proctologist, in addition to laboratory tests (urine and blood, sowing on the eggs of the worm and pathogenic microflora), can be assigned:

• Instrumental examinations (anoscopy, rectoscopy, irrigoscopy, ultrasound). Necessary to clarify the diagnosis, exclude other diseases, tumor formations.
• Consultations of specialists (cardiologist with ECG, anesthesiologist, therapist, other doctors in the presence of pathologies).
• Hygiene procedures (shaving hair in the anus, cleansing enemas (repeat twice), taking Fortrans or Microlance preparations).
• Dieting. The exclusion of alcohol, products that can provoke meteorite phenomena, eating easily digestible food.

This list can be shortened or expanded depending on the condition of the person and the method of surgical intervention chosen by the proctologist. Passing additional studies reduces the risk of sudden complications during and after surgery.

Operation technique

Tissue removal can be performed with a surgical scalpel, laser knife, using the Surgitron apparatus (with electroradiocoagulation). An approximate algorithm for performing crack excision can be represented as follows:

• Anesthesia. Local (injection of an anesthetic that "freezes" a certain area for 2-4 hours) or spinal (injection of an anesthetic into the spinal canal, legs, buttocks and perineum are anesthetized for 4-6 hours, it is advisable not to get up for 12 hours).
• Introduction of a rectal mirror and divulsion (expansion) of the sphincter.
• Excision of a crack in the form of a mucocutaneous triangle with granulations at its bottom. The wound is not sutured.
• Dissection of the sphincter. It is performed in the presence of spasm of the sphincter in a closed (under the control of a finger) or open (under visual control) method.
  Removal of hemorrhoids (in the presence of hemorrhoids).

The duration of the operation usually does not exceed 10-30 minutes (including analgesic measures). The minimum hospital stay is 1 day. Bandaging of the wound is necessary daily until it is completely healed.

Recovery after surgery

Rehabilitation measures are aimed at reducing the severity of pain caused by the intervention, accelerating wound healing and stopping inflammation. In addition, restorative therapy should contribute to the normalization of the digestive tract. Postoperative therapy may include:

• Taking medication. During the period of postoperative rehabilitation, proctologists prescribe analgesics (relieve pain), antispasmodics, venotonics (indicated with concomitant hemorrhoids), laxatives / prokinetics (inhibit or stimulate intestinal activity) - Proctosan, Natalsid, Mukofalk,
• Diet. It is recommended to use fermented milk products and products of plant origin, avoiding salty, spicy foods and alcohol. With a tendency to constipation, diet No. 3 is prescribed, with a tendency to diarrhea - No. 46.
• hygiene measures. Daily sitz baths, washing after each bowel movement, wearing loose underwear.
• Reduced physical activity. Do not lift heavy objects, stand or sit for long periods of time.

In rare cases, after surgery, there are difficulties with urination. This problem is solved by installing a catheter. Bleeding is normal, but if it tends to increase, then you need to contact a proctologist.

Treatment of an anal fissure in a child

In childhood, an anal fissure is formed due to frequent constipation caused by malnutrition of the mother or the child himself, helminthic invasion, food allergies, and inaccurate use of enemas. Its symptoms are: bloody marks on the stool, pain during bowel movements, accompanied by screaming and crying (in newborns), restlessness and fear of the potty.

The main method of treatment is conservative. It aims to relieve pain in the baby, tighten the crack and normalize the consistency of the stool. It contributes to:

• Supplementing the child with water or a decoction of dried fruits.
• Compliance with a lactating mother hypoallergenic diet.
• Taking medications that promote soft stools (glycerin suppositories, lactulose-based drugs).
• The use of suppositories and ointments that relieve itching and redness, contribute to the delay of microtraumas (Alginatol, herbal baths, suppositories with sea buckthorn, Posterisan, Solcoseryl).
• Increased hygiene requirements. Washing the priests after each trip to the toilet, treating the anus with greasy creams or Bepanthen.

Self-treatment of an anal fissure in a child is not permissible! It must be shown to the pediatrician, who will prescribe adequate treatment. Uncontrolled use of suppositories is fraught with loss of rectal sensitivity receptors. Then the child will no longer be able to empty the intestines without the help of suppositories or enemas.

Treatment during pregnancy and after childbirth

Pregnancy is accompanied by hormonal changes, and it already affects intestinal motility in the early stages. Presses on the intestines and the growing uterus, squeezing the vessels of the small pelvis. This is expressed in a decrease in the tone of the rectum, which causes constipation with severe straining, as well as in its edema and plethora.

The result of constipation and edema can be an anus fissure. Treatment during the period of bearing a child is limited, because. many drugs can affect intrauterine development. During pregnancy, it comes down to:

• Preventive measures: dietary nutrition with the inclusion of a large amount of vegetable fiber in the diet, walking, physiotherapy exercises, a water toilet after defecation, taking laxative herbs.
• Conservative local treatment: wound healing and anesthetic suppositories and ointments, baths and microclysters are prescribed. The following drugs are allowed: Natalsid, Buscopan, Papaverine in suppositories, Pasteurisan in suppositories and ointments.
• Surgical excision. It is necessary at a high risk of fistula formation, tissue rupture.

The problem may begin to bother in the postpartum period. Its most common cause is attempts during labor. If the child is breastfed, then the mother should also monitor the diet and take certain medications. We list gentle, but effective therapeutic measures:

• Normalization of the stool: diet, taking laxatives.
• Medications that do not penetrate the bloodstream: suppositories with sea buckthorn, posterisan, solcoseryl, microclysters with herbal decoctions.
• Washing with warm water without soap.

If sparing methods of treatment are ineffective, it is necessary to visit a proctologist for additional studies, because. there may be another proctological disease.

Video

We offer you to watch a video in which the proctologist of the BIOSS clinic Vladimir Tolstykh talks in simple terms about the types of anal fissures, methods of their conservative and surgical treatment.

Don't delay your treatment! Remember that advanced forms of this disease can degenerate into a malignant tumor. The operation allows to achieve recovery in 94-100% of patients.

Anal fissure - damage (cracking) of the mucous membrane of the rectum, which occurs along the wall of the anal canal. This ailment is more often detected in the female sex, as well as in people who have anal sex. There are cases when the disease occurs in children.

stages

A fissure in the anus has two stages of flow:

1. Acute fissure of the rectum. It is formed with a sudden rupture of the walls of the mucous membrane of the final part of the digestive tract. Such wounds tend to heal quite quickly, within 2-3 days. Treatment with medications may not be carried out.
2. Chronic fissure of the rectum. The disease passes into the chronic stage of the course when, for some reason, an acute gap does not heal. It also happens if a person suffers from chronic constipation. Cracks increase significantly in size. At the same time, they are exposed to constant infection with pathogenic microorganisms. During straining, a person has a spasm of the anal sphincter. The resulting wound tends not to heal over a long period of time, bringing a person severe pain and discomfort.

The defect of the anus can be single and multiple.

Provoking factors

Currently, the causes of the disease are not fully understood by medicine. But the main reasons are:

• chronic constipation, its consequences and impaired blood flow in the pelvic organs. The main causes of congestion and constipation are an inactive lifestyle, prolonged sitting on the toilet, lifting weights, sedentary work. This is especially true for office workers, people engaged in heavy physical labor, features of the anatomical structure of the digestive tract;
• injuries received during anal sex;
• chronic diseases of the gastrointestinal tract (chronic gastritis, duodenal ulcer and stomach ulcer, cholecystitis);
• hemorrhoids. With varicose veins of the anal veins, thrombosis develops. It also significantly increases the chance of cracking in the anus. Often hemorrhoids cause the development of pectenosis, which has a detrimental effect on the elasticity and tone of the walls of the rectum;
• pregnancy and childbirth. Especially if there were complications.

Complications

If the defect in the anus is not treated, then the following complications can be provoked: paraproctitis, blood discharge (in some cases very abundant) during and after the act of defecation, colitis, formations of purulent fistulas, weakness of the anal sphincter, constant pain (not only during the time of bowel movement, but also when walking, sitting), itching, the development of oncological diseases of the intestine.

Complications of cracks in the anus are very dangerous for men. Spread of infectious inflammation to the prostate gland is possible. As a result of this, respectively, there is prostatitis.

Timely treatment of anal fissure avoids the development of life-threatening consequences.

Treatment

Before starting to treat rectal fissures, it is necessary to conduct a complete differential diagnosis (finger examination of the anus, anoscopy, sigmoidoscopy, ultrasound). The choice of method of therapy will be determined by the attending physician after a complete examination. Depending on the nature and clinical manifestation of the rectal defect.

Initially, the treatment of a fissure is aimed at eliminating pain symptoms and muscle spasm of the sphincter. And only then - to normalize the work of the gastrointestinal tract and tighten the defect itself.

With an acute rectal fissure in about seventy percent of patients, effective results can be achieved fairly quickly after the therapeutic measures taken, combined with strict adherence to the prescriptions of the attending doctor: proper diet, hygiene, increased physical activity, lifestyle changes.

Methods of treatment

Treatment for an anal fissure in humans includes:

1. Compliance with the diet.
2. Conservative methods of therapy. The use of special pharmacological preparations (rectal suppositories, creams, ointments).
3. Operative (surgical) methods of treatment.

diet therapy

The first step in the treatment of defects in the anus is to change the patient's lifestyle, normalize metabolic processes in the body, and eliminate the cause of constipation. First of all, the treatment of a fissure is aimed at preventing the occurrence of chronic constipation (or diarrhea).

Patients who have a wound in the rectum should exclude salty, fried, spicy, floury, spicy, sour foods and, of course, alcoholic beverages from their menu.

Patients with a defect in the anus are recommended to eat cereals, salads with vegetable oil, bread with bran (no more than 20 g per day), mucous soups, natural yoghurts. To improve peristalsis, a diet high in fiber is recommended (prunes, kiwi, dried apricots, bananas, beets, figs, boiled carrots, baked apples, etc.), as well as dairy products. Don't forget to drink plenty of water.

If a person has diarrhea, it is necessary to exclude cabbage, legumes, fresh vegetables and fruits of fruit trees, confectionery from yeast dough, and milk from the diet.

Medical therapy

If a patient has a rectal fissure that does not heal for a month, then from the acute stage of the course it passes into a chronic one.

Conservative treatment involves the use of rectal suppositories and ointments. Also, injections are made to relieve spasm of the sphincter.

Modern pharmacology provides a huge range of drugs. The choice of one or another remedy depends on the symptoms of the disease and the degree of the inflammatory process.

Rectal suppositories

Rectal suppositories are the most effective medicine. Rectal suppositories have the ability to be absorbed into the body in a short period of time. This form of the drug is made on the basis of cocoa butter, vegetable and animal hydrogenated fats, which simultaneously act as a laxative. If the patient has a chronic fissure in the anus, then therapy is carried out with combined rectal suppositories with analgesic and antispasmodic effects. Candles can be used twice a day after a bowel movement. Rectal suppositories that reduce pain and itching near the anus include:

• Anuzol. The composition of the drug includes xeroform, rubuha, zinc sulfate;
• Anestezol. Ingredients: anestezin, bismuth subgallate, menthol, zinc oxide;
• Proctosan. Ingredients: lidocaine, bismuth subgallate, bufexamak, titanium dioxide;
• candles with belladonna extract, etc.

Rectal suppositories that eliminate the inflammatory process, stimulate healing, and have a hemostatic and analgesic effect include:

• Relief;
• Rkelif Advance;
• Posterized, etc.

Medicines of this group are contraindicated in children under twelve years of age, during pregnancy and lactation, in violation of blood clotting. To stimulate metabolic processes and immunomodulatory effects, suppositories with methyluracil are used. Sea buckthorn suppositories have a highly effective effect on shallow wounds.

Most medical professionals believe that it is rectal suppositories that are the most effective way of therapy to eliminate inflammation and cure the disease.

Laxatives

Using laxative drugs, you can get rid of the main cause of cracking around the anus. Medications that facilitate the act of defecation are divided into emollients (Norgalax) and those that help cleanse the body (Naturolax, Mucofalk, Fiberleks, Fiberal, Fibercon, etc.).

Ointments

If the patient has a strong pain syndrome, then it is very difficult to use rectal suppositories in this case. In such a situation, conservative treatment involves the use of ointments and creams for wounds in the rectum.

It is necessary to treat the disease with fatty-based ointments or creams that do not provoke irritation of the skin and mucous membranes around the anus.

It is advisable to use medications that eliminate inflammation and accelerate the healing process of the wound:

• Ultraproct;
• Aurobin;
• Dexpanthenol;
• Bepanthen;
• Pantesol;
• Solcoseryl;
• Methyluracil, etc.

An ointment or cream is applied around the anus once or twice a day after a bowel movement and a bath.

Surgery

If the disease cannot be cured with medications for 13-16 days, then in such a situation, surgical methods of treatment are used. As a rule, only chronic cracking is necessary to be treated with an operative method.

The essence of surgery is to eliminate the wound. The operation (excision) can be carried out in two ways:

1. Electrocoagulator.
2. laser.

As evidenced by numerous forums, laser surgery is recommended.

Alternative treatment

Currently, folk methods of therapy are widely used in combination with medical drugs. There are a large number of different folk methods of therapy: decoctions, teas, sitz baths.

Treatment of an anal fissure at home using folk methods is used both during an exacerbation of the disease, and during the chronic stage of its course. During an exacerbation of the disease, traditional medicine helps to reduce pain symptoms, eliminate inflammation, and relieve spasm of the sphincter.

After surgery and in case of chronic damage, traditional medicine helps to heal the damage in the anus.

• microclysters with the addition of oil, medicinal herbs (St. John's wort, mother herb, medicinal marigold) and honey;
• sitz baths at room temperature (not more than 40 ° C), it is possible with medicinal plants or with a solution of potassium permanganate;
• ointments from bee glue and spruce resin (at home, with your own hands).

It should be remembered that it is impossible to cure the disease only by means of traditional medicine. After the final cure, all the causes that provoked the onset of the disease (constipation, inactive lifestyle, hemorrhoids, etc.) should be eliminated. If you follow all the recommendations of the attending doctor, then you will no longer have a crack in the anus.

Education: Graduated from the Russian National Research Medical University. N.I. Pirogov, Faculty of Medicine. Took advanced training courses. Primary specialization - in coloproctology at the State Scientific Center of Coloproctology. Worked at the City Scientific and Practical Center of Coloproctology of St. Petersburg.

Work experience: Proctologist. Experience in medical practice - 25 years. Author of more than 40 medical articles. A regular participant of conferences and symposia, which highlights the problems of modern medicine.

Provides highly qualified diagnostics and treatment of many diseases: hemorrhoids, anal fissures, various diseases of the colon, successfully diagnoses neoplasms of the perianal region and rectum in the early stages. He also conducts examinations of children.

Everyone is well aware of the problem of constipation, as well as the fact that they often cause hemorrhoids, and this is how its initial stage manifests itself - a crack in the anus.

Symptoms and Causes

The most important and main symptom is quite painful sensations, they can be like short-term as well as long-term.

The characteristics are exactly the same, ranging from sharp and cutting pain, ending with strong and aching.

The pain can also be transferred to the genitals, in men very often because of this they begin problems with urination.

To reduce pain with cracks in the anus, you can take the fetal position, pulling your legs up to your stomach in a prone position, or it is simply recommended to walk a lot. In duration, it takes from a minute to a whole day, or even two.

Most clearly, pains with cracks in the anus appear during emptying, the cracks themselves are localized in the anus, namely on the intestinal wall.

Manifestations of bleeding from the anus during emptying are not excluded.

Useful video:

If we talk about the causes of cracks in the anus, then they include:

• Chronic diseases of the stomach or intestines. Examples are gastritis and ulcers;
• People leading a sedentary lifestyle;
• Various injuries of the anus. They occur with constipation, or with the introduction of foreign bodies into the anus;
• One of the main reasons is hemorrhoids. If such a problem occurs, nodes swell, which injure the intestine during emptying, and this causes cracks inside.

One of the main causes of constipation and diarrhea is use of various drugs. To improve bowel function after taking the drugs, you need every day drink a simple remedy ...

List of medicines:

• Relief - it can be found both in the form of candles and in the form of an ointment. Eliminates nodes with cracks in the anus, works very well in the initial stages of hemorrhoids. Do not take with antidepressants.
• Proctosan - has an anesthetic and wound-healing effect, so it is prescribed both for anal fissures and hemorrhoids.
• Posterisan - activates and maintains the properties of the immune system, acts as an anti-inflammatory and healing, eliminates itching, quickly copes with mucous tissues that are prone to all kinds of damage.
• - from the name it is clear that the composition contains, acts as an antibacterial, regenerating agent, has an anti-inflammatory effect. Relieve itching and swelling of cracks in the anus.

Photos of candles:

• Propolis candles have the same properties as sea buckthorn. But propolis, by its properties, helps better, as well as short-term and intestinal damage.
• Methyluracil suppositories - enhance regeneration, act as fairly fast wound healing. Stop bleeding, heal wounds and tears, relieve inflammation. They contain methuracil, which provokes anti-catabolic and anabolic effects.
• Salofalk - acts as an anti-inflammatory agent, suppositories are also used in ulcerative colitis.
• Depantol is an antimicrobial drug that acts as an anti-inflammatory, and also promotes rapid healing and regeneration.

Photo gallery:

Medication treatment

There are a large number of different ointments, as well as just drugs for the treatment of cracks in the anus.

We will consider the most basic of them:

1. Heparin ointment. This drug contains components for tissue regeneration with cracks in the anus, softens the skin, eliminates itching and pain. From the name it is clear that the main component is heparin. But it is desirable to take it when there is no bleeding.
2. Everyone knows Vishnevsky's ointment. Many have known about it for quite a long time, as it easily eliminates all minor injuries in the anus, as well as stronger and more serious ones. Eliminates itching and pain, relieves inflammation, carries regenerative properties.
3. Detralex. This drug can be found in the form of tablets, they have the properties of blood thinning for cracks, strengthening blood vessels, restoring, they are often used in acute and chronic hemorrhoids.
4. Levomekol. Available in the form of an ointment. Very quickly promotes the healing of cracks in the anus, especially purulent wounds, severe cracks, ulcers and burns of 2 and 3 degrees. It contains the antibiotic chloramphenicol in its composition, this type of antibiotic easily copes with bacteria and chlamydia.
5. Bepanten. Promotes active absorption of the skin with cracks, as well as simply stimulates the healing of the skin and cracks in the anus. It is very quickly absorbed by the skin, so it also has a moisturizing and softening effect.
6. Ichthyol ointment and methyluracil. They have a fairly strong antiseptic effect. The first is used more for healing scars that can occur with hemorrhoids, it also has a not very pleasant smell, but high efficiency and effectiveness have been proven. The second ointment promotes a stable metabolic process in cells, renews damaged skin areas, regenerates and restores.

Related video:

How to treat folk remedies

The most effective folk remedies for cracks in the anus according to statistics:

• Steam baths.

It is necessary to sit over the steam several times a day with the same boiled pumpkin seeds.

Such a bath is made from 2 liters of water and one kilogram of pumpkin seeds, it is advisable to carry out such a procedure for 30 minutes at a time.

Such baths are made on the basis of medicinal plants.

To do this, you need to collect leaves of oak, birch, bird cherry, coltsfoot, sage, wormwood grass, thyme, black poplar buds and oat straw.

If desired, you can add chamomile flowers, plantain and nettle. Plantain leaves promote tissue regeneration, as well as tissue healing.

All this must be poured with one and a half liters of water (approximately), the water should be warm, but not at room temperature, but higher, you need to sit on it for 15-20 minutes.

• Compresses.

The most effective compress consists of an equal amount of grated beets and carrots, then dividing it into three equal parts mixed with ox bile.

We spread all this on a clean cloth, it is possible on a gauze bandage, and keep it on the anus for about 15 minutes a day.

Diet and nutrition

If you find yourself with such a problem as cracks in the anus, you should immediately pay attention to your diet, it should be balanced and complete, try to move more and try not to sit in one place.

It is worth including fermented baked milk in the daily diet, etc. from fermented milk products that need to be taken every morning, as they fill the body with useful substances and vitamins, as well as normalize the flora and intestinal microflora.

As well as with hemorrhoids, with cracks in the anus, you should immediately include fiber in your diet, it is found in vegetables and fruits, as well as cereals.

Be sure to use soups twice a day, containing cauliflower or zucchini. Figs and dried apricots are also very useful.

In terms of cereals, you can use any, except for rice and semolina, since they dull the metabolism a little, from cereal cereals you need to take only rye bread,.

You will have to give up fatty, fried, too spicy. Advantages should be given only to steaming or in the oven.

If the form of cracks in the anus is quite neglected and medications do not help, as well as folk remedies, you need to consult a doctor and have an operation, namely excision of a crack in the anus.

Excision is of two types:

• Classic;
• Minimally invasive methods (laser surgery and electrocoagulation).

These two methods of treatment are not considered severe, their duration is no more than 15 minutes.

But first, it is worth preparing properly, after passing the tests and consulting with the doctor, you need to go on a diet and do it the day before the excision of the anal fissure.

There are also some restrictions, if the patient has profuse bleeding, it should first be left with medication, but only so it will be possible to carry out this procedure.

Like all people, in pregnant women it starts with pain in the anus, sometimes they are quite strong.

Almost everyone faces such a problem as constipation and cracks in the anus during pregnancy, but this does not mean that you do not need to do anything and wait until everything goes away by itself.

You should immediately contact your personal doctor for treatment of a fissure in the anus.

Since there are a number of complications that can cause severe harm to both the mother and the child:

1. Purulent process of the anus. It can also be a provocation to activate the fistula.
2. Anemia - if you have bleeding that cannot be stopped.
3. The most important and most terrible is a malignant tumor, it can occur with a chronic fissure in the anus, which did not respond to treatment at all.

Prevention

After treating a crack in the anus, it is worth it, as well as the foods that you eat, how they affect the stomach and intestines.

Also now watch your chair, it should be regular and stable, so avoid constipation.

Drink as much liquid and water per day as possible (at least 1.5 liters of water). Constant mobility and sports.

Anal fissure, or anal fissure, is a rupture of the rectal mucosa of various depths. 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 come with questions of discomfort in the rectal area. They are more common in women of reproductive age.

By itself, an anal fissure, the symptoms and treatment of which we will consider, can be an independent phenomenon that has arisen as a result of exposure to various traumatic factors. However, much more often, painful defects in 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).

The reasons

1. Anal mucosal injury, which occurs during the passage of solid dry feces during constipation. Prolonged stretching of the anal canal leads to traumatic damage to its posterior wall, especially in men. This zone 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, cracks in the anterior part of the anal canal are more common in women. Fissures rarely occur on the side walls of the anal canal.
2. Diseases of the digestive system- various, can lead to the formation of cracks in the anus. Statistics show that 95% of patients suffering from inflammation of hemorrhoids have anal fissures.
3. Violation of the cardiovascular system and related diseases (congestion in the pelvic area and rectum, atherosclerosis obliterans, 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 defecation, as a result of which the expectant mother may develop anal fissures. This pathology is also not uncommon in young mothers - the appearance of cracks in the anus is facilitated by perineal ruptures during childbirth.

You should not hope that the newly formed mucosal defect will heal by itself, especially if the patient does not change anything at all in his lifestyle and diet. Moreover, an acute fissure (it is considered acute for the first 4 weeks of its existence) can turn into a chronic one, which persists for months and takes the patient out of a state of physical and mental balance.

If a person turned to a specialist in time, then ointments or suppositories are prescribed for the treatment of an anal fissure at home, and only in an advanced case, a surgical operation is offered. Microcracks are a few millimeters, and deep ones reach two centimeters.

Symptoms of an anal fissure

When an anal fissure occurs, the most important and main symptom is pain and slight bleeding (see photo). Unpleasant sensations persist after defecation, while itching and burning are noted. Over time, sphincter spasm may also join them. Such signs are observed at any stage of the disease.

However, if in the acute form the wound can heal in a few weeks without special treatment, then the chronic crack does not close for a very long time. Pain during a long stay in a sitting position, constant discomfort causes fear of defecation. As a result, constipation appears, which only worsens the condition of a person. The patient becomes irritable, sleep disturbances are noted.

Anal fissure in children

Children suffer from cracks to a lesser extent than adults, but even infants can experience similar symptoms. If a child has encountered a 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.

Do not treat your child at home. Folk remedies can only relieve symptoms, unlike medicines.

chronic fissure

Over time, the acute form of the disease can flow into the chronic stage, especially with improper wound care or the use of incorrect medications. Most often, an anal fissure in women after childbirth acquires a permanent character, which is also explained by natural changes in the body of the new mother.

Pain in the chronic form brings suffering not only during defecation or after a long sitting, but also in any forced uncomfortable position, walking. To itching, discomfort and bleeding, a panic fear of the toilet is added.

The patient is increasingly resorting to the help of laxatives, enemas, suppositories, thereby aggravating the process. Perhaps the development of insomnia and increased irritability.

Effects

Complications of anal fissures include:

1. Acute paraproctitis (when an infection enters through a defect in the rectal mucosa into the surrounding fatty tissue).
2. Strong pains. As a rule, severe pain in 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).
5. Profuse bleeding.
6. Fistulas of the rectum.

Diagnostics

The proctologist can easily determine the presence of an anal fissure even at the stage of a routine examination, since the swollen areas and mucous membranes are broken. If a chronic fissure of the rectum is located inside, then a digital examination is performed.

So the proctologist can determine its size, feel the edges. When there are problems with palpation, a sigmoidoscope is inserted into the anus. This device makes it possible to examine the rectum at a depth of twenty centimeters. If necessary, a colonoscopy, irrigoscopy is prescribed.

How to treat an anal fissure

If any disease has become the cause of this problem, then its treatment is necessary, since it is impossible to cure anal fissures without eliminating the cause of their appearance.

In addition, when starting the treatment of anal fissure, it should be clearly understood that no means 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 a way to deal with such an ailment in a particular case is determined by the proctologist after a preliminary examination, depending on the clinical manifestations and nature of the disease.

Anal fissures are treated in the following ways:

1. Medical method is the use of drugs that allow you to achieve an analgesic effect and heal the fissure of the passage. The course of treatment depends on the degree of the disease, is carried out by the patient independently at home.
2. Minimally invasive method is laser removal of a crack in a hospital.
3. Operational way also performed in a hospital, performing laser removal and sphincterotomy.

They start, of course, with a conservative one. 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. Treatment of the anus 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.

Candles and ointments for cracks in the anus

As medications, special suppositories or ointments for cracks in the anus are most often prescribed. They allow you to relieve spasm of the internal anal sphincter.

Painkillers:

• Ichthyol candles;
• Proctoglivenol;
• Ultraproct;
• Glycerin suppositories;
• Salofalk;
• Candles with calendula;
• Betiol with belladonna;
• Anestezol.

They usually include some kind of analgesic, which alleviates pain in the anus.

Wound healing and anti-inflammatory candles:

1. Relief (contain shark liver oil, which has anti-inflammatory, hemostatic and analgesic effects);
2. Propolis. To prepare the medicine, grate it on a fine grater, mix with butter, heat until dissolved. After receiving a liquid solution, the drug is poured into trays that have the shape of a candle;
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 preparation contains inactivated intestinal bacteria, as well as their metabolic products. The tool increases immune defense and has an anti-inflammatory effect;
6. Hepatrombin T - rectal suppositories to stop rectal bleeding with analgesic and anti-inflammatory action;
   Hamamelis (homeopathic herbal remedy).

They help heal rectal fissures and prevent complications.

Relieve constipation and soften feces

By making the stool softer and the stool daily, one of the main reasons why there is a crack around the anus can be eliminated. Medications that facilitate bowel movements are divided into the following groups.

1. Funds, 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-irritant to the intestines), Sorbitol, Macrogol, Laktiol (see all laxatives).
3. Emollients (vaseline and sea buckthorn oils, Norgalax). At home, for problems with the anal sphincter, counter microclysters are used 10 minutes before emptying (100 ml of pasteurized sunflower oil and 200 ml of boiled water at room temperature).

Folk remedies

To treat an 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 out in the form of a suppository from a tuber, inserted into the anal canal, and kept all night. Then she comes out on her own with a bowel movement. To enhance its therapeutic effect, you can dip it in honey or oil, for example, sea buckthorn, before use. The course is 10 candles.
2. If the crack goes deep into the anal canal, therapeutic microclysters can be used. For example, they mix 30 ml of sea buckthorn oil and infusion of chamomile flowers, gently inject the mixture into the anus in a warm form with a syringe and hold until there is enough patience. The procedure should be done before going to bed 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 grass), 1.5 cups of boiling water. Hops and St. John's wort must be boiled, insisted 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 help in wound healing. For such baths, infusions of herbs are needed. All the same are taken as a basis: chamomile, knotweed, calendula, St. John's wort, oak bark, immortelle. In this case, the water should be warm, and the duration of the procedure should be at least 20 minutes.

Proper nutrition and diet

The diet for an anal fissure should promote regular stools, make the feces 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 the stool softer. And daily intake of fermented milk products gives a laxative effect.
2. It is necessary to give up bread made from white flour, as it slagging the intestines, as well as hot spices, smoked and pickled foods, alcohol, especially high strength.
3. It is desirable that the basis of the diet is vegetables and fruits. They contain coarse fiber (dietary fiber), which aids in digestion.

Surgery

In some cases, extensive and difficult to heal anal fissures require surgical intervention for effective treatment. Several options are used. The most common surgeries are called lateral internal sphincterotomy.

During this procedure, the doctor makes a tiny incision and separates certain layers of the sphincter muscles. This prevents muscle spasms, which leads to the complete elimination of tension during bowel movements. The method of suturing the walls and excising the mucous membranes, which are affected by scarring and sclerosis, 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 therapy regimen.

Non-surgical treatment of a fissure with diet, hygiene procedures and medicines at home can help relieve the symptoms of the disease in a few days and lead to a full recovery in 4-8 weeks.

The complexity of surgical treatment of an 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.