How to treat an anal fissure and what are its symptoms. Fissure in the anus - successful treatment A fissure has appeared in the anus, what to do

Anal fissures are the second most common disease after proctological disease. This article examines the reasons for this sensitive issue, preventive measures and treatment.

It is believed that in adults such a problem as anal fissures occurs much more often than in children, while women get sick more often than men. This is due to the structural features of the female body. The fact is that cracks do not form anywhere in the anus, but only on the back or front wall. For various reasons, a mucosal defect forms here - a small, usually about two centimeters, gap that exposes a layer of muscle.

Anal fissures can occur unexpectedly (the process is considered an acute form of the disease), and without proper therapy or surgical intervention develop into chronic form. An acute crack that has appeared recently responds well to conservative treatment and heals quickly. But if a person does not want to see a doctor, the disease is likely to progress.

Note! Chronic anal fissures do not go away on their own, gradually increasing in size and depth, so the more advanced the disease, the lower the chances of treating the fissure with medications - more often surgical intervention is required.

But even in this case, a person must devote the rest of his life to great attention relapse prevention. Anal fissures are a disease that always appears again if the patient does not want to take care of his health.

Table 1. How to determine the form of the disease?

Patient's signs and sensations	At acute course illnesses	In case of chronic disease
Sphincter spasms	Throbbing, increasing pain. Patients feel afraid of defecation, often take laxatives to relieve cramps, or even try to go to the toilet less often, which only worsens the situation.	Spasms are not expressed.
Soreness	Occurs during defecation and lasts about half an hour after. The discomfort is usually of very high intensity, to the point of inability to concentrate on other areas of life.	It intensifies with straining, poor diet, physical activity, and prolonged sitting.
Bleeding	Drops of blood are possible, and if there is a strong rupture, the bleeding is quite strong, like a cut.	In the form of drops on toilet paper or the surface of stool.
Features upon inspection	Pain in the specific area where the crack is located.
Relapses	Possible during the transition to a chronic form.	Occur regularly. Even after healing, the crack can split apart during physical stress or when bowel movements are disrupted.
Complications	Fistulas in the rectum, paraproctitis, mucosal suppuration, abscesses.

Causes and factors contributing to anal fissures

There are quite a few reasons for a fissure to occur in the anus. Some of them do not depend on a person, while others you can easily protect yourself from. Factors that anyone can avoid include:

• long-term sitting on the toilet, severe straining during bowel movements;
• mechanical injuries (careless administration of enemas or other objects, anal sex);
• sudden and improper lifting of weights;
• eating “dry food”, non-compliance with the diet, abuse of foods that cause constipation (crackers, pasta, potatoes, strong coffee and tea, chocolate, fortified wine, etc.);
• alcohol abuse, smoking.

TO external factors, which are quite difficult to influence, can be classified as:

• pregnancy. The growing uterus puts pressure on neighboring organs, including the rectum, slowing down and complicating the process of defecation;
• attempts during childbirth, which lead to ruptures of the mucous membrane and fissures of the anus, as well as improper recovery in the postpartum period (the first stool in women who gave birth with ruptures should be caused by a microenema);
• vascular diseases and disorders (vasculitis, thrombosis, hemorrhoids, atherosclerosis, aneurysms, etc.);
• gastrointestinal diseases: gastritis, ulcers, cholecystitis;
• paraketarosis - changes in the epithelium of the whole body, leading to keratinization of the upper layer of cells;
• congestion in the pelvic area;
• sphincter lesions of a neuromuscular nature (rectal muscles do not receive sufficient nutrition;
• colitis, proctitis, irritable bowel syndrome.

Rarely, anal fissures occur in children. Usually the problem is related to the child, or to the fact that excretory system has not yet been fully formed and functions with disabilities. It is worth understanding that even a single and mild constipation can cause damage and a crack in the baby’s anus. As a rule, parents find out about this in two ways - either they see bloody discharge in the stool, or they are guided by the child’s behavior. The baby is afraid and refuses to go to the toilet “for the most part” because he is in pain.

Symptoms of a fissure in the anus

Above, we briefly indicated that a person whose anal mucosa has developed a crack will experience pain. The pain occurs when going to the toilet and can be very intense - often compared to a sensation similar to finding broken glass in the anus. Patients also experience burning and itching; the discomfort may not disappear throughout the day.

When the disease becomes chronic, pain begins to appear when sitting for a long time, before going to bed. Patients often develop anxiety, nervousness due to this, and fear of defecation. Besides, clear symptom anal fissure - bleeding. This can be literally a couple of drops, or it can be serious blood loss leading to anemia - it depends on the depth and size of the damage.

The main difficulty of this disease is that the damaged mucous membrane is constantly in contact with feces. This means the constant mechanical impact of feces on the healing crack, and the settling of millions of bacteria on the wound. Over and over again, the crack becomes infected, inflamed, and the disease can develop into a chronic one.

Diagnosis of the disease

Obviously, a person is unlikely to be able to examine his own anus to see the cause of the pain. Therefore, at the first signs of discomfort, it is better to visit, who will carefully examine the problem area and make a diagnosis.

“Self-diagnosis” can also be harmful because the symptoms of polyps, anal fissures, hemorrhoids and paraproctitis are quite similar, but the treatment varies. Therefore, a visual examination is necessary to accurately identify the disease. As a rule, cracks are clearly visible and felt upon palpation, but or may be required. These methods allow you to see the rectum in depth and assess the presence and extent of damage. It is important to understand that discomfort in anus may be caused not only by the crack that has appeared, or not only by it alone. Therefore it is important to choose exact method diagnostics

Table 2. Modern methods for diagnosing diseases in the anus

Name	What reveals	How does the procedure work?
Irrigoscopy	Clarifies or excludes pathologies and diseases of the large intestine	Using an enema, a contrast agent is injected into the anus, then an X-ray examination is carried out in a special cabin
Ultrasound	Detection of polyps, tumors, including those growing into other organs or the walls of the rectum	The examination is performed rectally using a small device. The device screen displays information about the condition of tissues and mucous membranes
Rectoscopy	Identification of concomitant diseases, exclusion of complications and serious diseases (oncology). Possibility to take a piece of tissue for biopsy	A device equipped with a camera and a flashlight is inserted into the anus to a depth of about thirty centimeters.
Anoscopy	Clarifies the location of the damage, allows you to identify	The examination is carried out using a small device, which is inserted 12 centimeters into the anus.
Colonoscopy	Detects any changes in the large intestine with high detail and accuracy	Study small intestine using a probe. Information in good resolution is transmitted to the monitor, from where it is easy to read

It is worth noting that modern medicine allows such procedures to be carried out practically painlessly; in case of an acute course of the disease, the patient may first be prescribed painkillers, or an examination may be carried out using painkillers.

How to treat anal fissures?

Doctors immediately warn that treating anal fissures is a long process, and the patient must approach it with special responsibility. Complete recovery and absence of relapses depends on a person’s discipline, because it includes not only drug therapy, but also diet and lifestyle changes in general. Let's look at these three steps you can take to treat anal fissures.

Diet

The nutrition of patients suffering from fissures in the anal canal should be aimed at eliminating the main irritant - constipation and hard stool. It makes no sense to be treated with tablets, ointments or suppositories, when each act of defecation will again provoke tension in the anus and injure the mucous membrane.

The dietary table consists of recommended dishes that improve peristalsis and soften stool. Among such products are lean meat, kefir, yoghurt, vegetables and fruits; you can separately eat dry fiber, drink berry jelly and compotes. It is good to include prunes, beets, and oven-baked apples in your diet. Compliance with the drinking regime plays an important role - water, green tea, fruit drinks and other types of liquid should be supplied to the body daily in a volume of at least one and a half liters. In the morning on an empty stomach, it is advisable to drink a glass of warm water with a spoonful of honey, and at night - a glass of fresh kefir, you can add a teaspoon of vegetable oil.

The following products need to be removed from the diet or reduced to a minimum: fast food, sandwiches (and white bread in principle), crackers and chips, alcohol, potatoes, pasta, pastries, chocolate, especially milk chocolate. Strong tea, coffee, cocoa, fatty, spicy or canned foods are also excluded.

Lifestyle change

Patients are advised to give up a sedentary lifestyle. The list of recommendations includes visiting the pool, hiking, cycling (allowed only after treatment). People holding positions that do not require activity during the day should get up every half hour or hour, do light exercises, and walk up the stairs.

During the cold season, it is important to dress properly and cover your lower back and buttocks. During frosts, especially women, you need to wear thermal underwear or other warming clothing to prevent inflammation in the pelvis and rectum.

Particular attention should be paid to personal hygiene. After defecation the best option Wash the anal area with warm water or use damp toilet paper. It is better to put away traditional paper rolls until the time of recovery.

Pharmaceuticals

For conservative treatment For anal fissures, medications are used in various form factors. Most often these are suppositories, various gels, creams, ointments and balms. Let's consider effective and popular drugs.

Candles

It is suppositories that are considered the most effective way for the therapeutic treatment of any problems in the anus, including fissures. Suppositories are easy to use at home, they have a direct effect directly in the anus, and rarely have contraindications.

Table 3. Candles for cracks

Name, price	Characteristic	Mode of application
"Natalsid", about 500 rubles for 10 pieces	Wound-healing, anti-inflammatory and hemostatic drug based on sodium alginate (obtained from seaweed)	Twice a day for two weeks
“Proctosan”, about 400 rubles for 10 pieces	Has an astringent and drying effect, heals well, relieves pain due to the content of lidocaine	Once a day (at night) for 8-10 days
"Ultraprokt", about 650 rubles for 10 pieces	Anesthetizes, eliminates itching and burning, heals, relieves inflammation. Contains anesthetic
“Posterizan”, about 400 rubles for 10 pieces	Stimulates local immunity (as it contains cells of killed coli), relieves itching, relieves pain, restores mucous membranes	Morning and evening after bowel movements for two to three weeks
Suppositories with propolis, about 200 rubles for 6 pieces	A drug with an immunostimulating, wound-healing, anti-inflammatory effect. Contraindications – allergies to bee products
Suppositories with sea buckthorn, about 130 rubles for 10 pieces	Relieves irritation, itching, softens the rectum, promotes healing	Before bed for two weeks
"Salofalk", about 1400 rubles for 10 pieces	Contains salicylic acid, kills bacteria, disinfects, relieves pain and burning sensation	Three times a day for 7-10 days
“Procto-Glivenol”, about 400 rubles for 10 pieces	Reduces pain, relieves inflammation, swelling, provokes venous outflow, stimulates healing	Before bed for two weeks

Creams, ointments, gels

Medicines in liquid form also popular for treating anal fissures due to their local action. Almost all of them have an anti-inflammatory and analgesic effect, which is felt within a few minutes after use.

To prevent an allergic reaction to any component, before use it is recommended to apply cream or ointment to your wrist and wait about half an hour.

Table 4. Ointments for cracks

Name, price	Characteristic	Mode of application
Solcoseryl ointment, about 180 rubles	Stimulates the growth and strength of blood vessels, improves protective and metabolic function, contains amino acids that nourish the mucous membrane	Twice a day until all symptoms disappear
Levomekol ointment, about 120 rubles	It has a combined healing, antimicrobial and anti-inflammatory effect. Softens, moisturizes, simplifies bowel movements	Twice a day for ten days
Balm “Ratovnik”, about 80 rubles	Eliminates swelling, inflammation, itching, restores mucous membranes, creates a protective barrier against bacteria, activates local immunity and tissue protection mechanisms	After every visit to the toilet
Nitroglycerin ointment, about 50 rubles	Improves blood circulation, softens, reduces trauma to the damaged area, heals, relaxes the sphincter muscles	Rub into the anus 2-4 times a day
Fleming's ointment, about 300 rubles	Consists of herbal components, improves blood circulation, relieves itching and burning	Three times a day for a week
Ointment "Aurobin", about 350 rubles	Heals cracks well, softens, facilitates bowel movements, quickly relieves pain after visiting the toilet	Twice a day for a week
Relief ointment, about 200 rubles	Contains enzymes from shark liver, increases local immunity, relieves pain, irritation, itching, relieves swelling, and heals. Copes well with acute forms of the disease	Twice a day after visiting the toilet
Ointment "Gepatrombin G", about 200 rubles	Eliminates bleeding, relieves inflammation and pain, quickly heals even large cracks	Morning and evening for two weeks
Emla cream, about 1600 rubles	Contains lidocaine and prilocaine, due to which it provides an immediate analgesic effect. It is, in fact, a temporary external anesthesia for excessive pain.	Once for severe attacks of pain

Folk remedies

After visiting the toilet and before using a suppository or ointment, it is recommended to fill a basin with water (35-36 degrees), dissolve potassium permanganate in it until pale pink, or pour in dried chamomile, calendula or St. John's wort flowers, pre-brewed according to instructions. After this, the person must squat down and lower his buttocks into the basin so that the solution washes the anus. The time for taking such a bath is no more than fifteen minutes. If it is difficult for the patient to sit in the basin, you can pour the solution into the bath itself so that the liquid layer is about ten centimeters.

Conclusion

Anal fissure is an unpleasant, but not at all fatal disease. With a quick diagnosis and prescribing a treatment regimen, the chances of a successful outcome are very high. As a last resort, you can resort to surgical intervention, after which relapses are unlikely if you follow a diet and a healthy lifestyle.

First of all, a person who feels discomfort in the anal area should put aside the feeling of awkwardness and consult a specialist. Sooner or later you will have to do this, because the disease will remind you of itself endlessly, even at rest. Don't delay. Take care of your health!

Video - Anal fissure, proper treatment

Anal fissure most often occurs in women of reproductive age. However, both men and children are susceptible to this disease. The risk category includes people who are sedentary, often suffer from constipation, and also eat poorly.

An anal fissure is a rupture of the mucous membrane rectum. Cracks come in various sizes and cause great discomfort to the patient. If a person has had it for a long time, in this case an anal fissure may even appear on the side walls of the anal canal. 25% of people who consult a proctologist for one issue or another are diagnosed with an anal fissure.

The very first and main symptom– sharp pain that occurs during the act of defecation. Soreness can persist for 40 minutes after bowel movement, and if at first the patient is bothered by a sharp pain, then it develops into a dull, throbbing pain.
If the crack is deep enough, you may notice a small amount of scarlet blood on the toilet paper.

If with each subsequent time the pain intensifies and the amount of blood released increases, you must urgently consult a proctologist. At first, conservative treatment is sufficient - the doctor will prescribe special ointments or suppositories, but if the disease is advanced, then it may be necessary surgery.

The main cause of anal fissure is frequent constipation. In addition, constipation can also cause hemorrhoids, and this disease is much more serious than an anal fissure. The following factors may also contribute to the development of the disease:

If the disease is caused by constipation, normalizing the stool will eliminate the disease over time. However, at the first constipation, the disease returns. Basically, anal fissure is caused by several factors, so if you notice the first signs of the disease, you need to contact a proctologist as soon as possible.

Anal fissures are divided into two subtypes:

1. Acute fissure - occurs as a result of constipation, passes quickly and does not cause much discomfort;
2. Chronic fissure - appears as a result of hemorrhoids and thinning of the rectal mucosa. Requires special treatment and constant monitoring.

What complications can an anal fissure cause?

Due to the fact that small bleeding wounds appear on the anus, infection, swelling, and irritation may occur. In addition, a crack can contribute to disruption menstrual cycle among women. At chronic illness The anal ring thickens (pectenosis), as a result of which the patient may experience constipation.

Infections lead to the patient having... Also, if infected, it is possible that the wounds may become suppurated and severe itching, weeping and maceration.

Anal fissures can often be no different in symptoms from a more serious disease - hemorrhoids. In this case, only an experienced coloproctologist can recognize which disease is troubling the patient. Don't hesitate to visit the doctor!

Bloody and purulent discharge, difficulty in defecation, acute pain can also become. If you do not seek help in a timely manner, self-medicate (especially if the patient believes that he has hemorrhoids or hemorrhoids), you may miss the moment when the disease is in its infancy and needs to be treated.

Diagnostics

In some cases, a visual inspection will be enough for a specialist. If the fissure is located inside the anus - in this case, the proctologist inserts a finger into the anus - using the palpation method, he will be able to determine the degree of the disease, feel the size of the anal fissure, its depth.

A sigmoidoscope is a special device that is used to identify rectal problems. Thanks to this device, you can diagnose diseases such as fistula, hemorrhoids and anal fissure. It is usually used if the crack is deep, or if diagnosing it using the finger method is unacceptable for a number of reasons. The doctor may also use anoscopy - examination of the final section of the rectum.

Almost every time anal fissures appear in people who have serious specific diseases: HIV, AIDS, tuberculosis, syphilis, . If you have the above diseases, you must inform your doctor before the examination.

Anal fissure in children

An anal fissure in a child is most often caused by poor nutrition, namely, eating too spicy or smoked food. In addition, there are additional factors:

Anal fissures in children are much less common than in adults, so surgery is prescribed in extremely rare cases.

Usually the doctor prescribes an ointment for anal fissures, suppositories, and a diet. It is necessary to include foods rich in fiber in your child’s diet – vegetables, bran bread, fruits. It is also necessary to consume a sufficient amount of vegetable and animal fats. Kefir, yogurt, fermented baked milk, whey - all fermented milk products should be present in the baby’s diet every day!

Treatment of anal fissure

Many people are concerned about the question of how to cure a fissure in the anus quickly and permanently. We have already mentioned suppositories and ointments (this is the most common method of treatment). You can relieve pain and speed up wound healing at home.

Warm baths (no more than 45 degrees C) with the addition of medicinal herbs such as mint, celandine, and chamomile help well with anal fissures. To relieve sphincter spasm, use nitroglycerin ointment or potassium permanganate.

Tablets will help normalize stool:

• Senadexin,
• Ajax,
• Bisacodyl.

A decoction with the addition of hay and buckthorn also helps normalize stool. Rectal suppositories containing benzocaine will also give a positive effect. For the healing of anal fissures, "Ultraproct", etc.

Do not forget about ointments - “Solcoserine”, “Levomikol” are quite effective means that quickly eliminate pain and promote the healing of rectal wounds. Experts recommend taking relaxing baths before using ointments and suppositories - this will enhance the results of treatment.

In what cases is surgery prescribed?

If the prescribed treatment does not help, the anal fissure does not heal and continues to hurt, cause discomfort and bleed, the patient is prescribed surgical intervention.

The essence of the operation is that the proctologist sews up the cracks. The operation is simple, and after literally three days the patient is ready to return to normal life and forget about the problem that bothered him. After the operation, you must follow a simple rule - watch your diet and avoid constipation and other mechanical damage to the anus.

Treatment of anal fissure with folk remedies at home

Traditional medicine recipes are an effective, harmless and uncomplicated way to get rid of the disease. Candles for a fissure in the anus (like ointments) can be prepared at home.

All suppositories must be stored in the refrigerator!

Baths:

If you are concerned about a disease such as anal fissure, it is very important to follow the rules of personal hygiene. Otherwise, the wound may become inflamed, the process of suppuration will begin, and an infection will begin to develop. This will complicate the course of the disease and add discomfort, in addition, treatment will take much more time.

Warming up helps a lot with anal fissures if done regularly. Don't forget about fiber - if you can't include it in your diet fresh vegetables and fruits, buy fiber at the pharmacy and take it 1 tbsp. twice a day before meals.

get rid of anal fissures - the tablets can be taken orally, or you can make an ointment out of them. To do this, you need to heat the flower honey and add crushed mummy tablets into the resulting liquid substance.

Cabbage juice therapy is a good method to improve the functioning of the stomach and intestines. Take 100 fresh cabbage juice on an empty stomach daily.

The most effective and popular ointments for treatment

Many of us live in a frantic pace of life, and self-cooking There is neither time nor energy for ointments and suppositories. In this case, it is better to turn to pharmacy medications - many of them are based on natural ingredients. Below is a list of the most effective ointments which will quickly help eliminate the disease.

1. Nitroglycerin ointment is the oldest, most common and effective way treatment of anal fissure.
2. - antiseptic, which quickly heals wounds and blocks inflammatory processes in the rectal area.
3. “Ultraproct” - not only disinfects wounds and promotes healing of anal fissure, but also has a pronounced analgesic effect.
4. Ointment “Rescuer”. A well-known remedy that we use to heal wounds. Possesses antiseptic properties, based on natural ingredients. Suitable for use even with chronic anal fissures.
5. “Solcoseryl” - will quickly restore wellness, promotes cell regeneration and restoration of mucosal tissue. To enhance the effect, the ointment can be applied to a tampon and inserted into the anus at night.

Anal fissures during childbirth and pregnancy

During pregnancy, significant changes occur in the female body, which... As a result, there are complications in the form of anal fissures and hemorrhoids.

Since during pregnancy women are not recommended to use pharmacological agents, proctologists recommend adjusting the diet in order to soften the stool and prevent the development of constipation.

Pregnant women who suffer from ruptures of the anal mucosa are recommended to consume:

Do not forget about the water diet - at least 2 liters of liquid per day. Tea and coffee are not taken into account, drink only natural water without adding gases!

It is very important to identify the disease in a timely manner, since during childbirth an anal fissure can turn into a rupture of the rectum - which is fraught with additional complications.

Prevention of anal fissures

Anal fissure is one of the diseases that is not commonly discussed. Indeed, not every person admits that he has problems with anus. And yet, such a disease 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. Women get sick somewhat more often than men, and children - less often than adults.

Description of the disease

An anal fissure (anal fissure, rectal fissure) is a narrow and long defect in the mucous membrane of the anus. In this place, the mucous membrane seems to be torn into pieces, exposing muscle layer. The length of the anal fissure is usually small - no more than 2 cm. The width and depth are several millimeters. Cracks may not form anywhere in the anus, but only on its front and back walls. Anterior localization of the crack is much more common in women than in men, which is associated with the biological features of the structure of the weaker sex. Rarely, a crack occurs on the lateral surfaces of the anus.

The disease has two main forms - acute and chronic. A crack that has appeared relatively recently is called acute. A sharp crack can heal if conditions are favorable. But without proper treatment, an acute crack can become chronic after a few weeks.

A chronic fissure is characterized by rougher edges and small bumps at the beginning and end. A chronic fissure almost never goes away on its own and requires surgery to treat. Although the disease may experience remissions, one should not hope that they will lead to a complete cure. Under certain circumstances (diet violation, constipation), the disease may return with renewed vigor. In most cases, an anal fissure is accompanied by sphincter spasm, which makes defecation even more difficult, especially during constipation.

Complications

With each act of defecation, an unhealed fissure is exposed to feces. This is especially dangerous with constipation, when the stool is hard. In addition, a huge amount of bacteria settles on the crack (as is known, more than half of human feces consists of bacteria). This leads to even greater inflammation of the wound.

Untreated fissures located in the anus can lead to severe complications– acute purulent paraproctitis, formation of fistulas, trophic ulcers, massive bleeding, gangrene and sepsis. In men, anal fissures increase the likelihood of prostatitis.

Symptoms

Photo: Brian A Jackson/Shutterstock.com

Cracks in the anus make themselves felt by severe pain that appears after using the toilet or during the act of defecation itself. The pain is usually acute and resembles the sensation of having broken glass in the anus. Pain syndrome with a crack may persist long time, worsening with prolonged sitting. It can lead to neurotic conditions and insomnia. The patient may also develop a peculiar fear of defecation. This leads to even more severe constipation, which in turn further aggravates the disease.

Another important sign is bleeding during bowel movements. It can be either minor, consisting of a few drops of blood, or serious, leading to anemia. It all depends on the nature and size of the crack.

The disease can affect a person's lifestyle. The inability to sit painlessly entails the inability, for example, to engage in sedentary work. And job loss already exacerbates the unfavorable mental condition sick.

Causes

The immediate causes of the disease can be divided into mechanical damage to the anal passage and damage to the mucous membrane as a result of sphincter tension.

Mechanical damage can occur:

• during defecation - due to damage to the mucous membrane by solid objects found in the stool
• during anal sex
• at instrumental studies rectal fissure may appear as a result of unqualified actions of medical personnel

Tears of the mucous membrane due to muscle tension mainly occur when pushing during bowel movements. Also, quite often, rectal fissures can occur in women during childbirth.

It has long been established that the main factor provoking the appearance of a fissure is chronic constipation. Constant efforts during bowel movements lead to increased tension in the muscles of the anus. In addition, hard feces have a negative impact on the condition of the anal mucosa. All this can lead to its rupture and crack formation. Somewhat less often, cracks can form 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 is that hemorrhoids do not affect this process in any way. These two diseases have many similar symptoms, but in general they have different etiologies, and the approaches to their treatment are also very different. However, it is not uncommon to find both diseases present in one patient.

Factors also contributing to the occurrence of the disease are:

• drinking alcohol, eating too fatty, spicy or salty foods
• sedentary work
• lifting weights
• sedentary lifestyle
• diseases of the lower intestines - colitis, proctitis, irritable bowel syndrome

In addition, diseases of the upper gastrointestinal tract - stomach ulcers and duodenum and gastritis, cholecystitis, blood diseases leading to impaired blood clotting and stagnation in lower parts bodies.

Separately, it is worth mentioning pregnancy and the birth process. These factors can also contribute to the appearance of fissures in the anal area. In the first case, the reason is an increase in the size of the uterus and the associated difficulty in defecation. This weakens the anal area, and childbirth, accompanied by pushing, can cause damage to the anal mucosa. Of course, in the first days after childbirth 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 excluded. IN 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 mild constipation can cause damage to the child's anal area. Symptoms of an anal fissure in young children may include fear of the toilet, blood in the stool.

Photo: filippo giuliani/Shutterstock.com

Diagnostics

When pain occurs in the anus, the patient is naturally unable to determine the cause of the syndrome and make a diagnosis, and, moreover, determine the size and shape of the crack. Therefore, it is recommended to immediately contact a proctologist so that he can analyze the symptoms and prescribe treatment. In most cases, cracks are clearly visible upon visual inspection. In some cases, palpating the anus may be necessary, but this operation may be difficult due to extreme pain for the patient and spasm of the sphincter. Also used for diagnosis are sigmoidoscopy (examination of the anus 20 cm deep) and colonoscopy. When diagnosing, it is necessary to differentiate a fissure from hemorrhoids, proctitis and paroproctitis, erosions, polyps and tumors.

How to treat the disease

Treating a fissure in the anus, especially one that arose long ago and is large in size, is a difficult task. Nevertheless, a complete cure for the disease is possible, although it requires significant effort, both on the part of the patient and on the part of doctors.

Unlike many other diseases, with anal fissure, the acute form of the disease is treated conservatively, and the chronic form is treated surgically.

If an anal fissure occurs, do not big size– microcracks, it is better to let it heal on its own. Such cracks can heal in a few days, provided that they do not become re-irritated. This can be achieved if stool does not form and does not come out. That is, you can go on a diet for several days and wait until the crack heals itself.

However, as a rule, the anal fissure is too large and will take too long to heal. In the case of a large crack, a complex treatment method is used, which includes:

• drug treatment
• diet
• lifestyle change

How to treat the disease

Conservative treatment of cracks is carried out using a comprehensive and gradual method. Practice shows that effective treatment diseases can be treated at home. In the presence of a strong pain syndrome and sphincter spasm, painkillers and antispasmodics are used first, and then wound healing agents are used. In most cases, treatment can be carried out at home and 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 the form of tablets.

Photo: i viewfinder / Shutterstock.com

Of the tablet medications, laxatives should be noted first. These drugs can be prescribed in case of illness caused by constipation. As a rule, preparations based on senna and aloe are the most effective, but they are contraindicated for irritable bowel syndrome. In this case, it is best to use preparations based on plantain seeds and artificial cellulose. You can also use laxatives based on polyhydric alcohols, such as Duphalac.

Antispasmodic medications, such as drotaverine, can also be taken in tablet form. Antibiotics in tablets for anal fissures are usually not prescribed, since local remedies are much more effective.

Main forms for rectal treatment:

• baths with bactericidal solutions
• candles (suppositories)
• ointments and creams
• microenemas

The choice of dosage form is dictated by the circumstances of the disease and associated symptoms. In case of severe pain, it is difficult to use suppositories, and in case of discharge from the anus - ointments. In some cases, injections of painkillers and antispasmodics are indicated.

An anal fissure, in its etiology, differs little from an ordinary wound, and when treating it, similar principles must be followed. However, two unfavorable factors should be taken into account that make it difficult to treat a crack: concomitant with the disease sphincter spasm and constant infection of the wound area with pathogenic bacteria. Therefore, drugs used in the treatment of cracks must perform two functions - remove muscle spasm and have strong anti-inflammatory and bactericidal properties.

Ointments

Ointments should usually be applied to the area around the anus once or twice a day after bowel movements. There are antispasmodic ointments and ointments with a predominantly wound-healing effect.

Among local antispasmodics, nitroglycerin ointment 0.2% has proven itself well. This ointment is not sold in a pharmacy in finished form, but is prepared in a pharmacy upon presentation of a doctor's prescription.

Among the new treatment methods, ointments containing botulinum toxin, which relieve vascular spasms, should be noted.

For antiseptic purposes, an ointment for cracks with strong antibiotics is used, for example, Levomikol, containing chloramphenicol. Ointments based on sea buckthorn oil, Relief ointment, and Argosulfan have also proven themselves well. The drugs Actovegin and Solcoseryl, which stimulate healing processes, have shown high effectiveness.

Also worth noting are the ointments Ultraproct, Aurobin, Dexpanthenol, Bepanten, Methyluracil.

Suppositories

Healing suppositories are considered the most effective dosage form for treating cracks. If there are no contraindications for use, then it is preferable to opt for them. Crack suppositories are usually used after bowel movements once or twice a day. Most of them have a wound-healing effect, and many suppositories also have laxative properties. Some drugs may have an effect that stimulates local immunity. For example, Posterizan suppositories contain killed bacteria that cause a response from the immune system. This drug also has a wound healing and analgesic effect.

Many suppositories also have an analgesic effect. Among them it is worth noting Proctoglivenol, Ultraproct, Anestezol, suppositories with ichthyol, belladonna extract.

Relief suppositories, containing shark liver components, have both anti-inflammatory, analgesic and hemostatic effects.

Not all suppositories are suitable for use in childhood and pregnancy. Anti-inflammatory suppositories Natalsid are among the drugs approved during pregnancy.

You can also note Methyluracil - suppositories that are well suited for wound healing and have immunomodulatory properties, Hepatrombin - suppositories with a hemostatic and healing effect

Baths

For acute cracks, it is recommended to take baths every day, preferably in the evening, with disinfecting solutions, for example, a solution of potassium permanganate. The water temperature should be +40 ºС. Baths with plain warm water can also be performed, which help relieve spasms. The duration of the procedure is 10-20 minutes.

Enemas

For anal fissures, microenemas containing sea buckthorn oil and chamomile decoction help well. This mixture must be injected into the anus in a volume of 50 ml. The procedure is carried out daily for two weeks.

To facilitate stool, you can use counter enemas, administered 10 minutes before. before defecation. They contain 100 ml of pasteurized sunflower oil and 200 ml of boiled water.

Diet

The diet is primarily aimed at eliminating the main cause of the disease – constipation. Indeed, no matter how effective treatment with ointments and suppositories is, it will be completely pointless if the next stool leads to severe tension in the sphincter and an even greater increase in the size of the crack in the anus.

Photo: Barbara Dudzinska / Shutterstock.com

The diet must be selected individually, since different foods have different effects on different cases. However, most experts agree that it is best to remove fatty, fried, pickled and sweet foods, smoked foods from the diet and consume more plant fiber contained in vegetables and fruits, and dairy products. For meat, it is preferable to eat chicken and lean beef. You should also reduce the amount of white bread in your diet, replacing it with bran bread and drink more liquids (except coffee and alcohol).

Lifestyle change

You should give up a sedentary lifestyle and exercise more physical activity to avoid stagnation in the lower part of the body. Even simple walks can have a positive effect on the treatment of the disease.

Surgery

If conservative treatment is ineffective, as well as when the disease enters 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 consists of removing scars and bumps along the edges of the crack that interfere with its healing. The operation can be performed either traditionally or using a laser. If sphincter spasm interferes with the treatment of the fissure, then sphincterotomy is performed - partial cutting of the sphincter muscle fibers.

Prevention

Compliance with preventive measures to prevent the disease will be useful not only for those who have already recovered from the disease, but also for those who have never encountered it.

The risk group includes people who lead a sedentary and sedentary lifestyle and suffer from constipation. Prevention of cracks largely coincides with the measures that are used in their treatment. First of all, it is aimed at preventing constipation. It is necessary to be physically active, move more, eat a varied diet, little by little, but as often as possible. Chewing food thoroughly is important, as hard, undigested remains increase the likelihood of injury to the anus. Therefore, it is necessary to treat diseases of teeth and gums in a timely manner. Anal sex should also be avoided.

Anal fissure– a defect in the rectal wall that has a linear or ellipsoidal shape. On average, cracks are 1-1.5 cm long, 0.2-0.5 cm wide and 0.1-0.2 cm deep. The leading symptoms of anal fissure are: pain, sphincter spasm and bleeding from the rectum.

Pretty anal fissure frequent illness Among all pathologies of the rectum, it ranks third after hemorrhoids and colitis. The incidence rate is from 9% to 15%. On average, anal fissure is 20 cases per 1000 adults. Women suffer from of this disease several times more often than men (except for gay men, for whom this percentage may be even higher). Mostly, the age of patients ranges from 20 to 60 years. Thus, more than half of patients suffering from anal fissure are people of working age (21-40 years).

Typically, a crack occurs on the coccygeal wall of the anus (85%-90%), less often in the area of ​​the anterior commissure (10-15%), and even less often two cracks appear simultaneously opposite each other on the anterior and back wall(about 1%). Such a high percentage of crack formation along the posterior wall is explained by the anatomical feature of this section of the rectum: 1) the special direction of the muscle bundles of the external sphincter in the form of the letter “U”, 2) deeper crypts (depressions between the folds), 3) less extensible muscles in the anteroposterior direction.

Anatomy of the rectum

The rectum is the final section of the large intestine, located next to sigmoid colon. The length of the rectum varies from 12 to 17 cm. The following sections of the rectum are distinguished: supramullary, ampullary and perineal (anal canal). The length of the last section is only 1.5 cm - 3 cm.
The anal canal is located under the levator ani muscle (m. levator ani), below the pelvic diaphragm. At the border of the transition of the ampullary part to the anal canal there is an anorectal line (serrated, scalloped). 4 layers take part in the formation of the rectal wall: 1) mucous membrane, 2) muscular plate of the mucosa, 3) submucosa, 4) muscular layer.

Mucous membrane forms two types of folds in the rectum: longitudinal and transverse. Longitudinal folds are formed due to a well-defined submucosal layer, such folds are also called (Morgani columns). Between such folds, depressions (crypts or Morganian sinuses) are formed; mucus accumulates in them to facilitate the passage of feces. The number of such depressions varies from 6 to 12. The deepest of them is located on the posterior wall of the anal canal (up to 2 cm) - the most common place for anal fissures to occur.
Longitudinal folds are located in the upper parts of the rectum, ranging from 3 to 7. Due to the helical arrangement, the longitudinal folds contribute to the progressive movement of feces.

Muscularis It is represented by two types of fibers: longitudinal and circular. Longitudinal fibers are evenly distributed along the entire length of the rectum. Circular fibers are actively involved in the movement of feces. Throughout the rectum, the fibers form a series of thickenings and act as a kind of sphincters.

Blood supply and innervation of the rectum

Arteries:

• Superior rectal artery, continuation of the inferior mesenteric artery
• Middle rectal artery, present in 70% of cases
• Inferior rectal arteries, branches of the internal pudendal artery

Vienna:

• The superior rectal vein drains into the inferior mesenteric vein (portal vein system)
• The middle and inferior rectal veins drain into the internal iliac vein (inferior vena cava system
• In the rectum there is a connection between two venous systems: portal vein and inferior vena cava.

Innervation:

• Parasympathetic nerves: branches of the vagus nerve, splanchnic pelvic nerves.
• Sympathetic nerves: branches from the superior, middle and inferior rectal plexus.
• Somatic nerves going to the striated muscles (external anal sphincter): branches of the anal part of the pudendal nerve (n. pedendus).

Functions of the rectum

• Final formation, accumulation and excretion of feces
• The rectum has the ability to absorb liquids and some ions, but there are no digestive processes in it. This property is used in medicine for the administration of drugs or parenteral nutrition.

Predisposing factors

• Frequent constipation, less frequent diarrhea
• Diseases of the large intestine and rectum: colitis, proctitis, hemorrhoids, irritable bowel syndrome, etc.
• Crohn's disease localized in the anal canal.
• Diet violations: excessively spicy, salty, smoked foods, alcoholic drinks.
• Unconventional sexual preferences. Anal sex.

Course of treatment 7-14 days

Posterisan Killed microbial cells of E. coli
Excipients: phenol, emulsifying solid fat, hydroxystearate, macrogol-glycerin

• Immunostimulating
• Antipruritic
• Promotes recovery and healing
• Anti-inflammatory

Morning and evening, as well as after each bowel movement. 14-21 day course. Natalsid The main substance is sodium alginate, a natural component obtained from brown seaweed.

• Pronounced hemostatic effect (hemostatic)
• Anti-inflammatory
• Wound healing

Rectally, 2 times a day, one suppository. Course duration 7-14 days Proctosan Active substances:

• Drying
• Anti-inflammatory
• Astringent
• Painkiller
• Wound healing

After bowel movements (recommended), 1-2 times a day, for 8-10 days. Salofalk A drug salicylic acid

• Pronounced anti-inflammatory effect
• Wound healing effect

3 times a day, rectally, 1 suppository (500 mg) or 2 soups. (250 mg each)
To prevent repeated exacerbations, 250 mg 3 times a day. Maximum daily dose 3 grams. Suppositories with propolis
Active ingredient: propolis

• Antibacterial action
• Anti-inflammatory
• Wound healing
• Immunostimulating

1 suppository, before bed, daily, 10-20 days. Intensive treatment – ​​1 sup. In the morning and in the evening.

• Candles with sea buckthorn
• Relief candles

Ointments for anal fissure

Name of ointment	Description and composition	Effects	Application
Nitroglycerin ointment 0.2%	Nitroglycerin, lanolin-vaseline base	Dilates blood vessels, improves blood circulation, relaxes the sphincter, reduces trauma to the crack, accelerates the healing process	2-4 times a day, course 15-30 days.
Ultra-proct	Main active ingredients: glucocorticoid (fluocortilone) and anesthetic (cinchocaine)	Anti-inflammatory Wound healing Anesthetic Antipruritic	After screwing the special tip onto the tube, squeeze a small amount of ointment directly into the anus. 2 times a day, the first day up to 4 times. The course of treatment is from 7 to 14 days.
Proctosan	Active substances: Bufexamac, bismuth subgalate, titanium dioxide, lidocaine hydrochloride monohydrate	Drying Anti-inflammatory Astringent Painkiller Wound healing	On the affected area of ​​the anus, twice a day. For rectal use, after bowel movement, the ointment is inserted into the rectum using an applicator. The course of treatment is 8-10 days.
Levomekol	Combined antibacterial agent: chloramphenicol and methyluracil	Antimicrobial Anti-inflammatory Promotes early healing.	2 times a day, course 7-10 days.
Solcoseryl	Blood hemodialysate from dairy calves. Contains a wide range of natural low-molecular substances (amino acids, glycolipids, nucleotides, etc.)	Accelerates tissue repair processes Strengthens and stimulates vascular growth Strengthens cell defense mechanisms Improves metabolic processes	1-2 times a day, up to complete cure
Ointment-balm Ratovnik	Ingredients: milk fats, sea buckthorn oil. Echinacea extract, beeswax, vitamin E, essential oils ( tea tree, lavender, rose)	Relieves all signs of inflammation: pain, redness, irritation. itching Activates tissue repair processes Has an antibacterial effect Creates a reliable protective barrier	Morning and evening, recommended after each bowel movement The duration of the course is until complete recovery.

Tablets and injections for anal fissure

Anti-inflammatory drugs
The drug salofalk for the prevention of exacerbations 15-30 mg/kg/day, for 2 doses.
Salofalk has a pronounced anti-inflammatory effect. Significantly reduces the risk of re-development of anal fissure.

Vitamins
It is better to take a complex of vitamins A, E, which promote wound healing and strengthen the skin's protective mechanisms.

Laxative
Laxatives are used to regulate bowel movements. Preference is given to funds plant origin(for example, the drug Senade). Such drugs stimulate the movements of the colon, causing stool 8-10 hours after ingestion. Senade selectively acts on the large intestine, restoring its normal functioning without causing addiction. Take 1-2 tablets before bed.

Laxative Normaze. The main active ingredient is lactulose. The drug softens stool, increases its volume, and stimulates intestinal activity. In addition, normase improves intestinal microflora and prevents the development of pathogenic microorganisms.

Take after meals. Adults: 15-40 ml per day for the first three days, and then 10-25 ml per day. On average, the course of treatment is from 1 to 3-4 months.

Blockades
Blockades are used to eliminate sphincter spasm and relieve pain. One type of effective blockade is novocaine-alcohol blockade. It is inserted under the base of the crack 1-2 cm deep. Inject 1% or 2% solution of novocaine 5-7 ml, and then, without removing the needle, inject 1 ml of 70% alcohol. Thus, the superficial and subcutaneous part of the anal sphincter is anesthetized. From 1 to 4 blockades are required per course, the interval between blockades is 3-5 days.

Diet for anal fissure

A fermented milk and plant-based diet is recommended. They regulate intestinal function well: boiled beets, carrots, wheat bran, prunes. However, an excess of food with plant fiber can increase the frequency of stools, increase gas formation and negatively affect the course of the disease. The diet should contain a sufficient amount of protein foods: cottage cheese, eggs, boiled meat, broths.

Should be excluded: spicy, salty, sour foods, seasonings, alcohol, smoked foods. In addition, do not forget about liquid. It is recommended to drink up to 2.5-3 liters of water per day. A sufficient amount of fluid will help soften and move stool through the intestines. It is advisable that for two weeks the patient has stool only with the help of a cleansing enema.

Cleansing enema for anal fissure

Cleansing enema is one of essential means in the treatment of anal fissure.
Rules for performing cleansing enemas:

• Take 1 liter of boiled water at room temperature
• Generously lubricate the enema tip and anal area with Vaseline ointment.
• The tip is inserted into the anus along the opposite edge from the anal fissure
• The patient can go to the toilet 7-10 minutes after the enema
• The frequency of procedures depends on the patient’s need for bowel movements
• During the acute period of illness, do not allow independent stool

Baths for anal fissure

Baths are done immediately after cleansing the intestines (after an enema). Potassium permanganate (potassium permanganate) is added to a bowl of water at 35-36 degrees. Squatting down so that the buttocks are spread apart and the anal passage is washed. The duration of the procedure is 10-15 minutes. After the baths, it is recommended to insert a suppository or ointment with anti-inflammatory properties (natalsid, ultraproct, etc.) into the anus. This type of manipulation should be repeated before bedtime.

Surgery for anal fissure

Indications

• Chronic fissure with dense scar edges and “sentinel tubercles”
• Ineffectiveness of treating acute fissures with conservative methods

Purpose of the operation

• Excise the edges and bottom of the ulcer in such a way as to remove all altered tissue that prevents the healing of the crack.

How is the operation performed?

• The operation is performed under general or local anesthesia. After the anesthesia procedure, a rectal speculum is inserted into the anal canal. Be sure to widen the narrowed sphincter (divulsion). Then the crack is excised as a single block in the form of a mucocutaneous triangle. So that not a trace of scar tissue remains. If there is sphincter spasm, the operation is completed with a posterior dosed dissection of the internal sphincter to a depth of 0.5 cm. After which the wound remains open. Or, a lateral submucosal dissection of the sphincter is performed with a long scalpel under the control of a finger inserted into the rectum. However, this method has a high percentage of complications such as: insufficiency of the internal sphincter and damage to the vessel with the formation of extensive subcutaneous hemorrhages.
• In the case of a combination of a chronic anal fissure with hemorrhoids, the hemorrhoids are removed according to Milligan-Morgan with the restoration of mucocutaneous wounds and excision of the fissure leaving mucocutaneous bridges.
• In general, the duration of surgery to eliminate anal fissure takes from 20 to 40 minutes.
• In 94% of cases, the patient recovers completely.

Postoperative period

The patient is prescribed a salt-free diet, and dressings with ointment are applied daily. By the evening after the operation or the next day, the patient can already begin to walk. On the 3-4th day, stool is induced by a cleansing enema. Be sure to periodically lubricate the wound surface with ointment to prevent premature adhesion of the wound edges. The patient is discharged within 7-10 days. Complete healing of the wound and restoration of sphincter function occurs 2-4 weeks after surgery.

How to prepare for surgery?

Preparing for surgery does not cause great difficulties, but failure to comply with basic precautions can cause a number of unpleasant complications.

Preparation for surgery includes the following points:

• Passing standard laboratory and instrumental analyzes (general analysis blood, urine test, stool test, ECG, ultrasound internal organs) and carrying out additional ones if necessary (rectoscopy, irrigoscopy, etc.)
• Consultation with a therapist, anesthesiologist, and, if necessary, other specialists if present with the patient accompanying pathologies.
• Preparing the surgical field: shaving the hair and thoroughly toileting the perineum
• Purgation. Cleansing enemas (1 liter) at intervals of one hour, 2nd in the evening and 2nd in the morning before surgery.
• Diet. A day or two before surgery, you need to switch to easily digestible food that does not overload the digestive tract. But at the same time, the food should be balanced, rich in minerals and vitamins. It is recommended to include more carbohydrate foods (jam, sugar, honey, etc.) in your diet. Completely exclude foods that can cause flatulence and excessive intestinal activity (smoked foods, spicy, salty, legumes, flour, etc.). Alcoholic drinks are strictly prohibited. On the day of the operation, you can drink a cup of tea with sugar or honey, since the body needs energy, both at the time of the operation and in the postoperative period.

Traditional methods of treating anal fissure

If you really care about your health, any use of medicines, especially traditional ones, should be consulted with your doctor.

Form	Compound	Cooking method	Mode of application	Effect
Microclyster	Calendula, sea ​​buckthorn oil	Pour one tablespoon of calendula into 100 ml of boiling water, bring to a boil, leave for 1 hour. Strain and add 2 teaspoons sea buckthorn oil	Use the resulting mixture to make a microenema (50-200ml) Give an enema before bed. Every day until complete recovery.	Anti-inflammatory Antimicrobial Accelerating recovery processes Strengthening local immune mechanisms
Sitz baths (infusion)	Chamomile, sage, St. John's wort, calendula	Take 20 grams of herbs in equal proportions and mix. Pour 1.5 liters of boiling water and strain. Then dilute with warm water to 38-40 degrees.	Preferably take a bath before for 15-20 minutes	Anesthetic Hemostatic Reduces inflammation Reduces skin sensitivity and irritation Activates recovery and healing processes Strengthens local defense mechanisms
Ice candle	Tansy, chamomile, wormwood, plantain, calendula, oak bark, lingonberry leaf, celandine, birch leaf, yarrow, birch buds.	Mix the available herbs in equal proportions, pour 1 glass of the mixture with 1 liter of boiling water and boil for 5 minutes. Let cool completely. Then pour the broth into the fingers of a rubber glove or into special ice trays. Place in the freezer.	Insert suppositories into the anus, before bed, every day until complete healing.	Hemostatic Painkiller Anti-inflammatory Antimicrobial
Compresses	Carrots, red beets, Ox or pork bile	Grate carrots and beets (3 parts) and mix with 1 part fresh ox or pork bile	The resulting mixture is spread on a clean cloth and applied for 15-20 minutes.	Relieves inflammation Has antiseptic and antimicrobial effects Promotes healing
Candles made from potatoes and badger fat	Bear or badger fat, propolis, alcohol 70%, raw potatoes	Add to 40 gr. fat 40 gr. Propolis and 40 gr. alcohol 70%. Stir and refrigerate for 3 days.	Cut a stick or candle out of raw potatoes, dip it in the resulting mixture and insert it into the anus. Perform the procedure before bedtime.	Elimination of spasm Pain relief Reduces inflammation Accelerates recovery and healing processes

Complications of anal fissure

• Bleeding. Chronic, sometimes minor bleeding can lead to anemia.
• Infection of the fissure can lead to the purulent process spreading to nearby tissue and paraproctitis (inflammation of the peri-rectal tissue) developing.
• Long-term purulent inflammation anal fissure can lead to the formation of a rectal fistula.
• The chronic course of an anal fissure can become a predisposing factor in the development of tumor diseases of the rectum.

Prevention of anal fissure

Prevention
It is recommended to do:	It is recommended to avoid:
Normalize the stool! Diet. Prevention of constipation. A glass of cold water or juice on an empty stomach. A glass of kefir with a spoon of sunflower oil at night. Moderate physical activity, physical education, swimming, etc. Timely and fully treat intestinal diseases. Especially to cure hemorrhoids. Proper management of childbirth and postpartum period	Excessive physical activity, especially those that increase pressure in the rectum. Errors in nutrition (too spicy, salty, alcohol, etc.) Long-term constipation Mechanical injuries of the rectum Hypothermia

Answers to frequently asked questions

Anal fissure during pregnancy - how to treat it?

Pregnancy is a stressful period for a woman’s entire body. During this period there is high risk exacerbation chronic diseases. Quite often, constipation and hemorrhoids worsen in pregnant women. These, in turn, are the primary factors in the development of anal fissures. Considering the fact that many drugs are prohibited during pregnancy, it is necessary to look for alternative methods for treatment. Here are some tips to help cope with the disease and at the same time not harm the health of the mother and child:

• In the first place is a diet in order to naturally regulate stool. You should drink enough fluid 1.5-2 liters per day. Eat more fresh fruits and vegetables and cereals containing a lot of fiber. Prunes, beets, and fermented milk products cope well with stagnation in the intestines. However, pregnant women should not greatly limit themselves in their food preferences. Since nature naturally regulates all the necessary needs for both mother and child.
• If it is not possible to improve your stool with diet, you can use mild laxatives: Normaze, Fitomucil, food bran. Which will not have a harmful effect on the body of the mother and child.
• For strained stools, it is recommended to use oil microenemas (with sea buckthorn, calendula).
• The following drugs are effective and safe to directly affect the anal fissure (eliminate inflammation, pain, healing): sea buckthorn suppositories, propolis suppositories, relief-advance suppositories, Aurobin ointment, baths with chamomile, sage, calendula.
• Personal hygiene. It is recommended that after each bowel movement, wash the anus area with antibacterial soap, chamomile or calendula infusion, and lubricate the skin with Vaseline oil and baby cream.
• Moderate physical activity. Nature walks, swimming, etc.
• Important! If you really care about your health and the health of your child, be sure to consult a specialist doctor (gynecologist, proctologist).

Anal fissures in a child - how to treat?

Anal fissures in children are quite common. Mostly these are acute cracks, less often they become chronic. The most common cause of anal fissure in children is constipation, less commonly diarrhea and helminthic infestation. And, as a rule, after the stool normalizes, the cracks go away on their own. In this regard, the normalization of the child’s stool comes to the forefront of treatment. To do this, the first step is to review the child’s diet; more plant foods (vegetables, fruits) and fermented milk products (kefir, fermented baked milk, etc.) are included in the diet.

It is also important drinking regime, the child must receive sufficient fluids ( pure water, juices, fruit drinks, compotes). However, diet alone is often not enough, since the psychological factor becomes the underlying factor in most cases of constipation.

Wrong family and social education has a detrimental effect on the child’s psyche and automatically affects his physical condition. In this case, an experienced psychologist or pediatrician will provide indispensable assistance in treating the child. Parents should immediately suspect the disease and pay attention to the following points: unreasonable anxiety of the child, the child does not want to go to the potty, or sits on it for a long time, strains, cries. And most importantly, examine the child’s stool for the presence of drops of blood, most characteristic symptom anal fissure. If you have such symptoms, you should definitely contact your pediatrician or pediatric surgeon, in order to exclude more serious diseases and correctly prescribe treatment.

Some tips for treating anal fissure in children:

• Normalize the child's stool. Diet. Psychological work. Laxatives (normase, food bran, phytomucil, etc.). Cleansing enemas.
• Eliminate pain and inflammation in the anal canal, speed up the healing process of the fissure. Recommended preparations: suppositories with sea buckthorn, suppositories with propolis, alginatol suppositories, posterizan suppositories, relief suppositories, solcoseryl ointment, troxevasin ointment, baths with chamomile, sage, potassium permanganate, oil microenemas with sea buckthorn, calendula, etc.
• Personal hygiene. After each bowel movement, thoroughly wash the anus area. Lubricate with Vaseline or baby cream to moisturize and increase skin elasticity in order to eliminate increased trauma to dry skin.

Anal fissure after childbirth - how to treat it?

The process of childbirth is a serious test for a woman, during which time the body experiences enormous stress. The pelvic organs, including the rectum, are especially subject to such stress. This explains the high percentage of development of anal fissures after childbirth. Postpartum period has a number of features and one of them is that a nursing mother cannot take the entire range of standard medications, as this will immediately affect the milk and the health of the child. However, an untreated acute anal fissure can easily turn into a chronic fissure, and then surgical intervention is not necessary.
Here are some tips on the way to safely healing an anal fissure after childbirth:

• Consult with an experienced proctologist. Because under the mask of symptoms of a banal anal fissure, formidable diseases can be hidden.
• Normalize stool:
  1. Diet: plant foods (vegetables, fruits, cereals), dairy products. Example: boiled beets, prunes, kefir, etc. A sufficient amount of liquid is 1.5 -2.5 liters.
  2. Laxatives (normaze, duphalac, phytomucil, food bran)
  3. Cleansing enemas
• Eliminate pain, inflammation, spasm, speed up the healing process:
  1. Candles: with sea buckthorn, with propolis, natalsid, posterizan
  2. Ointments: solcoseryl, Ratovnik balm, Actovegin and Troxevasin (with caution)
  3. Baths: with chamomile, with calendula, with sage, with potassium permanganate.
  4. Microclysters: with sea buckthorn, with calendula, etc.
• Personal hygiene.

Washing after each act of defecation. Application to the anus area, Vaseline ointment, baby cream or other ointments (solcoseryl, Ratovnik balm, etc.)

Walk outdoors

Swimming, etc.

Proper management of the postpartum period

The first bowel movement after childbirth should be induced by laxatives or an enema.

Anal fissure and hemorrhoids due to chronic constipation, how to treat?

Internal and external hemorrhoids are quite often accompanied by anal fissures. One of the factors in the occurrence of anal fissures against the background of hemorrhoids is venous congestion, in which the rectum and anus are poorly supplied with blood, which makes these structures vulnerable to various traumatic factors, in particular constipation. But in practice it turns out to be a completely different picture. In most cases, chronic constipation, hemorrhoids and anal fissure are the result of other diseases of the gastrointestinal tract, poor diet and sedentary lifestyle. So the presence of such a triad of pathologies of the large intestine is a reason to think about your health and life positions.

To understand how to treat this complex of colon pathologies, it is necessary to understand the causes in detail.

Rice. No. 1. Schematic representation of the causes of hemorrhoids, anal fissure and constipation.

The reasons can be depicted in the form of an inverted triangle, the apex of which is the triad: constipation, hemorrhoids, anal fissure. But the basis of this triangle is stomach diseases, namely gastritis and stomach ulcers, that is, pathologies associated with disorders of excretion gastric juice as a result inflammatory process. Also, various pathologies of each part of the gastrointestinal tract can lead to digestive disorders resulting in constipation, hemorrhoids and anal fissure. Separately, we can highlight habitual constipation, in which changes in the rectum are caused by stretching of its ampoule. Trigger this state is a psychological and stress factor.

But overall cause of most diseases digestive system are:

• irregular, irregular nutrition , binge eating;
• taking certain medications;
• bad habits (alcohol abuse);
• sedentary and sedentary lifestyle;
• infections (Helicobacter pylori, viral hepatitis, salmonellosis, dysentery and others), helminthic infestations, intestinal dysbiosis.

When normal functioning of the gastrointestinal tract is restored, the problems of anal fissure, constipation and hemorrhoids will go away without special treatment rectum. And it is the elimination of the causes of these diseases that can prevent the development of their relapses.

But before treatment, you need to undergo a complete examination of the digestive system. To do this, in addition to the proctologist, you need to visit a gastroenterologist.

Examination plan for constipation, hemorrhoids and anal fissure:

3. Rejection of bad habits.

4. Drug treatment of pathology, which caused diseases of the rectum.

5. Conservative treatment of fissures and hemorrhoids – prescribed individually by a doctor.
Medicines for oral administration:

• Methyluracil;
• Vitamin K (Vikasol);
• Ginkor Fort;
• Lactulose (Duphalac, Normaze);
• Salofalk and others.

Preparations for external use (ointments, gels, creams, rectal suppositories):

• Nefluan;
• Proctosan Neo;
• Proctoglivenol;
• Sea buckthorn candles and many others.

6. Surgical treatment used when there is no effect on the background of drug treatment. The type of operation is determined individually for each patient.

The basic principle of treating anal fissures and hemorrhoids is the elimination of the causes and comprehensive therapy, and all this against the backdrop of a radical correction of the patient’s diet and lifestyle.

What to do if an anal fissure does not heal after excision surgery?

Excision of anal fissure is the main type of surgical treatment for chronic anal fissure. In most cases, such an operation gives the expected result, but there are cases when such an operation is ineffective. Let's figure out why this can happen.

Causes of anal fissures after surgery:

• surgical technique excision of anal fissure is less effective if there has been no surgical intervention on the rectal sphincter (dissection);
• possible complications of the operation in the form of a sphincter spasm, which increases resistance to feces and promotes the development of repeated anal fissures;
• non-compliance with bed rest , hygiene rules, improper care of postoperative wounds in postoperative period;
• infection postoperative wound;
• surgery only eliminates the crack, not the cause its occurrence, therefore after the operation it is necessary to reconsider your diet, lifestyle, and undergo a course of treatment for diseases of the gastrointestinal tract;
• constipation and hemorrhoids after surgery will contribute to the lack of healing of the anal fissure, so it is very important to prescribe laxatives and decide on the method of treating hemorrhoids.

After surgery to excise an anal fissure, healing occurs within 3-4 days, up to a maximum of 2-4 weeks. During this period there may be postoperative complications, some of which require emergency assistance.

Symptoms indicating complications after surgery for anal fissure:

Read more about the given methods of treating anal fissures in the section of the article.

If the treatment is effective, the symptoms of anal fissure will decrease after a few days and completely disappear within 1-2 weeks. Constant adherence to the diet, that is, proper nutrition, personal hygiene, normal regular bowel movements are the key to preventing recurrence of anal fissures.

Anal fissure: photo, what does it look like?

Photo: chronic anal fissure due to hemorrhoids. Signs of rough scarring of the crack indicate a chronic process.

Photo of rectoscopy: the “inner” part of the anal fissure.

Photo: signs of paraproctitis and rectal fistula – purulent complications of anal fissure.

Photo: rectal polyp , which protrudes outward from the anus - a complication of a chronic anal fissure.

Surgical treatment of anal fissure. Surgery for excision of chronic anal fissure is a rather “bloody” manipulation; violation of the surgical technique can lead to insufficiency of the rectal sphincter.

Treatment for rectal fissures aims to relieve pain, treat constipation, and soften stools. For chronic rectal fissures, when symptoms last more than 6 weeks, surgery may be necessary.

Treatment methods for anal fissure

Anal fissure is a very painful and common disease that causes a lot of suffering to the patient. Therefore, people often wonder how to cure 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 recommend treatments that alleviate the symptoms and speed up the healing of the anal fissure.

Treatment of adult patients

An anal fissure, like many other diseases, can be cured at home. However, you should strictly follow your doctor's recommendations, which are usually aimed at eliminating constipation and relieving symptoms.

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

Treatment of anal fissures at home includes:

• Increasing the amount of fiber consumed daily by including a sufficient amount of fiber-rich foods in your diet - fruits, vegetables, whole grain cereals and bread.
• Drinking enough water to avoid dehydration.
• Exercise – such as walking or jogging.
• Developing the habit of going to the toilet at the same time.
• You should not put off going to the toilet when you have the urge to have a bowel movement.
• When using wet wipes, you should avoid those that contain fragrances or alcohols, as they may cause discomfort or itching.
• Using toilet paper preference should be given to its soft types.
• You should wash the perineum and anal area with warm water several times a day, especially after bowel movements, to relax the anal muscles, increase blood flow and cleanse without rubbing or irritating the skin.

Doctors may also prescribe various treatments for fissures around the anus in adults. medications, which help relieve symptoms and allow them to heal faster.

Laxatives

These help make bowel movements easier. In adults, to treat anal fissures, laxatives are used to increase the volume of stool. They help retain more fluid in the intestinal lumen, which makes the stool soft and bulky.

The doctor may recommend a low starting dose of the laxative, gradually increasing it over several days until the patient has bowel movements soft chair every 1-2 days. Cured constipation is the key to getting rid of fissures quickly.

Painkillers

If a person experiences prolonged pain after defecation, the doctor may prescribe painkillers such as Paracetamol or Ibuprofen.

Nitroglycerin ointment

If your anal fissure symptoms do not improve within 1 to 2 weeks, your doctor may prescribe nitroglycerin as an ointment to treat, which should be applied directly to the anal area, usually twice daily. Nitroglycerin dilates blood vessels in and around the anus, which helps improve blood supply to tissues and promotes more fast healing cracks. 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. For chronic cracks, the effectiveness of this drug is about 70%.

Since nitroglycerin is absorbed into the systemic circulation through the hemorrhoidal veins when nitroglycerin is used to treat anal fissures, many patients may develop headaches. 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 easier to tolerate 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. They are recommended to be used immediately before bowel movement. The ointment should be applied directly to the affected area.

Medicines used to treat anal fissure are also often prescribed for exacerbation of hemorrhoids. These drugs do not speed up the healing of the crack, 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

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

Side effects of calcium channel blockers may include headaches, dizziness, and itching or a burning sensation where the drug is applied. They usually go away within a few days of use, as the patient's body gradually gets used to the treatment.

Topical calcium channel blockers are considered as effective as nitroglycerin and can treat rectal fissures when other medications have failed.

Botulinum toxin injections

It's relative new method treatment of anal fissures, which is usually 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.

In case of anal fissure, 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 botulinum toxin injections help more than half of patients. Its effect lasts 2-3 months, which is enough for the crack to heal. Main side effect This treatment results in weakness of the sphincter muscles, which is manifested by fecal incontinence, which, as a rule, is temporary.

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

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

For anal fissures, the following operations are performed:

• Lateral sphincterotomy. The procedure involves making a small incision in the ring of sphincter muscles surrounding the rectum. This helps relieve pressure inside the anus and allows the anal fissure to heal, and also reduces the risk of recurrence of the disease. This operation does not last long, it is relatively simple and is usually performed under general anesthesia. Lateral sphincterotomy is one of the most effective methods treatment of anal fissures, most patients recover completely within 2-4 weeks. With 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 anal fissure. This technique is used for chronic anal fissures.

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

Treatment of anal fissures in children

Rectal fissures in children are quite common, so many parents are interested in how to treat them.

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

All tips for non-drug treatment cracks in the anus in an adult patient can also be used in 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 comfortable conditions.

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

Most often they prescribe:

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

For anal fissures in children surgical interventions are carried out very rarely - in case of ineffectiveness of conservative treatment and chronic cracks. The most commonly used methods are lateral sphincterotomy and excision of chronic fissures.

Treatment of anal fissures in pregnant women

If fissures 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.

If these measures are insufficiently effective, 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 fissures in the anus is usually carried out after childbirth if conservative therapy is ineffective.

Traditional 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 facilitate bowel movements. It can be administered directly into the rectum in an amount of 50 ml. Also a mixture olive oil, honey and beeswax relieves pain, reduces bleeding and itching in the affected area. To obtain this mixture, the ingredients must be mixed in a bowl in equal proportions, then heated in the microwave until the beeswax completely melts. After the mixture has cooled, it should be applied to the damaged area several times a day.
• Aloe. Has healing and anti-inflammatory properties. You need to cut one leaf from the plant, cut it along its entire length and squeeze out the juice. You should then 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 hot water, cover and leave 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 an anal fissure, the first place in the patient’s complaints is acute, cutting pain that appears or intensifies after defecation. With ordinary hemorrhoids, people often complain of blood discharge 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 with hemorrhoids can develop when hemorrhoids thrombose. The pain in this case is very severe and constant.

Establish a correct diagnosis and give correct recommendations Maybe a doctor, whom you should contact. In addition, it should be remembered that the presence of hemorrhoids does not deny 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. If conservative treatment is ineffective, surgical intervention is performed.

Useful video about the causes and treatment of anal fissures