Anal fissure

An anal fissure (fissure of the anus) is a defect in the wall of the anal canal 1-2 cm long slit or triangular in shape, the upper end of which reaches the scallop (dentate) line.

The disease ranks third after hemorrhoids and colitis, accounting for 11-15% in the structure of proctological diseases. Women are affected about twice as often as men. The disease occurs at any age, but more than a third of patients are of working age.

Anal fissure classification
By the nature of the flow
-Acute: up to 2 months, conservatively treated. Treatment efficiency 50-60%
-chronic: more than 2 months, is treated promptly, the effectiveness of treatment is 94-100%
By localization
– back – 87, 5%, more common in men
– anterior – 9.5%, more common in women
– side – 3%
By spasm of the sphincter
-with spasm
-without spasm

Causes of anal fissure
An anal fissure occurs as a result of a mechanical violation of the integrity of the mucous membrane of the anal canal with constipation, less often with diarrhea. Predisposing diseases are proctitis, colitis, hemorrhoids, etc. In women, cracks can form during childbirth and with improper management of the postpartum period, when the first stool is not caused by enemas or laxatives.

In the pathogenesis, the leading is the neuro-reflex theory, according to which there is a spasm of the sphincter due to severe pain syndrome, which leads to tissue ischemia and prevents the healing of the crack.

Symptoms
A triad of symptoms is characteristic: pain during or after the act of defecation, minor bleeding and spasm of the anal sphincter. The pain in an acute fissure is characterized as unbearable, acute, burning and is associated with the act of defecation, lasts up to several hours after it. It can radiate to the lower back, less often to the lower abdomen, sometimes reflexively cause urination disorder. This creates a vicious circle, which only aggravates the course of the disease, bringing patients to neurotic disorders. Bleeding is not abundant and is noted as a narrow strip of blood on the stool. Anal itching is relatively common during the course of a fissure (see table Anal itching). With an acute anal fissure, only a painful area on the wall of the anal canal (most often on the posterior canal) is usually revealed, and the seals, the raised edges of the fissure, the sentinel tubercle at its distal edge may not be detected. With a chronic fissure, the pain is of a more prolonged nature, intensifies not only after stool, but also with a prolonged forced position. Patients develop symptoms such as fear of stools and stool retention.

Diagnostics
An anal fissure must be differentiated with thrombophlebitis of the hemorrhoidal node, Crohn’s disease, ulcer-cancer, specific ulcers of the anal canal (syphilis, tuberculosis). In unclear cases, along with other studies, a biopsy is performed.

Treatment
The duration of the disease is not decisive in the choice of the method of treatment. Treatment of acute cracks is conservative. It has been proven that well-chosen treatment leads to recovery in about 70% of patients. The primary tasks of conservative treatment are: relieving pain, sphincter spasm, eliminating constipation, observing the rules of personal hygiene, using drugs that promote crack healing. Currently, many patented suppositories are produced that patients can use in the future on their own, determining the most suitable ones. After stool, before the introduction of the candle, take a warm (36-38 C) sitz bath. The same manipulation is performed at night. No antibiotics should be prescribed.

At the time of treatment, a predominantly vegetable and fermented milk diet is prescribed, with the exception of spicy, salty foods, seasonings, and alcohol. Boiled beets, carrots, wheat bran, prunes, etc. well regulate intestinal function https://en.wikipedia.org/wiki/Intestinal_permeability.
Healing of an acute fissure is somewhat individual and occurs within a few weeks.
Surgical treatment is used for chronic fissures, when the fissure actually turns into an ulcer with dense scar edges and sentinel tubercles.