Cracks in the anus: symptoms and treatment
Cracks in the anus are the most common complaint that patients present with a proctologist. Not a single person is insured against their appearance, but most often they form in elderly people. A crack in the anus can appear both on its own and as a result of other diseases of the digestive system.
- The essence of pathology
- Predisposing factors
- Causes of anal fissure
- Anal fissure symptoms
- Diagnostics of the anal fissure
Methods for treating a crack in the anus
- Diet therapy
- Intestinal ozone therapy - will it help?
- Laser and other minimally invasive surgeries
- How to heal an anal fissure after childbirth?
- Cracked anus in a child
The essence of pathology
A fissure in the anus is a disturbance in the normal structure of the rectum, which is the end of the large intestine. Such a crack, in fact, is a normal rupture of the mucous membranes.
Most often, the size of the defect is small. However, this does not prevent him from significantly reducing the patient's quality of life. If a person suffers from hemorrhoids for a long time, then the cracks can even spread to the side walls of the anus.
Like any other disease, cracks can be acute or chronic. Up to 25% of all patients come to the proctologist with sharp cracks.
Main characteristics of an acute anal fissure:
- Severe pain during bowel movement, which subsides on its own after 15-20 minutes. The pain is throbbing.
- Pain occurs with every compression of the sphincter.
- Intermittent bleeding. In this case, the blood will have a bright red light. It can stand out drop by drop, or flow in a stream.
- On examination, the doctor visualizes an area of inflammation on the intestinal wall. When touched, the patient complains of acute pain.
Characteristics of a chronic anal fissure:
- Mild pain that worsens after the act of defecation. After a few minutes, they completely disappear. Also, painful sensations will bother with a violation of the stool with an error in the diet and during any straining.
- Blood visible in stool.
- Consolidation of the intestinal wall.
- The normal sphincter tissue is replaced by scar tissue.
- Symptoms of the disorder are repeated all the time.
Risk factors for the formation of a crack in the anus:
- Constipation and diarrhea, that is, any chronic stool disorder.
- Diseases of the rectum and large intestine: colitis, hemorrhoids, proctitis, IBS, etc.
- Crohn's disease.
- Errors in the diet. The danger is the consumption of salty and spicy foods, as well as the intake of alcoholic beverages.
- Anal sex.
Video: Live Healthy “Anal fissure. What does constipation lead to? ":
Causes of anal fissure
The most common causes that can lead to the formation of a crack:
Diseases of the gastrointestinal tract: stomach ulcer, gastritis, colitis, hemorrhoids.
In 95% of patients with inflammation of the hemorrhoids, anal fissures are found.
Stool disorder: chronic constipation and diarrhea.
Received rectal injuries. Injury can occur during sigmoidoscopy, anoscopy, colonoscopy, when the doctor with a sharp movement inserts the tube of the device into the intestine.
Other damage to the integrity of the rectum. Most often, these situations occur in people who have anal sex.
Pregnancy and childbirth. The growing uterus begins to press on the internal organs that are located below. Under its pressure, the intestines fall, which leads to constipation and increases the likelihood of cracking. Attempts during childbirth also contribute to the violation of the integrity of the anus.
- Decreased muscle tone of the pelvic floor.
- Excessive physical activity.
- Diseases such as: condyloma of the anus, sphincteritis, dysentery, syphilis, HIV and AIDS, tuberculosis, paraproctitis.
Anal fissure symptoms
The symptoms of anal fissure are as follows:
Pain. The deeper the defect, the more intense it will be. At first, pain occurs only during bowel movements, or when it is irritated. As the inflammation progresses, the pain will be present on an ongoing basis. The pains can be of a different nature: burning, sharp, pressing, pulling. Rectal spasm often occurs in patients with chronic anal fissure. This leads to increased pain during the act of defecation.
Discomfort and itching. Discomfort is especially strong in those patients who wear tight underwear made of unnatural fabrics, as well as in people who sit for a long time or suffer from stool disorders. The longer the crack, the more itchy.
The appearance of scarlet blood. It will be visible on the surface of the stool, not inside it. Blood is released when straining. Venous blood can appear only with deep damage to the intestinal wall. In this case, prolonged and massive bleeding may develop.
All of these symptoms may indicate not only a fissure of the anus, but also much more serious diseases, for example, hemorrhoids or even bowel cancer.
Diagnostics of the anal fissure
In order to make the correct diagnosis, you will need to undergo the following examinations:
Examination of the anus in the doctor's office. Most often, it is not difficult for the doctor to understand that the patient has an anal fissure.
Delivery of a blood test. It is important to assess the level of hemoglobin and erythrocytes, to exclude anemia, which often develops in patients with anal fissures. This is due to prolonged bleeding.
- Feces delivery for coprogram. This study allows you to exclude inflammation in the intestines, to detect occult blood in the feces. The Gregersen test allows you to clarify whether there is bleeding in the upper intestine.
- Feces delivery for bacterial culture to detect pathogenic microflora and establish its sensitivity to antibacterial agents.
Anoscopy. During the study, an anoscope is inserted into the anus with which the doctor examines the surface of the intestine.
Rectoscopy. The procedure is performed using a rectoscope. It is represented by a tube equipped with a magnifying system and a flashlight. The device is introduced to a depth of 35 cm.
Irrigoscopy. This is an x-ray examination using a contrast agent.
Ultrasound. A device that emits ultrasonic waves is used to assess the condition of the intestines.
- Revealing the presence of parasite eggs in the feces.
It is important to carry out differential diagnosis of anal fissure with pathologies such as:
- Crohn's disease.
- AIDS, which can disrupt the condition of any tissues and organs.
- Thrombophlebitis of the hemorrhoid.
- Fistula in the rectum, which did not lead to its complete perforation.
- Proctitis and proctosigmoiditis.
- Actinomycosis (infection of the body with parasites).
- Gumma (an ulcer that forms against the background of syphilis).
- Rectal tuberculosis.
To exclude all these diagnoses, a comprehensive examination of the patient is required.
Methods for treating a crack in the anus
The main task facing the doctor is the need to relieve the patient of pain, as well as to eliminate the cause of the appearance of the anal fissure. This will prevent it from reoccurring.
Treatment methods that can be shown to patients with anal fissure:
- Conservative therapy.
- Surgical intervention.
Therapy depends on the cause of the cracks and on the intensity of the symptoms of the disorder. Therefore, only a doctor can prescribe treatment after an examination.
The main directions of conservative therapy:
- Compliance with dietary food. The diet should contain vegetables, fruits, broths, protein products.
- The use of ointments and suppositories, which are aimed at healing tissues and destroying pathogenic flora.
- Physiotherapy treatment. Baths with chamomile help to cope well with anal fissure.
- Taking medications to relieve constipation and soften stool.
Patients with anal fissure should refuse to eat salinity, spicy, fried, flour, spicy, sour foods and alcoholic beverages. Patients are advised to eat salads, cereals, season them with vegetable oil. Bran bread (up to 20 g per knock), boiled soups are useful.
That to normalize the intestines is required to include dried apricots, prunes, bananas, figs, boiled carrots, baked apples in the diet. You also need to drink as much water as possible, consume dairy products.
Patients with diarrhea should avoid legumes, cabbage, fresh vegetables and fruits, yeast bread, and whole milk.
There are many medications that can help you get rid of a crack in your anus.
Read more: Diet for hemorrhoids - how to eat?
Suppositories for anal fissure
Suppositories are often prescribed for patients with anal fissure.
The most effective drugs include:
- Posterized. These suppositories are aimed at enhancing immunity, helping to eliminate itching and tissue regeneration.
- Natalsid. The preparation contains an antimicrobial component. The use of these suppositories allows you to get rid of bleeding.
- Proctosan. This tool promotes the healing of the crack, has a drying effect.
Candles with propolis. They have an immunomodulatory effect, destroy pathogenic flora, and stop the inflammatory response.
Ultraproject. These are anti-inflammatory suppositories that quickly relieve itching and pain.
To get rid of the crack faster, you will need to use candles 2 times a day: in the morning and in the evening.
Read more: Suppositories for hemorrhoids: which is better to choose?
Ointments for a crack in the anus
When the fissure is close to the anus and a person can touch it, doctors recommend using ointments.
The most effective drugs include:
- Levomekol. This tool allows you to sanitize the affected area from pathogenic flora, eliminate inflammation, and restore damaged tissues.
- Proctosan. It is a drying ointment that helps to stop the inflammatory reaction.
- Proctosed. This drug is prescribed to relieve inflammation and painful sensations, as well as for tissue regeneration. Its use allows you to relieve itching, reduce swelling and relieve the patient's well-being.
- Relief. This agent creates a film-like barrier on the crack surface. Through it, germs cannot enter an open wound. The use of the ointment allows you to reduce pain, dry out a bleeding defect, and accelerate tissue regeneration.
Ultraproject. This drug allows you to get rid of painful sensations and itching, promotes tissue repair, and eliminates inflammation.
Warrior. The ointment-balm destroys the pathogenic flora, eliminates all uncomfortable sensations.
Nitroglycerin ointment. It promotes healing of cracks, stops bleeding, improves nutrition of the affected area.
Hirudoproct. This ointment strengthens blood vessels, increases local immunity, and eliminates inflammation. Thanks to its use, the wounds quickly contract, they do not suppuration.
Bezornil. This is an antimicrobial agent that perfectly disinfects the anus with a fissure. It is also prescribed to treat hemorrhoids.
In addition to the listed ointments, there are other drugs, but a doctor must prescribe them.
Read more: Review of 17 hemorrhoid ointments: advantages, uses and prices
Pills and injections for anal fissure
If the patient develops a spasm of the sphincter, then botulinum toxin injections are shown to him. One injection is enough to relax the muscle. The drug is injected into the lower part of the internal sphincter of the rectum. The dose of the drug should not exceed 20 units.
For the treatment of anal fissure, the patient may be prescribed drugs such as Detralex or Venarus. They are used in both acute and chronic forms of the disease. They help to increase the tone of weak intestinal muscles, relieve swelling and inflammation, and reduce the intensity of pain.
Venarus and Detralex are not prescribed for pregnant and lactating women, as well as the elderly.
Read more: Hemorrhoid pills
Patients with anal fissures are prescribed vitamin A and E. They allow to restore the damaged rectal mucosa and improve the condition of the skin.
If a person begins to regularly go to the toilet, and his feces are soft, then it will be possible to quickly restore the integrity of the anal passage and get rid of the crack.
Drugs that help facilitate bowel movements:
- Emollients: sea buckthorn oil, vaseline oil, Norgalax. At home, before bowel movement, you can put enemas with sunflower oil and water (100 ml of oil per 200 ml of water). The procedure is performed 10 minutes before the act of defecation.
- Agar or psyllium-based preparations that increase the volume of feces: Naturolax, Fiberlex, Mucofalk. Preparations containing cellulose: Fiberkon, Fiberal.
- Polyhydric alcohols, which are used more often than others, since they do not irritate the intestinal walls. These are drugs such as: Normaze, Duphalac, Lactulose, Sorbitol, Lactitol, Macrogol.
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Indications for surgical intervention for patients with anal fissure:
- Lack of effect from taking medications (provided that therapy is carried out for at least 6-8 weeks).
- Patient complaints of severe discomfort.
- Arising complications of anal fissure.
- Combination of anal fissure and hemorrhoids.
- Fecal incontinence.
Surgical care for anal fissures can be of the following types:
Anal divulsion. This is a kind of "middle" between surgery and conservative therapy. The patient is administered anesthesia, after which the sphincter is expanded. This procedure is not prescribed for the elderly.
Cryodestruction. You can try to repair an anal fissure with liquid nitrogen, but this treatment does not always solve the problem.
Sphincterotomy. During the operation, the crack is excised. If the patient has a spasm of the sphincter in parallel, then it must be dissected. Recovery takes up to 6 days. After this time, dressings with Levomekol are required.
The sooner treatment is started, the faster it will be possible to cope with the anal fissure. If a person does not delay going to the doctor, then it will be possible to get rid of the problem with the help of conservative therapy.
Intestinal ozone therapy - will it help?
Ozone therapy was previously used only in cosmetology, but doctors borrowed this method to treat the intestines. It involves taking 8 ml of blood from a patient, after which it is divided into plasma and erythrocyte mass in a centrifuge. The plasma is additionally enriched with biologically active substances and platelets, after which it is administered to the patient in the area under the anal fissure. This allows the tissues to regenerate faster.
Plasma can be enriched with ozone, which will increase the therapeutic effect and will additionally stimulate the patient's immune system. Ozone therapy for anal fissures is actively used in various countries. In recent years, this method has begun to gain popularity in Russia.
The opinion of doctors
Zagryadskiy A. E (professor, doctor of medical sciences, member of AMTS RF, head of the department of proctology of MC ON CLINIC): “There are clear protocols for the treatment of anal fissures. Ozone therapy is not included in these protocols. In order for the patient to recover, it will be necessary to normalize the stool, relieve spasm from the sphincter, stimulate tissue healing, and increase blood circulation in the capillaries. To achieve the latter goal, phlebotonics are prescribed: Phlebodia or Detralex."
Lagodich L. G (surgeon, traumatologist, proctologist): “It will not be possible to cope with an anal fissure with one single method. An integrated approach is needed."
Laser and other minimally invasive surgeries
Minimally invasive techniques are used to treat anal fissure more and more often. They are not associated with the risk of complications and allow you to quickly get rid of the existing problem.
Procedures that can be used to treat anal fissure:
- Laser treatment.
- Electrocoagulation of cracks.
- Treatment of cracks with ultrasound.
It is laser therapy that is used more often than others.
How to heal an anal fissure after childbirth?
Anal fissures often occur in women after childbirth. During pushing, the anus is under tremendous stress, and the perineum is stretched. As a rule, obstetricians do not treat cracks, but after 2 days a woman is faced with painful sensations when trying to empty the intestines. To soften the feces, it is required to take drugs that do not penetrate into milk, or do not enter the systemic circulation. You cannot ignore the problem, you need to contact a doctor.
Treatment is reduced to the use of suppositories with sea buckthorn, Duphalac, Methyluracil. Sometimes doctors prescribe Posterisan suppositories, and for the treatment of the skin around the anus, the drug Emla and Katejel gel.
It is important to start treatment immediately after delivery. If the defect does not go away for more than 3 months, then the edges of the crack become keratinized, and metabolic processes in the affected tissues slow down. In such a situation, the help of a surgeon may be required.
Read more: Hemorrhoids during pregnancy
Cracked anus in a child
In children, anal fissures occur frequently. The child will suffer from acute manifestations of the disease, the process is rarely chronicled. Parents should pay attention to the refusal of the baby to go to the toilet, or to his long time on the potty. However, he can cry and be capricious. If adults find an anal fissure in a child, you need to see a doctor.
A child suffering from constipation is prescribed Duphalac (Lactulose). It will be necessary to follow a diet, offer the baby a varied and plentiful drink. Older children should eat soups. If constipation is of a neurological nature, then you need to consult a neurologist. The doctor may prescribe sedatives to the patient that are appropriate for the treatment of children.
In some cases, it is required to get rid of worms, treat dysbiosis.
If the baby is haunted by diarrhea, then Stop-diar and Ersifuril are prescribed for him. Macrophages can also be used. Eubiotics are taken within a month after the completion of the main therapy.
To facilitate the discharge of feces, children under one year old are prescribed candles with sea buckthorn oil. They are divided into 2 parts and used 2 times a day. For children over a year old, insert a whole candle in the morning and evening. Promote the early healing of cracks in the bath with disinfecting herbs, for example, with chamomile or calendula.
Oflokain is prescribed to anesthetize the affected area. It contains an analgesic and an antibiotic. Levomekol is prescribed for up to 7 days, this ointment allows you to speed up healing. The dose must be strictly observed, since the drug can cause anemia and lead to a decrease in the level of leukocytes in the blood.
Candles or Aurobin ointment can be used for 5 days. Children are inserted by? candles, or apply 0.5 cm of ointment. In addition, in childhood, drugs such as D-panthenol, Methyluracil, Bepanten can be used.
In order to prevent the formation of anal fissures, you need to follow simple recommendations:
- Empty your bowels on time, get rid of diarrhea or constipation.
- Go in for sports, swim, walk as much as possible.
- Drink at least 2 liters of water a day.
- Observe the rules of personal hygiene.
- Treat all diseases of the gastrointestinal tract in time.
- Do not try to cope with illness on your own.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.