Anal Fissure
It is the tear or ruptures in the skin in the anus area. It is one of the most uncomfortable and painful diseases in the anus region. While there is a feeling of pricking needles or itching in the anus area at intervals during the day, the main problem occurs during and after defecation in the toilet. While there is a complaint of bleeding in the foreground in hemorrhoids (piles), pain is more prominent in anal fissure, and bleeding is less.
What Causes Anal Fissure?
There is always a history of constipation in patients with anal fissures, and it occurs when hard stools rupture the anal skin while going out. Sudden tears usually occur together with straining after diarrhea or constipation and is called acute anal fissure. It generally heals spontaneously within four to six weeks. It is important that there is no constipation or diarrhea during recovery, so that the condition does not recur. If the disease continues for more than two months and a deep ulceration of wounds has formed at the site of the rupture, then the disease becomes chronic and requires medical intervention.
When the anal fissure becomes chronic, that is, it will last for a long time and does not heal easily, a deep tear (ulcer) and a skin fold called acrochordon, which patients often think of as hemorrhoids, develop in the anus, indicating that it is time to intervene in the disease.
Apart from these reasons, anal fissures or ulcers can be encountered more rarely in pregnancy, in the individuals with intestinal diseases such as Crohn’s disease or ulcerative colitis, bacterial or viral infections around the anus and also with skin cancer around this region. Therefore, in the presence of symptoms such as anal pain, bleeding and wound around the anus, it is useful to consult a surgeon without delay.
How is Anal Fissure Treatment Performed?
The main problem in anal fissure disease is the increase in the pressure in the muscles in this area due to the wound and pain. Even if the disease heals in this way, the increase in the pressure is persistent and it causes partial stenosis in this area, thus, increases the risk of re-tears. When the anal fissure re-occurs, the muscle pressure increases a little more and increases the possibility of further anal fissure to recur. In this way, a vicious circle occurs.
For this reason, the main purpose of anal fissure treatment is to break this vicious circle in chronic and ulcerated fissures, while the main purpose is supportive treatment in newly formed cracks. Non-surgical treatments performed for this purpose are indicated below;
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Supportive treatment:
It is applied as the treatment of newly formed breech cracks. Stool softening drugs and painkillers are given to prevent constipation. To prevent constipation, patients should drink plenty of water, and eat legumes and fibrous foods. To reduce pain, hot water baths and pain relief creams before and after defecation are helpful.
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Topical treatments:
Rectal muscles are generally made of smooth muscles and some special creams can be used to reduce the pressure of these muscles. Creams prepared from some drugs such as diltiazem and nifedipine used in patients with hypertension are applied 2-3 times a day to the as anus region and 1-2 cm inside of anal canal. The aim is to decrease the muscle pressure in this area. Treatment is usually beneficial in half of the patients and it should be applied for at least six to eight weeks.
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Botulinum toxin administration:
It is a method that is frequently preferred especially in America and increasingly preferred in our country in recent years. Botulinum toxin, which is also used for cosmetic purposes, is applied around the anus and in this way, it is aimed to reduce muscle pressure. It provides 60-70% efficiency, but its effectiveness decreases in advanced disease. The risk of recurrence of the disease is higher than the surgical method and its administration is painful.
How is Anal Fissure Surgery?
Anal fissure surgery aims to remove some of the anus muscles with increased pressure and thus reduce the pressure. It is performed under operating room environment. After the patient is under general anesthesia, a very small incision, approximately 1-2 cm, is made on the side of the anus and half or a little less of the muscles called internal sphincter, which also allow stool retention, are visualized and removed according to the developed stenosis.
Reduced pressure in the anus can be felt by examining by palpation. Surgical method is the most effective method in the treatment of anal fissures and provides 95% success. At the same time, the risk of recurrence of the disease is lower after surgical treatments than other methods. However, as with any surgery, there is a risk of complications in this surgery. Temporary or permanent stool and gas incontinence complaints may occur due to excessive muscle removal. However, this risk is very low if performed by anexperienced surgeon.