Anal fissure (anal fissure)

Anal fissure: forms of the disease

There are acute and chronic anal fissures. If a rectal fissure exists for more than 4 weeks, then this is a chronic form of the disease. Morphological changes occur: the edges of the crack thicken, scars and tubercles appear. Chronic anal fissure cannot be cured using conservative treatment methods; surgical methods are required.

Chronic anal fissure is a fairly common disease. It occurs in 2-2.5% of adults. It accounts for 12-15% of all proctological diseases (this is 3rd place after hemorrhoids and paraproctitis).

Advantages of SM-Clinic

Our clinic employs some of the best pediatric proctologists in St. Petersburg - highly qualified doctors with impressive experience. There is modern diagnostic and treatment equipment and its own laboratory. In the postoperative period, children are accommodated in comfortable rooms with round-the-clock supervision by medical personnel.

To schedule a consultation, call us.

Sources:

1. E.A. Lapteva, I.V. Kozlova, Yu.N. Myalina, A.L. Pakhomova. Colon polyps: epidemiology, risk factors, diagnostic criteria, management tactics (review) // Saratov Medical Scientific Journal, 2013, v. 9, no. 2, pp. 252-259.
2. A.A. Podberzskaya, R.M. Salmin, E.V. Mogilevets, V.A. Mitskevich, S.V. Zhdonets, Yu.F. Pakulnevich, A.G. Kalach, T.T Room. Modern surgical methods for the treatment of colon polyposis // Journal of the Grodno State Medical University, 2016, No. 4, pp. 26-29.

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.

Possible complications of anal fissure

An anal fissure left untreated can cause the following complications:

• massive bleeding;
• rectal fistula;
• ascending (moving up the intestines) inflammation of the mucous membrane (sphincter, rectum, sigmoid colon);
• paraproctitis (inflammation of fatty tissue around the rectum);
• in men – prostatitis (if inflammation has spread to the prostate gland).

Causes of anal fissure

An anal fissure can be caused by:

• defecation with very hard stools;
• anal sex;
• straining with constipation;
• inflammation in the anorectal region (the area of ​​the anal sphincter and rectum), for example, proctitis.

To summarize, we can say that anal fissures occur either as a result of trauma to the anal canal (most often) or due to thinning of the mucosa.

Factors contributing to the formation of anal fissures are:

• sedentary lifestyle;
• staying in a sitting position for a long time (sedentary work);
• heavy physical work (weight lifting);
• poor nutrition. This is a common cause of constipation. For example, an insufficient amount of fluid consumed leads to excessive thickening of stool, and an insufficient amount of dietary fiber (fiber) slows down the passage of food through the gastrointestinal tract, as a result of which stool accumulates in the rectum;
• haemorrhoids.

During certain periods, the risk of anal fissures increases:

• in infancy (anal fissures are quite often observed in children aged 6 to 24 months. It is believed that the main reason for their formation is constipation);
• in old age (cause - impaired blood microcirculation in the anal area, constipation and intestinal dysfunction);
• during childbirth (due to pushing).

General information about the disease

Polyps of the rectum or colon in children can be single or multiple. In the second case, the disease is called “polyposis”.

Neoplasms can degenerate into malignant tumors, so the disease is considered to be a precancerous condition. In addition, polyps provoke paraproctitis, inflammation and cracks in the intestines. For these reasons, contacting a doctor should be done immediately at the first suspicion and symptoms.

The size of the tumors varies from 3 mm to 4 cm, but in rare cases they can be larger. A single tumor may not manifest itself for years; the clinical picture becomes brighter with polyposis. Source: E.A. Lapteva, I.V. Kozlova, Yu.N. Myalina, A.L. Pakhomova Colon polyps: epidemiology, risk factors, diagnostic criteria, management tactics (review) // Saratov Medical Scientific Journal, 2013, v. 9, no. 2, pp. 252-259

Most often, polyps occur in children of both sexes equally at the age of 3-6 years.

Symptoms of anal fissure

First of all, the manifestations of an anal fissure are pain and bleeding.
Rupture of the mucous membrane leads to the fact that during defecation, the nerve endings of the muscle ring that holds back feces are irritated. As a result, a spasm of the anal sphincter occurs (this is the name of this muscle ring) - it increases pain, which can persist for a long time. Sphincter spasm also makes defecation difficult.

The symptoms of an anal fissure are largely the same as those of hemorrhoids. At the same time, hemorrhoids are a factor contributing to the formation of anal fissure, and quite often these two diseases occur simultaneously. Only a doctor can make an accurate diagnosis in a particular case.

Pain during bowel movements

Pain is felt primarily during bowel movements. In the case of an acute crack, there is usually no pain at rest.

With a significant size of the anal fissure, as well as if the rectal fissure has become chronic, the pain during defecation can be quite severe and even cause the so-called “fear of stools” - i.e. the desire to postpone bowel movement as long as possible, just to avoid experiencing unpleasant sensations.

Blood in stool

Blood may be found in stool or on toilet paper.

Itching in the anus

In the case of an acute fissure, patients may complain of itching in the anus at rest.

When you need help quickly

The diet helps restore normal digestion and frequency of bowel movements, but cannot help empty the bowels when results are needed quickly. In such cases, it is recommended to use pharmaceutical products.

An effective and safe laxative for hemorrhoids and anal fissures - Fitomucil norm. It contains two natural sources of fiber: the pulp of homemade plum fruits and the shell of the Psyllium plantain seeds. Dietary fiber softens stool and maintains optimal stool consistency, stimulates bowel movements without cramps, pain and bloating.

The right choice of laxative is a first aid for anal fissures. The natural remedy promotes gentle natural restoration of stool, so tissue regeneration will take less time. Before using Fitomucil norms, consult a specialist.

Anal fissure treatment methods

Anal fissures require treatment. It is possible that a recently formed crack will disappear on its own, but there is a risk of the disease becoming chronic and it is quite high (10-15%). Besides, there is no point in putting up with pain and discomfort.

If an anal fissure is not treated, there is a possibility of a “vicious circle”. Pain during bowel movements causes bowel movements to be delayed, resulting in harder stool. Spasm of the anal sphincter makes defecation difficult; you have to push harder. All this leads to repeated injury to the mucous membrane and does not allow the crack to heal.

A timely visit to a doctor (immediately after detecting signs of crack formation) will allow you to avoid surgery and limit yourself to non-surgical and minimally invasive treatment methods. Getting rid of a fissure brings joy, because life with a fissure is filled with painful sensations and inconveniences, so much so that a person’s character may even change.

Qualified proctologists at the Family Doctor have the experience to choose the most effective course of treatment, and the modern equipment of the clinics allows operations and manipulations to be performed efficiently, quickly and in the most painless manner for the patient.

Conservative treatment

Acute anal fissure

treated conservatively. Treatment of rectal fissure is aimed primarily at normalizing stool (eliminating constipation or diarrhea). The patient is prescribed a diet that excludes spicy, salty and sour foods, as well as alcoholic drinks. The goal of drug treatment (suppositories, ointments) is to reduce pain, reduce sphincter spasm, and speed up healing.

Surgical treatment of anal fissure

For the treatment of chronic anal fissures

Minimally invasive surgical methods are used, and (if surgery is indicated) acute excision of the anal fissure is performed. The operation is performed under local anesthesia.

At the “Family Doctor”, surgical treatment of an anal fissure, depending on its nature, can be carried out using various methods: using a laser, using a radio wave scalpel (Surgitron radio wave surgery device), sharp excision of the fissure.

More information about the treatment method

Make an appointment Do not self-medicate. Contact our specialists who will correctly diagnose and prescribe treatment.

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Anal fissure (anal fissure)

Anal fissure

(
anal fissure
) is a defect in the mucous membrane of the anal canal, located on the wall of the rectum in the area of ​​transition of the anoderm into the mucous membrane of the anal canal. Anal fissure is characterized by the following symptoms:

• pain during bowel movements
• spasm of the internal anal sphincter
• bloody discharge from the anus

There are:

• acute anal fissure
• chronic anal fissure

Based on the location of the crack, the following are distinguished:

• posterior anal fissure
• anterior anal fissure
• lateral anal fissure

Based on the presence of sphincter spasm, the following are distinguished:

• with sphincter spasm
• without sphincter spasm

Acute anal fissure

The main complaint of patients with anal fissure is the pain that occurs during defecation, which is usually very strong and can last for a long time. Because of these pains, patients often delay bowel movements, which can lead to the development of constipation. The pain causes a spasm of the anal sphincter, which, starting during defecation, can last for a long time, up to several days, until the next act of defecation. Thus, pain can cause sphincter spasm; spasm increases pain and prevents the healing of the anal fissure. Constant injury to the mucous membrane by stool is accompanied by slight bleeding from the anus. Acute anal fissures most often (in 90% of patients) heal spontaneously or with therapy, most often within 6–8 weeks. However, in some patients this does not happen, which leads to the formation of a chronic anal fissure.

Chronic anal fissure

Chronic anal fissure occurs in 2-2.5% of the adult population, occupying third place among proctological diseases after hemorrhoids and paraproctitis.
The existence of a defect (crack) for a long period of time, as a rule, is accompanied by the appearance of distinctive morphological features: the presence of muscle fibers of the internal sphincter of the anus at the bottom of the defect, its dense “callous” edges, the proliferation of granulations in the form of a fibrous compaction “sentinel tubercle” at the distal end of the crack , compaction of the apex of the anal papilla at its proximal end (Krylov N.N.). The microbial landscape of chronic anal fissure is represented by associations of aerobic and anaerobic microorganisms. The anaerobic microflora is dominated by representatives of the genus Bacteroides

.
Among the representatives of aerobic microflora, gram-negative rods (most often E. coli
) and gram-positive cocci (
Enterococcus spp.
), sensitive to fluoroquinolones (ciprofloxacin), aminoglycosides (gentamicin) and cephalosporins (ceftriaxone, cefuroxime) were identified (Maleeva E.A.).

Treatment of anal fissure

Treatment of anal fissure can be therapeutic (conservative) and surgical.
Conservative includes diet *), drug treatment to normalize stool, suppositories, ointments, warm sitz baths. Conservative treatment of acute anal fissure

includes warm sitz baths and laxatives containing psyllium - the shells of plantain seeds: "Mukofalk", "Metamucil" or "Fiberlex", can reduce pain, stop bleeding and heal in half of those suffering from acute anal fissure with minimal risk of side effects. Adding local anesthetics and anti-inflammatory drugs to the treatment regimen does not affect its results. Such treatment of acute anal fissure is contraindicated in the following cases:

• erosive and ulcerative lesions of the upper gastrointestinal tract, which requires limiting the intake of fiber contained in psyllium
• intestinal obstructions
• malignant neoplasms in the pelvic area.

Conservative treatment of chronic anal fissure
should include medications to relax the internal anal sphincter. For this, organic nitrates are used, in particular nitroglycerin ointment 0.4%, which is prepared by mixing a concentrated oily solution of nitroglycerin and petroleum jelly.

0.5 ml of nitroglycerin ointment is applied 2 times a day to the perianal skin and inserted with a finger into the anal canal to a depth of 1 cm. For accurate dosing, use a ruler on which a column of ointment is applied (if it is packaged in tubes), or use a syringe.

The use of 0.4% nitroglycerin ointment allows for recovery in half of those suffering from chronic anal fissure. However, its use only slightly increases the rate of healing of anal fissure, significantly speeding up only the time of disappearance or reduction of pain. The number of relapses of anal fissure after treatment with 0.4% nitroglycerin ointment is significantly higher than the number of relapses after surgical treatment, although the frequency of complications is much lower. The main side effect of nitroglycerin ointment is headache, which occurs in 20-30% of patients.

If side effects occur that prevent treatment with organic nitrates, it is possible to use calcium channel blockers such as diltiazem or nifedipine (Clinical guidelines of the Association of Coloproctologists of Russia).

During surgical treatment

Excision of the anal fissure is performed in combination with sphincterotomy or without it. The need for sphincterotomy is determined using anorectal manometry (Groshilin V.S.).

Patient Materials

• Demin A.A. Anal fissure / www.GastroScan.ru, 2022

The website GastroScan.ru contains materials for patients on various aspects of gastroenterology and coloproctology:

• “Advice from doctors” in the “Patients” section of the site
• “Popular gastroenterology” in the “Literature” section
• “Popular gastroenterology” in the “Video” section

Note. *) The diet corresponds to the diet for constipation, see “Constipation”, “Diet for children with constipation”.

Resources for healthcare professionals regarding the diagnosis and treatment of anal fissures

Printed materials

• Krylov N.N. Chronic anal fissure. // Bulletin of surgical gastroenterology. - 2008, - No. 1, - p. 5-11.
• Groshilin BC The importance of anorectal manometry in the choice of tactics for surgical treatment of anal fissures // RZHGGK. - 2010. - T.20. - No. 5. - Adj. No. 36. - P.50.
• Clinical recommendations for the diagnosis and treatment of adult patients with anal fissure // Association of Coloproctologists of Russia. Moscow. 2013 17 p.
• Clinical recommendations. Coloproctology. Anal fissure / ed. Yu.A. Shelygina. M.: GEOTAR-Media, 2015. pp. 12-29.
• Maleva E.A. Microecological status of chronic anal fissure and its impact on the choice of treatment method. Abstract of dissertation. PhD, 01/14/17 – surgery, 02/03/03 – microbiology. South Ural State Medical University, Chelyabinsk, 2014.
• Lyukhurov R.N. Surgical tactics for chronic hemorrhoids stage III-IV in combination with anal fissure. Abstract of dissertation. PhD, 01/14/17 – surgery. KRSU, Bishkek, 2016.
• Rogozhkina E.A. Differentiated pathogenetic approach to the treatment of chronic anal fissures. Abstract of dissertation. PhD, 01/14/17 – surgery. RostSMU, Rostov-on-Don, 2022.
• Adiev R.F. Surgical tactics and complex treatment of patients with chronic anal fissure. Abstract of dissertation. PhD, 01/14/17 – surgery. BSMU, Ufa, 2013.
• Achkasov E.E., Solomka A.Ya., Ulyanov A.A., Gribanov I.I. A new method of combined treatment of chronic anal fissure // Modern theory and practice. Surgery: materials X All-Russian. conf. general surgeons with international uch. and conf. young scientists-surgeons. Ryazan. 2018. pp. 154–155.
• Belik B.M., Kovalev A.N., Khatlamadzhiyan A.L. The use of PRP therapy in the complex treatment of anal fissure on an outpatient basis / Coloproctology. 2022. T.18. No. S3(69) P.17. .
• Rivkin V.L. Transanal (internal) and paraanal (external) dosed sphincterotomy: indications, technique, practice // Gastroenterology. Surgery. Intensive therapy. - 2018. - No. 02. pp. 55–57.

On the website in the “Literature” section there is a subsection “Surgery of the colon and rectum”, containing medical articles related to the treatment of the rectum and diseases of the anal canal.

Video

Kitsenko Yu.E. Anal fissure. Elective “Basics of Coloproctology” (video)

Anal fissure with fistulous passage into the intestine. Still from the film: Tsodikov G.V. and others. Instrumental and laboratory methods for studying the gastrointestinal tract. Medfilm. 1985

On the website in the “Video” section there is a subsection for patients “Popular Gastroenterology” and a subsection “For Doctors”, containing video recordings of reports, lectures, webinars in various areas of gastroenterology for healthcare professionals.

Anal fissure in ICD-10

In the International Classification of Diseases ICD-10, anal fissure is classified as “Class XI. Diseases of the digestive organs”, section “K60 Fissure and fistula of the anus and rectum”, which includes the following subsections:

• K60.0 Acute anal fissure
• K60.1 Chronic anal fissure
• K60.2 Anal fissure, unspecified

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