Rectal fissure: causes, symptoms and treatment of pathology

An anal fissure is a defect in the mucous membrane of the anal canal, the bottom of which is muscle fibers.

Anal fissure is the second most common disease after hemorrhoids and paraproctitis. This disease most often affects people aged 20 to 60 years. Women suffer from anal fissure disease 2 times more often than men.

An anal fissure is a small vertical cut in the mucous membrane of the outer part of the anal canal, approximately 2 cm long, 2 to 5 mm wide, and 2-3 mm deep.

An anal fissure can be slit-like or oval in shape and runs longitudinally relative to the length of the anal canal.

Sometimes, women develop anal fissures located in the anterior part of the anal canal. In some cases, there is a combination of several anal fissures of different locations. Anal fissures located opposite each other are common.

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Consultation with a proctologist in MedicCity

2 Consultation with a proctologist in MedicCity

3 Consultation with a proctologist in MedicCity

Remember, self-treatment of anal fissure is unacceptable! Every day the edges of the crack will become more and more rough, and its size and depth will increase. This can bring unbearable suffering to the patient.

An anal fissure is dangerous due to malignancy (malignancy). The cause of 20% of anal cancer is an anal fissure. The second dangerous complication of this disease is paraproctitis (inflammatory changes in the perirectal tissue due to infection through the crypts into the surrounding tissues) and fistulas. This is why early diagnosis of the disease is so important.

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).

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).

Useful tips in the postoperative period

After perianal fissure surgery, it is advisable to adhere to the following recommendations:

• After defecation, instead of using toilet paper, you should wash yourself with warm water;
• It is useful to take sitz baths with potassium permanganate to relieve pain and inflammation;
• it is necessary to reconsider the diet and adhere to a diet consisting of vegetables, fruits, fermented milk products, boiled dishes, and wholemeal bread;
• It is recommended to drink up to 2 liters of water per day;
• it is important to exclude fatty, spicy and pickled foods, and smoked foods from the diet;
• if prescribed by a doctor, use suppositories, ointments with a wound-healing and anti-inflammatory effect (for example, sea buckthorn suppositories);
• it is necessary to sit less, stand and not lift weights at all.

Reviews about the treatment of anal fissure indicate a good healing result.

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).

Diagnostics

The diagnosis of rectal fissure is made based on the patient’s complaints (itching, pain in the anus, bleeding) and an objective examination by a medical specialist.

Rectal examination

Main article: Digital rectal examination of the rectum

A proctologist or surgeon performs a digital examination of the walls of the rectum. Palpates the location of the anal fissure, its size, shape and configuration of the edge, as well as the presence of internal hemorrhoids and traces of bleeding on the glove. The examination may be difficult if there is increased tone of the anus muscles. The doctor also examines the anal ring area for the presence of external hemorrhoids and areas of inflammation (swelling, redness, scratching).

Laboratory research methods

• A complete blood count is necessary to detect anemia due to prolonged bleeding of a rectal fissure. Also helps in diagnosing infectious inflammation.
• Blood testing for dangerous diseases (HIV, syphilis, hepatitis B and C), in which one of the symptoms may be anal tear.
• Taking swabs for enterobiasis and stool for worm eggs if helminthic infestation is suspected in children and adults.
• Blood test for sugar. Diabetes mellitus disrupts blood circulation in the body and reduces the ability of tissues to regenerate. Pathological changes most often affect the lower extremities and pelvic organs. This leads to the appearance of cracks in the heels and the development of hemorrhoids with long-term non-healing anal tears in the rectal canal mucosa.
• Sowing for pathogenic fungi and bacteria. Anal fissure can be a specific symptom of actinomycosis, intestinal tuberculosis.

Instrumental research methods

• Sigmoidoscopy is used when the presence of a tumor in the rectum is suspected, as well as for a detailed study of its mucous membrane over 25 cm. This method allows you to find polyps, fissures, developmental anomalies of the lower parts of the digestive system and diagnose ulcerative colitis. The study is contraindicated in cases of severe pain and bleeding from the anus, the development of infectious inflammation of nearby tissues (paraproctitis), acute anal tear and narrowing of the rectal lumen.
• Anoscopy is an examination of the rectal canal and anus. Helps in the diagnosis of hemorrhoids (the severity of the pathological process) and inflammatory changes in the rectal canal (cracks, condylomas, anal fimbria, neoplasms). The procedure is contraindicated in cases of narrowing of the anal lumen, infectious processes (paraproctitis), exacerbation of chronic rectal fissures and thrombosis of hemorrhoidal veins.

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.

Symptoms

The following types of symptoms inherent in this disease are distinguished:

• Sitting or walking for a long time causes itching in the perineum, which cannot be tolerated.
• During defecation, a strong and sharp pain is felt, which quickly passes.
• There is a slight discharge of scarlet blood.
• In response to constant pain, frequent constipation occurs.

If such symptoms appear, you must immediately consult a doctor to prevent the development of this problem and begin treatment on time.

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

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Treatment

Basic principles:

1. In the acute course of anal tear, conservative (drug) therapy is chosen.
2. Chronic rectal fissure requires surgical intervention.
3. Treatment should be aimed at pain relief, elimination of inflammation and regeneration of the rectal mucosa.
4. Be sure to eliminate the symptoms (constipation, diarrhea, spasm of the anal sphincter) that provoke the development of rectal fissures.
5. Treatment of concomitant pathological conditions (hemorrhoids, irritable bowel syndrome, Crohn's disease, ulcerative colitis, etc.) that cause exacerbation of anal tear.

Diet

Principles of nutrition

• To normalize stool, it is necessary to include vegetable fiber (vegetables, fruits, cereals) and fermented milk products enriched with beneficial microflora (lacto- and bifidobacteria) in the menu. This will help deal with constipation.
• For rare bowel movements, fish oil and dried fruits (dried apricots, prunes) are useful.
• It is necessary to exclude from the diet foods that injure and irritate the rectal mucosa. It is recommended to avoid spicy, salty, fried, fatty, smoked foods, as well as alcoholic beverages.
• Meals should be fractional (small portions) and frequent (every 2-3 hours). A varied menu is required.
• Abundant drinking regime (up to 1.5-2 liters per day of filtered or bottled water, not boiled). Drink a glass of clean drinking water every day on an empty stomach.
• Eat meat and fish 2 times a week, the main diet is dairy and vegetable.
• Quitting cigarettes. Nicotine has an irritating effect on the body, promotes blood stagnation and venous thrombosis. It is a provocateur of hemorrhoids with rectal fissures.
• Food should improve intestinal motility and digestion. Bran is good for regular bowel movements.
• Diet is extremely important not only at the stage of anti-inflammatory therapy, but also in the postoperative period, when rapid healing of the mucous layer of the rectal canal is necessary.

Products

The diet for rectal fissure is aimed at preventing constipation and regular bowel movements. Properly selected food products prevent the swelling of veins and inflammation of hemorrhoids in the rectal canal. Fermented milk products restore the balance of intestinal microflora and accelerate the healing process of cracks.

Diet is an auxiliary but necessary method of treating anal tear. High-quality nutrition allows you to achieve successful results in conservative therapy and surgery.

Drugs

Drugs for the treatment of rectal fissures should have the following effects:

• anesthesia;
• relieving inflammation;
• elimination of spasm;
• regeneration (healing);
• stopping bleeding;
• relaxation of the chair.

“Proctosan” (suppositories, ointment) is a combination drug. Reduces inflammatory manifestations, eliminates pain, itching, heals anal tear (drying effect) and prevents infection of the mucosal defect. The ointment is applied externally, applied in a small layer in the anus. Internal use is possible using an applicator into the rectal lumen. The suppositories are inserted through the anus into the rectal canal. Both forms of the drug are used twice a day (morning and evening) after defecation and mandatory hygienic procedures for the anus. Treatment for no more than 10 days.

The drug rarely causes side effects. Most often this is allergic intolerance (dermatitis, urticaria). In such cases, after using the dosage form, itching intensifies, swelling and rashes appear. The drug should be discontinued and an alternative replacement should be found.

"Natalsid" (suppositories) is a medicine based on sodium alginate, obtained from seaweed - kelp. It has anti-inflammatory, wound-healing and hemostatic effects. Rarely causes side effects, it is allowed for pregnant and breastfeeding women. For anal tear, use 1 suppository 2 times a day after bowel movements and hygienic toilet of the anus. Treatment is continued for 7-14 days.

"Hepatrombin G" (ointment, suppositories) is an effective drug for the treatment of rectal fissures combined with thrombosis of hemorrhoidal veins. It has anti-inflammatory, analgesic, antithrombotic (promotes the gradual resorption of blood clots and prevents the formation of new ones). Relieves swelling and itching, accelerates the process of tissue regeneration. The drug is contraindicated for people with allergic intolerance and impaired blood clotting.

The ointment is applied externally to the affected areas 2 to 4 times a day, or through an applicator into the lumen of the rectum. Rectal suppositories are inserted into the anus in the morning and evening, 1 piece each. To obtain a visible effect, treatment should be continued for 1-2 weeks.

"Levomekol" (ointment). Effectively heals anal tears and prevents purulent inflammation. The ointment is applied externally to the anus 3-4 times a day.

“Relief” (ointment, suppositories) is a preparation containing shark liver oil.

It has a hemostatic and anti-inflammatory effect, helps the rapid healing of anal tear. Easily eliminates itching and swelling of tissues.

Suppositories are used up to 4 times a day: after hygiene procedures and spontaneous bowel movements. The ointment can be used for external application to areas of inflammation or for rectal administration through an applicator. Prescribed according to the same scheme as suppositories.

For rectal cracks, suppositories with methyluracil , sea buckthorn oil and benzocaine (Anestezol) are good for restoring the mucous membrane and preventing bleeding. They also relieve pain and reduce swelling.

Laxatives for constipation

“Glycerin” (suppositories) is an irritating drug. It has a direct effect on the receptors of the lower intestinal mucosa. Stimulates peristalsis and excretion of feces. The active substance (glycerol) of the drug softens hard stools, bowel movements become painless and regular. The drug does not disrupt the functioning of the digestive tract and is not addictive. Approved in pediatrics. Available in 2 dosages: 1.24 g and 2.11 g of glycerol. Children under 3 years old are prescribed half a suppository (1.24 g) once a day, from 3 to 7 years old - 1 suppository (1.24 g) once a day. Over 7 years of age and adults, 1 suppository (2.11 g) per day is recommended.

The drug is used in the morning, half an hour after breakfast. The candle is inserted into the anus while lying on its side. The laxative effect occurs within 10-15 minutes.

Bisacodyl suppositories have a similar effect

Microlax is a combined laxative drug. Available in the form of tubes with a solution - microenemas. The drug increases the absorption of water in the intestines, dilutes dense stool, and facilitates bowel movements. Emptying occurs within 5-15 minutes after using the drug. The tip of the microenema is inserted completely into the anus (for children under 3 years old - only halfway), after which the contents of the tube are squeezed out. The drug is used once a day. Not used for long-term treatment.

Mild laxatives (prebiotics) in syrups are also effective: Duphalac, Normaze, Lactusan.

Read more: Fast and mild laxatives

Antispasmodics to relieve spasm of the anal sphincter

“No-spa” (tablets) is used to eliminate any spastic conditions of the gastrointestinal tract. Prescribe 1-2 tablets (40-80 mg) 2-3 times a day. For maximum effectiveness, the drug should be taken an hour after eating with a glass of drinking water.

"Duspatalin" (tablets) eliminates increased muscle tone of the digestive tract. Take 1 tablet 3 times a day. When a therapeutic effect is achieved, the dose is gradually reduced.

For severe pain and spasm of the anal sphincter, rectal suppositories with antispasmodics are helpful: Buscopan, Papaverine, Anuzol.

Antidiarrheals

Rectal fissure associated with chronic diarrhea is much less common than with constipation. Frequent loose stools irritate the rectal canal mucosa and contribute to the formation of a defect. To treat an anal tear, it is necessary to eliminate the cause that caused its appearance. Antidiarrheal drugs are prescribed: Imodium, Lopedium, Uzara, Loflatil. To remove toxic substances from the body, enterosorbents are additionally recommended: “Smecta”, “Enterosgel”, “Polysorb”, “Lactofiltrum”.
Read more: Antidiarrheal drugs

Surgery

Conservative treatment helps only with acute rectal fissure or minor inflammation of chronic anal tear. Therapy can be carried out for 2 months. If treatment is ineffective, as well as cicatricial changes in the mucosal defect, spasm of the rectal sphincter, or the presence of complicated hemorrhoids, surgery is required.

Minimally invasive surgery – laser coagulation

It is used for small defects in the rectal mucosa, absence of anal sphincter spasm (20-30% of cases), relapses and complications. The procedure is performed under local anesthesia and does not require a long recovery period.

Progress of the procedure. A surgical speculum is inserted through the anus into the rectal canal, the crack is fixed with a clamp and excised using a laser beam. A fresh wound is formed that heals quickly. The muscle fibers of the anus are not injured, therefore, the possibility of relapse is excluded.

Recovery period. The patient should not get up for an hour. After the procedure, a gauze swab soaked in an antiseptic solution is inserted into the anus. The wound is disinfected every day for a week and after defecation. The surgeon also monitors the patient’s stool, prescribes nutritional therapy and laxatives (if necessary). The patient's condition improves on the 2nd day after laser coagulation. But the wound heals completely after 3-4 weeks.

Laser coagulation is the most acceptable method of treating anal fissure.

Radical surgery - surgery to remove an anal tear

Used after a course of conservative treatment (elimination of pain, spasm, acute inflammation, constipation). The operation is recommended for long-term chronic course of the pathological process, the presence of spasm of the anal sphincter, as well as for significant defects in the rectal mucosa and its scarring.

Progress of the procedure. To access the rectal canal, the anal sphincter muscles are dissected, then the edges of the fissure are excised using a scalpel or radio knife (Surgitron apparatus). The fresh wound is sutured or left without suturing (Gabriel operation). If there is a spasm of the rectal sphincter, the muscles of the anal ring are excised. Sphincterotomy is highly effective (in 90% of cases) in healing rectal fissures. The operation is performed under general anesthesia or local (spinal) anesthesia.

Recovery period. After surgery, daily antiseptic treatment of the wound is carried out, healing medications are prescribed, and constipation is prevented (diet, laxatives). On the first day after surgery, the patient should not get up. In the absence of spontaneous bowel movements, a cleansing enema is prescribed on the 3-4th day. After each bowel movement, the patient needs to wash himself; using regular toilet paper is not recommended.

On the first day after surgery - complete refusal of food, drinking plenty of fluids. Then they begin fractional meals (up to 7 times a day in small portions). A slag-free, salt-free diet is prescribed for 3-5 days. From 3 days onwards, fermented milk products and vegetable fiber are allowed. Recommended dishes include crumbly porridges, vegetables in the form of purees and salads, meat in the form of cutlets or soufflés.

Discharge 7-10 days after surgery.

Folk remedies

To treat anal tear, herbs are actively used in traditional medicine. To improve digestion and reduce inflammatory symptoms, use tea made from chamomile, sage, and St. John's wort.

Herbal decoctions are prepared for local use. A collection of chamomile, sage, oak bark and yarrow copes well with inflammation, bleeding and pain of a rectal fissure. Take 2 tablespoons of each herb, add a liter of boiled water and cook over low heat for about an hour. The resulting broth is filtered through a sieve and poured into a basin, diluted with clean water (2-3 l) to a temperature of 38-39°C. They sit in a basin with a medicinal solution and warm up for 20 minutes. The procedure is recommended to be carried out after spontaneous bowel movements or bowel movements after the introduction of microenemas. Warm baths with a slightly pink (several drops or granules of the product per 2-3 liters of water) solution of potassium permanganate are also effective. Do not use high concentrations of the drug, as this may cause burns.

Herbal decoctions can be used as microenemas. To do this, you need a 50 ml syringe and a warm (37 ° C) medicinal solution: add a glass of boiling water to 2 tablespoons of herbs and cook over low heat for 10 minutes, cool to the desired temperature. The procedure is carried out after bowel movement. The tip of the syringe is lubricated with cosmetic Vaseline and carefully inserted into the anus while lying on its side. Squeeze out the medicinal solution (volume 30-50 ml) and remove it from the anus. You should try to keep the liquid in the rectum for an hour. You can also use the juices of medicinal plants for douching: aloe and Kalanchoe.

You can make herbal candles at home. For this you will need herbs - plantain, motherwort and chamomile flowers. Take 1 teaspoon of raw materials. Then melt 150 g of beeswax, add 3 teaspoons of various herbs to it and stir. The resulting mixture is poured into small molds and placed in the refrigerator to harden. You should get 10 suppositories, which are good for relieving inflammation and itching during anal rupture. Raw materials should only be stored in the refrigerator.

For microenemas, mix aloe juice, liquid fish oil and a raw chicken egg. All ingredients are taken 1 tablespoon at a time and mixed. The mixture is used for douching before bedtime. The minimum course of home treatment is 10 days.