Fissures

The fissures is a linear strain wall of the anus, which continues into the anal canal, grasping his skin part. The length of the crack about 1-1,5 see
There is a crack usually under the strong natureway during constipation, weight lifting, and women often during childbirth. Predisposing to the development of cracks is hemorrhoids, especially large external hemorrhoids.
As a rule, there is only one crack, often - on the back of the PC wall. Occasionally there are two cracks, located opposite one another on both the front and rear walls.
One should distinguish the true crack from various surface skin damage secondary character, Often with a diagnosis of cracks anus patients are treated for skin irritation, scratches, monetami crashing in the result of inflammatory processes in the straight and thick intestines. The so-called "sphincteric"refers to inflammation of the anal canal, "kriptimi", various "ability" (inflammation of the hypertrophied papilla) also accompanied by skin irritation with the formation of multiple superficial lacerations due to the corrosive skin pathological discharge. However, all these manifestations of the effects of other diseases Requiring respectively, and other treatment.
What is true fissures?
This traumatic tear the walls of the anus with a violent spasm of the sphincter and a pronounced pain syndrome. Unlike various abrasions and superficial lacerations that may be located all around the anus, the crack is observed only on the middle line on the "six hours" (PC side), at least - on "twelve hours" (front side).
This is clearly expressed localization cracks due to anatomic features of the structure of the sphincter of the anus.
The entire anal canal is the most sensitive area of the rectum. Here are intertwined spinal nerves and numerous branch of the autonomic nervous system.
As a result of anguish is irritation of nerve endings - there comes a strong reflex spasm of the sphincter, which prevents self-healing of cracks. That is why you must first remove the irritation of nerve endings. In those cases, when the acute fissure manage to capture a spasm, it can be quickly eliminated.
In the cases of chronic fissures one relieve spasm is not enough, since prolonged irritation of nerve endings causes neuritis and there is a completely different pathological condition characteristic of trophic ulcers.
Thus, there are two main types of pathology: a sharp crack and chronic trophic) ulcer.

Sharp crack

The clinic is very bright. In the foreground - the pain syndrome, which occurs immediately after defecation and usually lasts two to three hours (sometimes longer). The pain is so severe that the patient does lose control, can't work, literally finds no place.
Another characteristic feature sharp crack - spasm of the sphincter. It increases the pain, make it pulsing. Patients may fear of defecation. Fear of the chair leads to the fact that the patient himself or artificially delays the work of intestines, or takes a laxative. However, the use of laxatives leads to the fact that the particles of the liquid feces penetrate to the bottom of the crack and increase irritation of nerve endings.
Bleeding during the crack, as a rule, insignificant (in the form of drops or streaks on the surface of the stool).
To detect acute fissure, it is necessary to dissolve the buttocks and with the help of two napkins to push the anus. At this time on the back of the PC wall easily detect a linear crack in the form of fresh anguish. When breeding anal she started to bleed.
However, to examine the entire crack due to spasm of the sphincter is usually not possible. For the same reason unable to perform digital examination of the rectum and the sigmoidoscopy.
We must not forget that the crack may accompany or be a consequence of other serious diseases - polyps, cancer and so on, that is why the examination of the rectum should not be delayed.
It is best to make the inspection, using local anesthesia. With this purpose under a crack at the outer edge of the anus is injected with a small needle 2-4 ml of 2%solution novokaina. The sphincter at that relaxes and you can carry out the necessary research.



Chronic fissure

(Trophic ulcers). When her pain less acute. Usually it is held after defecation few minutes, seeking only after natureline and violations of the diet. Spasm also not as sharp.
When urinating on the surface of the stool is found the blood drops.
The study, if it is done in a "quiet period"does not require anesthesia. The external inspection of the anus (usually on the back) is visible defect in length of 1,5-2 cm long, 0.5-1 cm, with Rubtsove edges. The bottom of the ulcer is often covered with a grey tinge. At the top of the pole cracks often defined bump in the form of a hypertrophied papilla, which is sometimes mistaken for anal polyp. As a result of chronic course of the process on the peripheral end of cracks is formed external hemorrhoid site.
A characteristic feature of chronic fissure is pectins - replacement part fibers subcutaneous part of the sphincter muscle, connective tissue. In the long course pectins leads to a weakening of the sphincter.
Chronic fissure is sometimes complicated by the formation of the incomplete or regional fistula rectum. There are small purulent discharge, itching, irritation in the anus.
For chronic fissures, as for any sores, characterized by circular flow. They may like to live. However, at the slightest violation of the diet in natureway during defecation or small physical stress once again open. So the cracks usually require surgical treatment.
It is necessary to tell about one kind of cracks, so-called Stroitelnaya. It has no character of trophic ulcers and in their clinical course, and looks like a sharp crack. However, Saiva under the influence of conservative therapy, this crack (unlike acute) for constipation, physical stress occurs again.
How does the treatment of acute fissure?
First, it is well and quickly heals using conservative methods. Of course, required strict diet. From food is excluded all spicy, salty, and bitter. And most importantly - all of alcoholic drinks. It is recommended that easy, mostly protein food: cheese, eggs, chicken, boiled meat, broth, white bread.
Often patients try to use a laxative. However, only cleansing enema - main treatment for severe cracks. The use of laxatives is not recommended: they can increase pain.
Enema can supply either the patient himself or somebody from the family. Water should be boiled, room temperature, up to 1 L. the Tip should be richly smear vaseline ointment, well also be smeared with vaseline and the area of the anus. The most important thing is to correctly enter the tip. It should be entered on the edge of the anus, opposite to that where is the crack.
The procedure is performed once a day. We stress once more: the independent chair during this period should not be.
After the cleansing of the bowel is manganese bath.
Then in the back passage introduces the candle that liberally smeared with vaseline. The area of the anus and the outer part cracks should be coated several times a day ointment (novocaine 0,5; streptocide 5,0; zinc ointment 50,0).
The course of treatment is 14 days. Then the patient can be independent chair.
It is necessary to provide a number of measures for the possible relapse of cracks due to natureline when urinating. First of all we have to change the diet. Now advised to eat foods containing plant fiber.
When conservative treatment does not give effect, have to resort to surgery, which involves excision of the crack. With a strong spasm of the sphincter is partial rear sphincterotomy to a depth of 0,5 see If detects hemorrhoids (external or internal), then they excise. Otherwise, the nodes can become inflamed, and hinder the healing of the operating wound.
After the operation the patient within 5-6 days there should be a chair. With this purpose, appointed a special diet, and medicines that delay the work of the bowel (type Rebeca).
Due to the fact that the fissures often occurs as a result of strong natureline, preventive measures should be aimed at combating constipation. As the therapy of persistent constipation not always effective, people suffering from them, should know about the events which can prevent the occurrence of cracks. In particular, it is necessary more carefully to comply with toilet, after defecation to use sedentary warm manganese trays. At the slightest soreness in the back passage should be applied candles and ointment. If laxatives do not help, you must resort to a cleansing enema.