See also: anal itching; natural remedies for anal fissures:
Anal fissures: What are they?
The fissures are small but deep skin erosions, which can affect various body regions and in particular the orifices, such as the mouth and anus.
From the site: www.colorectalcentre.co.uk
Specifically, the anal fissure is a small "cut" that is created on the homonymous opening, due to an excessive dilation during the passage of the feces. Here the presence of abundant nerve endings makes the disorder particularly irritating and painful. The pangs become more intense at the moment of defecation, above all when hard and voluminous feces are expelled which, due to friction, favor the lesion of the anal folds. In addition to aggravating this annoying disorder, constipation is also one of the main casual agents.
Given the spread of the constipation problem, it is therefore not surprising that anal fissures constitute an affection frequently found in proctological practice.
Causes
Main predisposing factors:
- constipation, with all its consequences, is the determining cause of anal fissures. In addition to the consistency of the faeces it is necessary to take into consideration other factors, such as the abuse of laxatives or the use of digital maneuvers to facilitate evacuation;
- diarrhea: when the intestinal peristalsis is particularly fast, the reabsorption of water, electrolytes and a small part of nutrients is incomplete. The combination of these substances gives an alkaline pH to the faeces, which is particularly harmful to the anal mucosa. When diarrhea is frequent, due to pathological causes or the abuse of laxatives, the anal canal tends to shrink. In such situations the sudden passage of hard and voluminous feces represents a further insult to the anal mucosa;
- anal coitus and other sexual practices focused on the insertion of objects or body parts in the anal orifice;
- reduced personal hygiene.
The presence of fissures causes a spasm of the internal anal sphincter, whose control, unlike what happens for the outer ring, is independent of the will of the individual. This contracture condition is responsible for the chronicity of the disorder, because, in addition to preventing the normal and physiological dilation of the anus, it hinders the blood supply and with it the possibility of spontaneous healing.
Symptoms and diagnosis
To learn more: Anal Symptoms
The symptomatology of anal fissures, in its drama, is characteristic, so as to make the disorder easily identifiable. The pain associated with defecation is in fact particularly intense, so annoying as to push the patient to fear the mere thought of evacuation.
These psychological repercussions tend to induce secondary constipation or to aggravate a pre-existing constipation, making the subsequent and inevitable evacuation even more tragic.
The pain associated with defecation recognizes three characteristic moments: at the passage of the feces it becomes particularly acute, after which it fades for a few minutes and reappears, with different degrees of intensity, in the following three or four hours. To describe this symptomatology we speak of " pain syndrome in three times of fissure ".
If we consider the real extent of the injury, the pain associated with anal fissures is often disproportionate. In addition to the generally contained dimensions, a fundamental anatomical feature of the cracks is the longitudinal course that appears, in the vast majority of cases, in the posterior and superior locations.
Often the crack is so small as to be unrecognizable to the naked eye, especially when examined by a non-expert. As the disease becomes chronic, the edges of the lesion become more irregular and obvious.
Another characteristic sign of fissure is the finding of traces of bright red blood in toilet paper, more rarely blood marks are noted around the stool. However, this is a contained hemorrhage which, basically, has nothing to do with the more copious one associated with the haemorrhoidal disorder.
Since in some cases the two pathologies are associated, the presence of blood traces can be due to the concomitant presence of hemorrhoids or other lesions.
Care
To learn more: Medications for the treatment of anal fissures - Natural remedies for anal fissures
One of the few positive aspects of anal fissures concerns the relative ease with which the disorder resolves itself in a fair number of cases. The most superficial lesions can in fact heal spontaneously within a few days.
If this were not the case, the first approach to the disease involves the use of fiber supplements and mild laxatives, accompanied by abundant quantities of water.
The use of these dietary supplements must, of course, be preceded by a clear medical indication. In any case, it is good to start the therapy with cautious graduality, to avoid that an excessive laxative effect results in diarrhea, worsening the problem.
On the other hand, warm baths and anesthetic ointments are designed to control pain and promote loosening of the internal anal sphincter.
Washing with lukewarm water, although effective in reducing sphincter spasm, gives only temporary relief and must therefore be repeated with a certain frequency. The possible efficacy of anxiolytic drugs should not be underestimated, to avoid stress and daily tensions ending up discharging on the "second intestinal brain".
If the internal anal sphincter remains heavily contracted, the doctor may recommend the use of anal dilators . In many cases their regular use in fact allows a slow recovery of the sphincter elasticity.
Whatever the real extent of the disorder, regularization of the intestine is always and in any case an essential factor to promote the healing of anal fissures.
Read also: All remedies for anal fissures
Surgery
Sometimes this "soft" approach is not sufficient to solve the problem and, after phases of temporary improvement, the symptoms tend to recur.
In the case of chronic fissures the surgical solution is often undertaken, based on the partial resection of the internal anal sphincter, or on the so-called anuloplasty. This last surgical technique is based on the local insertion of skin flaps taken elsewhere, with the aim of covering the injured area. Both interventions are quite simple, they do not require particularly long stays (normally the patient is discharged within 24 hours) and have a low risk of complications. One more reason to win taboos and reticences, addressing the doctor to the appearance of the first symptoms attributable to the presence of anal fissures.
