Related articles: Anal fissures
Definition
Anal fissures are small wounds that form in the inner edge of the anal canal. Often, these cuts are caused by the expulsion of particularly hard or bulky stools; in similar circumstances, the defecatory effort causes an excessive dilation of the anal wall, which leads to its laceration. The appearance of anal fissure is, therefore, strongly associated with constipation: the stools rest in the intestine more than normal, harden and at the time of defecation can produce small superficial lesions. Other predisposing factors are diarrhea, stools rich in irritants (due to food or drugs), local infections and loss of elasticity of the anal canal secondary to surgery (eg for fistulas and hemorrhoids). On the other hand, traumas that result from the introduction of foreign bodies (eg cannulae for enemas) or anal intercourse represent a rare but still possible cause of anal fissures.
Most common symptoms and signs *
- Anal burning
- dyschezia
- Anal pain
- haematochezia
- Gastrointestinal hemorrhage
- Encopresis
- Stomach ache
- Anal itching
- rettorragia
- Blood from the anno
- Blood in the stool
- Muscle spasms
Further indications
The characteristic symptom of the presence of an anal fissure is the pain, very intense and burning, during the passage of the feces. The stinging or burning sensation typically appears at each defecation and can last from a few minutes to a few hours after evacuation, due to the stiffening (spasm) of the anal sphincter muscle. Bleeding is characteristic of the fissure, therefore it is possible to notice a streak of bright red blood on the faeces or on the toilet paper. In rare cases, recurrence may occur. Serum secretion from fissure, if abundant, can also cause itching in the anal region.
Diagnosis is made with inspection and further investigation to ascertain a specific cause. The fissures must be differentiated from neoplasias and lesions typical of syphilis, tuberculosis and Crohn's disease.
Treatment involves strict local hygiene combined with the use of laxatives to minimize trauma during defecation (eg, emollients of faeces, psyllium and other fibers) and local anesthetics (eg benzocaine or lidocaine) for temporary relief.
The correct closure of the laceration is facilitated by the use of protective ointments (eg glycerin for topical use) or glycerine suppositories, useful for reducing anal pressure and lubricating the lower part of the rectum. Sometimes, injections of botulinum toxin type A may also be indicated. However, if the fissures do not heal with conservative treatments, it is necessary to resort to surgery.
