Anal fissure, or in medical terms 'anal fissure', is a small tear in the skin covering the anus (anus) area, causing pain, bleeding and itching in the anus. Generally, the crack starts superficially and heals quickly. Sometimes it can deepen and reach the underlying anus inner muscle (sphincter muscle). In this case, the disease has become chronic. The cause of anal fissure is increased resistance and thickening in the inner anus muscle (sphincter muscle). During each defecation, the feces comes into contact with the wound and delays healing. This causes the inner anus muscle to contract. Contraction of the internal anal muscle or failure to relax (anismus) prevents the crack from healing. While excessive contraction of the anal muscles is observed in an average of 25% of healthy people, this rate is determined as 90% in patients with anal fissures. Anal fissures are located at the back of the anus in 90% of cases; It is reported that they are located in the front of the anus in 25% of women and 10% of men.
What does fissure triad mean?
Patients with chronic anal fissure (anal fissure) are often called 'fissure triad'. A triple symptom is observed. 1. The presence of a nozzle on the anal skin, which is called 'sentinel pleat' or 'skin tag'. 2. Fibers of the internal anal muscle (internal anal sphincter) are seen at the base of the thickened crack edges. 3. At the upper edge of the anal fissure, hair and sweat glands called enlarged papillae (hypertrophic anal papillae) are seen. The presence of anal pain for more than 4 weeks and the symptoms called fissure tirade above for 8-12 weeks is called anal crack or tear, 'chronic anal fissure'.
Why does a crack or tear occur in the anus?
• Intense constipation: It occurs when a hard, dry (stone-like) feces tears this area during its forced passage through the anus.
• Profuse diarrhea
• Dietary changes
• Continuous use of stool softeners (laxatives)
• Crohn's disease: treatment of the underlying disease usually heals the fissure.
• During pregnancy and early puerperium They are seen in two months.
• After anal sexual contact (rear intercourse, anal sex, anal sex)
• Leukemia disease
• Immune system weakening
Does anal fissure occur because the anus is not cleaned sufficiently?
It is known that personal hygiene, defecation or cleaning of the anal area has nothing to do with the development of anal fissures or anal fissures.
What are the symptoms of a crack or tear in the anus?
• Pain in the anus: Patients often describe a burning or tearing sensation and severe pain during defecation. Pain may last for minutes or hours after defecation. Pain; It depends on the contraction (spasm) of the internal anus muscle (sphincter muscle). Patients may often avoid defecation due to pain, and as they delay defecation, the stool becomes harder, causing the tear to deepen further. Thus, the patient experiences these complaints in a vicious circle, and their complaints become increasingly evident.
• Swelling in the anus: Skin swelling may develop as a result of swelling on the outer edge of the crack. It can be noticed by the patient during cleaning of the anal area.
• Anal bleeding: It is usually a small amount of bright, red bleeding and blood is seen on toilet paper and stool in approximately 70% of patients. However, it should be known that the same complaints may also occur in hemorrhoid disease and colon cancer.
• Itching in the anus: The discharge during the sequential healing and reopening of the crack and tear in the anus may cause itching.
Anal fissure ( Anal fissure) can be confused with which diseases?
• Anal fistula
• Anal abscess
• Anal wart
• Anal prolapse
• Anal cancer
• Rectal polyp< br /> • Crohn's disease
• Tuberculosis
• Anal AIDS (HIV)
• Psoriasis (psoriasis)
The anal fissure has a protrusion (hypertrophic papilla) and an extension on the skin (skin tag). Most patients think that the skin extension of the anal fissure is a hemorrhoid.
Is anal fissure a cause of cancer?
No, it is not, but the signs and symptoms of anal fissure or tear may be similar to the symptoms of colon cancers and other digestive system diseases.
How is anal fissure treated?
It is possible to treat anal fissure without surgery or with surgery.
Anal Fissure SURGERY
1. Fissurectomy: It is the process of surgically cutting and removing the anal fissure.
2. Anus widening (anal dilation)
It is the process of widening the anus by a surgeon under general anesthesia or spinal anesthesia. Since anal enlargement or anal dilatation surgery alone, which was used in the past to treat anal fissure, brought a recurrence rate of 10-50%, it is now preferred in elderly or at-risk patients who may have fecal retention problems.
3. Lateral internal sphincterotomy (cutting the internal anal muscle)
Today, the most commonly used method in the surgical treatment of anal fissure is lateral internal sphincterotomy. The basis of this technique is based on the principle of cutting the internal anal muscle (internal anal sphincter) by the surgeon, which causes high resting pressures in the anus area, but in some patients, despite the sphincterotomy attempt, anal resting pressures may remain high.
a. Open technique: Lateral internal sphincterotomy surgery is often performed by making an incision of approximately 0.5-1 cm in the skin between the internal and external anal muscle (intersphincteric area), separating the internal anal muscle from the intestine and cutting the internal anal muscle (internal anal sphincter). It is called 'open sphincterotomy'.
b. Closed technique: a small incision is made in the skin between the internal and external anus muscle (intersphincteric area), the intersphincteric area is entered with a knife, and the tip of the scalpel is directed towards the internal anal muscle (internal anal sphincter), and the internal anal muscle (internal anal sphincter) is cut by the surgeon's hand. and this technique is called "closed sphincterotomy".
During the surgery, some surgeons remove the cracked part (fissurectomy) or burn it with a tool called electrocautery, while others do not remove the crack. During lateral internal sphincterotomy, the protrusion of the crack (hypertrophic papilla) and its extension on the skin (skin tag) are also removed. Sphincterotomy surgery in the treatment of anal fissure is performed with open or closed technique. The most technically important point in lateral internal sphincterotomy surgery is that the external anus muscle (external sphincter) is not damaged during this procedure. During the lateral internal sphincterotomy procedure, damage to the external anus muscle (external sphincter) causes the problem of inability to hold stool and gas. After lateral internal sphincterotomy, a 90-92% improvement is observed in patients within two months. In the long term, 0-15% (average 5%) recurrence and 0-15% complications of fecal and gas incontinence are observed.
4. Pressure-controlled sphincterotomy: inadequate cutting of the internal anal muscle may be responsible for the recurrence of anal fissure. On the other hand, cutting some fibers of the external anus muscle may result in gas and fecal incontinence. A gradual and controlled sphincterotomy can be performed by controlling the anal pressures with the help of a device called anal manometry, which is used to measure the pressures of the anus muscles. In this way, the risk of gas and fecal incontinence complications can be eliminated to a great extent.
5. Fissurectomy and flap technique: After the area where the anal crack, tear or fissure is located is surgically removed, this removed area is filled with a flap from the surrounding tissues (anoplasty).
6. Burning the fissure with laser: The anal fissure or anal fissure area is burned and vaporized (vaporization) under operating room conditions with laser beams.
7. Sphincterotomy with radiofrequency (RF): the internal anal muscle (internal anal sphincter) can be cut with radiofrequency (RF).
How long does it take for the patient to recover after the surgery?
• Pain in the anus often occurs for a few days. It disappears within a short time.
• The patient can return to work within an average of 3-4 days.
• Full recovery occurs within a few weeks.
What kind of complications may occur after anal fissure surgery?
1.Infection: Infection is rarely seen after anal fissure surgery, it is known that anal abscess may develop at a rate of 1-2%.
2 .Gas and fecal incontinence: While gas incontinence is seen at a rate of 12-27% after anal fissure surgeries, fecal incontinence or light wetting (soiling) is seen at a rate of 10-15%.
3. Development of anal fistula: An anal fistula (perianal fistula) develops after the intestinal surface (mucosa) is opened during surgery and is seen in less than 1% of patients.
4. Bleeding from the anus: Bleeding at a level that requires treatment It is very rare.
5. Recurrence of anal fissure: Recurrence or recurrence after surgery is seen in 1-6% of patients. It has been determined that approximately 50% of patients with recurrent anal fissures have a problem with inflammatory bowel disease called Crohn's disease.
How should anal fissure patients eat?
In anal fissure disease, it is important to protect yourself from the disease. It is very important for them to eat an appropriate diet and to be comfortable during periods of exacerbation of the disease. In order for the act of defecation to be comfortable, you should consume around 2 liters of water a day and choose a natural diet with plenty of fiber. The daily amount of fiber in the diet of people in the 20-50 age group should be an average of 40 grams for men and 25 grams for women. A balanced intake of grains, legumes, soybeans, barley, rice and wheat, vegetables and fruits increases bowel movements and is very useful in combating constipation.
Foods that are harmful for anal fissure patients
Spicy foods (red pepper, black pepper, chili pepper, cayenne pepper, isote, etc.)
/> Kebabs
Hamburger
Pickles
Pizza
Alcohol
Tea and coffee (excessive consumption)
Citrus fruits (lemon, tangerine, orange, grapefruit)
Dairy products (cheese, milk, buttermilk)
Ketchup
Chocolate
Foods that are beneficial for anal fissure patients
Grain foods Fruits
Bran Apple (with peel) )
Corn Apricot
Corn flakes (muesli)
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