It is a tear that occurs distal to the dentate line. The pathophysiology of anal fissure is thought to be related to trolley or hard stool passage resulting from prolonged diarrhea. A tear in the anoderm causes internal anal sphincter spasm, which results in pain, tear enlargement, and decreased anoderm blood supply.
Cycle of pain, spasm, and ischemia can adversely affect wound healing and lead to chronic fissure.
SYMPTOMS AND RESULTS
The characteristic symptoms are tearing pain with defecation and hematochezia.
Patients complain of severe and painful anal spasm sensation lasting for hours after bowel movement.
Chronic fissures, ulceration and the white fibers of the internal anal sphincter form a visible line at the base of the ulcer. Often there is an accompanying external skin pouch or hypertrophied internal anal papilla. These fissures are the most difficult to treat and may require surgery. The lateral location of the chronic anal fissure may be evidence of an underlying disease such as Crohn's disease, HIV, syphilis, tuberculosis, or leukemia. If the diagnosis is doubtful or if there is suspicion of other causes for perianal pain such as abscess or fistula, examination under anesthesia may be required.
TREATMENT
It focuses on breaking the cycle of pain, spasm and ischemia responsible for the development of anal fissure. Treatment aimed at minimizing anal trauma includes mass agents, stool softeners, and a warm sitz bath. Acetic lidocaine or other analgesic creams may provide additional symptomatic relief. Nitroglycerin ointment is used to increase local blood flow but can often cause headaches.
Oral and topical calcium channel blockers are used to heal fissures. Its side effects are less common than topical nitrates.
Newer agents such as topical bathenecol and arginine are also used in the treatment of fissures.
Botox (botulinum toxin) creates temporary muscle paralysis by preventing acetylcholine release from presynaptic nerve endings. The curative effect of botulinum toxin injection is equivalent to other medical treatments, but with fewer complications than surgical treatments. may cause. Surgical intervention is recommended for chronic fissures that cannot be effective from medical treatment. Lateral internal sphincterotomy procedure may be preferred. It is preferred because it reduces internal sphincter spasm by dividing a portion of the muscle. The internal sphincter fibers are separated laterally by open or closed techniques. Recurrence occurs in some patients and the risk of incontinence is seen, even if it is small.
Read: 0
