RECTAL BLEEDING
The most common causes of rectal bleeding are problems related to the structures in the anal area.
In addition, diseases of the large intestine can also cause bleeding, but problems related to the anal area
are more common.
The most common conditions in this region are hemorrhoid disease and anal fissure.
The main complaint of both conditions in patients is bleeding. The type of bleeding may
vary. While relatively darker colored blood contaminated with the stool is observed in hemorrhoid disease, bright red colored bleeding in the form of drops after defecation is more typical in the anal fissure. In hemorrhoid disease, breast-shaped bumps appear on the patient's hand in the anal area. From time to time, these bumps can be hard and painful due to blood clotting in the hemorrhoid tissues. In anal fissure, difficulty in defecation and severe pain after defecation are observed.
Apart from hemorrhoid disease and anal fissure, tumoral conditions in the large intestine may
cause bleeding. Masses and blisters seen on the surface of the large intestine (colon) and the last part of the large intestine (rectum)
may indicate cancer or may first manifest itself with bleeding
. In addition, inflammatory diseases of the small and large intestines may also cause bleeding. In every patient with bleeding from the anal area, it should be ensured that this bleeding is not due to a disease originating from the large intestine. For this reason, colonoscopy is recommended for most of the patients who apply to the physician with the complaint of bleeding from the anus.
ANAL FISSURE
There are two intertwined muscle structures that surround the anus and allow us to retain our feces, and the internal and
br /> They are called external sphincters. The outer sphincter structure has a striated muscle structure and contracts and relaxes depending on our wishes, just like our arm or leg muscles. The external sphincter is the system that helps us hold our stool until we go to the toilet
when we feel like defecating. Of course, like all striated
muscles, it gets tired after a while. Therefore, there is a need for a mechanism that will keep the anus area dry even at rest. The inner one of the muscles surrounding the anus
It is called the internal sphincter and it has a smooth muscle structure (like the muscles in the vein walls), therefore
it contracts and relaxes automatically, not according to our will, but under the control of some centers in our brain. This muscle, which is constantly contracted at rest, prevents the fluids in the anus from leaking out and ensures that the area around the anus remains dry. When we sit on the toilet to defecate, the internal sphincter relaxes and opens the way for the feces to come out. If a person is constipated, the internal sphincter, which puts too much force on it because of straining too much during defecation, does not relax in response to this, even though it should relax. For this
reason, the feces that have to pass through a narrow area cause abrasions and wounds on the intestinal wall during this passage. These wounds, which would heal quickly under normal conditions (the skin of the anal area has a very high healing potential), become deeper due to the recurrence of the same problem with each defecation
and the internal sphincter that does not relax compresses the blood vessels in the region. In order for it to occur, the blood flow to that area must be very good).
These wounds that occur on the wall of the anus are called anal fissure (crack).
TREATMENT
Anal fissure is a new-onset (acute) and It is divided into two as prolonged (chronic). While drug treatment is mainly used in acute fissure, surgical treatment is on the agenda in chronic fissure. As mentioned before
, the source of the problem is the internal sphincter that does not relax, and the aim of the treatment is to relax this
sphincter. In acute fissure, muscle relaxant creams (nitrates) are used for this purpose. In addition, hot water sitz baths aim to relax the internal sphincter. Pain is relieved with painkillers (creams or pills), stool softeners (laxatives) are also given to facilitate defecation and to allow the fissure to heal. The duration of drug
treatment is approximately 3 weeks. Surgical
treatment should be considered for fissures that do not heal after this period.
POST-SURGERY PROBLEMS
The problem that may be encountered in the surgical treatment of anal fissure is, although rarely, gas or fecal incontinence. This situation When detected, it is treated with exercises or surgery depending on its severity.
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