Anal fissure, popularly known as a fissure, is a tear that occurs in the mucosa in the anal area. Because this area is very rich in sensory nerves, it causes pain and sometimes pain during defecation. It manifests itself with bleeding. It is seen in young and middle-aged people. Patients sometimes confuse it with hemorrhoids (piles). We divide the fissure into 2 groups. We call superficial tears that can heal with medical treatment or even spontaneously as acute fissures. The other group is the chronic fissure group, which is deeper and requires medical treatment and often even surgery. In general, cracks that do not heal within 4 weeks despite medical treatment are included in the chronic fissure group.
- Fissure formation mechanism
Feces and gas in the anal area. There are 2 muscle groups that prevent abduction. Essentially, the external muscle group prevents stool and gas leakage, while the internal muscle group functions to help retain gas. The internal muscle group consists of 3 rings. This group of 3 rings has a weak area at the 12 o'clock position in the standing position of the person. Tearing mostly occurs in this area.
Usually, a hard stool after constipation causes tearing in the very thin anal skin during defecation. If this tear occurs once, the tear has the opportunity to heal. As constipation and thus hard stools continue, tearing recurs with each defecation, and the tear does not have the opportunity to heal. When the anus is opened during defecation, the crack also opens, causing severe pain. Patients who are afraid of this pain do not want to defecate. This causes the feces waiting inside to become even more solid. Eventually, the stool that comes out becomes harder and more irritating to the wound. This continues in a vicious circle.
- Fissure Complaints
The main complaint is pain during defecation. This pain occurs for a few hours after defecation. It may continue further. Sometimes a small amount of bleeding may occur. There may also be complaints of constipation and gas due to fear of pain. It may also be accompanied by complaints of itching and restlessness in the anal area.
- Diagnosis
A physician experienced in this regard should It is enough for the world surgeon to look at the anal area. By gently parting the buttocks, the cracks and the sentinel protrusion can be easily seen. If the chronic fissure is frequently seen in the anal region and is single, there is no need for another examination. Finger examination is not recommended as it can be painful. However, if it is in an abnormal location and there are more than one in number, additional examinations such as colonoscopy may be performed, thinking that it may be a symptom of another disease.
- Treatment
Treatment of acute fissure is to correct constipation and prepare the ground for healing by using hot water baths and pain-relieving ointments. Sitting in hot water both relieves pain and increases blood flow to the anal area for wound healing. A diet rich in fiber is also recommended to relieve constipation. With this treatment, acute fissures heal to a great extent.
However, in chronic fissures, these methods only reduce the symptoms but do not provide healing. Definitive treatment of chronic fissures is only possible with surgery. Low and non-permanent improvements have been reported with creams containing nitroglycerin or calcium channel blocker (nifedipine) or botilismus toxin (botox).
- Surgery
Surgery is performed with local or general or preferably epidural anesthesia. Most of the time, chronic fissure and protrusion are removed or burned until healthy tissue emerges, and sometimes that part is not touched at all. The main surgery is to cut in one place a part of the inner muscle that causes pain due to spasm. Thus, the spasm is eliminated and the blood flow to this area increases and the pain disappears. Muscle cutting can be done where the fissure is located, or preferably at 3 or 9 o'clock.
The surgery is completed in 15 - 20 minutes. While the patient can go home after 6-7 hours, it is recommended that he/she preferably spend the night in the hospital. After a 2-3 day recovery period, people return to their normal lives. Gas leakage may occur in the early postoperative period. When performed properly by experienced surgeons, this is not permanent and the disease does not recur. The success rate is over 9%5. In very rare cases, if the complaints do not disappear within 1 month after the surgery, it means that insufficient muscle cutting has been performed and the first The surgery can be repeated on the opposite side of the surgery.
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