It is popularly known as a crack or tear in the anus. These are tears that occur within the anal canal and extend to the outer skin layer. It mostly occurs during difficult straining due to constipation or due to irritation in long-lasting diarrhea attacks. Sometimes it may occur together with chronic intestinal diseases. The location of the anal fissure begins at the junction of the skin and mucosa and progresses inwards. After anal fissure occurs, defecation becomes more difficult for two reasons. After crack formation, patients involuntarily squeeze their anus, causing the crack to widen further during defecation. There is severe pain during defecation. Because of this fear of pain, they do not want to go to the toilet and delay their defecation as much as possible. After this delay, the stool hardens and defecation becomes more difficult, and the healing of the crack is delayed. So it enters a vicious circle. Although anal fissure can be seen at any age, it is frequently encountered in young and middle-aged adults. It is seen equally frequently in men and women.
Anal fissures are defined in two ways: acute and chronic. There is no difference in terms of complaints between acute and chronic cracks. Cracks that do not heal within a month or so are considered chronic. The location of anal fissures in the anal canal is generally towards the back and is seen at 12 o'clock when the patient is in a prostrate position. It is seen less frequently at 6 o'clock. Anal cracks are rarely located on the side walls.
All cracks actually start as acute cracks, and while some of them heal, some of them do not heal and become chronic cracks. The reason why acute cracks do not heal and become chronic is that the crack formed due to the acute crack in this area causes the muscles in the anal canal, which we call sphincters, to contract involuntarily, resulting in a decrease in blood flow to this area. This procedure causes pain. The pain occurring in the anal canal increases the severity of the anal spasm (contraction in the anus) and reduces the blood flow to the back of the anal canal, that is, the area where the crack occurs as a result of the spasm, and this causes the healing of the wound formed there to be delayed. A wound that does not heal continues to cause pain sooner and the cycle starts again. As this cycle is repeated, it is inevitable for the crack to become chronic.
There are three findings in chronic anal cracks, usually called the crack trio;
· skin fold outside the anal canal,
· anal canal. enlarged papilla
· deep crack base.
These cracks can sometimes become deep enough to show the muscle layer. If treatment is delayed, complications such as abscess at the base of the crack and fistulized chronic anal fissure develop. These complications cause anal stenosis, progressing to narrowing in the anal canal and making defecation a torture for the patient.
Although it is not known what causes anal fissure, factors that strain the anal mucosa are emphasized. These are: Irregular defecation habit (severe straining, etc.) Chronic constipation Chronic diarrhea Pregnancy Trauma Anatomical predisposition Anal surgery Inflammatory bowel disease
What are the symptoms of anal fissure?
The main complaint is pain in the anus, which becomes very severe with defecation and may continue as a spasm afterwards.
This pain may be accompanied by a few drops of bright red blood coming with the stool.
The patient has an existing constipation or diarrhea. It may also occur.
Physical examination of anal fissure: It should be done very sensitively because it may cause a lot of pain. For this reason, diagnosis is made by seeing cracks and skin folds under good light, without touching too much of the anal canal. Additionally, when the sides are lightly touched with the fingertip, it can be seen that the sphincter muscles are in spasm.
Differential diagnosis:
In the presence of more than one anal crack or a crack outside the place where it should be, In the differential diagnosis, the presence of underlying inflammatory diseases of the intestine, tuberculosis, syphilis, AIDS, anal abscess and anal cancer should be evaluated. Direct mechanical traumas that may cause anal crack formation should not be ignored. It is important to identify and eliminate the factors underlying the anal crack in order to prevent the disease from recurring.
Anal crack treatment.
Anal fissure What are the craving treatments
1) Change in eating habits; It is desirable to consume more fibrous foods and drink plenty of water during the day. He/she is asked to stay away from spicy foods and animal foods.
2) Adjustment should be made in defecation habits: One should not wait for the toilet to come, and should go to the toilet daily, if possible, in the morning. One should try to avoid diarrhea and constipation. During defecation, it should be done without too much strain. Long periods of time should not be spent in the toilet.
3) Hygiene rules should be followed as much as possible during feeding and cleaning.
4) Hot water sitz bath; Sitting in hot water for 15-20 minutes 3 or 4 times during the day. The number and time of sitting in hot water can be done more frequently in the beginning.
5) Comfortable clothes should be worn.
6) Simple pain-relieving creams can be used 3-4 times a day.
In addition to this general supportive treatment, special treatments are also included in the treatment of anal fissures. also available. We can categorize the specific treatment of anal fissure under 3 main headings. These are medication, botox treatment and surgery. These special treatments are used in patients with chronic anal fissures.
a) Medication:
Acute anal fissures can be treated with some local drugs that have been developed in recent years.
b) Botox Injection:
There is a muscle in this area that works against our will. With an injection into this muscle, these muscles are paralyzed and thus the spasm is resolved.
c) Surgical treatment methods for anal fissure:
Surgical treatment of anal fissure consists of cutting off a section of the involuntarily contracting muscle in the anal canal. In this way, the weakened muscle cannot contract and the spasm is resolved. Since there is no spasm, the blood supply to this area will increase and healing will be accelerated.
After anal fissure surgery, the crack may recur, although rarely; The most important factor in this recurrence is If the recurrence occurred before 6 months, either an inadequate surgery was performed or the patient may have other diseases that caused the crack. If the crack recurred after 6 months, a factor causing the anal crack may still be present.
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