Anal fissure: symptoms, causes and treatment from experienced doctors at the MEDSI clinic

Causes of rectal fissure

Most often, it is not possible to establish the exact cause of a rectal fissure. It is believed that the development of the disease can lead to:

• disturbances of blood flow in the walls of the anus (in people with heart and vascular diseases, in those who have to sit or stand in a monotonous position for a long time);
• prolonged constipation or diarrhea;
• inflammation of the mucous membrane of the rectum and anus;
• injuries to the mucous membrane (including during anal sex, medical procedures);
• diseases of the digestive system: gastritis, colitis, cholecystitis;
• eating large amounts of spicy food and alcohol;
• heavy physical activity;
• woman's injuries during childbirth.

Anal fissure: symptoms, causes and treatment from experienced doctors at the MEDSI clinic

Table of contents

• Causes
• Symptoms
• Anal fissure in children
• Chronic fissure
• Consequences (complications) of anal fissures
• Diagnostics
• How to treat anal fissure?
• Prevention
• Advantages of treatment at MEDSI

An anal fissure (anal fissure) is a tear in the lining of the rectum. As a rule, pathology develops in people who suffer from chronic constipation or lead a sedentary lifestyle. Fissures are diagnosed in approximately 20% of patients who consult a doctor with the problem of discomfort in the rectal area. The pathology can be either independent - arising from exposure to traumatic factors, or secondary - a consequence of a number of concomitant diseases (external hemorrhoids, peptic ulcers, disorders of the gastrointestinal tract).

Causes

An anal fissure is caused primarily by trauma to the rectum or constipation and hemorrhoids.

Damage may result from:

• Gastritis, peptic ulcer, colitis
• Congestion in the rectum and pelvis caused by disruption of the cardiovascular system
• Pregnancy during which the uterus puts excessive pressure on internal organs
• Childbirth associated with prolonged pushing

Don't think that an anal fissure will heal on its own. If the patient does not change the nutritional system and eliminate traumatic factors, nothing will change. In addition, acute pathology often becomes chronic. In this case, the patient suffers from severe discomfort and often experiences not only physical, but also psychological problems. If you contact a specialist immediately after detecting signs of pathology, treatment will be carried out quickly using conservative methods. In advanced cases, treatment of chronic anal fissure is often only possible through surgery.

Symptoms

The main symptoms of anal fissure that require consultation with a doctor and treatment are:

• Discomfort after defecation
• Pain
• Minor bleeding

Over time, these symptoms are often accompanied by:

• Sphincter spasm
• Unpleasant sensations when sitting
• Constipation

The patient becomes irritable, sleeps poorly, and fears bowel movements.

Anal fissure in children

Children suffer from anal fissures less often than adults, but in some cases the pathology occurs even in newborns. To prevent the disease from becoming chronic and causing complications, treatment should be started as early as possible. Any self-medication is strictly prohibited, since it only relieves symptoms, but does not eliminate the problem, starting the course of the pathology.

Young children cannot report signs of pathology to adults, so you should monitor:

• Baby's behavior when excreting feces
• Stool density
• Child's behavior before going to the toilet. Children often become irritable and nervous and do not want to sit on the potty.

If a child cries before and during bowel movements, is afraid of going to the toilet, or suffers from constipation, you should definitely consult a doctor.

Chronic fissure

The acute form of anal fissure often becomes chronic. Especially often, pathology develops rapidly in the absence of adequate therapy. It develops into a chronic form mainly in women who have recently given birth. This is due to physiological changes in the body of a young mother. With pathology, the patient suffers not only during bowel movements, but also after it, with prolonged sitting and walking. Constant discomfort, itching and bleeding are added to the standard symptoms. The process is often aggravated by self-medication, taking laxatives, using suppositories and enemas.

Consequences (complications) of anal fissures

If an anal fissure is not treated, the following complications arise:

• Constant bleeding
• Infectious processes in the intestinal mucosa
• Prostatitis
• Rectal fistulas
• Colitis
• Acute paraproctitis

All of them are dangerous not only for health, but also for the life of the patient, and also lead to the development of a number of psychological problems.

Diagnostics

To make a diagnosis, a comprehensive examination of the patient is performed.

It includes:

• Examination of the anus
  . An anal fissure is diagnosed fairly quickly, as the mucous membranes lose their integrity and become swollen
• Finger examination
  . With such a study, the proctologist can determine the size of the crack and feel its edges
• Sigmoidoscopy
  . Allows you to examine the rectum to a depth of 20 centimeters

Laboratory diagnostics, colonoscopy and irrigoscopy may also be prescribed.

How to treat anal fissure?

Conservative therapy

Treatment of anal fissure is always carried out comprehensively. It is important to eliminate not only the symptoms of the pathology, but also its cause. The underlying disease must be eliminated. Treatment will be useless if the patient suffers from constipation and hard stool constantly damages the anus.

Typically therapy includes:

• Treatment of the anus with emollient compounds
• Relaxation of anal muscles in warm baths
• Preventing constipation
• Using ointments and suppositories for pain relief, wound healing and inflammation relief

Treatment is determined by the form of the pathology, the factors that provoked its development, and the individual characteristics of the patient. It can only be prescribed by a doctor after a comprehensive diagnosis.

Surgery

Surgical interventions are resorted to when conservative therapy does not give the desired result.

All methods used are divided into 2 types:

• Minimally invasive
  . Usually the crack is removed using a laser. Its edges are simply sealed. Recovery after such an intervention does not take much time. Within a few days the patient returns to his normal lifestyle and does not experience discomfort.
• Standard
  . The sphincterotomy technique is used. During this intervention, the doctor makes an incision and separates the layers of sphincter muscle. Thanks to this, the existing spasm is eliminated, which allows you to reduce tension during bowel movements. Also, suturing of the walls and excision of the mucous membranes on which scars have appeared are carried out.

The choice of surgical intervention technique is made by the doctor.

Prevention

There is a set of preventive measures to prevent the formation of an anal fissure.

This includes:

• Healthy lifestyle. You should completely stop smoking and drinking alcoholic beverages, eating fatty, fried and salty foods, which stimulate problems in the cardiovascular system and digestive tract. It is important to consume foods rich in fiber, vitamins and valuable microelements in sufficient quantities.
• Compliance with personal hygiene rules. You should wash regularly and prevent the development of inflammatory and infectious processes.
• An active lifestyle, including regular, but not excessive or tiring physical activity. It is enough to walk at least 20-30 minutes a day
• Proper drinking regime. You need to drink at least 1.5-2 liters of fluid every day
• Avoiding eating foods that are too hot or cold

It is important not to restrain the urge to defecate and promptly treat any diseases of the gastrointestinal tract.

Advantages of treatment at MEDSI

• Use of current treatment methods. Our clinics use drug blockades, excision of anal fissures and other procedures and interventions.
• Experienced doctors. MEDSI proctologists constantly improve their qualifications and master modern methods of conservative therapy and surgical interventions
• Comfortable conditions. All examinations and treatment are carried out by experienced specialists whom our patients trust. There is no fear or embarrassment during the procedures
• No queues. You can consult a doctor at a convenient time
• Compliance with confidentiality rules

If you want to make an appointment with a proctologist at MEDSI, call +7 (495) 7-800-500.

Symptoms

The disease begins with sudden severe pain in the anus after visiting the toilet. Bright scarlet blood appears in the stool. If a rectal fissure is combined with hemorrhoids, then the first sign of the disease may be prolapse of nodes and severe bleeding. In response to pain, the muscles of the anus contract and become tense, and this further intensifies the pain.

Usually the pain goes away quickly and the bleeding stops.

If you do not see a doctor within 3 to 4 weeks from the moment the first symptoms appear, the rectal fissure becomes chronic. The pain decreases, but becomes constant.

A small amount of blood is constantly released from the anus. The patient is bothered by severe itching in the anus.

Symptoms of anal fissure in children

The clinical picture of the disease depends on the stage of development, the individual characteristics of the child and the size of the mucosal defect. Classic symptoms of anal fissure:

• Pain in the anal area during bowel movements. This is one of the most common signs of the disease, which is caused by mechanical damage to the inner surface of the intestine. Between bowel movements, the baby can behave absolutely normally and not show any complaints.
• Blood in the stool. This is the most common reason for parents to turn to a pediatric proctologist, who notice streaks of scarlet blood during the next diaper change or while cleaning the potty. Its appearance is due to the presence of a defect in the mucosa and injury to small vessels.
• Abnormal bowel movements such as constipation. Due to pain in the anorectal area, the child tries to suppress the defecation reflex. There is a fear of bowel movements.
• Anxiety, sleep disturbance, moodiness. All these symptoms are caused by the child’s irritation, which develops against the background of pain in the anus and bowel dysfunction.

If the above symptoms occur, you should seek help from a pediatrician, proctologist or pediatric surgeon. This will allow you to identify the problem in the early stages of its development and begin adequate treatment without delay.

What can a doctor do?

Treatment of anal fissure begins with conservative methods:

• Normalization of stool. For this, various dietary supplements are used.
• Diet. It is necessary to exclude from the diet foods that can cause irritation of the rectum: spicy, fried, sour, salty, alcohol.
• Pain-relieving suppositories and ointments. They are used after a warm sitz bath (water temperature 36 - 38⁰C).

Usually improvement occurs within 2 to 3 weeks. If this does not happen, surgical treatment is resorted to.

Types of operations for anal fissure:

• Excision using a scalpel. The surgeon either excises only the mucous membrane or makes an incision on the anal sphincter, after which it relaxes. After the operation, you must take warm sitz baths for a week and apply medicinal ointments to the anus.
• A more modern technique is radio wave surgery. Excision of anal fissure is carried out in a non-contact manner using high frequency radio waves. This minimizes the risk of bleeding and infection and shortens the rehabilitation period.

Diagnosis of anal fissure

Anal fissure is diagnosed by a pediatric proctologist or surgeon.
Even when parents first contact a doctor, a specialist may suspect the presence of this disease. The doctor pays attention to the child’s characteristic complaints, the influence of provoking factors, and the history of the development of the pathological process. A digital rectal examination is required to make a definitive diagnosis. However, in order not to cause psycho-emotional discomfort in the presence of severe pain, the doctor may first limit himself to a simple examination of the anal area. Sometimes the defect can be identified immediately.

If a rectal examination is not performed immediately, it will be postponed to the next visit. The fact is that anal fissures are often a consequence of other proctological diseases, which may not be diagnosed without a full examination. This means that the pathology of the rectum will steadily progress.

To comprehensively assess the patient’s condition, the following tests are performed:

• General blood and urine analysis. Allows you to identify concomitant diseases, primarily anemia, inflammation.
• Coprogram is a microscopic analysis of feces, which is especially important if dysfunction of other parts of the gastrointestinal tract is suspected.
• Blood chemistry. Detects metabolic changes in the body.
• Ultrasound of the abdominal organs. Detects abnormalities in the development of internal organs.

If a concomitant pathology is identified, its treatment is carried out in parallel, which helps to avoid recurrence of the anal fissure.