Anal fissure - a small defect in the mucous membrane of the anal canal. Moreover, the shape of the defect can be either linear or oval. The most common cause of anal fissure believe the passage of very hard stools, or a large amount of them. It can occur in adults and in children aged 6 - 24 months. Less commonly, the disease is common in older children.
Anal fissure may appear severe pain and bleeding. More than 90% of cases, this fracture will heal itself without surgery. Conservative treatment of anal fissure in the form of special ointments or rectal suppositories is often a positive effect. In the event of failure of conservative treatment carried out anal fissure may become chronic and cause pronounced discomfort.
In the case where the crack does not heal and conservative treatment does not succeed, resorting to surgery.
The incidence of anal fissure
Anal fissure - the disease is not all that rare. After colitis and hemorrhoids anal fissure among the diseases of the colon ranks third (11%). Mostly anal fissure affects women young and middle age.
Newly emerged (fresh), the crack is usually in the form of cracks with smooth, even edges. The bottom of anal fissure is a muscle (the muscle anal sphincter). If untreated, anal fissure, its edges and the bottom covered with granulation tissue with fibrin coating.
During a long anal fissure leads to the widening of the so-called connective tissue at the edges. The edges of the cracks are tight, violated their trophism. Sometimes, domestic, and sometimes the outer edge of the anal fissures formed areas of excess tissue - the so-called "watch-bumps." In the future, these bumps can be formed fibrous polyp.
Causes of anal fissure
The causes of anal fissure quite a lot. By the appearance of anal fissure predispose mechanical and vascular disorders in the anal area, changes in the epithelium around the anus and anal sphincter defects.
Causes of anal fissure:
It is very hard stools.
Constipation and prolonged straining during bowel movements.
Inflammatory processes in the anorectal region (eg, proctitis).
In addition to the above conditions for the emergence of anal fissure predispose these inflammatory bowel diseases (such as colitis, proctosigmoiditis, enterocolitis), hemorrhoids, and others. This is evidenced by the fact that 70% of patients with anal fissure are marked chronic diseases of the upper gastrointestinal tract such as gastritis, peptic ulcer and duodenal ulcer, cholecystitis. Quite often anal fissure is combined with hemorrhoids.
Risk factors for anal fissure
Risk factors that increase the risk of anal fissure:
Infancy. Many infants in the first year of life is marked anal fissure, although the reason for its occurrence at them, many researchers do not know.
Advanced age. In elderly patients, the cause of anal fissure may be a poor microcirculation of blood in the anal region, frequent constipation and disruption of the intestine.
Constipation. Frequent constipation and prolonged straining leads to an increased risk of anal fissure.
Delivery. At birth a woman has to make an effort, which also increases the risk of this disease.
Crohn's disease. When the disease is marked inflammation of the colon, and the anal canal mucosa becomes more susceptible to injury.
Manifestations of anal fissure
Anal fissure is a fairly typical appearance. During a long anal fissure leads to irritation of nerve endings of the anal canal mucosa, causing sharp pain and often leads to a spasm of sphincter of the anus.
This spasm of the sphincter, which occurs after a bowel movement, can last a long time, for several hours until the next bowel movement. Formed as a vicious circle: anal fissure causes sharp pain that cause spasm of the anal sphincter (mostly internal), and this, in turn, does not heal the crack, which leads to tissue ischemia (lack of blood flow in them).
Anal fissure is characterized by the following symptoms:
Pain in the anus during a bowel movement or after (the most characteristic feature)
Spasm of the anal sphincter,
Minor bleeding during bowel movements (less than a characteristic feature.)
Pain occurs as acute anal fissure and chronic. Such pains lead to the patient is afraid to go to the toilet. This leads to a delay in the chair, which is the cause of constipation. Stool hardens, and they, in turn, lead to additional trauma fractures in the stool.
Sometimes, when a long-term anal fissure pain can not be. During defecation pain in the anal area is enhanced, and it causes a spasm of the anal sphincter. Spasm as it increases the pain in this area. Note that the spasm of the anal sphincter occurs in more than half of patients with anal fissure.
Finally, another sign of anal fissure is bleeding. But bleeding with anal fissure is not such as hemorrhoids. Basically, it's pretty meager. Such bleeding occur during or immediately after defecation. His reason - this is a common injury to the walls of the anal fissure. If, however, anal fissure you have observed more severe bleeding, the cause may be other diseases (hemorrhoids, colon cancer, etc.).
Classification and types of anal fissure
Anal fissure, depending on the nature of its course may be acute or chronic.
Acute anal fissure - is a newly arisen defect in the mucosa of anal canal when the disease has not yet passed into the chronic phase.
During acute anal fissure usually manifests a strong but relatively short-term pain. The pain occurs only during defecation and lasts an average of 15 - 20 minutes after it. In this case, acute anal fissure sphincter spasm manifested pronounced, and bleeding is minimal.
In the long anal fissure becomes chronic, particularly in the absence of adequate treatment. Chronic anal fissure is characterized by compaction and thickening of the edges. The fabric of the scar is, and at the bottom of the crack is formed polypoid thickening - the so-called "Hump watchdog."
Pain in chronic fissure longer lasting. It increases not only after a bowel movement, but also prolonged forced position of the patient. These patients are afraid to go to the toilet. Therefore, they are increasingly resorting to various means of laxatives, enemas. They vary in nature, they become irritable, insomnia appears.
Location of anal fissure
Most often anal fissure is localized to the posterior margin of the anus (ie, 6 hours, if you imagine it as a clock). The smaller number of patients (mostly women), anal fissure is localized at the forefront of anal fissure. On the side walls of the anal fissure is extremely rare (0.5%).
In some cases, an anal fissure may be localized at the anterior and posterior wall of the anal canal. The most common location of anal fissure on the back wall of the anal canal due to a poor blood supply in this area, as well as more likely trauma during defecation.
Anal fissure rarely leads to complications. If the crack is healed, it can become chronic. The crack is considered chronic if it has more than 6 weeks. In this case, if the crack has healed, it can recur.
Such a defect in the walls of the anal canal is gradually transferred to the internal sphincter of the rectum. This leads to spasm, which is a complication of anal fissure. Spasm of the sphincter of slow healing of fractures.
Other complications were anal fissure bleeding from the walls of the anal fissure, as well as an acute abscess, caused by opportunistic infection entering through the mucosal defect in the anal canal paraproctium.