What kind of complication is anal fissure? In which people does this disease occur? How is it possible to diagnose fissure? What is the drug treatment for fissure? Do you know the effective preventive methods against this disease? A river that needs specialized treatments, surgery and laser are among the effective methods in this field.
What is a fissure?
Fissure or fissure is a crack or wound that occurs in the beginning of the anus, which is very painful and sometimes accompanied by brief bleeding during defecation. The causes of this ulcer are different, but in most patients it is associated with a change in bowel movements such as constipation or severe diarrhea. Physiologically, they have raised the problems of decreased blood supply in the back part of the anus, and some researchers have raised the pressure inside the anal canal. ) are considered as its physiological causes. The most common place of this wound is in the posterior part, and in terms of the occurrence of fissure, it is equally common in both men and women, especially in young adults, but this disease affects from infants to the elderly. Fissures in the posterior part are more common than the anterior part because the blood supply of this part is weaker.
Crack detection
A fissure can be diagnosed by seeing a wound in the anus. Internal examination can be done to rule out other causes of bleeding. If the patient has severe anal pain, the internal examination of the anus should be postponed until recovery. If a person has multiple fissures or a wound in an unusual place, for example, on the left or right side, the possibility of other diseases should be investigated, such as inflammatory bowel diseases, syphilis, immune system disorders, tuberculosis, AIDS, rectal cancer.
Fissure treatment
The best and most preventive way to treat fissures is to relieve constipation and prevent constipation, which can be controlled with proper diet and eating habits. Usually, at a young age, the symptoms of fissure will disappear with the removal of constipation and loosening of the stool. However, when fissure occurs – if it has been 3-6 weeks since the onset of symptoms, we call it acute fissure. Acute fissure occurs in 95%. Cases respond to drug treatment. If more than 6 weeks have passed since the onset of symptoms, it is called chronic fissure and 95% do not respond to drug treatment. Merman’s fissure usually has a prominent border and becomes fibrotic and a skin growth can be seen at its end. If a chronic fissure is seen in areas other than the midline, it can be a sign of other diseases such as Crohn’s, AIDS, syphilis, tuberculosis, or leukemia.
Fissure treatment principles
Constipation is treated with a diet rich in fiber and liquids and sometimes laxatives, pain control, warming the area. Local anesthetics along with corticosteroids are used to control pain. Internal sphincter spasm is usually reduced with nitroglycerin and diltiazem 2%. In cases where nitroglycerin ointment causes headache, diltiazem ointment is better. The ointment is inserted with a finger or an applicator; if it is inserted with a finger, it is better to massage the ointment on the sphincter for 20-30 seconds. If an applicator is used, it has two advantages: the ointment enters deeper and opens the anal sphincter. Botox injection is also used in the treatment of fissures. But this method is painful and it is not a definitive cure for fissure. Sitting in a basin of warm water for 3-5 minutes and 3 times a day helps to reduce sphincter spasm and pain.
Drug treatment of fissures
_ For mild pain, use medications such as acetaminophen or local anesthetics.
_ Applying zinc oxide ointment or Vaseline to the area may prevent the burning sensation.
Stool softeners may also help prevent pain during bowel movements.
Lidocaine ointment may be recommended.
– Nitroglycerin ointment is suitable for acute fissure, which causes blood supply to the anus area, as a result, the wound heals faster.
_ Psyllium and cellulose contain a lot of fiber that softens stool by absorbing water.
Creams, foams, ointments, or suppositories may be helpful in reducing pain and making the affected area slippery. Many of these products are available without a prescription, or your doctor may prescribe a stronger medication.
Herbal treatment of fissures
Rubbing behedana glaze on the skin is useful for soothing and healing fissures. A mixture of mulberry fruit with vinegar is useful for fissures. People with hemorrhoids or fissures can benefit from the healing effects of five fingers plant and sit in the decoction of this plant until the problem is resolved. Treatment of fissures can be done by applying honey to the area and gently massaging it. Before defecation and defecation, lubricate the anus with the oil of the leaves. This causes the anal wound to not stretch and tear again when you touch the anus opening to wash.
Before every meal, it is effective to drink a mixture of half a glass of yarrow and half a glass of aloe vera. After lunch and dinner, put 2 tablespoons of esfarza in a glass of sweetened water and drink it after glazing. And be sure to drink a glass full of water afterwards. After the meal, mix a spoonful of wheat bran with a spoonful of wheat germ and put it in a bowl of yogurt and eat it, and be sure to drink a glass of water after that. Watermelon and grapes and Eat lots of vegetables, pears, and oranges. Do not eat bananas, kiwis, or apples.
Read more: Anal bleeding treatment methods
Treatment of acute fissures
acute fissure
To treat this disease, there are several methods of pain that are used at the same time and it takes about ten days for the full effect.
A) Use of substances that increase the volume of stool and soften the stool:
By following a diet containing fibrous foods such as cabbage, lettuce, cucumber, apple with its skin, fruits, water-soluble sorghum, water-soluble saffron, dried figs that have been watered, or medicines such as psyllium, lactulose syrup or Magnesium syrup can achieve this goal.
b) Sitting in a basin of warm water containing a few drops of betadine three to five times a day and each time for about twenty minutes.
c) Using pain-relieving drugs that include topical lidocaine anesthetic ointment or oral painkillers
t) Using drugs that increase blood supply to this area, such as nitroglycerin ointment. By dilating the blood vessels of the anus area, this ointment increases the blood supply to it and thus accelerates wound healing. Of course, the use of this medicine in some people causes burning in the place of use or headache. The method of using it locally on the anal wound is two to three times a day.
The above treatments almost always improve acute fissure, but in chronic fissure, only half of the cases resolve the symptoms, and the rest of the people need surgery.
Treatment of chronic fissures
Chronic fissure
Types of chronic fissures that do not respond to medical treatment should undergo surgery. The surgical method is that part of the internal muscle of the anus that has contracted is cut. This causes the contraction to be removed and the patient’s pain to disappear. After removing the pain, the anal ulcer will gradually heal. After the operation, the pain related to the chronic fissure disappears, but the pain related to the incision and surgery continues for several days, which can be controlled with painkillers and does not cause any problems for the patient. If the chronic fissure is seen in areas other than the midline It can be a sign of other diseases such as Crohn’s AIDS, syphilis, tuberculosis or leukemia.
Burning pain and itching of the anus
Burning and itching of the anus can have various causes, which in the early stages may be due to constipation – wearing tight or plastic clothes – subcutaneous hair – digestive diseases and worms or types of fungi, which should be treated in the early stages. Otherwise, if you don’t pay attention to these symptoms, the disease will progress and the disease will turn into more advanced types.
Fissure treatment and surgery
In cases where fissures do not respond to drug treatment or recur after treatment, surgery is recommended, especially laser fissure surgery.
Cleft surgery
The preferred operation is the partial cut of the internal sphincter, as a result of which the resting pressure of the sphincter is reduced and the wound is repaired. In 8% of cases, gas or stool incontinence occurs after this procedure, which is the same percentage in people who are treated with other methods, such as drugs.
Laser anal fissure
Application of laser in the treatment of fissures
In acute fissures, low-power lasers can be used for treatment. Laser 2-3 sessions per week and up to 12 sessions in total can be continued. In this method, the laser helps to heal the wound and reduce pain.
High power lasers can be used in chronic fissures that have not responded to conservative treatments. With this type of laser, the fissure wound and its skin growth are removed and sphincterotomy is performed.
The benefits of laser in the treatment of fissures and why the use of laser is preferable to open fissure surgery
During the cutting and removal of the skin tag, the laser restores the end of the cut nerve, and as a result, the patient has no pain or very little pain after the operation.
The laser repairs the small vessels cut during the operation, and as a result, the bleeding during the operation is reduced.
Fissure laser surgery can be performed on an outpatient basis without anesthesia.
The patient rests only the first night and does not need more rest.
The patient has a faster return to his work environment and normal life.
With this type of laser, all types of hemorrhoids, fissures and fistulas can be treated at the same time.
The laser sterilizes the operation environment and reduces the infection of the operation site. It is worth mentioning that because of this, the transmission of viral diseases such as hepatitis and AIDS is zero.
During the operation, the laser does not damage the surrounding tissue and does not cause necrosis like the cautery, so the pain after the operation is reduced and the anal sphincter is not damaged. This advantage of laser reduces the problem of anal incontinence.
If a person is also suffering from hemorrhoids, it is possible to have fissure and hemorrhoid surgery at the same time.
Why is fissure not easily repaired?
1- The anal canal is always full of different microbes and is susceptible to infection
2- The passage of hard stools during defecation prevents wound healing
Care after hernia operation
You may experience mild pain for up to a week after hernia surgery. If you have pain, you may be unable to pass stool, which can lead to more severe constipation. Keeping the stool soft helps the stool move more easily through the digestive tract. Also, some pain relievers may aggravate constipation. Your doctor may also prescribe laxatives or stool softeners after surgery. After a high-fiber diet, the stool will become firmer and increase the absorption of water into the stool by the intestine. High fiber foods such as fruits and vegetables as well as whole grains. To prevent constipation, it is recommended to eat four servings of fruits and vegetables a day and four cups of cereals and other whole grains. Putting on a fruit and vegetable mask provides the body with additional fiber. Wheat and barley fiber is more effective than fruits to prevent constipation. Fruits and vegetables with skin provide more fiber to the body. If you are a woman, consume at least 20 grams of fiber per day, and if you are a man, consume at least 30 to 35 grams of fiber per day.
Complications of cleft surgery
Performing surgery in some people causes a brief gas incontinence, which will gradually disappear after a few months. In some people, bleeding will continue, which will be resolved after two weeks, and some people will experience urinary retention after the operation, which will be resolved after 24 hours.
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