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Rectal fissure: symptoms and treatment, causes of formation

The most delicate problem among proctological diseases is the defeat of the last segment of the gastrointestinal tract - the rectum (rectum). It has no bends, stretches along the posterior part of the pelvis for 15-20 centimeters, ending in the anus. Various lesions in the mucous (outer) layer are often diagnosed as an anal fissure of the rectum (fissure).

The initial, “fresh” fissures are characterized as a slit-like tear, the edges are smooth and even. Their bottom is lined with sphincter muscle tissue. Gradually, the entire crack is overgrown with a young, grainy connective tissue, covered with white or muddy patina (see photo).

The duration of the disease provokes the growth of young fibers. Along the edges of the strain, they are compacted and covered with ulcers. Sometimes, excessive tissue overgrowth along the inner or outer edge of a crack forms tubercles from which fibrous polyps subsequently form.

People of different ages are susceptible to the disease, but such a feature is noticed: in women, pathology is detected more often at a young age, and men tend to be sick in a mature one.

Content

Classification of manifestations

Rectum fissure photo scheme

Fracture of the rectum is classified in four ways, dividing the pathology into subspecies.

1. By the duration of the process:

  • acute form, lasting no more than four weeks;
  • chronic course with a characteristic formation of callous edges (more than four weeks).

2. According to localization:

  • lesion of the posterior intestinal wall. Such a rectal fissure is characteristic of men;
  • longitudinal defect of the anterior intestinal wall. Localized mainly in women;
  • lateral arrangement of a rupture of a mucous layer. It is noted in patients with hemorrhoids.

3. According to the severity of the clinical picture:

  • there are no pronounced complications;
  • with the manifestation of bleeding and acute forms of paraproctitis.

4. According to the level of discovery of motility of the sphincter apparatus:

  • with muscle spasm of the valve apparatus;
  • with a lack of muscle spasm of the internal sphincter.

Causes of cracking

Causes of cracking

photo diagram of the occurrence of rectal fissure

The appearance of cracks provokes many factors, the main of them are due to:

  • exposure to mechanical damage;
  • pathologies of a vascular nature, manifested by the development of hemorrhoids;
  • structural epithelial changes in the intestinal mucosa;
  • disturbed circulation of the anus zone (sedentary work);
  • valve injuries (unsuccessful proctological operations);
  • neuromuscular changes in the valve apparatus.

The cause of the disease are traumatic injuries of the intestinal walls during defecation, accumulated in the intestine fecal plugs. The fracture of the rectum in women may be accompanied by damage to the walls of the vagina, as they are separated only by a thin chaff.

Protracted chronic processes contribute to the formation of a rectovaginal fistula connecting the vaginal cavity with the intestinal segment. What provokes an imbalance of the microbial flora of the vagina and the development of a variety of urological and gynecological diseases.

One of the causes of rectal fissures in women is the tearing of the intestinal tissue during pathologically difficult labor, with injuries and tears in the perineum. The development of chronic pathology is often caused by a combination of processes - hemorrhoids and rectal fissures.

Infectious flora causes inflammatory processes, spreading to the deep layers of intestinal tissue. The act of defecation becomes painful, or completely impossible.

If a foreign body enters the intestinal segment, or frequent constipation, the probability of rectal fissure increases significantly.

To provoke a disease can:

  • overuse of alcohol;
  • weight lifting;
  • improper diet;
  • anal sex.

Symptoms of rectal fissure, photo

photo of rectal fissure

photo of rectal fissure

The manifestation of the characteristic symptoms of rectal fissure are expressed:

Болезненностью в анальной зоне. 1) Soreness in the anal area. Increased pain symptoms manifested in the process of defecation. With exacerbation of the disease, it can last more than half an hour, characterized by slight bleeding.

Хроническая патология усугубляет процесс продолжительными, сильными болями, которые могут проявиться когда угодно, появляется рубцовая ткань на краях щели. 2) Chronic pathology aggravates the process with prolonged, severe pains that can occur anytime, scar tissue appears at the edges of the slit.

Как ответная реакция на боли, появляются спазмы внутрикишечной или копчиковой круговой мышцы, вызывающие дискомфорт. 3) As a response to pain, spasms of the intestinal or coccygeal circular muscles appear, causing discomfort. The process is accompanied by compression of blood vessels, which limits bleeding.

Появление фиссур может спровоцировать кровотечения из анального прохода, калом с примесями крови. 4) The appearance of fissures can cause bleeding from the anus, feces with blood impurities.

The preliminary diagnosis of rectal fissure of the anus is made on the basis of the patient's complaints, external examination and digital rectal examination:

  • localization and damage to the mucous layer is detected,
  • determined by the severity of muscle spasm of the valve apparatus.

Instrumental diagnostics is permissible only for signs of tumor formation. It is performed by the rectoscopic method, using the children's diameter of the tube, after stopping the pain with perisfingural anesthesia, or after healing.

Along the way, the level of trophic lesions of the sphincter membrane, the presence of cicatricial formations and the differentiation of rupture of the mucous layer of the intestinal segment from other intestinal pathologies is determined.

Rectal Fissure Treatment Methods

Rectal Fissure Treatment Methods

Treatment, at the first signs and symptoms of rectal fissure, must begin as soon as possible. It can be conservative (medical) or surgical. The goal of drug treatment is to reduce the pain symptom and relieve spasm of the sphincter apparatus.

One of the effective treatments for rectal fissures, ointments, rectal suppositories and gels based on glycerin trinitrate, eliminating two drawbacks at once - helps to reduce spasm of the sphincter anal apparatus and improves blood flow in the perineum, which promotes healing of fissures.

To reduce the load on the anal sphincter, are assigned:

  • drugs of laxative action, which are administered under the fissure;
  • hormonal drugs and antibiotics, depending on the severity of the clinical picture;
  • the introduction of botulinum toxin into the muscle tissue of the anal sphincter, which makes it possible to minimize its tone;
  • electrocoagulation, ultrasound, or laser treatment;
  • compression sclerotherapy - in the presence of hemorrhoids.

In many cases, conservative therapy can prevent surgery.

Operation

In complicated cases, when conservative methods are ineffective, various surgical techniques are used to remove a rectal fracture — the classical, selective, or lateral sphincterectomy method.

Fissure is excised together with the affected tissues and with part of the adjacent skin. The operation takes no more than half an hour, is performed under general or local anesthesia. Healing lasts up to two weeks.

Rectal fissures during pregnancy

Rectal fissures during pregnancy The formation of anal fissures in pregnant women is caused by many factors:

  1. Fetal growth and increase in the uterus leads to compression of the venous vessels of the pelvis and impaired blood flow in it, which causes stagnant processes in the vessels of the intestinal segment, creating conditions for the formation of fissures.
  2. Contributes to the pathological process of hormonal changes in the body of a woman, causing the formation of edema, decrease intestinal tone.
  3. Impaired blood flow causes stagnant processes in the vessels of the rectum, and the hormonal alteration of the body creates in it swelling and reduced functions of peristalsis.
  4. A favorable factor for the formation of anal fissures is a predilection for sweets and low activity characteristic of many pregnant women. Sweet causes digestive disorders, and low activity - constipation, as a fact, damage to the intestinal mucosa during bowel movements and possible bleeding.

In order to avoid complications during childbirth, treatment should take place at any phase of pregnancy.

Preventive measures

The formation of rectal fissures is very simple and quite feasible.

  • activity - prevents impaired blood flow in the pelvic region;
  • balanced, proper vitamin diet - the main factor in the normalization of intestinal functions;
  • prevention of constipation and intestinal disorders;
  • strict compliance with hygiene standards;
  • timely treatment of provoking diseases.

It is easier to give up bad habits and a habitual diet than to subject yourself to long-term treatment.

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