Анус жарақаты: себептері, диагностикасы және емдеуі

An anal fissure is a break or tear in the skin of the anal canal. Anal fissures may be noticed by bright red anal bleeding on toilet paper and undergarments, or sometimes in the toilet. If acute they are painful after defecation, but with chronic fissures, pain intensity often reduces and becomes cyclical.

External anal fissures on the anal verge can be diagnosed by visual inspection. Internal anal fissures in adults on anterior side, posterior side or within any part of the inner circumference of the anal sphincter muscle can be diagnosed with beak proctoscope 23mm diameter, Chelsea Eaton anal speculum 23mm diameter, Park anal retractor or by digital rectal examination with a finger inside the anal sphincter muscle. Narrow anal fissures might not be felt by finger during rectal examination due to the glove. Note that colonoscopy, sigmoidoscopy, or normal proctoscopy is for diagnosing internal hemorrhoids and other internal rectal diseases and not for diagnosing anal fissures.

Non surgical treatments are recommended initially for acute and chronic anal fissures. These include topical nitroglycerin or calcium channel blockers (e. g. diltiazem), or injection of botulinum toxin into the anal sphincter. Other measures include warm sitz baths, topical anesthetics, high fiber diet and stool softeners.

Surgical procedures are generally reserved for people with anal fissures who have tried medical therapy for at least one to three months and have not healed. It is not the first option in treatment. The main concern with surgery is the development of anal incontinence. Anal incontinence can include the inability to control gas, mild fecal soiling, or loss of solid stool. Some degree of incontinence can occur in up to 45 percent of patients in the immediate surgical recovery period. However, incontinence is rarely permanent and is usually mild. The risk should be discussed with one's surgeon. Surgical treatment, under general anaesthesia, is either anal stretch (Lord's operation) or lateral sphincterotomy where the internal anal sphincter muscle is incised. Both operations aim to decrease sphincter spasming and thereby restore normal blood supply to the anal mucosa. Surgical operations involve a general or regional anaesthesia. Anal stretch is also associated with anal incontinence in a small proportion of cases and thus sphincterotomy is the operation of choice.

Lateral internal sphincterotomy (LIS) is the surgical procedure of choice for anal fissures due to its simplicity and its high success rate (~95%). In this procedure the internal anal sphincter is partially divided in order to reduce spasming and thus improve the blood supply to the perianal area. This improvement in the blood supply helps to heal the fissure, and the weakening of the sphincter is also believed to reduce the potential for recurrence. The procedure is generally performed as a day surgery after the patient is given general anesthesia. The pain from the sphincterotomy is usually mild and is often less than the pain of the fissure itself. Patients often return to normal activity within one week. LIS does, however, have a number of potential side effects including problems with incision site healing and incontinence to flatus and faeces (some surveys of surgical results suggest incontinence rates of up to 36%). Though lateral internal sphincterotomy (LIS) is considered safe on a short term basis, there are concerns about its long term safety. Pankaj Garg et al. published a systematic review and meta analysis in which they analyzed the long term continence disturbance two years after the LIS procedure. They found the incidence of long term continence disturbance to be 14%, so caution and careful patient selection are needed before undergoing LIS.

Anal dilation, or stretching of the anal canal (Lord's operation), has fallen out of favour in recent years, primarily due to the unacceptably high incidence of fecal incontinence. In addition, anal stretching can increase the rate of flatus incontinence. The incidence of incontinence is thought to be due to a lack of standardization and that proper technique results in little chance that it will occur. In the early 1990s, however, a repeatable method of anal dilation proved to be very effective and showed a very low incidence of side effects. Since then, at least one other controlled, randomized study has shown there to be little difference in healing rates and complications between controlled anal dilation and LIS, while another has again shown high success rates with anal dilation coupled with low incidence of side effects.

Fissurectomy involves excision of the skin on and around the anal fissure and excision of the sentinel pile if one is present. The surgical wound can be left open. New skin tissue grows and it heals.

The incidence of anal fissures is around 1 in 350 adults. They occur equally common in men and women and most often occur in adults aged 15 to 40.