ANAL FISSURE (ANEST Crack)
They are tears in the anus. The most common cause is hard stools or long- term diarrhea. The tear causes severe pain. Pain increases the contraction of the muscles in this area, which results in impaired blood flow. The impaired blood flow also deepens the crack, turning the event into a vicious cycle. In medicine, this is called the pain, spasm, ischemia cycle. They are mostly in the posterior midline of the anus. (90%) They are less common in the anterior midline. (10%)
There are 2 types of anal fissure.
1) Acute anal fissure: They are short- term superficial lesions. They develop suddenly as a result of diarrhea or constipation. They look like superficial scratches.
2) Chronic anal fissure: They are deep, persistent, long-lasting lesions. The crack is swollen. There is a skin protrusion at the end (skin tag).
WHAT ARE THE SYMPTOMS AND FINDINGS
The main complaint in anal fissure is the pain that starts after defecation and sometimes lasts for a long time and is described as tearing or cutting glass. Patients may bleed after defecation.
In acute fissures, the complaint passes in 1-2 days with or without treatment.
In chronic fissures, the complaints may last for 6-8 weeks despite treatment. Even after the complaints pass, the disease recurs with even a little straining.
DIAGNOSIS
Diagnosis in anal fissure is made with a simple examination. Gentle moves should be made while examining the patients.
In patients with bleeding, a colonoscopy should definitely be performed after the painful period has passed.
In the examination, the location of the fissure, its depth and whether there is a skin protrusion with it are important. The skin protrusion called Skin Tag is a sign of chronic fissure.
TREATMENT
The aim of the treatment is to break the pain, spasm, ischemia cycle responsible for the development of fissures. With this logic, the first stage of the treatment is to keep the stool soft and to have a warm sitting bath.
Local anesthetic creams may be beneficial. Nitrogliderin containing pomades can also be used in the treatment. They are effective drugs. However, they can cause headaches as a side effect.
Botox application, which is applied in many branches of medicine, especially in aesthetic surgery, can be safely applied in anal fissure treatment with its muscle spasm preventing effect.
WHICH PATIENT, WHICH TREATMENT
The place of surgery is limited in acute anal fissures. These fissures are treated with warm sitting baths and the pomades listed above.
The gold standard treatment for chronic anal fissures is surgery. The preferred method is LIS (Lereal Internal Sphincterotomy). LIS is a simple operation that can be performed with local anesthesia and daily hospitalizations.
Although the gold standard treatment for Chronic Anal Fissures is surgery, 80% cure with non-surgical treatments (Nitroglycerin and Botox applications) requires us to try these methods first