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Anal fissure: Definition

An anal fissure is an ulceration of the mucosa (tissue covering the inside of hollow organs in contact with air) the anus.

The term fistula means anything that refers to a crack. Thus, we speak of a fistula syndrome to describe the appearance of severe pain in a patient with anal fissure pain occurring mainly during and after defecation. The term refers to the expulsion of defecation feces (droppings). 

This wound, rather elongated shape is due to erosion. It is a superficial tear. Anal fissure is related to the presence of a tiny wound located in the folds of the anus. 

It is aggravated by defecation (excreta) and spasm (contraction) of the internal anal sphincter (part of the anus located inside). On the other hand, it leads to a contraction of the muscles which delays healing. 

Other diseases of the anal margin are (non exhaustive list):

Ulcers of the anus: they are deeper and more chronic crack and cause painful symptoms of anal sphincter during and after defecation. 

Anal fistula is a channel leading from the rectum to the skin around the anus. Anal fistulas are usually caused by abscesses in the same region. 

Rectal abscess is most often due to the move to the anal region of a collection of pus from the rectum or the junction between the rectum and the sigmoid colon (part of the colon). It sometimes found the cause of perianal abscess, diverticulitis (inflammation of a diverticulum).
  • The diverticulum is an abnormal pouch ending in a cul-de-sac and communicating with the gastrointestinal tract. 
  • Crohn's disease
  • Surgical history
  • Proctitis (inflammation of the rectum) with an anite (inflammation of the anus) due to radiation therapy (using x-rays to treat cancer, among others). 
Anal fissure: Causes

The cause of anal fissure can be:
  • Abscess located on the anus, caused by bacteria (staphylococcus, E. coli)
  • Crohn's disease
  • Cancer
  • Surgery on the anus or the rectum (end part of the large intestine, which follows the sigmoid colon and ends at the anus). 
  • Tuberculosis
Anal Fissure: Symptoms

Defecation causes the so-called fissure syndrome:
  • Pruritus (itching)
  • Presence of sawgrass (small nodules of firm consistency on the perimeter of the anus) called sentinel and next to the crack. 
  • Severe pain
  • A tearing sensation and burning at the anus
  • Traces of blood on stool and toilet paper
Anal fissure: Medical Examination

Exploration by proctoscopy (fiber optic to see inside the rectum) allow direct visualization of lesions in the rectum sitting. This examination can be done only outside of painful crises.

Anal fissure: Complications of the disease

Events that could aggravate an anal fissure are:
  • The presence of hemorrhoids
  • Severe diarrhea
  • Delivery
  • Infection
  • An anal
Anal fissure: Treatment

Hot sitz bath designed to reduce the spasm of the anal sphincter (closure of the anus) Application of anesthetic cream (eliminating the sensation of pain) before defecation. 

Anal fissure: Prevention

Avoid constipation possibly taking laxatives, but abuse as there is a risk of inflammation of the intestinal mucosa Locally: ointments anti-inflammatory and healing properties, or based on glyceryl trinitrate, were effective in some patient's injection in fissured. In failure of medical treatment, you can practice surgery (sphincterotomy anal side) under general anesthesia, in which a section of a few muscle fibers is carried out, which promotes healing. This procedure replaces the manual dilatation leading to long incontinence.

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