Spasm of an anal sphincter – a pathological state at which involuntary reductions of the smooth muscles surrounding back pass are observed. Can develop at some injuries and diseases of a rectum and area of an anus, violations of an innervation, vegetative frustration and emotional instability. The spasm of an anal sphincter is followed by the pains in the field of back pass irradiating in a tailbone, a stomach, a crotch etc. It is diagnosed on the basis of complaints, the anamnesis, a rectal research, a rektoromanoskopiya, a kolonoskopiya and an irrigoskopiya. Treatment – a diet, spazmolitik, analgetics, physiotherapeutic procedures, surgical intervention.
Spasm of an anal sphincter
Spasm of an anal sphincter – rather widespread pathological state resulting from frustration of an innervation and vegetative regulation, traumatic damages, operations, chronic diseases or the expressed emotional instability. The main symptom of a spasm of an anal sphincter are pains in an anus zone (proktalgiya) of different duration and intensity. People of middle age suffer mainly, the disease equally often occurs at patients of both floors.
The spasm of an anal sphincter has tendency to a long current. Negatively influences quality of life, is followed by emotional and mental exhaustion. The kantserofobiya which is explained by initial mental instability and tendency of many patients to neurotic reactions is possible. Treatment of a spasm of an anal sphincter is performed by experts in the field of a proktologiya. In the presence of the expressed mental violations participation of the psychologist or psychotherapist is required.
Reasons of a spasm of an anal sphincter
In a back wall of a rectum a large number of the nervous terminations and blood vessels is located. Violations of normal work of this site of intestines are followed by emergence of a set of nervous impulses which cause reflex reduction of the smooth muscles surrounding external and internal sphincters of back pass. At intensive stimulation of this reflexogenic zone separate reductions can pass into spasms of an anal sphincter of various duration. Such spasms, in turn, involve violation of blood supply of a rectum and surrounding fabrics, cause a bigger irritation of the nervous terminations and aggravate reduction of muscles that provokes emergence of "vicious circle".
The spasm of an anal sphincter belongs to the category of polietiologichesky diseases and can be primary or secondary. In the absence of organic changes speak about primary frustration. Vistsero-neurotic violations and mental instability become the reason of development of primary spasm of an anal sphincter. The disease often comes to light at persons with the expressed hysterical component, the neurasthenia raised by emotional lability and vegeto-vascular dystonia.
The secondary spasm of an anal sphincter arises against the background of the states which are followed by emergence of organic changes and functional violations in a zone of an anus and the lower departments of a rectum. Among the common causes causing development of this pathology – such chronic diseases of area of an anus as hemorrhoids and an anal crack. Besides, the spasm of an anal sphincter can be provoked by inflammatory processes in the lower departments of intestines (a disease Krone, ulcer colitis), the benign and malignant tumors of a rectum, locks, injuries of a zone of a sacrum and tailbone complicated by childbirth, surgical interventions and solderings in a small pelvis.
Symptoms of a spasm of an anal sphincter
Characteristic displays of this disease are the pains of various duration and intensity irradiating in a tailbone, a crotch, coxofemoral joints or the lower part of a stomach. Pains at a spasm of an anal sphincter pristupoobrazny, can develop during defecation or arise without visible communication with a condition of a rectum (emptied or not emptied) and other circumstances. Low efficiency of analgetics is noted, at the same time the pain syndrome quite often disappears or weakens after completion of defecation or acceptance of a heat bath.
The spasm of an anal sphincter can be provoked not only by the act of defecation, but also chronic stresses, sharp emotional and psychological pressure, overfatigue, heavy physical activities and some neurologic diseases. At the same time, the spasm of an anal sphincter quite often itself becomes a push for developing of long stresses, increase in emotional instability and development of mental disorders of neurotic level.
Depending on a type of a pain syndrome allocate two forms of a spasm of an anal sphincter: with a long and short-term proktalgiya. At a short-term proktalgiya the severe pains pulling or pricking. Because of high intensity of a pain syndrome and its irradiation to the neighboring anatomic areas the patients suffering from a spasm of an anal sphincter quite often find it difficult to define localization of pains and can regard this symptom as display of diseases of a reproductive or urinary system. At a long proktalgiya of pain usually less intensive, are badly stopped by analgetics.
At a secondary spasm of the anal sphincter which arose against the background of hemorrhoids, an anal crack and other diseases accurate communication between a proktalgiya and the act of defecation is, as a rule, traced. Pain develops at desires on a chair, amplifies at a natuzhivaniye and several hours (sometimes – about one days and more) after the end of defecation remain. Constant pains negatively influence quality of life of the patients suffering from a spasm of an anal sphincter and can cause fear of the act of defecation because of which patients "postpone" visit of a toilet. It aggravates the arisen violations even more.
At primary spasm of an anal sphincter communication with the act of defecation is traced less accurately. Pains quite often develop at night or in the mornings. At patients sleeplessness develops. Groundlessness of emergence of a pain syndrome, a sleep disorder, initial emotional instability and predisposition to neurotic frustration create the psychoemotional spirit promoting emergence of a kantserofobiya and violations of an ipokhondrichesky range.
Diagnostics of a spasm of an anal sphincter
At diagnosis careful collecting complaints, clarification of a life story and a disease is of great importance. When collecting complaints the proctologist pays attention to character of a pain syndrome, its communication with the act of defecation and time of day. At clarification of the anamnesis of life of patients with suspicion on a spasm of an anal sphincter are accented on existence of chronic pathology of a thick gut and zone of back pass, the previous operations and injuries of this anatomic area, vegeto-vascular dystonia, neurotic frustration and emotional lability.
In some cases it is possible to establish that, despite the absence of the diagnosed vegetative and mental disorders, in the history of life of the patients suffering from a spasm of an anal sphincter the repeating spasms of smooth muscles of various bodies concerning which patients in the past addressed gastroenterologists, pulmonologists, otolaryngologists and other experts are traced. The plan of inspection at suspicion on a spasm of an anal sphincter includes a rectal research and a rektoromanoskopiya. At suspicion appoint an irrigoskopiya and a kolonoskopiya to existence of pathological changes in the top departments of a large intestine. At the expressed psychoemotional violations of patients direct to consultation to the psychologist or the psychotherapist.
Treatment of a spasm of an anal sphincter
Treatment can include a diet, medicamentous therapy, physiotherapy and surgical intervention. Medical tactics is defined individually taking into account the reason of development, weight and duration of a disease, somatic and psychological state of the patient. To the patient recommend to refuse the greasy and spicy food rendering irritant action on an intestines wall advise carefully to follow rules of personal hygiene and to avoid traumatizing a perianalny zone rough toilet paper.
If necessary carry out antibacterial therapy. Appoint spazmolitik and analgetics (mainly – in the form of candles, creams and microenemas). At locks register laxative medicines. For elimination of a spasm of an anal sphincter use thermal procedures, an electrodream, UVCh, a darsonvalization and other physiotherapeutic techniques. At inefficiency of conservative therapy carry out a sfinkterotomiya with partial excision of the smooth muscles surrounding an anus.