The anal crack is a slit-like defect of a mucous membrane of an anus, is more often than its back wall. It is characterized by an itch, the intensive burning pain amplifying at defecation and after it, insignificant release of scarlet blood, a sphincter spasm. Because of intensive pains patients have a rektofobiya (""), nevrogenny frustration razviatsya: aggression, apathy, irritability. The constant travmatization and irritation leads to education is long not healing ulcer, to its infection and suppuration. Treatment includes a diet, local and general medicamentous therapy. According to indications operations are carried out.
The anal crack is the defect of a mucous membrane of back pass, as a rule, a linear or ellipse form arising on a wall of the anal channel. Usually settles down on the median line of a back wall. Defect length most often no more than 1 centimeter, however, this very serious disease able to have dangerous consequences. Anal cracks are distinguished on existence duration: sharp (formed recently) and chronic (it is long existing).
Among diseases of a rectum of a crack of back pass are very widespread and are the proktologichesky diagnosis, the third on frequency, after inflammations of a rectum and hemorrhoids. The anal crack meets at women of 25-40 years more often (Bol of 60% of cases). Sharp () the crack of back pass in a form looks as a crack with smooth, smooth edges. Muscles of an anal sphincter form a crack bottom. Gradually at a bottom and edges granulations which become covered with fibrin are formed.
It is long the existing crack it is characterized by the condensed edges (due to growth of connecting fabric) with violation signs traffic. On internal (sometimes and on external) edge of a crack the soyedinitelnotkanny hillock ("a sentry hillock") which can become a basis for development of a fibrous polyp is formed.
Reasons and risk factors
The most frequent reasons of emergence of anal cracks, according to experts in the sphere of a clinical proktologiya, frequent locks and ponosa, hemorrhoids, hard physical activity, sedentary work, abuse of alcohol and spicy food, mechanical injury of a mucous membrane of the anal channel by an alien subject or dense stake are. Inflammations of a large intestine belong to the diseases promoting emergence of cracks in back pass (including - proktita).
In 70% of cases the crack arises at the persons having pathologies of a stomach, small intestine, liver, pancreas and biliarny system. At the similar number of patients pathology is combined with hemorrhoids. For a long time existing chronic hemorrhoids promote decrease in elastichesky properties mucous the anal channel (as a result of a pektenoz), tendency to emergence of its defects turns out to be consequence of what. The area of the grebeshkovy line of a wall of the anal channel is the most vulnerable in case of tension.
In most cases (85%) the anal crack arises on a back wall on the median line (for 6 hours). It is explained by specifics of a structure of the anal channel – in this place blood supply of a sphincter the weakest, the wall of the channel is most vulnerable at a tension during defecation or at penetration into a rectum of foreign matters. In 8-9% of cases (mainly at women) the crack can arise on a forward wall, in extremely exceptional cases it is localized on lateral faces of the anal channel. In 3-4% of cases the combination of cracks of a forward and back wall is found.
Symptoms of an anal crack
Pathology differs in rather specific clinical picture. At for a long time existing disease quite expressed painful symptom and a tonic spasm of a sphincter after defecation is noted. The spasm can will remain for several hours. A tonic spasm – one of factors of formation of the vicious circle promoting progressing of a disease: the anal crack causes a resistant spasm which provokes ischemia of fabrics of walls of the anal channel and prevents defect healing.
The sharp anal crack is shown by a spasm of an anal sphincter, pain during defecation, bloody separated from an anus. The pain syndrome is, as a rule, the main complaint of patients with this pathology. Pain arises at the beginning of defecation, quite expressed, often remains throughout a long time. Irradiation of pain to the area of a crotch or in a sacrum can be noted. Intensive morbidity of defecation can force patients to postpone this act that conducts to locks.
The spasm of an anal sphincter is reflex, connected with an intensive painful symptom, a tonic spasm – one of basic elements of pathogenesis of a disease. The spasm caused by pain worsens blood supply, promotes strengthening of pain and prevents regeneration of fabrics and healing of a crack.
Bloody allocations from the anal channel usually happen poor (bloody streaks to Calais or traces of blood on paper), are connected with traumatizing mucous at defecation. If the expressed bleedings take place, then it is possible to assume associated diseases: hemorrhoids, tumor, etc. The uncured sharp crack of the anal channel existing 3-4 weeks becomes chronic. At the same time there is a thickening and consolidation of its edges, formation of a rough hem, formation of "a sentry hillock" on an inner edge.
Unlike sharp process at a chronic anal crack pain most often arises after defecation and more long time disturbs. At long stay in a sitting position morbidity amplifies. The constant painful symptom considerably reduces quality of life of patients, causing irritability, sleep disorders, neurosis. Often patients with a chronic anal crack have a fear of defecation, they often use laxative medicines.
At long locks during intense defecation there can be bleeding from back pass. Sometimes there is suppuration of an anal crack and from back pass purulent separated appears. At a chronic crack the tonic spasm of a sphincter is less intensive and remains not for long. The anal itch is often noted. Synchronization of process can be followed by inflammatory processes of terminal departments of intestines: sfinkterity, proktity, proktosigmoidity.
Diagnostics and difdiagnostika
As a rule, the anal crack is found at survey of field of back pass. For carrying out survey carefully part the patient's buttocks, and study an anus zone. After cultivation of walls of the anal channel defect of mucous comes to light. Sometimes (at small cracks in the depth of the channel) doctors-proctologists make a manual research, at the same time noting the available tonic spasm of a sphincter. Carrying out a manual research in the presence of a visible crack is inexpedient in view of possible damage of mucous.
Are not made by the patient with not healed anal crack expressed by a painful symptom and a spazmirovanny sphincter tool techniques of a research of a rectum, or in the presence of indications (plentiful bleedings, suspicion on proktit, tumoral educations, purulent complications) are carried out with use of local anesthesia. The diagnostic rektoromanoskopiya on height to 20-25 cm can be made after healing of a crack for control of a state and detection of the accompanying pathologies.
Differential diagnostics does not cause special difficulties. The anal crack is differentiated from incomplete internal fistula of a rectum. At this pathology of a spazmirovaniye of a sphincter do not note, the painful symptom less intensive, the main clinical manifestation is office of pus from an anus. The palpation of defect mucous a maloboleznena, at the bottom is found deepening (a fistula cavity).
It is also necessary to exclude probability that the crack is not display of infections of a rectum (a syphilitic gumma, tubercular defeat, fungal or parasitic infection, injury of a rectum at a disease Krone). For this purpose make careful collecting the anamnesis, establish terms and the causes, features of a current.
Patients with suspicious concerning infection of HIV with the anamnesis (drug addiction, chaotic sexual communications, homosexuality) can have various diseases of a rectum connected with acquired immunodeficiency syndrome. Identification at such patients of anal cracks often is followed by an unusual clinical picture.
Anal cracks can be infected and be complicated ascending (moving ahead up intestines) by an inflammation of a mucous membrane of terminal departments of intestines (a sphincter, a direct and sigmovidny gut). At penetration of an infection into deep layers can develop paraproktit. Pathology can be complicated by the expressed plentiful bleeding, at regular small blood losses sometimes there is iron deficiency anemia. At men the inflammation can extend to a prostate gland (prostatitis).
Treatment of an anal crack
Main objectives of therapy of this disease are anesthesia, removal of a tonic spasm of a sphincter, normalization of a chair and healing of a crack. Treatment can be performed by conservative methods and by means of surgery. The timely address to the doctor, at a fresh uncomplicated crack (no more than a week) with smooth edges, allows to heal quicker and more effectively a crack by means of therapeutic means. Conservative therapy is a sufficient measure and leads to treatment in 65-70% of cases.
One of significant factors is observance of the diet directed to activization of work of intestines and promoting defecation simplification. The diet has to be nutritious, balanced, rich with vegetable components and fermented milk products. The exception of spicy, salty and bitter food, the seasonings annoyingly operating on mucous, alcohol is recommended. Beet, prunes, a dried apricots, dried apricots and a fig has positive effect on intestines. Beet can be used boiled, together with vegetable oil or sour cream. It is necessary to draw fruit a little before the use in boiled water. Such diet promotes a softening of a chair and simplification of defecation.
Therapeutic methods of treatment of anal cracks are presented by medicines of local and general action. For local treatment appoint warm trays with weak solution of manganese (10-15 minutes to 3 times a day), nitroglyceric ointment for removal of a spasm of a sphincter (to apply in small quantities as absorption of nitroglycerine in the general blood-groove influences warm activity and nervous system), Botox (botulinum toxin, interrupts passing of nervous signals to muscles, at local impact on a sphincter also promotes removal of a spasm), candles and ointments with anesthetics (novocaine, lidocaine, benzocaine), melituratsit also sea-buckthorn oil for acceleration healing (also in candles or ointments).
The general treatment can consist in reception of laxative medicines and blockers of calcic channels (diltiazy, nifedipine) for removal of a tonic spasm. Besides, there are such techniques of treatment of an anal crack as infrared coagulation (chronic cracks when there is no spasm treat and cicatricial changes), laser or radio-frequency coagulation (removal of perianalny fabric under local anesthesia by means of the laser or radio waves take place), medicinal blockade, surgical treatment.
Indications to surgical treatment: the deep chronic crack with the expressed cicatricial changes of edges which is followed by a considerable spasm resistant to conservative treatment. In such cases defect excision is carried out. Often the anal crack is followed by hemorrhoids. As a rule, in such cases operation on removal of gemorroidalny knots (gemorroidektomiya) with simultaneous excision of a crack is recommended. The choice of tactics of treatment depends on a condition of the patient, the course of a disease, the available complications. Self-treatment and tightening with the address to the doctor can lead to development of complications, will make the subsequent treatment longer and unpleasant.
Forecast and prevention
Prevention of an anal crack consists in healthy nutrition, active lifestyle, timely treatment of the diseases which are followed by frustration of a chair. Prevention of developments of stagnation in the field of a basin is promoted by regular walks, walking, physical culture. Quickly revealed and in due time treated conservatively anal crack completely recovers in 60-90% of cases. Inadequate treatment, self-treatment, tightening of the address to the doctor promotes development of a chronic anal crack that worsens the forecast and can result in need of surgical treatment. Surgical excision of an anal crack leads to recovery in most cases.