Chronic anal crack – it is long not healing defect of a mucous membrane in a zone of the anal channel. It is shown by the burning pains arising at the time of an excrement and remaining within several minutes or hours. At patients the itch, increase in a tone of a sphincter and allocation of drops of blood are observed during the act of defecation. The chronic anal crack is diagnosed on the basis of complaints, survey of perianalny area, an anoskopiya, a rektoromanoskopiya, an irrigoskopiya and other researches. Treatment – a diet, medicines of the general and local action, physiotherapeutic procedures, a side sfinkterotomiya, is more rare – the isolated fissurektomiya.
Chronic anal crack
Chronic anal crack – the widespread pathology which is followed by education it is long not healing defect, a wound or an ulcer in a zone of transition of an anoderma to a mucous membrane of an opening of back pass. The chronic anal crack is diagnosed for 2-2,5% of inhabitants of Earth aged 18 years are more senior. Is a proktologichesky disease, the third on prevalence, after hemorrhoids and a paraproktit. The share of the given pathology in the general structure of proktologichesky incidence fluctuates from 12 to 15%. Speak about a chronic form of a disease in cases when duration of existence of a crack exceeds 6-8 weeks. After existence during the marked time defect of mucous gains the lines characteristic of chronic processes and interfering healing. Treatment of a chronic anal crack is performed by experts in the sphere of a proktologiya.
Reasons of a chronic anal crack
Function of a sphincter of back pass on keeping of gases and kalovy masses is implemented, thanks to two muscular components: to the external sphincter consisting of cross muscular tissue and the internal sphincter formed by gladkomyshechny fibers. Activity of an external sphincter is regulated randomly, activity of internal is provided at the expense of a tone of smooth muscles. The increase in a tone of muscles caused by various pathological and physiological influences involves a sdavleniye of vessels and deterioration in blood supply of fabrics in the field of back pass. Especially strongly the back wall of the anal channel in which less vessels, than in other sites of an anus usually settle down suffers.
Deterioration in blood supply of this anatomic zone and trauma when passing kalovy masses via the narrowed anal channel become the reason of education is long not healing defect (a chronic anal crack). Because of the raised sphincter tone defect disappears pleated fabrics and is badly cleared in the natural way. There is an inflammation provoking further increase in a tone of an internal sphincter and aggravating the arisen violations. The vicious circle is formed. 1,5-2 months later from the moment of emergence of defect of edge of a crack are condensed, in a disteel part there are growths of granulations, gladkomyshechny fibers at the bottom appear.
The reason of increase in a tone of an internal sphincter and formation of a chronic anal crack are injuries when passing too firm kalovy masses or at ponosa, an excessive natuzhivaniye at locks, increase in pressure in a sphincter at a raising of weights, anal sex, violation of the technology of washing of a rectum when using an enema and rough introduction of medical tools. Women the factors provoking development of a chronic anal crack can also have a patrimonial activity, the wrong maintaining the postnatal period and a travmatization of defecation, mucous during the first act, after the delivery (at refusal of an enema or depletive).
Symptoms of a chronic anal crack
The classical triad of symptoms of a chronic anal crack includes a sphincter spasm, a pain syndrome and bleeding during the act of defecation. Sometimes at a chronic form of a disease one or several symptoms from the listed triad are poorly expressed or appear irregularly. At a typical course of disease in the course of defecation the patient with a chronic anal crack has burning sharp pains remaining within several minutes or hours. The expressed pain syndrome can be followed by fear of the act of defecation because of which the patient "postpones" visit of a toilet that involves consolidation of fecal masses and a further travmatization of field of anal pass.
Bleeding at a chronic anal crack insignificant. Usually bloody and mucous allocations are found in the form of dabs on toilet paper or underwear or become visible at hit a calla in a toilet bowl because of water coloring change. The spasm of a sphincter is revealed when carrying out a manual rectal research. The patient with the chronic anal crack which is followed by the expressed pain syndrome before the research carry out anesthesia. At advance of a finger find strong pressure. The finger moves ahead hardly, in the absence of preliminary anesthesia patients report about strengthening of pain.
At long existence of pathology complications of a chronic anal crack in the form of suppuration or rigidny narrowing of the anal channel are possible. At suppuration abscesses or fistulas of a rectum can be formed. At rigidny narrowing of the anal channel there are violations of the act of defecation. The patient with a chronic anal crack can be emptied only at a strong natuzhivaniye, the kcal departs in the form of a narrow tape. Locks develop. For normal depletion of intestines patients should use enemas or depletive constantly.
Diagnostics of a chronic anal crack
The disease is diagnosed on the basis of complaints, data of survey of anal area, a rectal research and an anoskopiya. For identification of the secondary changes of a rectum caused by a chronic anal crack and also for performing differential diagnostics proctologists use a rektoromanoskopiya, an irrigoskopiya, a proktoskopiya, carry out the analysis a calla on and other researches. The chronic anal crack settles down on a gut axis, as a rule – on a back wall of the anal channel. Less often the forward cracks and "mirror" defects which are the friend opposite to the friend on a forward and back wall come to light.
In most cases an external part of a chronic anal crack is looked through at cultivation of buttocks. Full patients and patients with intensive pains can have not productive results of survey of anal area. Palpatorno in the field of defeat is defined the condensed painful site. When carrying out an anoskopiya the chronic anal crack is looked through as defect of a slit-like, ellipse or linear form. The edges of defect condensed, uneven, are at the bottom visible granulations and a grayish raid.
Differential diagnostics of a chronic anal crack is performed with thrombosis of gemorroidalny knots, nonspecific ulcer colitis, a disease Krone, proktity, rektosigmoidity, syphilitic and tubercular damage of a rectum, and also with HIV infection. At suspicion of syphilis and AIDS during the poll focus attention on sexual orientation and sexual habits of the patient, if necessary direct the patient to consultation to the venereologist.
Treatment of a chronic anal crack
Conservative and operational techniques are applied to treatment of this pathology. As usually the otkhozhdeniye of too dense kalovy masses is the main reason for a constant travmatization of field of anal pass, a part in treatment of a chronic anal crack is played by normalization of a chair by means of a diet and correctly picked up depletive. Chronic defects of fabrics badly give in to healing even after elimination of the injuring factors therefore the listed actions in itself (unlike sharp cracks) do not provide recovery and are only a necessary basis for use of other methods of treatment.
For decrease in a tone of an internal anal sphincter at a chronic anal crack use in the form of injections, donators of nitrogen oxide in the form of ointments and blockers of calcic channels orally. Healing of defect when using blockers of calcic channels and donators of nitrogen oxide manages to achieve from 40-70% of the patients suffering from a chronic anal crack, at the same time at a half of patients the disease recurrence during 1 year comes to light. In other cases medicamentous therapy does not provide desirable result, or treatment should be interrupted because of emergence of side effects.
Healing of a chronic anal crack after a three-months course of injections of a botulotoksin is noted at 80-90% of patients. A recurrence is observed less than when using other conservative methods. 4-10% of patients with a chronic anal crack in the course of therapy have an incontience a calla and gases disappearing after end of a course of treatment. A lack of a technique is its high cost. At inefficiency of conservative methods of treatment carry out a side sfinkterotomiya. In some cases carry out excision of an anal crack (the isolated fissurektomiya).