WHAT IS ANAL FISSURE?
It is a rupture that occurs in the breech channel and continues until the opening. The mechanism is generally known to occur when a stiff feces occurs in the breech channel during discharge or due to increased pressure due to prolonged strain. Constipation is the most common cause, but can also be seen in people who do not have constipation. The reason for this can be explained as follows: in patients with anal fissure,� working normally out of control and normally remain muscular, keeping the breech of the bladder closed, which is due to the fact that the muscle layer more tight than normal, even if constipation is caused by the occurrence of hard� stools and� related tears. In addition, the tears often on the breech posterior wall, in some people, this region is weaker in terms of blood circulation feeding and the blood vessels during the shrinkage of the blood shrinkage decreased and the rupture is easier.
WHAT ARE THE REASONS OF ANAL FISSURE?
Anal fissure is quite common among the anal region diseases and is usually the disease of young adults. The most common reasons;�
- Constipation, prolonged straining, straining with hard feces
- Irritations due to frequent use of the breech duct in cases of diarrhea
- Excessive consumption of spicy and bitter foods�
- Long lasting time in the toilet�
- Continuous deferment of the need for toilet�
- Anal intercourse
- Following stenosis due to previous operations�
- Inflammatory bowel diseases (Sometimes Chron and Ulcerative Colitis may be the first sign of disease)
WHAT ARE THE SYMPTOMS OF ANAL FISSURE?
The most common reason for presentation is pain in the rectum. During defecation, a pain in the form of rupture, described as a glass incision, is felt. Many of the patients postpone excretion to avoid this pain and the hardening of the waiting stool inside becomes more painful, and the event becomes vicious.
Another complaint is rectal bleeding. It is small in color and bright red and appears at the end of excretion. Some patients also complain of itching. Due to the secretions from the torn area, wetness and itching are observed.�
Depending on the chronic anal fissure, there may be a small breast (skin tag = hypertrophic papilla) on the outside of the anus. It is a growing skin extension due to the tear that tries to heal itself. It is an indication that the incident is old and chronic. It can cause breech stenosis when it is very advanced.
HOW TO DIAGNOSE ANAL FISSURE?
It is possible to diagnose easily with the patient's history and examination. An anal examination on the knee and elbows shows the fissure line in the form of a cut-out, inwardly extending, in the side of the anus that usually appears on the side of the tail. Due to the pain in the breech muscles due to spasm during rectal touch is not made during the examination. If more than one rupture is seen around the breech during examination, further investigation should be performed to avoid an underlying disease (cancer, HIV, tuberculosis, Chron, ulcerative colitis).
HOW TO TREAT ANAL FISSURE?�
In patients presenting with anal fissure, firstly, lifestyle changes, constipation, fiber-rich diet and some medications are tried. In spite of these, botox application can be performed in patients who have complaints. Due to the botulinum toxin, the spasm on the breech muscle, which is the cause of the event, is relieved and the muscle is relaxed and thus defecation is facilitated. However, the maximum activity is 5-6 months and must be repeated. In this way, approximately 70% of the patients are relieved. The disadvantage of the method is that the muscles can temporarily lose gas and feces due to loosening.
Surgical treatment in anal fissure is presented to the patient as the last option. In patients who have complaints despite medical treatments and lifestyle changes and who have severe pain to discontinue excretion, lateral internal sphincterotomy is performed. In the breech canal, the muscle in the spasm is cut off. The procedure is short term and is performed under general or spinal anesthesia.