Anal Fissure Treatment
Anus skin is a very sensitive area due to its dense nerve ending content. In addition, it is surrounded and tightened by two different and intertwined muscle layers. Especially in cases of difficult defecation when the body is not ready to defecate, or in cases of diarrhea where the anus is very irritated, tears may occur in this area. These tears, which are extremely painful, cause spasm in the muscles and are exposed to more pressure, and the tear does not have a chance to heal because their blood circulation is insufficient.
Patients feel severe pain when defecating. They feel as if they are removing small pieces of glass. However, the real pain occurs at the end of defecation and can last for hours. These pains can be so severe that they distract the person from their daily life.
Unfortunately, anal fissures, which are often described as “hemorrhoids” or “hemorrhoids”, are tried to be treated with some unnecessary and useless drugs, and even worse, it can go as far as hemorrhoid surgery. Because a small breast may form outside in a few weeks in fissures and this breast can be evaluated as a hemorrhoid breast and a diagnosis of hemorrhoid disease can be made.
The first step in the treatment of anal fissure is to determine whether the patient has a concomitant large bowel problem. However, finger examination and colonoscopy should not be performed until a patient with acute fissure is partially relieved.
The patient’s defecation habit should be questioned in detail and correct defecation recommendations should be made.
In the first stage, patients are recommended to take a shower at least twice a day, one after defecation, to set the water as hot as it can stand but not burn, and hold it to the rectum for fifteen minutes.
The next step in the treatment of anal fissure is the injection of botulin poison, popularly known as “botox”, into the anus. This method, which is successful at a rate of about 70%, temporarily acts with partial paralysis of the breech muscles.
Surgery is the last resort for anal fissure. In the surgery, the inner part of the muscles that contract the anus is cut and the blood circulation of the wound is increased and it is healed by itself. Although the success rate is around 98-99% when done correctly, it should be considered as the last option, especially in female patients, since it can cause problems such as gas incontinence in 3-5% of patients, and stool incontinence in case of diarrhea, and the treatment of these problems is almost impossible.
A common problem is fissures that do not heal despite surgery. Investigations in most of these patients reveal that the wrong muscle was cut. For this reason, although it may seem very simple, it is of great importance that the operation be performed by an experienced surgeon.
Anal fissure heals with medical treatment and lifestyle changes. This is an acute anal fissure. However, if it recurs within 6-8 weeks despite treatment and all precautions, this condition is called chronic anal fissure.
The current best treatment for chronic anal fissure is lateral internal sphincterotomy, and tailored LIS is performed in our clinic.
Flesh, sagging, or lingual appendage of the skin in the anal fissure is due to chronic lymphatic stasis. The presence of swelling suggests that there may be hemorrhoidal disease or abscess.