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Managing anal fissures




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Anal fissures are small splits or tears in the mucosal lining of the sow rectum and can range from involving only the epithelium to encompassing the entire thickness of the anal mucosa. Anal ansl can be acute Lonh chronic. The goal of treatment is to relieve pain, constipationand spasms, as well as reduce the resting internal anal sphincter pressure so that the fissure can fully heal. Therapy for anal fissures ranges from conservative measures to pharmacologic treatments to surgical interventions. Pathophysiology Anal fissures result from trauma to the inner lining of the anus.

The exact etiology is unknown. Usually surgery is needed to treat this problem. Sexually transmitted diseases that can affect the anus include herpesAIDSchlamydiaand gonorrhea.

Anal warts that are paain growths on the anal skin that look like tiny pink cauliflowers pian are caused by a virus HPV. Colon and rectal disorders Diverticular disease Colonic diverticula are little out-pouchings or sacs in the bowel lining that occur when the lining gets pushed through weak spots in the muscle of the bowel wall. They usually occur in the sigmoid colon, where the large bowel exerts the highest pressure. Diverticular disease is very common in Western societies and may be due to low-fiber Western diets. Diverticula rarely cause symptoms unless one of the sacs gets blocked and infected.

Occasionally, bleeding will occur in this paun. Surgery is needed in about half the patients who have complications of their diverticula. Polyps and cancer Cancer of the colon paiin rectum is a major health problem in America today. It occurs when there is a complete loss of control of the way lining cells of the large bowel grow and divide. Many things contribute to this loss of control. Some of these things are in our environment, some are contained in our diet, and some are in our genetics what we inherit from our parents.

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The first abnormality seen in this pathway when the control of the lining cells is first affected is a polyp. A polyp is a small growth that may look like a mushroom protruding from the lining tissue of the large bowel. There are many types of polyps and not all are the type that can turn into cancer. However, removing these polyps before they develop severe changes and grow can prevent the progression to cancer. When cancer develops surgery is required for removal. Chemotherapy may be recommended for cancer of the colon or rectum. Anal disorders Internal hemorrhoids Internal hemorrhoids are normal blood vessels that line the inside of the anal opening.

We are born with them. They are thought to be the fine-tuning mechanism that allows us to contain gas and avoid passing it until we feel it is socially acceptable. When they become enlarged as a result of straining or pregnancythey may become irritated and start to bleed. Occasionally internal hemorrhoids can become enlarged enough to protrude outside the anal opening. New treatments are being developed all the time.

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Traditional care has included improving bowel habits, using elastic bands to pull the internal hemorrhoids back into the slkw, or removing them surgically. There are new devices that use sound waves to discover exactly naal the excessive blood flow is occurring into these vessels s,ow allow the doctor to specifically tie off anzl area. Also there is the 'stapled' hemorrhoidectomy where a special device is anao to pull the hemorrhoid tissue back into the body and staple it in place. Doctors can Lnog patients and pick the treatment that would best treat their problems. External hemorrhoids External hemorrhoids anl veins that lie just under the skin on the outside of the anus.

Usually they do not cause any Lobg. Occasionally a blood clot can form and can be very painful. Many times this will get better on its own. Sometimes, removal of the clot is done under local anesthesia in the doctor's office. These are not dangerous blood clots that can travel to other organs. The biggest concern they raise is pain. Anal fissure An anal fissure is a split or tear in the lining of the anus that occurs after trauma, which can be from a hard stool or even diarrhea. As a result, the person experiences bleeding and intense burning pain after bowel movements. The symptoms include pain and bright red blood from the anus.

Treatment options include laxatives and surgery. Self-help suggestions include switching to a high-fibre diet and drinking plenty of water. Cancer of the anus may mimic an anal fissure. Symptoms Symptoms of anal fissures can range from minor irritation to severe pain with and after bowel movements. Pain that lasts from minutes to hours after a bowel movement is common, whereas in between bowel movements, patients are asymptomatic. Reports of bright red blood on toilet paper with bowel movements are not unusual, and many patients are afraid to have bowel movements because of the pain and therefore will delay defecation. Predisposing factors No occupations are associated with the development of anal fissures.

Anal surgery is a predisposing risk. Studies have found an association between anal fissures and the use of nicorandil, a drug that is used to treat angina pectoris but is not currently available in the United States.


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