Anal fissure treatment
Treatment of anal fissure depends on degree and duration of its existence.
Acute anal fissures are treated by medications with better result. High effect of treatment we admit in 65-70% of patients. The most important part of conservative treatment of anal fissure is liquidation of anal pain and spasm of sphincter and only after this, normalization of bowel movement and healing of anal tear become possible. Mostly this treatment is outpatient.
Patient should follow three the most important conditions:
- exclude alcohol, and spicy, soul, salty, bitter, fried food. Boiled beet (200-300g) with oil or soul cream is very useful. We recommend also eating a lot of damson, dried apricot and fig. Most of patients who go on this diet have soft bowel movement. For patient with constipation we recommend diet № 3, with diarrhea - diet № 4b and 4c (Pevzner`s classification).
- limit elevation of heavy things
- normalization of bowel movement (hard excrements break healing of fissure). That’s why it’s better to use laxatives, for example Forlax. If patient has diarrhea we prescribe adsorbents, ferments, pro- and pre-biotic. Every morning 30min -1 hour before defecation (it should be in the same time every day) patient should use suppository with anesthetic (Posterisan-forte, Posterisan). After defecation there is necessary to wash perianal area by breezy water and use again suppository with anesthetic. Subsequently it’s better to take sedentary bath (water should be warm – 37-39C). Duration of sedentary bath is 15-20min. After this we recommend to smear anal canal by unguent (Posterisan-forte, Posterisan). Patient should follow this treatment 2-3 weeks, and if it necessary to repeat it in 1-1,5 month.
If fissure is acute and non very deep but bleeding occurs often sometimes we apply non operative technique infrared coagulation of anal fissure, the principle is based on photocoagulation of tissue by light stream. The duration of influence is controlled by timer. We apply infrared coagulation of anal fissure under local anesthesia. From 4-8 points we impact on ends, bottom of fissure and border hill. The duration of procedure is 1-3sec. There is possible to apply this method even if patient is pregnant. The result of treatment of chronic anal fissure is much worse and recurrence occurs much oftener. If conservative therapy of chronic anal fissure is not effective during 1month proctologist should offer radical treatment - excision of anal fissure This technique can be performed in or out-patiently, it depends on the level of spasm of sphincter, localization of fissure, existence of border hill. The reason of excision of anal fissure is liquidation of scar tissue at the ends and bottom of fissure.
Created during operation «fresh» wound is healed easily by medications.
The indications for surgical treatment of anal fissure:
- Consequent pain
- Non effective medication treatment during 15-20 dais
- Complications (anal fistule)
- Anal fissure with hemorrhoids ІІІ and ІV degree
The methods of surgical treatment of anal fissure:
1. Excision of anal fissure (excision of scar tissue of anal canal and perianal skin)
2. Excision of anal fissure with posterior internal sphincterotomy (cut of internal sphincter performs to remove spasm of sphincter and consequently pain).
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