Important Facts About Hemorrhoids | Temple Health

Let’s face it: no one really wants to talk about hemorrhoids. But did you know it’s one of the most common gastrointestinal issues in the country? About 1 in 20 Americans has them.

I know hemorrhoids are embarrassing to talk about, but as a gastroenterologist I’ve helped many people find relief from this uncomfortable condition. Simple lifestyle changes (including stopping one very common habit) can help you treat or reduce the risk of getting hemorrhoids.

Here are answers to common questions that many patients have about hemorrhoids.

What are hemorrhoids?

Hemorrhoids, also sometimes called “piles,” are inflamed or swollen veins in the rectum or anus. They can be painful or itchy and may bleed.

Hemorrhoids can be external or internal. External hemorrhoids form under the skin around the anus and can easily be felt with your fingers. Internal hemorrhoids form in the lining of the anus or lower rectum, and you can’t feel them unless they form outside the anal opening.

Hemorrhoids generally don’t cause serious health problems, but they can be uncomfortable. Certain behaviors and habits could make you more likely to get hemorrhoids. 

How do hemorrhoids form?

We don’t always know what causes hemorrhoids. But they usually develop when too much pressure is placed on the veins around the rectum or anus. When someone has constipation or diarrhea, it can cause straining that leads to this pressure to develop. This can also happen if their bowel isn’t functioning properly from using laxatives or enemas too often.

What common habit can lead to hemorrhoids?

Many of my patients are surprised to learn that sitting on the toilet for long periods can also lead to hemorrhoids. The shape of the toilet seat puts extra pressure on the rectum and anus. This can cause the veins to become swollen when you sit there for a long time. Then when you’re pushing hard during a bowel movement, you’ve got the potential for hemorrhoids.

Some people need more time to move their bowels than others. But when I ask my patients about their bathroom habits, I often hear about one that is contributing to their hemorrhoids: smartphone usage. Yes, many of us are spending too much time scrolling the web while sitting on the toilet.

What other risk factors can cause hemorrhoids?

Older adults are more prone to hemorrhoids because their supporting rectal tissues are weaker. People who are pregnant, especially those in their third trimester, may also experience hemorrhoids due to a combination of constipation and increased rectal pressure from a growing fetus.

How can I tell if I have hemorrhoids?

Hemorrhoids are hard to miss, so if you think that you might have one, there’s a good chance that you’re right. Some of the common signs and symptoms include:

• Pain around the anal area, especially when sitting or straining. Rubbing or cleaning the area could also cause more pain.
• Itching around the anal area.
• A feeling of skin protruding during bowel movements.
• Bleeding during bowel movements, which you might notice as blood in your stool, in the toilet bowl, or on toilet paper after wiping.
• Sensitive lumps around the anal area. 

What’s the best way to treat hemorrhoids?

Hemorrhoids can be managed right at home within the course of a week. When a patient has a mild hemorrhoid, I typically recommend the following:

• Keep bathroom trips short. Limit toilet use to 1 to 2 minutes at a time as much as you can and avoid straining whenever possible.
• Eat more fiber and drink more water. Get 25 to 30 grams of fiber daily, either from fiber-rich foods (such as whole grains, fruits, vegetables, and beans) or supplements (such as Metamucil or Benefiber). This helps make stools easier to pass, reducing the need to strain.
• Try over-the-counter remedies. I frequently recommend hemorrhoid wipes with Witch Hazel, which help to gently cleanse the area while reducing swelling and pain. Hemorrhoid creams are also helpful, but should only be used in moderation as long-term use has side effects. Taking Tylenol is another option, but if your pain is severe and getting worse, you should seek medical care immediately.
• Apply an ice pack to the hemorrhoid area. Ice for 5 to 10 minutes at a time, but not any longer. Place a towel between the ice pack and your skin.
• Take sitz baths several times a day. Spend 10 to 20 minutes sitting in a sitz bath, a shallow amount of warm water. You can add Epsom salt or baking soda to the water to reduce inflammation, but avoid adding soap or bubble bath.
• Clean up after a bowel movement. Wet the area with a peri bottle, which you can buy at a drugstore. Fill the bottle with warm water and apply to the swollen area.
• Regular physical exercise. Exercise helps to promote gastrointestinal motility and reduce constipation.
• Limit intake of fatty foods and alcohol. These can worsen constipation.

Very painful or severe hemorrhoids may need to be treated with a surgical procedure performed by a physician. Depending on the size and location of the hemorrhoid, a gastroenterologist and colorectal surgeon can help determine the best procedure for you.

Do I need to see the doctor for a hemorrhoid?

Hemorrhoids can be treated at home, but you should let your doctor know if your symptoms haven’t improved after a week. In some cases, a hemorrhoid could be infected. Serious conditions — such as Crohn’s disease, ulcerative colitis, and colon cancer — can also cause rectal bleeding, so it’s important to have the condition examined if it isn’t getting better. (Keep in mind that hemorrhoids do not cause colorectal cancer or increase a person’s risk for it.)

Can hemorrhoids be prevented?

Hemorrhoids can’t always be avoided, but the steps to help prevent hemorrhoids are similar to the ones I recommend for coping with them:

• Sit on the toilet if you have the urge to go, but not longer. Try not to spend more than 10 or 15 minutes having a bowel movement and avoid straining or forcing. If you’re having trouble going, it’s better to get up and try again later than to simply keep sitting there.
• Limit distractions. It’s fine to read or look at your phone while you’re sitting on the toilet for a few minutes. Just set a timer so you don’t end up staying there for too long. (And clean your phone with an antibacterial wipe afterward.)  
• Eat more fiber. If you’re regularly having trouble going, adding more high-fiber foods to your diet can help. So can limiting your intake of low-fiber foods like cheese, meat, ice cream, fast food, and highly processed snacks.
• Avoid heavy lifting when possible. Straining to lift can put excess pressure on the rectal and anal veins.  

Get help for hemorrhoids

You don’t have to suffer with hemorrhoids. Schedule an appointment with a Temple Digestive Disease Center physician if you’re experiencing rectal bleeding, frequent hemorrhoids or constipation.

Helpful Resources

Looking for more information?

• Watch the Temple Health and 6ABC Segment on Hemorrhoids 
• What If Treating Hemorrhoids at Home Doesn’t Work? 
• How to Tell If You Have Constipation?
• Read About Other Hemorrhoid Treatment Options 

Hemorrhoids: Signs, Diagnosis, and Treatment

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Hemorrhoids happen when the veins around your anus become swollen, often due to straining during a bowel movement or constipation. Certain types of hemorrhoids may cause severe pain.

Hemorrhoids are swollen veins located around the anus or in the lower rectum. About 50 percent of adults experience the symptoms of hemorrhoids by the age of 50.

Hemorrhoids can either be internal or external. Internal hemorrhoids develop within the anus or rectum. External hemorrhoids develop outside of the anus. Hemorrhoids are also known as piles.

External hemorrhoids are the most common and most troublesome. Hemorrhoids may cause pain, severe itching, and difficulty sitting. Fortunately, they’re treatable.

Symptoms depend on the type of hemorrhoids you have.

Internal hemorrhoids can cause:

• blood on the tissue after having a bowel movement
• skin that sticks out of the anus during bowel movements

External hemorrhoid symptoms include:

• extreme itching around the anus
• uncomfortable lump(s) or swelling near your anus
• aches or pain around the anus, especially when sitting

Hemorrhoids often don’t cause pain. However, sometimes external hemorrhoids can form a blood clot on the skin. This is known as a thrombosed hemorrhoid. Internal hemorrhoids can also prolapse. That means they won’t retract back into the anus. Both prolapsed and thrombosed hemorrhoids can cause significant pain.

Although hemorrhoids can be quite uncomfortable, they aren’t life threatening and often go away on their own without treatment.

If you ever have bleeding or black bowel movements, see your doctor. Bleeding can be caused by something other than hemorrhoids and must be evaluated. Also see your doctor if hemorrhoids don’t get better within 1 week of home treatment.

Hemorrhoids occur when there’s too much pressure on the veins around your anus. Possible causes and risk factors include:

• straining during a bowel movement
• sitting for a long period of time, especially on the toilet
• having chronic constipation or diarrhea
• having a family history of hemorrhoids
• engaging in consistent heavy lifting or other activities that strain your body
• having obesity
• having anal sexual intercourse, which can irritate hemorrhoids
• being pregnant (an enlarged uterus presses on the vein in the colon, causing it to bulge)
• being over the age of 50

A visual examination of your anus may be enough to diagnose hemorrhoids. To confirm the diagnosis, your doctor may do a different examination to check for any abnormalities within the anus.

This check is known as a digital rectal exam. During this exam, your doctor inserts a gloved and lubricated finger into your rectum.

Depending on your risk factors for gastrointestinal disease, your doctor may order an additional test like an anoscopy, sigmoidoscopy, or colonoscopy.

Each of these tests involves your doctor using a small camera to diagnose any abnormalities in your anus, rectum, or colon.

An anoscopy examines the inside of your anus, a sigmoidoscopy examines the last 2 feet (50 centimeters) of your colon, and a colonoscopy explores the entire colon.

In these tests, a small fiber-optic camera fits into a small tube that’s inserted into your rectum. With this test, your doctor gets a clear view of the inside of your rectum so that they can examine the hemorrhoid up close.

You can find a primary care doctor, gastroenterologist, or other specialist near you through the Healthline FindCare tool.

You can have hemorrhoids treated at home or at a doctor’s office.

Pain relief

To minimize pain, soak in a warm tub of water for at least 10 minutes every day. You can also sit on a warm water bottle to relieve the pain of external hemorrhoids.

Find out how to make a warm compress at home.

If the pain is unbearable, use an over-the-counter (OTC) medicated suppository, ointment, or cream to relieve the burning and itching. You can find hemorrhoid suppositories online or in stores.

Fiber supplements

If you’re constipated, you can also use an OTC fiber supplement to help soften your stool. Two common supplements of this type are psyllium and methylcellulose.

Home remedies

OTC topical treatments, such as hydrocortisone or hemorrhoid cream, can ease your discomfort from hemorrhoids. Witch hazel pads can offer hemorrhoid relief as well.

You can buy both hydrocortisone and hemorrhoid cream online.

Soaking your anus in a sitz bath for 10 to 15 minutes per day can also help.

Practice good hygiene by cleaning your anus with warm water during a shower or bath every day. But don’t use soap, as soap can aggravate hemorrhoids. Also avoid using dry or rough toilet paper when you wipe after a bowel movement.

Using a cold compress on your anus can help reduce hemorrhoid swelling. Pain relievers, such as acetaminophen, ibuprofen, or aspirin can also alleviate the pain or discomfort.

Learn how to make a cold compress at home.

Medical procedures

If home treatments aren’t helping with your hemorrhoids, your doctor might recommend getting a rubber band ligation. This procedure involves the doctor cutting off circulation to the hemorrhoid by placing a rubber band around it.

This causes loss of circulation to the hemorrhoid, forcing it to shrink. This procedure should only be performed by a medical professional. Don’t try this by yourself.

If rubber band ligation isn’t an option in your case, your doctor may perform injection therapy, or sclerotherapy. In this procedure, your doctor injects a chemical into the blood vessel directly. This causes the hemorrhoid to reduce in size.

To prevent or avoid worsening hemorrhoids, avoid straining during a bowel movement. Also, try to increase your water intake. Drinking enough water can keep your stool from hardening.

Use the restroom as soon as you feel a bowel movement coming on to prevent hemorrhoids from developing. Exercise regularly to prevent becoming constipated, and avoid sitting for long periods, especially on hard surfaces like concrete or tile.

Consuming foods that are high in dietary fiber can minimize the risk of developing hemorrhoids in the future.

Good dietary fiber sources include:

• whole wheat
• brown rice
• oatmeal
• pears
• carrots
• buckwheat
• bran

Dietary fiber helps create bulk in the intestines, which softens the stool, making it easier to pass.

Complications from hemorrhoids are rare, but can include:

• blood clots in the swollen vein
• bleeding
• iron deficiency anemia caused by blood loss
• infection of an external hemorrhoid
• skin tags, or excess skin when an external hemorrhoid goes away

With proper treatment, you’ll likely experience an improvement. Following your doctor’s directions and maintaining a regimen, including exercising and avoiding sitting for long periods of time, can also improve your outlook.

Hemorrhoids are enlarged and bulging veins in and around the anus and rectum. They’re very common and caused by strain on the rectal veins. Risk factors include experiencing chronic constipation, pushing during bowel movements, having a family history of hemorrhoids, and being pregnant.

Most hemorrhoids go away on their own. Treatments usually focus on relieving symptoms and may include taking warm baths and using a hydrocortisone or a hemorrhoid cream or suppository. Exercising, drinking plenty of water, and eating more fiber can all help relieve constipation and prevent hemorrhoids from forming in the future.

Pain in the anus – the causes of occurrence, in what diseases it occurs, diagnosis and methods of treatment

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Pain in the anus: causes of occurrence, in which diseases it occurs, diagnosis and methods of treatment.

Definition

Pain that occurs in the anus (anus) is accompanied by significant discomfort, and its intensity is due to the presence of a significant number of nerve endings here.

Types of pain in the anus

Pain in the anus can be characterized as dull and aching, burning, sharp, piercing, spasmodic, radiating to the lower abdomen, coccyx and perineum. Often, a doctor can make a preliminary diagnosis based on the nature of the pain.

Pain may disturb when walking, sitting for a long time, at the time of defecation and immediately after it.

Possible causes of pain in the anus

The main causes of pain in the anus are diseases of the rectum. An assessment of their prevalence brings hemorrhoids to the first place. The initial symptoms of hemorrhoids are a feeling of incomplete emptying after defecation, discomfort and itching in the anus.

Pain with hemorrhoids appears only with a complication of the disease – prolapse and thrombosis of the hemorrhoid.

The development of hemorrhoids is caused by hereditary factors, as well as an unhealthy lifestyle, poor nutrition, and certain diseases, such as cirrhosis of the liver. Prolonged sitting, hot baths, heavy lifting, tight clothing – all these factors lead to venous congestion in the pelvic area and the formation of hemorrhoids. If at the same time the feces have a dense consistency due to a lack of fluid and plant fibers in food, then the act of defecation is accompanied by prolonged straining, which, in turn, contributes to the prolapse of nodes into the lumen of the rectum.

Hemorrhoids can occur with the abuse of laxatives and cleansing enemas.

Protrusion or prolapse of hemorrhoids, their infringement is accompanied by a feeling of pulling pain, fullness, itching. Symptoms are worse after spicy food, heavy physical labor, heavy lifting. Rupture of blood vessels leads to persistent bleeding, while clots of scarlet blood are clearly visible on the feces. A long-term disease leads to pain in the anus with any physical activity, being in an upright position or walking.

Among the diseases that cause pain in the anus, the second place is occupied by sphincteritis – inflammation of the mucous membrane of the circular obturator muscle. Sphincteritis most often develops against the background of diseases of the gastrointestinal tract: pancreatitis, peptic ulcer of the stomach and duodenum, chronic gastritis and duodenitis, irritable bowel syndrome. Constipation or diarrhea that accompanies these diseases increases the risk of developing inflammatory processes in the rectum. In the initial stage of the disease, patients complain of pain in the anus, burning and itching, which are aggravated by defecation. Then there are false urges to defecate and purulent discharge from the anus, so foaming mucus or pus is found on the feces. Sometimes pain can radiate to the perineum and neighboring organs.

The third place in the prevalence of diseases of the rectum, which give severe and persistent pain in the anus, is occupied by rectal fissures . This pathology is characterized by pain during and after defecation, and a small amount of blood may be released.

Cracks can be caused by congestion in the vascular network, a violation of neuromuscular regulation, and injuries. The latter are most often caused by damage to the intestinal mucosa with solid feces.

Often, cracks are combined with hemorrhoids, which is accompanied by prolapse of nodes and more profuse bleeding. The combination of these conditions leads to the formation of a vicious circle: pain during bowel movements causes spasm of the anal sphincter muscles, and spasm increases pain. Minor bleeding due to anal fissure occurs during or after a bowel movement. In the absence of timely treatment, the disease becomes chronic and is accompanied by inflammation of the surrounding tissues. Sometimes a crack leads to a fistula (fistula) – a pathological passage between the rectum and the surface of the skin near the anus.

Paraproctitis also leads to the formation of a fistula of the rectum. This is an acute inflammation of the tissues surrounding the rectum.

Paraproctitis is evidenced by increased pain, swelling in the anus, an increase in body temperature to 38 ° C and above.

The fistula may not close for several months, and then recur.

Malignant tumors that form in the anal area are characterized by pronounced symptoms: red blood in the feces, mucus admixture, pain in the anus (first during defecation, and then throughout the day), radiating to the genitals, thigh, underbelly. Clinical symptoms of hemorrhoids and malignant tumors are similar to each other.

Pain in the anus is not necessarily associated with diseases of the rectum. It can be caused by pathologies of adjacent organs and tissues, in particular, epithelial coccygeal passage , which manifests itself as pain in the sacrum only in case of inflammation. This formation is formed during the period of embryonic development and is a narrow channel lined with epithelium, inside of which there are hair follicles and sebaceous glands.

Another cause of pain in the anus – coccygodynia – inflammation in the coccyx.

Most often, coccygodynia is caused by trauma to the coccyx as a result of a blow or fall.

In a significant proportion of cases, coccygodynia is a spasm of the deep muscles of the pelvic floor as a result of irritation of pain receptors in surrounding tissues during radiculopathy, difficult childbirth, and inflammatory diseases of the pelvic organs. Pain in the anus appears at a certain position of the body, during inclinations or the act of defecation.

Pain in the anus is also characteristic of prostatitis . In acute prostatitis, in addition to acute pain in the perineum, groin and in the anus, an increase in body temperature, painful urination and defecation are possible. However, more often prostatitis develops gradually, acquiring a chronic form. In this case, the patient is concerned about the same symptoms, but their severity is significantly reduced.

Diagnostics and examinations for pain in the anus

Diagnostics begins with a thorough questioning of the patient, during which the doctor specifies the intensity, duration and nature of the pain syndrome, previous and concomitant diseases. In addition, without fail, the doctor gives directions for clinical and biochemical blood tests, a general urine test.

Clinical blood test: general analysis, leukoformula, ESR (with microscopy of a blood smear in the presence of pathological changes)

Synonyms: Complete blood count, UAC. Full blood count, FBC, Complete blood count (CBC) with differential white blood cell count (CBC with diff), Hemogram.
Brief description of the study CBC: general a…

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General urinalysis (Urine analysis with sediment microscopy)

Method of determination

Determination of physical and chemical parameters is carried out on an automatic analyzer using the “dry chemistry” method.

Hardware microscope…

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If anal pain is suspected, the doctor will perform a digital examination of the rectum. In the presence of a chronic crack, not only its localization is determined, but also the type of edges. With a digital examination, you can notice a fistula with a purulent discharge and determine the spastic contraction of the sphincter. In the presence of hemorrhoids, sigmoidoscopy is necessary.

If the digital examination reveals tenderness of the inner surface of the coccyx and its mobility, the doctor may prescribe an x-ray, which can detect subluxation of the coccyx, especially when dynamically examined in a sitting and lying position.

Radiography of the lumbar and sacral spine

X-ray examination to assess the condition and structural integrity of the vertebrae of the lumbosacral-coccygeal spine.

RUB 2,440

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If pelvic pain is suspected, an ultrasound of the abdominal cavity and small pelvis is prescribed, and for men, an ultrasound of the prostate gland.

US examination of pelvic organs (uterus, adnexa)

Ultrasound scanning of the female reproductive system to assess the shape and size, as well as exclude pathology.

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Ultrasound of the prostate

Ultrasound of the prostate, giving an idea of ​​the state of the prostate and the presence of pathology.

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Which doctors to contact for pain in the anus

If you experience pain in the anus, you should contact a proctologist or gastroenterologist. Women should be examined by a gynecologist. If a neurological nature of the pain is suspected, a consultation with a neurologist is required, and if the oncological nature of the pain is suspected, an oncologist or an oncourologist is involved in the treatment.

What to do in case of pain in the anus

Any diseases of the gastrointestinal tract are based on an unhealthy lifestyle and diet, therefore, when pain occurs in the anus, it is necessary first of all to correct the diet and drinking regimen. The next step is to reduce congestion in the veins by increasing physical activity, therapeutic exercises. When standing, it is advisable to use compression stockings and do gymnastics for the legs.

Treatment of pain in the anus

There are so many causes of pain in the anus that there is no one and the same way to treat all its varieties. Symptomatic treatment, that is, taking analgesics, can reduce the severity of pain, but does not eliminate its cause. Etiotropic therapy is selected individually and only after an accurate diagnosis has been made. It may include antibiotics, venotonics, hemostatic agents, antiplatelet drugs, etc.

Sources:

1. Kadyrov Z.A., Kryachko A.A. , Aliev Z.O., Faniev M.V., Ishonakov Kh.S. Chronic inflammatory diseases of the rectum and prostate gland (literature review). Andrology and genital surgery, journal. T. 17, 2016. S. 12-19.
2. Clinical guidelines “Anal fissure”. Developed by: Association of Coloproctologists of Russia. – 2021.
3. Clinical guidelines “Polyp of the anal canal”. Developed by: Association of Coloproctologists of Russia. – 2020.
4. Clinical guidelines “Hemorrhoid”. Developed by: Association of Coloproctologists of Russia. – 2020.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

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Anal fissure – symptoms, causes, signs and methods of treatment of anal fissure in adults in “SM-Clinic”

This disease is treated by Proctologist

• What is an anal fissure?
• Types of anal fissures
• Anal fissure symptoms
• Causes of anal fissure
• Anal Fissure Diagnosis
• Anal fissure treatments
• Prevention of anal fissures
• Rehabilitation after surgery
• Questions and answers
• Doctors

About disease

Among diseases of the proctological profile, anal fissures occupy, according to various sources, 2-3 places after hemorrhoids and paraproctitis. There are also combinations of various pathologies that greatly complicate the treatment.

Morphologically, fissures are a superficial defect of the anal canal mucosa of various sizes, usually surrounded by scars, and the so-called “anal sentinel tubercles”. They are formations covered with skin or mucous membranes and located in the anal canal. They are the result of inflammation of the tissues around the crack. Sometimes the tubercles are quite large, and are poorly distinguishable from anal canal polyps.

In almost 70% of patients, the fissure is combined with chronic diseases of the upper digestive tract (gastritis, peptic ulcer of the stomach and duodenum, cholecystitis). The same percentage of patients have a combination of anal fissure and hemorrhoids. In the chronic course of hemorrhoids, pectenosis often develops, in which the elasticity of the walls of the anal canal is disturbed, which predisposes them to damage in the scallop line.

Types of anal fissures

Anal fissure is a disease that can have both acute and chronic course. In the second case, we are talking about advanced cases when the patient did not turn to the proctologist in a timely manner. The period that determines the chronicity of the crack is on average 1.5-2 months. With chronic cracks, pathological changes appear that prevent the normal healing of tissues. The changes are the destruction of the elastic fibers of the muscle layer at the bottom of the ulcer, the formation of scars along the edges of the fissure, the formation of “sentinel” tubercles, the appearance of hypertrophy, and the compaction of the rectal crypt in the proximal part of the fissure (the so-called anal papilla).

Depending on the location of the mucosal defect in the anal canal, the cracks are:

• rear;
• front;
• lateral.

In most cases, the disease proceeds with a spasm of the anal sphincter, which significantly complicates the healing of the mucosal defect.

Symptoms of anal fissure

Anal fissure is a medical problem that is accompanied by pain in the anal canal. In the early stages of the disease, pain occurs immediately at the time of defecation and may remain for several minutes after a bowel movement. With the progression of the disease, the discomfort becomes more prolonged and is present almost constantly.

In addition to pain, anal fissure is accompanied by the following symptoms:

• constipation; violation of bowel movements can be both the root cause of the disease and its consequence due to the constant fear of pain during a trip to the toilet;
• blood in stool that remains on toilet paper;
• sleep disturbance due to nocturnal discomfort: the chronic form of the disease is characterized by an increase in the tone of the anal sphincter, the patient almost constantly feels pulsating discomfort and itching in the area of ​​the fissure.

Anal fissure pain is so intense that in most cases it contributes to an early visit to the proctologist and the start of proper treatment.

Causes of anal fissure

Normally, the mucous membrane of the anal canal does not rupture and does not crack on its own. The key mechanism leading to the appearance of the problem is a violation of local microcirculation. Because of this, the elastic and regenerative abilities of tissues deteriorate, which creates favorable conditions for the formation of a mucosal defect. Violation of microcirculation in this area occurs against the background of a chronic increase in the tone of the internal anal sphincter. Spasmodic muscles compress blood vessels, increasing the risk of developing pathology.

The immediate cause of the appearance of an anal fissure in such adverse conditions can be:

• traumatic damage to the mucous membrane by hard feces;
• overstrain of the smooth muscles of the sphincter with diarrhea;
• damage to the mucous membrane with poor-quality and hard toilet paper;
• instrumental methods for diagnosing the rectum, performed without proper preparation;
• attempts during the birth of a child;
• heavy physical activity.

In addition to increasing the tone of the anal sphincter, an important factor that increases the risk of cracks in the rectum is malnutrition. Lack of dietary fiber makes the stool hard. Constipation appears. The feces become even harder. During defecation, the pressure increases sharply, and the mucous membrane does not withstand – a crack forms. Because of the pain, the patient is afraid to defecate, which also leads to a decrease in the number of trips to the toilet and provokes the progression of the disease. Thus the vicious circle closes. Only a competent proctologist can break it, and the sooner the patient sees a doctor, the faster and less invasive the treatment will be.

Get advice

If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

To learn more about the disease, prices for treatment and sign up for a consultation with a specialist, you can call:

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Diagnosis of anal fissure

Anal fissure is a problem that can be easily suspected by a proctologist based on typical patient complaints. A typical pain syndrome and spotting during bowel movements support this diagnosis. However, to differentiate a crack from other pathologies, the doctor performs:

• digital examination of the rectum;
• sigmoidoscopy;
• anoscopy.

These procedures allow you to accurately determine the presence of a mucosal defect, its localization and the state of tissue regenerative potential.

Expert opinion

Anal fissure is a fairly common pathology that responds well to treatment. In every second case, it is possible to eliminate the problem without surgical intervention. The main thing is not to endure the pain, but to seek help.

If treatment is not carried out in time, then serious complications can develop that significantly worsen the quality of everyday life. This is, first of all, an active inflammatory process that can spread higher in the rectum, capture the tissue located around it (paraproctitis). Men are at risk of infection of the prostate gland with the development of prostatitis. The risk of acute bleeding or chronic long-term blood loss cannot be ruled out. In the latter case, the patient develops anemia. In advanced cases, the elimination of a crack almost always involves an operation.

Andrey Lavrinenko

Proctologist, Ph.D.

Anal fissure treatments

Anal fissure treatment can be conservative or surgical. Each of the methods has its indications and conditions.

Conservative treatment

Conservative therapy allows to get rid of anal fissure in 50-60% of cases. The sooner the patient seeks help from a proctologist, the higher the chance of successful treatment. Therapy is aimed at solving several key problems at once.

• Decreased tone of the anal sphincter. For this purpose, antispasmodics, calcium channel blockers, botulinum toxin injections are used.
• Stimulation of tissue regenerative abilities. For this, the proctologist prescribes special healing ointments, suppositories (candles), creams.
• Elimination of pain syndrome and local inflammation. Most often, traditional non-steroidal anti-inflammatory drugs are used against the background of warm baths.
• Normalization of digestion. The fight against constipation is carried out by increasing dietary fiber and water in the diet. Laxatives are also used.

Conservative therapy for anal fissures always provides for a comprehensive and individual approach to each patient. The doctor preliminarily evaluates the characteristics of a person’s life and tries to choose the optimal set of medicines for the rapid normalization of his well-being.

Another method of treating the problem without the use of a scalpel is to divulge the anus. The essence of the technique is to reduce the spasm of the anal sphincter due to the dosed inflation of the balloon introduced into the rectum. This procedure demonstrates good therapeutic results in combination with traditional ointments and suppositories.

One of the methods of conservative treatment of anal fissures is botulinum therapy or botulinum toxin (BT) injections. The method is used for spasms and severe pain syndrome. Botulinum therapy has a lasting effect even after 1 injection – up to 2-3 months, is relatively easily tolerated by patients and can be performed on the day of treatment. The dosage is selected individually, based on the weight of the patient and the route of administration. Of the few side effects, one can name the temporary development of insolvency of the anal sphincter, fecal incontinence.

Surgical treatment

In case of failure of conservative therapy or advanced cases of anal fissures (chronic fissures), treatment includes surgical excision of the defect and dosed dissection of the anal sphincter. This eliminates spasm, improves microcirculation and, thus, promotes healing of the mucosa. The operation is performed under regional anesthesia using a minimally invasive (laser) or traditional method with a scalpel. Despite the radical removal of the defect zone, the patient after surgery must monitor the diet, fight constipation and physical inactivity in order to prevent relapses.

Prevention of anal fissures

Prevention of the formation of anal fissures involves combating physical inactivity, good nutrition with enough fiber, timely visits to the doctor if any unpleasant symptoms appear. Prevention of constipation is of utmost importance, since it is straining that often leads to the appearance of a crack. If the patient has another proctological pathology, then it is important to visit the doctor regularly to avoid the concomitant appearance of an anal fissure.

Rehabilitation after surgery

After a minimally invasive excision of the anal fissure, the patient can go home on the day of the operation. For the first 2-3 days, the proctologist performs dressings on an outpatient basis and teaches the patient how to care for the operated area. The stitches are removed on the 7-10th day. Full recovery takes up to one month. During this period, it is recommended to avoid heavy physical exertion and monitor the stool (it should be soft and daily). Bathing, swimming in open water and pools, any thermal procedures (bath, sauna, solarium) are excluded until the tissues are completely healed.

Questions and answers

A proctologist is involved in the detection and treatment of anal fissures.

Yes. If the patient addresses about a “fresh” anal fissure (up to 10-14 days), then there is a high probability of its complete cure without surgical intervention. If the crack exists for a long time, then this leads to the development of a reflex spasm of the rectal sphincter. Under such conditions, the microcirculation of the mucosa is disturbed, and self-healing of the defect becomes almost impossible. Surgery required.

Prevention of recurrence of the disease involves the normalization of nutrition, the fight against chronic constipation, a sufficient level of physical activity.