What are the symptoms of rectal spasms. How can rectal spasms be diagnosed. What causes rectal spasms and how can they be treated. How do proctalgia fugax and levator syndrome differ. What home remedies can alleviate rectal spasm discomfort.

Understanding Rectal Spasms: Proctalgia Fugax and Levator Syndrome

Rectal spasms, also known as proctalgia fugax, are characterized by sudden, intense pain or cramping in the rectum and buttocks area. These spasms result from contractions of the pelvic floor muscles, anal sphincter, or rectal muscles. While often brief, lasting from a few seconds to several minutes, the pain can be severe enough to disrupt daily activities or sleep.

Proctalgia fugax is a form of levator syndrome, but there are key differences between the two conditions:

• Duration: Proctalgia fugax is typically temporary, while other forms of levator syndrome can persist for days.
• Pain location: Proctalgia fugax pain is primarily felt in the rectum, whereas levator syndrome pain can extend to the pelvic floor, thighs, and buttocks.
• Position impact: Levator syndrome symptoms often worsen when sitting and improve when standing or lying down.

Identifying Symptoms of Rectal Spasms

Recognizing the symptoms of rectal spasms is crucial for proper diagnosis and treatment. Common symptoms include:

• Sudden, intense pain in the rectum
• Cramping sensations lasting from seconds to minutes
• Pain severe enough to wake you from sleep
• Discomfort that interferes with daily activities

In chronic cases of proctalgia fugax, episodes may last longer than 20 minutes and occur more frequently. Additional symptoms in chronic cases can include discomfort from prolonged sitting and painful bowel movements.

Is there pain between episodes?

Typically, there is no pain or discomfort between episodes of proctalgia fugax. If persistent pain is present, it may indicate another anorectal condition, and consultation with a healthcare provider is recommended.

Unraveling the Causes of Rectal Spasms

The exact causes of rectal spasms can vary among individuals, making diagnosis and treatment challenging. Some potential triggers and contributing factors include:

• Stress and anxiety
• Sexual activity
• Constipation
• Abnormal bowel movements
• Menstruation

Research has shown a correlation between stress and both proctalgia fugax and levator syndrome. Many individuals experiencing these conditions also report psychosocial distress, including depression and anxiety.

Can underlying conditions cause rectal spasms?

Yes, in some cases, an underlying condition may be responsible for proctalgia fugax. Treating the root cause can often alleviate the symptoms of rectal spasms. It’s essential to consult with a healthcare provider to identify and address any potential underlying issues.

Diagnosing Rectal Spasms: Challenges and Approaches

Diagnosing proctalgia fugax can be challenging due to the sporadic and brief nature of the episodes. There are no specific tests for this condition, but healthcare providers employ various methods to rule out other potential causes of anorectal pain:

1. Detailed symptom history: Keeping an accurate record of spasm occurrences, duration, severity, and preceding events can aid in diagnosis.
2. Physical examination: Doctors may check for areas of tenderness in the rectum or pain upon touch.
3. Ruling out other conditions: Healthcare providers will investigate other possible causes of anorectal pain, such as hemorrhoids, ulcers, abscesses, anal fissures, or inflammatory bowel disease.

What information should I provide to my doctor for an accurate diagnosis?

To assist your healthcare provider in making an accurate diagnosis, provide the following information:

• Frequency and duration of spasm episodes
• Pain intensity and location
• Any activities or events that seem to trigger the spasms
• Impact on daily life and sleep
• Any other associated symptoms or discomfort

Effective Treatment Strategies for Rectal Spasms

Treatment for proctalgia fugax primarily focuses on symptom relief and pain management. Since episodes are often short-lived and irregular, treatment approaches may vary based on individual symptoms and triggers.

What are some at-home remedies for managing rectal spasms?

Several at-home treatments can help alleviate the discomfort associated with rectal spasms:

• Over-the-counter antispasmodic medications
• OTC muscle relaxers and pain relievers
• Warm baths
• Alternating heating pads and ice packs
• Increasing dietary fiber intake for softer bowel movements

It’s important to consult with a healthcare provider before initiating any treatment to rule out other potential causes of anorectal pain.

Are there medical interventions for severe cases of rectal spasms?

For more severe or persistent cases of proctalgia fugax, healthcare providers may recommend additional interventions:

• Botox injections around the anorectal area to reduce muscle spasms
• Prescription medications for pain management and muscle relaxation
• Physical therapy focusing on pelvic floor muscle exercises
• Biofeedback therapy to improve muscle control

Prevention Strategies for Rectal Spasms

While it may not always be possible to prevent rectal spasms entirely, certain lifestyle modifications and preventive measures can help reduce their frequency and severity:

1. Stress management: Practice relaxation techniques, meditation, or yoga to reduce overall stress levels.
2. Dietary adjustments: Increase fiber intake and stay hydrated to promote regular, soft bowel movements.
3. Exercise regularly: Engage in moderate physical activity to improve overall muscle tone and reduce tension.
4. Pelvic floor exercises: Strengthen pelvic floor muscles through targeted exercises prescribed by a healthcare provider or physical therapist.
5. Maintain good posture: Practice proper sitting and standing postures to reduce strain on pelvic floor muscles.

Can dietary changes help prevent rectal spasms?

Yes, dietary modifications can play a significant role in preventing rectal spasms. Increasing fiber intake can lead to softer, easier-to-pass bowel movements, potentially reducing the risk of proctalgia fugax episodes. Good sources of dietary fiber include:

• Fruits and vegetables
• Whole grains
• Legumes
• Nuts and seeds

Additionally, staying well-hydrated by drinking plenty of water throughout the day can help maintain proper bowel function and reduce the likelihood of constipation, which may trigger rectal spasms.

When to Seek Medical Attention for Rectal Spasms

While occasional mild rectal spasms may not necessarily require immediate medical attention, certain situations warrant consultation with a healthcare provider:

• Persistent or worsening pain
• Frequent episodes that disrupt daily life
• Blood in stool or rectal bleeding
• Unexplained weight loss
• Changes in bowel habits
• Pain accompanied by fever or chills

How can I differentiate between rectal spasms and other anorectal conditions?

Distinguishing between rectal spasms and other anorectal conditions can be challenging without professional medical evaluation. However, some key differences to consider include:

• Duration of pain: Rectal spasms typically last for short periods, while other conditions may cause more persistent discomfort.
• Pain location: Proctalgia fugax pain is usually focused in the rectum, whereas conditions like hemorrhoids may cause pain around the anus.
• Associated symptoms: Rectal spasms generally don’t cause bleeding or discharge, which may be present in other anorectal conditions.

If you’re unsure about the nature of your symptoms or if they persist, it’s best to consult with a healthcare provider for an accurate diagnosis and appropriate treatment plan.

Living with Rectal Spasms: Coping Strategies and Support

Dealing with rectal spasms can be challenging, but there are various coping strategies and support options available to help manage the condition:

1. Education: Learn about proctalgia fugax and levator syndrome to better understand your condition and available treatment options.
2. Support groups: Connect with others who experience similar symptoms to share experiences and coping strategies.
3. Mindfulness techniques: Practice mindfulness meditation or deep breathing exercises to manage pain and reduce stress.
4. Pain diary: Keep a record of your symptoms, triggers, and effective relief methods to identify patterns and optimize your management approach.
5. Open communication: Discuss your condition with family, friends, or employers to ensure understanding and support when needed.

How can I minimize the impact of rectal spasms on my daily life?

To reduce the impact of rectal spasms on your daily activities, consider the following strategies:

• Develop a quick-relief plan: Have a readily available kit with items like heat packs, over-the-counter pain relievers, or prescribed medications for immediate relief during episodes.
• Identify and avoid triggers: Pay attention to activities or foods that seem to precede spasms and try to minimize exposure when possible.
• Practice good sleep hygiene: Establish a consistent sleep schedule and create a comfortable sleep environment to reduce the likelihood of nighttime episodes.
• Stay active: Regular, low-impact exercise can help reduce muscle tension and promote overall well-being.
• Seek professional help: Work with a healthcare provider or specialist to develop a comprehensive management plan tailored to your specific needs.

By implementing these strategies and working closely with healthcare professionals, many individuals with rectal spasms can effectively manage their symptoms and maintain a good quality of life. Remember that each person’s experience with proctalgia fugax or levator syndrome may be unique, so it’s essential to find the combination of treatments and coping mechanisms that work best for you.

Symptoms, Causes, Diagnosis, and Treatment

Written by WebMD Editorial Contributors

Medically Reviewed by Dan Brennan, MD on April 28, 2021

• Symptoms
• Proctalgia Fugax vs. Levator Syndrome
• Causes
• Diagnosis
• Treatment

Pain is part of life. Headaches, stiff knees, and sudden back pain may make you feel uncomfortable. Similarly, you may have pain in your buttocks. 

Proctalgia fugax is pain or cramping felt around your buttocks and rectum. The rectum is the last part of the large intestine, ending in the anus, which removes solid waste from the body. ‌

This pain is the result of spasms or cramps of your pelvic floor muscles, anal sphincter muscles, or rectum muscles. Because proctalgia fugax is unpredictable, it is difficult for doctors to diagnose or researchers to study.

Proctalgia fugax is temporary rectal pain. You may have intense pain for a short time. Cramps in your rectum may last from a few seconds to several minutes.

Severe episodes of proctalgia fugax can be painful enough to wake you up from your sleep or keep you from going to work or school. Between episodes, you probably won’t have any pain or discomfort. If you do have pain that isn’t coming from another spasm, another anorectal condition may be causing it, so talk to your doctor to rule out other conditions.

Chronic proctalgia fugax. Episodes of chronic proctalgia fugax usually last for more than 20 minutes and happen more often than occasionally. Other long-term symptoms include discomfort from sitting for too long and painful bowel movements.

Proctalgia fugax is a form of levator syndrome (also called levator ani syndrome). Both include spasms of muscles in the pelvic area. Proctalgia fugax is temporary, but other types of levator syndrome can last for several days.

Another major difference is the location of the pain. Pain from proctalgia fugax is felt mainly in the rectum. Pain due to levator syndrome is felt in the pelvic floor — specific or vague areas — and in the thighs and buttocks.

Symptoms of levator syndrome are usually felt higher in the pelvis than the symptoms of proctalgia fugax. You may notice that symptoms worsen when sitting and improve when standing or lying down.

Finding the cause of proctalgia fugax may be difficult. The causes vary from person to person and need different approaches for treatment. Other conditions in the anorectal area may cause spasms that seem similar to proctalgia fugax but are diagnosed and treated as separate issues. Sometimes an underlying condition causes proctalgia fugax, and treating that condition will relieve the symptoms of proctalgia fugax.

Stress. Proctalgia fugax may be related to stress and anxiety. In some cases, people with proctalgia fugax felt stressed just before the spasms.

Studies have shown a similar relationship between stress and levator syndrome. Many people with levator syndrome have psychosocial distress, including depression and anxiety.

The following activities may cause proctalgia fugax:

• Sexual activity
• Constipation
• Abnormal bowel movement
• Menstruation

Proctalgia fugax is difficult to diagnose because of how quick and random the spasms can be. There are no tests for proctalgia fugax. But your doctor will rule out other possible causes for your anorectal pain.

Other anorectal conditions your doctor may check for are:

• Hemorrhoids
• Ulcers, abscesses, or other abnormal growths
• Anal fissures, or small tears
• Inflammatory bowel disease

History. Your doctor may make a diagnosis based on your symptom history. Keep an accurate record of when the spasms happen, how long they last, how severe they are, and what happened before the spasms to help your doctor make a better diagnosis.

Physical exam. Your doctor may do a physical exam to check for places of tenderness in the rectum, or pain when the area is touched. Tenderness in the rectum or its nerves can be the cause of proctalgia fugax. A similar physical exam is performed to rule out any other conditions that cause anorectal pain.

Most treatment options for proctalgia fugax depend on the symptoms. Treatments aim to ease pain and discomfort. This is mainly because the episodes are short, irregular, and without a clear cause.

At-home treatment. Before trying treatment options, check with your doctor to rule out other causes. You can take care of your symptoms on your own with the following methods:

• Over-the-counter (OTC) antispasmodic drugs
• OTC muscle relaxers and pain relievers
• Warm baths
• Heating pads and ice packs

Another at-home method that may help you avoid proctalgia fugax is to eat more fiber. Fiber will allow you to have softer bowel movements. These will keep your anorectal muscles from working too hard and may lower the risk of proctalgia fugax spasms.

Injections. For more severe pain, your doctor may recommend a variety of injections to stop muscle spasms. A Botox injection around the anorectal areas will relax the muscles. An epidural injection or a local anesthetic will numb the pelvic areas to ease muscle spasms.

Electrical stimulation. For severe proctalgia fugax, electrical stimulation of the anorectal muscles may provide relief. This treatment option involves inserting a small, finger-sized probe into the rectum and using a low voltage current to relax spastic muscles through vibration.

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Symptoms, Causes, Diagnosis, and Treatment

Written by WebMD Editorial Contributors

Medically Reviewed by Dan Brennan, MD on April 28, 2021

• Symptoms
• Proctalgia Fugax vs. Levator Syndrome
• Causes
• Diagnosis
• Treatment

Pain is part of life. Headaches, stiff knees, and sudden back pain may make you feel uncomfortable. Similarly, you may have pain in your buttocks. 

Proctalgia fugax is pain or cramping felt around your buttocks and rectum. The rectum is the last part of the large intestine, ending in the anus, which removes solid waste from the body. ‌

This pain is the result of spasms or cramps of your pelvic floor muscles, anal sphincter muscles, or rectum muscles. Because proctalgia fugax is unpredictable, it is difficult for doctors to diagnose or researchers to study.

Proctalgia fugax is temporary rectal pain. You may have intense pain for a short time. Cramps in your rectum may last from a few seconds to several minutes.

Severe episodes of proctalgia fugax can be painful enough to wake you up from your sleep or keep you from going to work or school. Between episodes, you probably won’t have any pain or discomfort. If you do have pain that isn’t coming from another spasm, another anorectal condition may be causing it, so talk to your doctor to rule out other conditions.

Chronic proctalgia fugax. Episodes of chronic proctalgia fugax usually last for more than 20 minutes and happen more often than occasionally. Other long-term symptoms include discomfort from sitting for too long and painful bowel movements.

Proctalgia fugax is a form of levator syndrome (also called levator ani syndrome). Both include spasms of muscles in the pelvic area. Proctalgia fugax is temporary, but other types of levator syndrome can last for several days.

Another major difference is the location of the pain. Pain from proctalgia fugax is felt mainly in the rectum. Pain due to levator syndrome is felt in the pelvic floor — specific or vague areas — and in the thighs and buttocks.

Symptoms of levator syndrome are usually felt higher in the pelvis than the symptoms of proctalgia fugax. You may notice that symptoms worsen when sitting and improve when standing or lying down.

Finding the cause of proctalgia fugax may be difficult. The causes vary from person to person and need different approaches for treatment. Other conditions in the anorectal area may cause spasms that seem similar to proctalgia fugax but are diagnosed and treated as separate issues. Sometimes an underlying condition causes proctalgia fugax, and treating that condition will relieve the symptoms of proctalgia fugax.

Stress. Proctalgia fugax may be related to stress and anxiety. In some cases, people with proctalgia fugax felt stressed just before the spasms.

Studies have shown a similar relationship between stress and levator syndrome. Many people with levator syndrome have psychosocial distress, including depression and anxiety.

The following activities may cause proctalgia fugax:

• Sexual activity
• Constipation
• Abnormal bowel movement
• Menstruation

Proctalgia fugax is difficult to diagnose because of how quick and random the spasms can be. There are no tests for proctalgia fugax. But your doctor will rule out other possible causes for your anorectal pain.

Other anorectal conditions your doctor may check for are:

• Hemorrhoids
• Ulcers, abscesses, or other abnormal growths
• Anal fissures, or small tears
• Inflammatory bowel disease

History. Your doctor may make a diagnosis based on your symptom history. Keep an accurate record of when the spasms happen, how long they last, how severe they are, and what happened before the spasms to help your doctor make a better diagnosis.

Physical exam. Your doctor may do a physical exam to check for places of tenderness in the rectum, or pain when the area is touched. Tenderness in the rectum or its nerves can be the cause of proctalgia fugax. A similar physical exam is performed to rule out any other conditions that cause anorectal pain.

Most treatment options for proctalgia fugax depend on the symptoms. Treatments aim to ease pain and discomfort. This is mainly because the episodes are short, irregular, and without a clear cause.

At-home treatment. Before trying treatment options, check with your doctor to rule out other causes. You can take care of your symptoms on your own with the following methods:

• Over-the-counter (OTC) antispasmodic drugs
• OTC muscle relaxers and pain relievers
• Warm baths
• Heating pads and ice packs

Another at-home method that may help you avoid proctalgia fugax is to eat more fiber. Fiber will allow you to have softer bowel movements. These will keep your anorectal muscles from working too hard and may lower the risk of proctalgia fugax spasms.

Injections. For more severe pain, your doctor may recommend a variety of injections to stop muscle spasms. A Botox injection around the anorectal areas will relax the muscles. An epidural injection or a local anesthetic will numb the pelvic areas to ease muscle spasms.

Electrical stimulation. For severe proctalgia fugax, electrical stimulation of the anorectal muscles may provide relief. This treatment option involves inserting a small, finger-sized probe into the rectum and using a low voltage current to relax spastic muscles through vibration.

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Pathologies of the gastrointestinal tract are found in almost every person. Deviations from the norm occur in 95% of the population. Most often, people are concerned about pain in the gastrointestinal tract, digestive disorders, etc. Particularly noteworthy are the conditions that are called tenesmus. This is a painful and unpleasant urge to empty the bowels. In this case, defecation, as a rule, does not occur. With tenesmus, mucus may pass from the rectum instead of feces, and sometimes there is spotting or pus. A person with such a pathology experiences pain. The place of localization of discomfort is the area of ​​the anus, perineum, sacral region. Still pain is sometimes felt in the gastrointestinal tract. Some patients described this uncomfortable condition as follows. There is a feeling of distention of the intestines from feces. However, after visiting the toilet there are no results – defecation does not occur. Cal, if it comes out, then in small quantities.

This condition is characterized as uncomfortable when there is an urge to empty the large intestine, but defecation is not observed. This phenomenon is sometimes associated with disruption of the gastrointestinal tract, other dangerous pathologies, up to cancer. Inflammatory processes in the intestines, colorectal cancer, as well as irritable bowel syndrome are capable of provoking false urges to empty. Tenesmus can also be caused by problems in the urogenital area, etc. To accurately determine the cause of this phenomenon, you need to undergo diagnostic procedures in a medical institution.

Causes and symptoms

In a condition such as tenesmus, the causes are different. Presumably, the occurrence of pathology is promoted by inflammatory processes in the large intestine. Moreover, inflammation can be both infectious and non-infectious in nature.

The phenomenon may be short-term or permanent. Short-term manifestations disappear after going to the toilet. Constant discomfort can manifest itself in the patient even in a calm state. As mentioned earlier, tenesmus is a manifestation of a particular pathology of the gastrointestinal tract or urogenital area.

The inflammatory process in the gastrointestinal tract sometimes provokes narrowing, blocking, perforation or scarring of the intestinal walls. As a result, the promotion of feces is difficult, there are false urges to defecate.

We list the main reasons due to which this anomaly of intestinal motility occurs:

• ulcerative colitis;
• intestinal infections;
• Crohn’s disease;
• rectal gonorrhea;
• irritable bowel syndrome;
• colorectal cancer;
• hemorrhoids and others.

As you can see, intestinal tenesmus has a variety of causes, so you should be examined by a specialist in time to find out the causes of the pathology.

What to do if you have symptoms of pathology

It is important not to self-medicate, but to seek qualified help. It is necessary to undergo an examination in the clinic as soon as possible, the following manifestations of the pathology make themselves felt:

• blood in stool;
• a person can shiver, have a fever;
• pain syndrome in the gastrointestinal tract;
• nausea, vomiting.

All this indicates the presence of an inflammatory process in the intestine. With these manifestations, you need to get medical help urgently.

When you need to urgently call an ambulance

An ambulance should be called if there is a suspicion of intestinal obstruction. That is, in addition to tenesmus, a person has symptoms such as the inability to empty the intestines for a long time, strong and cramping pain, or slowly increasing pain in the intestines. The symptoms are also dangerous if the patient has vomiting, frequent tenesmus with blood and no discharge of flatus, feces even after enemas.

Before the arrival of the ambulance, you should put the person on the bed, apply cold to the stomach and not give any food. In this condition, the patient should not take painkillers and laxatives. Also, you can not apply a heating pad to the stomach.

When to see a doctor

It is necessary to visit a doctor if there are difficulties with bowel movements, especially when they are accompanied by an intense pain syndrome. Why is it better to start treatment immediately? If the symptoms do not change within a few days, then without quality medical care, complications of the patient’s condition may occur.

Treatment

If a person experiences tenesmus, treatment is prescribed depending on the causes of the pathology, the severity of the condition, etc. It is very important to correctly determine the cause of the phenomenon. If a patient has colorectal cancer, it is best to detect it as early as possible. With such a disease, complex treatment is prescribed, which includes a variety of methods. It is also necessary to start treatment for inflammatory diseases of the gastrointestinal tract as soon as possible. Early diagnosis of these pathologies is the key to successful treatment outcomes.

The doctor at the reception will make a complete picture of the occurrence of the disease. The survey may include the following activities:

• blood tests;
• colonoscopy;
• stool culture;
• CT scan of the abdominofield region;
• screening for sexually transmitted diseases.

The treatment regimen will depend on what kind of pathology caused intestinal tenesmus. If the cause of tenesmus in adults is an inflammatory disease of the gastrointestinal tract, then the treatment regimen will be the same. With infectious diarrhea, completely different methods are already being used, etc.

Home care

Diseases that produce a false urge to defecate can often be treated at home. However, it should be noted that any use of medicines, including traditional medicine preparations, must be agreed with the attending physician. For example, in addition to the main treatment, auxiliary phytotherapeutic agents are also prescribed to the patient at home.

Let’s give examples. To achieve temporary relief of the patient’s condition, baths with herbal decoctions are sometimes prescribed. Enemas are often used using sea buckthorn and rose hips (for ulcerative colitis). With dysentery, painful symptoms are eliminated by bed rest, a special diet, drinking plenty of water, and taking medication prescribed by a doctor.

Prevention of tenesmus

Preventive measures for this pathology are as follows:

• high fiber diet;
• intake of sufficient quantity of clean drinking water;
• moderate physical activity;
• reduction of stressful situations at home, at work, etc.

A high-fiber diet is not beneficial for all patients. This preventive measure is very effective for false tenesmus, but is contraindicated in patients with Crohn’s disease and ulcerative colitis. You can not take foods high in fiber in such cases:

• period of exacerbation of chronic gastrointestinal disease;
• severe narrowing of the intestinal lumen.

Those people who are not prohibited from such a diet can alleviate their condition by eating:

• legumes;
• nuts;
• vegetables, fruits;
• lentils;
• seeds;
• whole grains, etc.

Equally important is the use of water in an amount of at least 2-3 liters per day. This is important for normal and timely defecation. Moderate physical activity, sports help to improve digestion, restore intestinal motor function and eliminate false urge to defecate.

It is important to keep a calm state of mind in any situation, as the intestines (and stomach) are very sensitive to stress. For this, relaxation methods, meditation, yoga, psychotherapy, etc. are used.

Which doctor to contact if you have a symptom

For the timely start of treatment, it is necessary to contact a coloproctologist who will examine the patient, prescribe the necessary diagnostic studies and develop an effective treatment regimen.

You can make an appointment with the specialists of JSC “Medicina” (clinic of academician Roitberg) by phone +7 (495) 775-73-60 or using the online form on the website.

Answers to some popular questions

Many people are interested in the question of what is urinary tenesmus. Tenesmus is a false urge to both defecate and urinate. Therefore, there are intestinal false spasms, and there are also tenesmus of the bladder. Accordingly, with such spasms, there is a tonic contraction of the muscles of the rectum or bladder. Spasmodic contraction of the sphincters may also occur simultaneously. In both cases, false spasms do not allow either the intestines or the bladder to empty, that is, they are ineffective. Such phenomena are uncomfortable, may be accompanied by severe pain.

Another popular question of patients: how to get rid of tenesmus? The success of treatment depends on correct diagnosis. The rate of recovery of the patient will depend on how quickly and correctly the doctor determines the cause of the pathology. In cases where false urges cause tumors in the rectum, inflammatory, infectious diseases in the gastrointestinal tract, treatment should be started as early as possible. Then the result of therapy will be positive, and the process of recovery from the disease will take less time. Therefore, at the first symptoms of tenesmus, one should not hesitate, but undergo an examination in a professional clinic.

Anal fissure – causes, symptoms, signs, diagnosis, treatment (excision operation)

Causes

Classification

Symptoms

Diagnosis

Treatment

An anal fissure is a linear or elliptical tear in the wall of the rectum that occurs spontaneously, followed by the formation of an ulcer on the walls of the anal canal. There are rectal and anal parts of the rectum, together they make up the last part of the gastrointestinal tract. They receive food waste in the form of feces and allow it to pass out of the body. The anal part is surrounded by a powerful muscular sphincter, richly supplied with blood and well innervated.

Fissures in the anus can be an independent disease or occur against the background of comorbid diseases – hemorrhoids, inflammatory diseases of the anorectal region. In children, anal fissures are much less common than in adults, however, due to severe pain during bowel movements, they lead to the formation of persistent rectophobia (fear of defecation).

Causes of anal fissures

Lead to the formation of anal fissures:

• prolonged constipation;
• diarrhea;
• mechanical injury;
• inflammatory bowel disease: colitis, proctosigmoiditis, enterocolitis;
• haemorrhoids;
• fungal diseases of the perineum;
• urinary infection;
• intestinal parasites (pinworms).

Classification (types) of anal fissures

According to the nature and duration of the course of the disease, anal fissure can be acute or chronic. Anal fissures lasting up to 6 weeks from the onset of the disease are classified as acute, more than 6 weeks – chronic.

For the first time (acute) anal fissures are slit-like, their edges are even and smooth, the bottom of the defect is meat-red in color, fine-grained, covered with fibrin threads. As a rule, this is a linear tear, which is located on the skin at one end and on the anus mucosa with the other, rarely affecting the muscle layers of the rectum. In the chronic course of the disease, the edges of the crack thicken due to the growth of connective tissue first, and subsequently scar tissue with the formation of “anal humps”, the bottom of the wound is exposed and filled with muscle fibers, which leads to disruption of the processes of nutrition and metabolism in tissues, subsequently – infection and ulceration.

Symptoms and signs of anal fissures

Anal fissures are manifested by sudden sharp pain during defecation. The pain is severe, patients can describe it as a “sharp dagger pain”, sometimes pulsating due to spasms of the sphincter, radiating (gives) to the sacrum or perineum. There is no heavy bleeding during defecation, usually a small amount in the form of drops of blood or bright red stripes on top of the feces.

With anal fissures in newborns and young children, each bowel movement is accompanied by a strong cry, crying, anxiety. Older children delay the act of defecation for a long time due to fear of pain, they may cry for a long time before bowel movements. When examining the feces from above, traces of blood are found on the feces, they can also be on toilet paper, underwear, and in infants – on diapers and diapers.

Anal fissure diagnostics

The diagnosis is made on the basis of subjective complaints of the patient, anamnesis, objective examination by a proctologist, additional laboratory and instrumental research methods.

A characteristic triad according to VD Fedorov:

• pain in the anus during defecation and after;
• spasms of sphincters, more often anal;
• a slight admixture of blood on top of the feces.

There are certain differences between acute and chronic anal fissure. In the acute process, pain occurs only during defecation, lasts 15-20 minutes after high intensity. The chronic form of the disease is characterized by a cyclical process, moderate, less intense pain lasting 2-3 minutes during bowel movements, may increase with straining, after a diet violation. Bloody discharge with fresh cracks is more abundant, sometimes a stream of scarlet blood; with a long course of the disease – in the form of small drops on the surface of fecal stools.

Examination of the anus in the knee-elbow position of the patient will reveal cracks in the form of longitudinal or triangular red ulcers, the edges of which may be dense, callused.

Digital rectal examination of the rectum causes excruciating pain and spasm of the sphincter. The absence of visual signs of the disease cannot be a reason for refusing a digital examination, which determines the degree of spasm of the external anal sphincter, the localization of the fissure, its size and condition of the edges, cicatricial strictures, in men – the size of the prostate gland, in women you can feel the cervix.

In addition, to verify the diagnosis of anal fissures, an examination of the rectum using rectal mirrors should be performed, and the “gold standard” of diagnostic research is sigmoidoscopy with the ability to examine the lower intestines for 25–30 cm from the anus.

Anal fissure treatment

When carrying out therapeutic measures, a step-by-step targeted approach is necessary, taking into account the age: is it a child or an adult. At the initial stages, the treatment is conservative and is aimed primarily at relieving pain and spasms, in the future – at healing cracks and normalizing stools. Apply:

• diet therapy with a high content of vegetable fibers, adherence to a drinking regimen to soften stools and eliminate constipation;
• for anesthesia: sitz baths with a solution of potassium permanganate, chamomile, calendula, perineal shower up to 3-4 times a day, electrophoresis, 0.5% solution of “Novocaine” on the anal area.

With the ineffectiveness of diet therapy and physiotherapy procedures in the early stages of the disease, medications are used to treat anal fissures: tablets, ointments. Prescribe medications:

• with a laxative effect: Mucofalk, Forlax, Fortrans, Duphalac, suppositories with glycerin, fish oil or vaseline oil inside;
• normalizing intestinal microflora: “Acipol”, “Bactistatin”, “Linex”, “Lactobacterin”;
• for the relief of pain candles with belladonna and anestezin: “Bellastezin”, “Proctosan”, “Anestezol”, “Proktostezol”;
• wound healing and anti-inflammatory effect is achieved by using applications with sea buckthorn oil, suppositories with methyluracil or benzocaine (“Relief”, “Relief Advance”), ointments: “Methyluracil” and “Levomekol”;
• alcohol-novocaine or hydrocortisone-novocaine blockade under the fissure to relieve pain;
• with a pronounced spasm of the sphincters, ointments with nitroglycerin and diltiazem are used, injections of muscle relaxants (botulinum toxin).

Surgery for anal fissures is indicated when conservative therapy fails. Perform excision (removal) of the tissues of the crack plus sphincterotomy.

With adequate conservative therapy in 50%, and with surgical intervention in 100% of cases, the prognosis is favorable. The disease must be treated regardless of the age of the patient. Like any disease, anal fissures can be complicated by severe pain, colitis, acute paraproctitis, prostatitis, profuse bleeding, and rectal fistulas can form. Illness must always be treated.

The author of the article:

Magomedov Maksud Gadzhievich

head of the inpatient department at Krasnye Vorota metro station, KMN, phlebologist, proctologist

work experience 21 years

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