Rectum fracture: symptoms and treatment
The rectal fissure also corresponds to such definitions of the actual pathological process as an anal fissure or anal fissure. The rectal fissure, the symptoms of which appear as a result of rupture of the rectal mucosa (to a greater or lesser degree), in most cases is diagnosed in those patients for whom the problem of chronic constipation or diarrhea is actual, the preference of anal sex to the traditional, and also a low-activity lifestyle.
Anal fissure acts as a linear defect, formed on the mucosa of the anal canal. Typically, a specific area of its location in the anus is on the back line or the front midline (in the latter case, most often this defect is noted in women). These variants of the lesion are associated with the denudation of the sensitive nerve endings, as a result of which the sphincter of the anus is subjected to sharp spasms, and this, in turn, leads to the appearance of pain during defecation. All this, first of all, is connected with a problem of a dense chair or constipation, which is topical for a patient, and if such a problem is not eliminated, the trauma of the mucous membrane acquires a permanent character. Against this background, there is a persistent pain syndrome in combination with spasm from the sphincter. As a result, the possibility of healing of the crack thus formed is excluded, moreover, due to the presence of pathogenic microflora in the rectum, the wound formed is constantly infected.
The above features of the current process, which is relevant for the formation of the anal fissure, lead to the fact that the active form of the inflammatory process in the affected area is constantly maintained. Over time, and, accordingly, with the progression of the process, the edges of the crack thicken, in depth it increases in size. Nerve endings against the background of these processes become even less protected with respect to such an effect, as a result of which the disease is transferred to the chronic form of the current.
If the anal fissure in its appearance is combined with the chronic form of the hemorrhoid flow, then in this case its location may fall on the side wall area of the anal canal. In general, with this variant of the course of the disease, its picture, as one can understand, is even more complicated in the features of actual processes. Hemorrhoids cause deterioration in the mucosa of the anal circulation channel, which in turn causes a decrease in its ability to regenerate, that is, to healing and recovery.
As you could already guess from the descriptions of the processes described above, depending on the features of the manifestation, the anal fissure can be acute (in this case, the duration of the disease is no more than 4 weeks), and chronic (in this case, respectively, is considered Longer duration).
Normalization of the stool and the use of appropriate analgesic therapy determine for patients the possibility of remission of the disease, lasting for months, and in some cases in years. Nevertheless, already the onset of the first diarrhea or constipation within the period of «calm» can cause a repeated occurrence of an anal fissure.
Linear rupture (in some cases it can, by the way, have a triangular or oval shape), relevant for this pathology, otherwise it can be defined as cracking of the rectal mucosa. As for the size of this gap, then in length it can reach 2 centimeters. It should be noted that the rectal fissure is one of the most common diseases diagnosed in the field of proctology, its frequency is determined on the average by 10-20% among the existing diseases that are relevant for the affected area (ie rectum). Concerning the susceptibility to the appearance of a rectal fissure, it can be noted that it occurs in children, both in men and in women. The factor of susceptibility to occurrence of an anal fissure is considered in a complex with the reasons provoking its formation.
Causes of rectal fissure
The appearance of an acute anal fissure can be accompanied by the following reasons:
- Disturbance of the blood supply to the anus. In this case, options are considered in which stagnation of blood occurs in the rectum area against the background of a sedentary lifestyle of patients, features of professional activity (sitting position), etc.
- Mechanical trauma to the anus. In this case, we are talking about the defeat of the rectum area against the background of frequent constipation or, conversely, diarrhea. Separate consideration of complications in the context of childbirth in women, provoking such trauma, as well as the preference of non-traditional forms of sexual intercourse (anal sex).
- Hemorrhoids. Already noted above, this disease is characterized by the fact that hemorrhoids lead to weakening of the walls of the anus, without being exposed to injury during defecation. Anal fissures with hemorrhoids are caused by a violation in the region of the anus of the blood circulation (in the form of thrombosis, blood stagnation).
- Disorders related to innervation of the rectal area. In this case, a disruption in the form of a long spasm of the sphincter resulting from a CNS pathology relevant to the patient is considered.
- Anatomical features. The structure of the rectum also determines the possible predisposition to the appearance of a crack in it. Rectum of the rectum in women due to those features that are relevant in general in the structure of female genital organs, arises from the front of the anal opening. Given this, respectively, the rectal fissure of the anterior part of the anus is a form of the disease in which, due to anatomical features, the predisposition to its occurrence is determined specifically for the appropriate sex of patients.
It should be separately noted that the predominant fissure of the anus is due to the combination of simultaneous exposure to several causes or factors.
Rectum fracture: features of acute and chronic forms
As we have already identified, anal fissures can, like a number of other diseases, manifest themselves in the acute and chronic form of one’s own course, we can also determine the specific form on the basis of the duration of the manifestations accompanying the disease, we also noted the time intervals above. The acute form of the flow is characterized by the spontaneity of the appearance as a result of rupture of the rectal mucosa, which can accompany the process of passage of constipation of high-density feces. Healing of acute anal fissures often occurs within 1-2 days, without any need for their treatment.
Where a more serious variant of the rectal fissure is a chronic form of the disease. Such cracks act as a variant of the continuation of the acute form, against which they actually develop, more precisely — against the background of cracks that are not completely closed and have been re-injured by this or that impact factor. Transformation into a chronic form proceeds with an even greater expansion and infection with microbes that are abundantly present on the walls of the rectum. The walls of chronic cracks are of high density, the process of their closing (healing) is long and complicated due to constant exposure to the affected area.
Rectum fracture: symptoms
The anal fissure clinic has very characteristic manifestations. As the main signs of this disease, a triad of symptoms is distinguished, in particular, pain in the anus, marked spasm of the anal sphincter, and bleeding, arising directly from the anus. If the course of the disease in combination with hemorrhoids is considered, then a symptom such as the loss of hemorrhoids combined with massive hemorrhage from the anus is added.
Symptoms of an acute anal fissure
Pain in the anus region is the leading symptom of the variants listed in the general description. Within the framework of this form of the disease, the pain is strong enough, but not very long. The appearance of pain is noted only in the process of defecation (bowel evacuation, stool), and also about 15 minutes after its completion. Basically, the detection of the area of soreness occurs with an acute anal fissure in the region of the posterior wall of the rectum.
Spasm of the anal opening (sphincter) similar to the pain sensations with this form of the disease has a rather intense character of manifestation. There is a spasm in the form of soreness, combined with a sense of difficulty, accompanying the process of defecation.
Bleeding from the anus has a minor character. Such bleeding occurs during defecation, which is explained by the passage of high-density stools.
In addition to these symptoms, the addition of difficulty of the defecation act is indicated as their supplement
Symptoms of a chronic rectal fissure
In this form, the symptomatology is similar to acute, but there are some differences, however. So, the pain in the anus area in this case differs from the case of an acute course of the disease. The duration of painful sensations here increases, their intensification occurs when there is a compulsory need to adopt a sitting position within a long period of time. The manifestation of painful sensations in this case determines the serious discomfort, in view of which the patients become irritable, they have problems with sleeping.
In addition to pain, the patients also develop a kind of fear of defecation, often against this background, they begin to take laxatives in order to avoid constipation and the accompanying symptomatic condition.
There are also bleeding from the anus, especially when they are constipated. In addition to blood from the anus, pus also begins to separate. As for the spasm of the sphincter, it is less pronounced in this case than in the acute course of the disease.
Rectum of rectum in child: symptoms
A rectal fissure can develop in a child mainly due to constipation. The disease manifests itself in an acute form, its main symptoms are the appearance of soreness in defecation, as well as traces of blood that can be found on toilet paper and on feces.
In the overwhelming majority of cases in children, this disease passes without the need for treatment, that is, independently, and the only aspect related to its elimination is the need to normalize the stool.
Fracture of rectum during pregnancy
Women in particular are predisposed to the appearance of problems with stools and constipation in particular, if we compare this situation with the male predisposition. And if we consider the period of pregnancy and childbirth, then there is an even greater risk of such changes. The appearance of the anal fissure is caused in pregnant women by the influence of a number of specific factors of external and internal scale, we will distinguish them below:
- Enlargement of the uterus. Against the background of this change in the female body, during pregnancy, the veins in the pelvic region are compressed, and along with it, there is a violation of the outflow of blood from the rectum. Because of stagnation of blood in the veins of the rectum, in turn, with the simultaneous action of hormones, relevant in the period under review, edema of the tissues develops, which is also accompanied by an increase in their susceptibility to negative effects.
- Hormonal changes. Decrease in the tone of the uterus during pregnancy occurs under the influence of an altered state of the hormonal background, along with this the influence of hormones extends to other smooth muscle organs, to which, as you already probably understand, the intestine also applies. Because of constipation and mild peristalsis during pregnancy, an anal fissure occurs.
- Food cravings. Due to changes in the nutrition of pregnant women and the appearance of specific predilections, including those relating to sweets and refined foods, digestive disorders develop, which in turn increase the risk of developing a rectal fissure.
- Decreased physical activity. It is difficult to keep in proper way, especially after 30 weeks, therefore, with the chair there are corresponding problems, which, as we have already noted, lead to the development of the process we are considering.
It should be noted that the rectal fissure after birth is also an equally common variant of its manifestation. The causes of a rectal fissure are not clear in this case, but it is assumed that its own and, quite possibly, a significant role here is played by the process of labor with accompanying sharp tension of tissues in the given area, arising at the moment of passage through the pelvic floor of the fetus and its head.
In some cases, an anal fissure appears and after a certain time after the birth of the child. It is caused by the often constipated constipation associated with the fact that a woman experiences a certain fear of an act of defecation. Subsequent passage of feces increased density leads to damage to the already injured tissues.
Complications that can occur with a rectal fissure, first of all, are the possibility of infection with the development of ascending inflammation, which determines the likelihood of its upward movement in the intestine. In particular, the danger of this process is determined for the mucosa of its shell in the region of terminal sections, such sections include the sigmoid and rectum, as well as the sphincter. Against the background of the effect of penetration of infection in the deep layers, paraproctitis often develops, in which, in turn, inflammation of fatty tissue concentrated in the environment of the rectum occurs.
Also complications of anal fissures can be the occurrence of severe bleeding. In addition, even with minor blood loss, patients develop anemia with time.
A certain danger exists for men separately, it consists in the spread of infection to the prostate gland, against which the prostatitis develops, respectively.
Identifying the presence of a rectum in the patient’s rectum, as a rule, is not difficult. To differentiate this disease is necessary, first of all, from the fistula of the rectum (the internal form of manifestation). In the framework of this pathology there is no spasm, the intensity of the pain syndrome is not so pronounced, and as the main manifestation of the symptomatology, the excretion of pus from the anus is taken into account. When feeling a defect in the mucosal area, a slight soreness is detected, and in the area of its bottom a fistulous cavity is revealed in the form of a characteristic depression.
In addition to fistula of the rectum, the association of symptoms characterizing the rectal fissure, with infections that infect the rectum (parasitic or fungal form of infection, Crohn’s disease with concomitant lesion of the rectal region, tuberculous or syphilitic lesion) should also be excluded. To exclude these variants, the history of the disease is carefully collected, causes of the onset and timing of the disease are determined, as well as the characteristics of the course that characterize it.
If you have a suspicious history regarding the possible relevance of HIV infection (against the background of homosexuality, promiscuity and drug addiction), patients may also have diseases that affect the rectum, which is directly related to HIV in this case. Often in patients with anal fissures in this case, a somewhat unusual character of their manifestations appears.
Basic diagnostic methods:
- external examination (in many cases it makes it possible to determine the presence of an anal fissure (part of it), externally anal fissure — longitudinal or triangular red ulcer)
- finger examination of the rectum area (palpation of the intestinal walls, determination of sphincter spasm)
- sigmoidoscopy (the most reliable method for conducting a study of this area with the possibility of examining the mucous membrane within the distance from the anal opening to within 30 cm)
- an anoscopy (an examination in which the final department of the rectum is to be examined).
In the treatment of an anal fissure, they focus on achieving results in terms of normalizing the stool, reducing pain, healing the affected area, and also reducing the increased tonus of the sphincter in this case. Two treatment options are used, surgical treatment and non-surgical treatment.
Within the framework of surgical treatment measures, the method of crack excision is applied, as well as sphincterotomy, the peculiarity of their realization is actually in the dissection of one portion of the anal sphincter region. This kind of intervention determines the possibility of achieving the required relaxation of the sphincter, eliminating the pain syndrome and creating an environment within which healing will be possible. Due to the intersection of this muscle, there is no disturbance in the retention of stool, the patient’s stay in the hospital does not require additional time.
As for non-surgical treatment, it primarily focuses on the following measures: normalization of the stool, sessile baths, diet therapy, taking medications to relieve the spasm of this area. Due to conservative therapy measures that are applicable in this case, recovery is possible in approximately 70% of cases.
Regarding such an issue as prevention of a rectal fissure, it consists in observing patients’ principles of proper nutrition and active lifestyles, as well as in the timely treatment of any type of disorders associated with stool. Exclusion of stagnant phenomena that occur in the pelvic region is achieved through regular walks, physical education and walking. Anal sex, due to serious risks to the area, should be excluded.
The prognosis for a rectal fissure determines the possibility of curing within 60-90% of the total number of cases of the disease, provided it is detected in the modern way and applies adequate therapy to him. Folk remedies for a rectal rupture, any type of self-treatment, as well as incorrectly prescribed treatment by a doctor can all cause the process to become chronic, thus, accordingly, the prognosis determines the negative consequences, reducing in most cases the subsequent treatment to the necessity of implementing surgical interventions. In most cases, such a measure as surgical excision of the anal fissure allows to achieve full recovery of the patient.
If symptoms appear that indicate a possible rectal fissure, you need to contact a proctologist (surgeon-proctologist) or a surgeon.