Causes cracking anusstudied deeply enough, however, no consensus on this issue does not exist yet. Whatever it was, the availability factor of constipation is considered one of the most important in the mechanism of formation of wounds. Rare, less than 3 times per week, stool, accompanied by a dense lumpy stool passage through the lower rectum department, leads to skin injury and the formation of acute anal fissure. Development of the disease contributes to a spasm of the anal sphincter, even more difficult bowel movements.
Fighting constipation - the basic direction of therapyanal fissure. The complex of therapeutic measures include the appointment of a special sparing diet high in vegetable fiber, stimulate peristalsis and prevent a delay chair. Additionally appointed laxatives, oil enemas, suppositories and creams from anal fissures. In 80-90% of patients with such therapy is bearing fruit, and anus crack heals well. The rest of it is transformed into a chronic form, and treatment of chronic anal fissure with diet, laxatives and suppositories are rarely ineffective as crucial to its existence does not play, even constipation, and spasm of the anal sphincter.
Effective treatment of anal fissure is impossiblewithout removing the anal sphincter spasm. Excessive contraction of the muscle closing anal course, leads not only to the difficulty of defecation and the constant irritation of the anal wounds, but also promotes blood circulation in the tissues of the colon, slows down the course of reparative processes and inhibits recovery.
The spasm of the sphincter increases the pain induring and after a bowel movement, severe pain leads to the formation of human fear of the chair. Deliberate delay chair causes amplification of constipation and lack of effect of conservative treatment of anal fissure.
More recently, in the treatment of chronic analcrack widely used mechanical divulsiya anus, that is, its violent expansion. As used for this purpose or special extenders doctor fingers. The purpose of such a penalty was to achieve sustained reduction in the tone of the anal sphincter. Crack after expansion anus really healed active, but its disadvantage is the initial increase during the procedure and the formation of new fractures of the mucosa and skin of the anus of the circle. Moreover, half of the patients fracture recurred throughout the year, in part pointed out persistent excessive decrease in the tone of the obturator sphincter, incontinence gas and loose stool.
Today, the expansion of the anus by mechanical means alreadyvirtually non-existent, there are more effective methods. Effective treatment of anal fissure today is impossible without medical dilatation of the sphincter, and nitroglycerin cream from anal fissures is the main drug for this purpose.
Drug sphincterotomy - an alternativesurgical treatment, implied a partial cut tufts obturator to reduce its tone. First-line drugs for the effective treatment of anal fissure are nitrates, which have expressed a relaxing effect on the smooth muscles of internal organs and blood vessels. Nitrates are known as drugs for the treatment of cardiovascular diseases, in particular, the familiar nitroglycerin used for cupping and treatment of angina pectoris. Treatment of chronic and recurrent anal fissure with nitrates can significantly reduce the pain accompanying a disease and 50% of the refuse surgery to conservative therapy.
For the treatment of anal fissures often todayoften used nitroglycerin cream 0.2% and 0.5% concentration. From anal fissures, these forms are equally effective and have similar side effects in the form of periodic headaches, caused by the expansion of brain vessels, and quickly relieves conventional analgesics.
About 5 minutes after applicationnitroglycerin ointment significantly reduced pain in the anus, defecation easier. Application means 2-3 times a day for 4-6 weeks, half the leads to healing anal fissure. Early termination of therapy due to chronic headache, dizziness, tachycardia leads to relapse and forced to resort to other methods of treatment and surgery.