Classic symptoms of chronic anal crack — Pain and bleeding from the rectum, the resistant spasm of the sphincter of the rear pass, exacerbating the course of the disease and preventing wound healing. The pain during anal crack occurs during defecation and continues from a few minutes to several hours. Its occurrence is caused by irritation of the wound with feasible masses when they pass through the narrowed anal passage. Pathological contraction of the muscles of the climbing rear-ground opening leads to a local circulatory impairment, oxygen starvation of fabrics and slowing reparation processes.
Treatment of chronic anal crack, first of all, implies the appointment of diet and laxatives to combat constipation. However, it has been established that not all patients with the chronic course of the disease have problems with the chair. How to cure an anal crack, really only the operation is able to solve the problem?
One of the main healing conditions of the crack — Overcoming the anus spasm. Previously, this problem was solved by mechanical stretching of the rear pass or dissection of parts of muscle fibers, today the method of treating anal cracks is becoming increasingly «Medical Sphincterotomy», being a good alternative operation. Preparations from a group of diltiazem and nifedipine are often used to drug dialing the sphincter.
Diltiazene and Nifedipine belong to drugs, the mechanism of action of which is associated with the blockade of channels, according to which Calcium enters the cells. The result of this influence becomes the expansion of blood vessels and relaxation of the smooth muscles of internal organs, including the sphincter of the rectum. The elimination of the anus spasm contributes to the disappearance of pain accompanying the anal crack, the normalization of rectal pressure, facilitating the defecation and accelerated healing of the wound of the rear pass. According to various sources in 75% of cases of using calcium channel blockers as an alternative to operation, it is possible to cure an anal crack completely. However, research in this area is still continuing. So, Italian scientists have tried to compare the effect of antigenuclear preparations used in proctology, with the effectiveness of a combination of nifedipine with lidocaine. The data obtained testified that the anus's spasm and pain in the chronic anal crack disappeared almost immediately after the start of treatment. The result of therapy in 95% of cases was the full healing of the wound.
It should be noted that the effect of the use of calcium channel blockers lasts only three months after the end of therapy, in the future the progressive spasm of the rear pass leads to a recurrence of anal crack. According to statistics in 60% of cases for 2 years, patients are forced to reach a proctologist again and undergo repeated courses for nifedipine treatment or use other methods of treating anal crack.
To eliminate the spasm of anal sphincter, diltiazene and nifedipine can be assigned sublingual or inside. It is believed that the optimal dose is 20 mg 2 times a day during the 8-week course of treatment. As side effects, a headache, a feeling of heat, redness of the skin, tachycardia, reduction of blood pressure, nausea. Local treatment with gels and creams, for example, 2% gel diltiazem is devoid of similar negative moments. The absorption of the drug is minimally, as well as its system action, but it is possible to appear to the drug and burning medication. The frequency of the full healing of the wound at the same way is higher than in the treatment of anal crack by distragan preparations.
For treatment, combined means containing calcium channel blockers can be used, in particular the emulsion of nifedipine gel. In addition to Nifedipine, lidocaine is included here, as an anesthetic, and isosorbit dinitrate, which helps to eliminate sphincter spasm, but different from nifedipine by. It is recommended to apply approximately 2 ml tools to the area of the rear pass 3-4 times a day for 28 days. Usually such a course of treatment together with a diet is enough to cure the disease.