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Modern treatments of anal fissures

When we experience pain in the heart, we see a cardiologist without undue delay. However, when experiencing pain in the anal area, many people tend to wait for the problem to resolve on its own or look for solutions online, engaging in self-medication, and are reluctant to seek medical assistance.

Proctologists remind that if you experience unpleasant symptoms, do not feel ashamed and delay seeing a specialist, because self-treatment of an easily curable disease could be long and ineffective, disease can become chronic and its treatment longer and more complicated.

One of the most common proctological diseases is anal tears or fissures. These are fissures in the skin of the anal area that range in size from a few millimetres to 2 cm. The causes of anal fissures are not fully understood, but they are usually associated with inflammation of the gastrointestinal tract, constipation (hard stools injure the anal area as they slide through the anal canal) and mechanical injuries. Anal fissures can also occur for specific reasons – Crohn’s disease, leukaemia, sexually transmitted infections, and colorectal cancer. Men and women of all ages suffer from anal fissures. If left untreated, inflammatory ulcers or fistulas can form, making treatment more difficult.

The anal area is very sensitive, so even the smallest wound can cause severe pain. The most common symptoms of anal fissures are sharp, stabbing, tearing pain during or after bowel movement. Itching, swelling, discharge or blood may also appear in the anal area, with occasional urination disorders. The pain caused by an anal fissure causes spasms of the muscle that closes the anal orifice, disrupts normal blood flow, thus, making healing of a fissure hard, no matter how small. In addition, people experience psychological discomfort – fear of pain, trying to restrict bowel movement, constipation, while hard stools cause additional injury of the anal canal. Medical proctologists would like to remind that without timely consultation with specialists and treatment of acute fissures, the problems becomes chronic and its treatment becomes longer and more complicated.

Anal fissures are diagnosed based on patient complaints and examination. However, bleeding and pain in the anal area may be a symptom of other anal diseases, such as haemorrhoids, polyps of the anus and rectum, inflammatory diseases of the rectum or oncological diseases, therefore, it is important to rule out the risk of more serious diseases before starting treatment by means of endoscopic examination of the anal area. Anal fissures can be treated with a variety of ointments or aerosol medications, botulinum toxin that produces temporary muscle paralysis, injections into the internal or external sphincter. Oral medications that reduce the tone of the anal sphincter muscle may also be prescribed. Their administration can be combined with a constipation relieving diet or laxatives. Following therapy with various medications, anal fissures usually heals within a couple of weeks. However, if the fissures becomes chronic and the tone of the internal sphincter increases, specific treatment may be required.

Until recently, failure to cure the rupture with medication has traditionally resulted in surgery. It eliminates muscle spasm and associated circulatory disturbance by dilating or partially incising the muscle that closes the orifice.

With the rapid development of medical technologies, new, minimally invasive methods that do not cause discomfort to the patient have been introduced for the treatment of proctological diseases. A better understanding of the mechanism of contraction of the smooth anal sphincter muscles led to new, sparing treatments that reduce the spasm of the anal sphincter muscle, thus allowing the fissure to heal without surgery.

Nowadays, anal fissures are safely and effectively treated using a minimally invasive method – laser coagulation. This method involves use of local analgesia while the recovery period is short and does not cause discomfort. The laser energy is directed precisely to the treated area, spot action causes little trauma to the tissues, without damages the mucous membrane and skin of the anal area. With the help of the device, an incision and coagulation of blood vessels are performed simultaneously, which allows to perform the necessary manipulations completely without loss of blood. This minimally invasive method is recognised as one of the most comfortable and effective anal fissure treatments. This treatment allows a scar-free procedure or only minimal scaring.

In order to maintain good health and proper bowel function, as well as to prevent anal fissures, experts recommend taking a fortified diet, consuming high-fibre foods, drinking enough water and remembering physical exercise.

Timely diagnosis and treatment of proctological diseases is also very important. If you experience any unpleasant symptoms, you should contact your doctor immediately, as pain or bleeding may also be symptoms of oncological or other serious illnesses.

Modern medicine allows timely proctological tests without any unpleasant sensations. If the disease is identified early, there are more opportunities to initiate a sparing treatment, solve the frustrating problem faster and improve the patient’s quality of life.

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