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Taboo topic Analfissur

Post by 
Dr. Mohamed Salama
Published 
June 29, 2022
A

nalfissures are a frequent cause of anal discomfort. Analfissures are equally common in men and women and occur most frequently in middle-aged and younger patients. However, children and the elderly can also develop analfissures. The disease should not be taboo!

What is the cause of an analfissur?
Dr. Salama: Unless analfissure is a complication of another condition, its exact cause is still unknown. It is thought that the passage of very large or hard stools, local diarrheal irritation, anorectal surgery, and anorectal intercourse place stress on the anal mucosa..

Does an analfissure heal on its own?
Dr. Salama: Small tears in the anal mucosa caused by hard stool are common, but usually heal quickly without permanent consequences.

In contrast, how do pathological processes manifest themselves?
Dr. Salama: Increased tension and enlargement of the internal sphincter are the most frequently detected abnormalities. The function of the sphincter apparatus is examined by means of a measuring catheter through which water flows. Most affected patients have a chronically high tone of the internal sphincter, which elongates the fissures and returns to a normal level after surgical transection of a sphincter. The increased tone of the internal sphincter causes locally decreased or absent blood flow to the tissue, which delays healing of the fissure and can lead to chronic injury. The branches of the inferior rectal artery that cross the internal sphincter supply the anal mucosa, and it has been noted that the blood supply to the anal mucosa is inversely related to the pressure of the internal sphincter.

How are anal fissures treated or treated surgically?
Dr. Salama: The vast majority of acute anal fissures heal on their own with conservative treatment. However, healing is more difficult, and only about 50% of chronic fissures respond to conservative therapy.
Surgical options should be chosen in those cases where nonsurgical treatment for more than 6 to 8 weeks does not produce the desired results. Conservative methods include surgical stretching of the sphincter and surgical treatment by surgical transection of a portion of the internal sphincter.

What novel treatment methods are available for anal fissures?
Dr. Salama: One new therapy is sacral nerve stimulation, a novel treatment option for those who choose not to undergo more invasive surgical procedures.
However, internal anal sphincterotomy is considered the gold standard for anal fissures, but it comes with the potential complication of fecal incontinence. In recent years, various modifications of the procedure have been developed to make it safer. In addition, there are a variety of innovative nonsurgical procedures available for treatment. Before deciding on a particular option, it is important for patients to undergo a complete evaluation, focusing on the characteristics of the incontinence. Only after the patient has been fully informed about the method, cure rates, complications and alternative options should the optimal treatment be chosen.
In some cases of anal fissures, colorectal cancer screening may be recommended; the gold standard is colonoscopy, which is recommended by the American Society for Colorectal Cancer Screening beginning at age 45.

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