Proctal cracks
Contents:
Description:
Proctal crack — a longitudinal gap, a wound or an ulcer between the gear line and edge of the proctal channel (anus). Usually is located on the average line, a thicket on a back semi-circle of an anus (at position of the patient on spin This disease can develop at any age, but is more characteristic of young people. Cracks can appear from behind a frequent chair, a diarrhea or on the contrary, locks, when passing through an anus of a firm chair. However arise without the visible reasons more often. Is one of the most widespread proctologic diseases.
Symptoms of Proctal cracks:
Distinguish acute and chronic cracks. Acute cracks — usually appear after an episode of a lock or diarrhea and independently begin to live at normalization of a chair. Chronic cracks — are present more than 3 months are followed by signs of chronic process (the raised, kalezny edges, a naked muscle of a sphincter, a sentry hillock, a hypertrophied proctal small fringe).
Symptoms: pain in an anus usually in time or after defecation. Pain stops after a chair, but several hours sometimes can last after or to be a constant. The bleeding which is usually not really expressed in the form of blood traces on toilet paper.
Reasons of Proctal cracks:
The disease is connected with the raised sphincter tone. At the acute or chronic injury of the proctal channel caused by locks and passing of a firm chair, or on the contrary a diarrhea occurs to a superficial gap mucous the proctal channel; acute cracks begin to live at 40-60% of patients at normalization of a chair. If it does not occur, they can become chronic as a result of formation of a vicious circle: in response to pain the tone of an internal proctal sphincter, i.e. its spasm increases. At the expense of supertension the crack "is" behind folds of the proctal channel and therefore it cannot be cleared that in turn leads to an inflammation, pains and besides strengthening of a spasm of a sphincter, etc.
Treatment of Proctal cracks:
Treatment of a crack aims at achievement of a normal regular chair and decrease in a tone of a sphincter.
Nonsurgical treatment. Normalization of a chair (at locks - light laxatives and "razmyagchitel" of a chair, increase in consumption of cellulose, liquid). Sedentary trays: help the patient to relax, provide the hygienic mode. The medicamentous means removing a spasm of an internal proctal sphincter.
• 0,2% nitrounguentum Glycerini locally (the amount of ointment which is located on a finger-tip is applied on area of an anus twice a day): probability of healing of a crack within 4-8 weeks — 40-60%; side effects: a headache (in particular in an initiation of treatment, it can be stopped by acetaminophen), tachycardia. It is contraindicated at reception of viagra (sildenafil): risk of malignant arrhythmia.
• 2% ointment with diltiazem or 0,2% with nifedipine: applications two or three times a day on perianal skin; treatment frequency same as at nitrounguentum Glycerini, the headache is less, but can cause bigger irritation. Candles methyluracil in the morning and нотальсид in the evening, and also tablets methyluracil 4 times a day after food. It is possible to advise homeopathic ointment траумельС, and injections of homeopathic medicines of Traumels, a mukoz a compositum, a placenta a compositum. A beam to do injections on akupuntura points.
• A Botox injection in an internal sphincter: local disinfection and an injection of 10-20 units of a botulinotoksin And (suspension in 1 ml of 0,9% of NaCl solution) directly in an internal proctal sphincter on each of the parties (total quantity: 20-40 units) the expected probability of treatment of a crack within 6-12 weeks of 80-85%.
Surgical treatment. Usually at this disease carry out excision of a crack and a sphincterotomy which essence consists that the section of one of portions of a proctal sphincter is made. This intervention leads to sphincteri incontinence, will remove a pain syndrome and creates conditions for healing. Crossing of this muscle is usually not led to disturbance of a continence by a calla and does not increase stay in a hospital.
