#Anal #fissureشرخ #فى #فتحه #الشرخاسبابه #وعلاجه
[ad_1]
Anal fissure:
An anal fissure is a break or tear within the pores and skin of the anal canal.
Anal fissures could also be seen by shiny pink anal bleeding on bathroom paper and undergarments, or typically in the bathroom.
Causes of Anal fissure:.
1-Most anal fissures are attributable to stretching of the anal mucous membrane past its functionality.
2-Superficial or shallow anal fissures look very like:
-a paper minimize.,
-and could also be exhausting to detect upon visible inspection;.
– they may usually self-heal inside a few weeks.
3- Nevertheless, some anal fissures turn into power and deep and won’t heal.
The commonest reason for non-healing is spasming of the inner anal sphincter muscle which leads to impaired blood provide to the anal mucosa.
4-The result’s a non-healing ulcer, which can turn into contaminated by fecal micro organism.
5-In adults, fissures could also be attributable to:
A-Constipation.,
B- the passing of huge.,
C- exhausting stools.,
D- extended diarrhea.
E–In older adults, anal fissures could also be attributable to decreased blood move to the realm.
6-When fissures are discovered laterally,:
A-tuberculosis.,
B-occult abscesses,.
C-leukemic infiltrates,.
D-carcinoma,.
E-acquired immunodeficiency syndrome (AIDS)
F- inflammatory bowel illness needs to be thought-about as causes.
7-Some sexually transmitted infections :.
-syphilis.,
-herpes.,
-chlamydia.
-human papilloma virus..
8-Different widespread causes of anal fissures embrace:
• -childbirth trauma in ladies.
• -anal intercourse.
• -Crohn’s illness.
• -ulcerative colitis.
• -poor toileting in younger youngsters.
Prevention.
For adults, the next might assist forestall anal fissures:
1-Avoiding straining when defecating. This contains treating and stopping constipation by consuming meals wealthy in dietary fiber.,
2-drinking sufficient water.,
3- occasional use of a stool softener.,
4-and avoiding constipating brokers.
5- Equally, immediate therapy of diarrhea might scale back anal pressure.
6-Cautious anal hygiene after defecation:
,A- together with utilizing tender bathroom paper.
B-cleaning with water.,
C-the use of sanitary wipes.
6-In circumstances of pre-existing or suspected fissure, use of a lubricating ointment (You will need to word that hemorrhoid ointment is contraindicated as a result of it constricts small blood vessels, thus causes a lower in blood move, which prevents therapeutic.)
7-In infants, frequent diaper change can forestall anal fissure.
8- As constipation generally is a trigger, ensuring the toddler is consuming sufficient fluids (i.e. breastmilk, correct ratios when mixing formulation) is helpful.
9-In infants, as soon as an anal fissure has occurred, addressing underlying causes is normally sufficient to make sure therapeutic happens.
Remedy of anal fissures:
1- topical Non-surgical therapies are beneficial initially for acute and power anal fissures.
These embrace:
a-topical nitroglycerin or calcium channel blockers (e.g. diltiazem),
B- injection of botulinum toxin into the anal sphincter.
C- heat sitz baths,.
D- topical anesthetics.
E- high-fiber food plan.
F-stool softeners.
2- Native software of anal fissures.
1-Native software of treatment to calm down the sphincter musclewith :
A-topical nitroglycerine ointment as 0.2%.
B-topical nifedipine 0.3% with lidocaine 1.5% ointment +nifedipine ointment.,
-topical diltiazem 2%.
*A standard aspect impact nitroglycerine ointment is headache, attributable to systemic absorption of the drug, which limits affected person acceptability.
2-A mixed surgical and pharmacological therapy.,
-administered by colorectal surgeons.,
– is direct injection of botulinum toxin (Botox) into the anal sphincter to calm down it.
– injection has much less and fewer potent, spending 1000’s of {dollars} within the meantime for a partial treatment.
3-Lateral sphincterotomy is the Gold Normal for curing this affliction.
4- Mixture of medical therapies might provide as much as 98% treatment charges.
**Surgical procedure.
1-Surgical procedures are usually reserved for folks with anal fissure who’ve tried medical remedy for a minimum of one to 3 months and haven’t healed.
2-It’s not the primary possibility in therapy.
3-The primary concern with surgical procedure is the event of anal incontinence.
4-Anal incontinence can embrace :
A-inability to manage fuel.,
B-mild fecal soiling.,
C-or lack of strong stool..
D-A point of incontinence can happen in as much as 45 % of sufferers within the quick surgical restoration interval.
E-Nevertheless, incontinence isn’t everlasting and is normally gentle.
4-Surgical therapy, beneath normal anaesthesia, was both anal stretch (Lord’s operation)
or lateral sphincterotomy the place the inner anal sphincter muscle is incised.
– Each operations intention to lower sphincter spasming and thereby restore regular blood provide to the anal mucosa.
– Surgical operations contain a normal or regional anaesthetia.
**Lateral inner sphincterotomy.
[ad_2]
