10/3/2023 0 Comments Sentinel pile removal recovery![]() These agents are effective in over half of cases. These ointments are all applied to the anal sphincter three times a day, and must be used for 6 weeks for success. In breast-feeding mothers, nitrates should not be used, and calcium channel blockers (diltiazem) in 2% gel form is an effective alternative. Headaches are a side effect of Rectogesic® and are less common with Isordil®. Topical nitrates such as 0.2% glycerine trinitrate (Rectogesic®) and 1% isosorbide dinitrate (Isordil®) work by relaxing the internal sphincter, and preventing spasm. Opioid medications containing morphine-like agents should be avoided as they cause constipation, which exacerbates the condition. Pain relief may be required and include over the counter non-opioid based analgesics including non-steroidal medications such as ibuprofen (Brufen®) and simple paracetamol (Panadol®). Laxatives are commonly required and include lactulose (Duphalac®) sterculia (Normacol®) or osmotic agents containing magroglol polymers and sodium phosphate (Movicol®). Stool softeners containing non-soluble fibre including natural psyllium husk (Metamucil®) or ispaghula husk (Fibogel®) are recommended. Once a fissure is established, the above measures rarely result in healing, and medical treatment is often required. To allow the fissure to heal we suggest showering or bathing, or using baby wipes after every bowel motion and taking regular warm-to-hot salt water (Sitz) baths, which involves sitting in a shallow bath of water for around 20 minutes. Simple lifestyle modifications to prevent constipation include drinking plenty of water (six to eight glasses of water a day), having a diet high in fibre, and exercising regularly. Commonly, examination is poorly tolerated and proper diagnosis requires examination under anaesthetic. DiagnosisĪn anal fissure is largely a clinical diagnosis based on the typical history including pain and bleeding on defecation, along with the classic features of pain on examination, and a visible fissure in the midline of the anus. Rarely, anal fissures can form an anal fistula (an abnormal tract that joins the internal anus to the external skin surrounding the anus). Over time, this can cause extensive scar tissue at the site of the fissure (sentinel pile). Failure to heal can result in the development of a chronic anal fissure. ComplicationsĪcute anal fissures are usually a benign condition not associated with more serious diseases, such as bowel cancer. If these measures failure, surgery may be indicated, where a small proportion of the internal sphincter is cut. These can also be combined with botulin toxin (Botox®) injections to the internal sphincter to allow temporary relaxation of the anus to allow for healing of the fissure. The topical application of medications to relax the sphincter such as Rectogesic® or diltiazem may help. Treatment options include the use of bulking agents such as Metamucil ® or Fibogel® to loosen the stool and laxatives such as lactulose (Duphulac®) or osmotic laxatives such as Movicol®. However, healing can be a problem if the pressure of passing bowel motions constantly reopens the fissure. ![]() Around half of cases heal by themselves with proper self-care and avoidance of constipation. Rarely it is due to Crohn’s Disease of the anus. CauseĬommon causes in adults include constipation and trauma to the anus. ![]() Symptoms include pain and bleeding from the anus when passing a bowel motion. This often leads to the avoidance of defecation, establishing a vicious cycle of constipation and repeated anal fissuring. Anal fissures result in severe pain on defecation, with anal sphincter spasm, and further tearing. This if often due to constipation with firm stools tearing the mucosa on defecation. An anal fissure is a tear or split in the lining of the anus (anal mucosa).
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