Anal crack is a small crack, crevasse or superficial lesion, located on the wall of the anal channel (at the base of the rectum). It occurs frequently in adults. It can be associated with repeated constipation seizures, hard saddles, diarrhea or more rarely, chronic inflammatory gut diseases or certain sexual practices, such as sodomy. Anal cracks are also common in babies 6 months to 2 years old but rare in older children.
Anal cracks cause strong pain and light bleeding, especially at saddle time. In the vast majority of cases, they can resorate without using surgery.
• POSSIBLE COMPLICATIONS
Several patients are reluctant to consult a doctor because they are embarrassed to discuss their symptoms. Pushing back treatment can however, in the long run create an apprehension of going to the saddle. This apprehension can cause the constipation and expansion of the tear. Thus begins a vicious circle.
When they fail to heal properly, cracks can become chronic. They can eventually touch the muscles of the sphincter, causing painful spasms.
• WHEN TO SEE?
Medical consultation is recommended when home treatment does not provide relief.
• SYMPTOMS
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Pain sometimes very intense, often with burns especially when saddles pass. Once the saddles pass, typically, the pain decreases, then it tends to return within hours.
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Traces of blood on the saddle surface or on toilet paper;
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Anus itching, often outside episodes of intense pain, which could lead to scratching lesions;
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Anal contracture due to muscle spasms of the anal sphincter;
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Reflex constipation for fear of pain.
• RISK FACTORS
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Age. Babies under 2 often suffer from anal cracks, for an unexplained reason.
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Repeated constipation seizures. Forcing and evacuating hard and large saddles is probably conducive to anal cracks;
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Childbirth. Women are more likely to suffer from anal cracks in this life span. They should not be operated, but treated medically, and in case of cracks becoming chronic, surgery can only be considered 6 months early after childbirth.
• PREVENTION
We can reduce the risk of anal cracks by preventing constipation:
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Prefer foods rich in dietary fibre, such as complete cereal, dry vegetables, fruits and vegetables and as needed, take a mass laxative in case of constipation (psyllium, metamucil ® etc. ) to soften the saddles.
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Drink enough;
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Practice regular physical activity;
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Go to the saddle whenever the need is felt and avoid forced.
• Treatments
Treatments aim to relieve pain and anal spasms, and heal the crack.
- Home treatment
Basic preventive measures help to heal half the acute anal cracks.
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consume enough fibre,
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Drink enough, be physically active,
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Avoid constipation, do not force by going to the saddle),
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Taking a 10 to 15 minute seat bath, 2 to 3 times a day, will relieve pain and itch.
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Sink soap and scented toilet paper because it can increase irritation.
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Use soft laxatives (non-irritating) such as mucilages, osmotic laxatives, or lubricants.
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Vitamin or anti-inflammatory healing preparations are available in pharmacy, but these treatments have shown no higher efficiency than a simple lubricant.
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Suppositories lubricating the anal channel and facilitating saddle passage can be useful
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Paracetamol or anti-inflammatory can relieve pain.
- Medical Treatments
Besides basic treatments, doctors prescribe treatments to act on the cause of anal cracks when they become chronic because of the hypertonicity of the anal sphincter.
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Nitrated derivatives like glyceryl trinitrate (Rectogesic ®) are effective against pain and improve healing at the dose of one and a half application. However, this type of treatment is often associated with headaches caused by systemic absorption of the drug.
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Calcium inhibitors are sometimes also prescribed. But these drugs do not currently have an official indication.
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The botulin toxic (Botox ®, Vistabel ®, Dysport ®, Xeomin or Neurobloc ®) can be injected into the sphincter to release the contracture seat muscles. By crippling muscles, toxin calms spasms and promotes healing. This is effective, but officially the indication is not known in France for this type of treatment. However this can prevent the use of surgery.
- Surgery
If symptoms didn’t disappear after 6 weeks of treatment, surgery may be necessary. She is the most effective treatment for chronic anal cracks. The procedure called Sphincterectomy, consists of cutting part of the muscles of the Sphincter to stop spasms and promote healing. Procedure is usually done in outpatient surgery without hospitalization. This scars in a few days. The risks of permanent anal incontinence after surgery are minimal but up to 45 % of patients have slight anal incontinence within days of surgery.