The anal fissure is an ulceration that occurs in the anal canal, ie in the small section between the intestine and the skin. Its onset is linked to the passage of hard stools that cause a tear in the mucosa. However such cases, extremely frequent, not normally determines a disease, as the laceration rapidly heals. Why this healing happen it is essential the normal relaxation of the internal sphincter muscle, ie of that part of the muscles placed around the anus to ensure continence which is not controlled by the will but by the autonomic nervous system that is involuntary. However, if there is an overtone, or the sharp contraction failure with relaxation of the internal sphincter, the tear does not heal and form rhagades.
The characteristic symptoms are: pain after defecation appears and stays for a few hours. The pain is almost always very strong. Can also be a mild bleeding.
The fissure may experience spontaneous healing, but if this does not happen within a few weeks the disease becomes chronic.
The course of the disease is characterized by alternating periods of exacerbation and remission periods.
Symptomatic therapy is the use of ointments that contain anesthetics and medications that relax contracted muscles and analgesics.
In general, when the periods of acute illness, with the presence of severe pain poorly controllable, is too long for the patient decides to undergo a definitive treatment.
Since the hypertonic sphincter dyssynergia is determined by the two systems (sympathetic and parasympathetic) that normally have to work harmoniously as they determine opposing actions, and this failure is typically caused by stress (patients with anal fissure are almost always anxious subjects) in many cases is decisive therapy neuro psycho physical optimization (REAC therapy) see
If, however, there are chronic wounds, which can not however heal with the aid of a conservative therapy, surgical intervention is indispensable.
The surgery that we developed and practiced is called internal sphincterotomy CALIBRATED.
It consists in the section of a part of the fibers of the internal sphincter muscle contract; since the intervention traditionally practiced can determine incontinence (ie decreased ability to voluntarily retain the emission of faeces or intestinal gas), our technique provides for the section of the muscle only up to a precise point (corresponding to the upper margin of the fissure): in this way you can not have incontinence.
Local anesthesia is practiced with very small quantities (tubofiale for dentistry) of anesthetic. Microinstruments are used appropriately developed.
The surgery is an outpatient practiced, lasts 5 to 10 minutes, is painless and allows the immediate resumption of all attività.Non are nessarie medications nor controls.