There are different views on the pathogenesis of anal fissure - hronichnoinonhealing ulcer in the anal canal. Obviously, the main link mechanism of an anal fissure are nerve endings change its bottom. Primary or secondary - these changes occur in response to persistent spasm of the anal sphincter, thus closing a vicious circle, or vice versa - this issue needs further study.
Dohrenbusch et al (1986) examine the anal crypts, as a pathological substrate anal fissures. The study sections in the area of ??perianal tissue and the dentate line of the anal canal showed that the cancer penetrates to the dentate line area in the anal canal, often forming a system of tunnels andzredka perforating the internal sphincter and branching in mezhsfinkternye expanses. Sometimes it ends ramifications of such glands are epithelial cells, wherein pidanodermalnye glandular structures has mostly circular, which does not allow to differentiate a rear or front surface of the gland. As noted by A. and F. Stele Safiktsner, anal epithelium mainly penetrates deeper anodermy in the internal sphincter, that is likely anal glands are structures identical anal crypts. Filling these crypts may cause anal fissure.
The local anti-inflammatory barrier, on the one hand,creates the conditions for long-term existence in the same range of anal fissure, and on the other - in the "hold" a virulent infection, the mouths of the anal glands, which, according to morphologists contained at the bottom of anal fissures, quickly spread to the cellular space around the rectum and calls GOSTR abscess. Ochevidno, with further study, for example, limfologichnyh factors of local immunity, there will be new data. While frequent among patients proctologic syndrome of anal fissure (known clinical triad - pain, cramps, bleeding) make patients go to the doctor.
One of the main factors of the pathogeneneza anal fissure is some pathophysiological mechanisms in the sustainable locks of different genesis in people with anatomically more acute anorectal angle (the physiological bend on the edge of the rectum and anal canal), there are direct injuries - tears of the mucosa, especially in those parts of the anal canal, which acrossanatomical features of the least mobile and therefore less compensate injury resulting from the passage of hard lumps of feces. These tears under certain conditions, destruction of local protivovosspali enforcement barrier in three or four months turn into chronic ulcers without signs of granulation and epithelialization.
During the first weeks and months after microtrauma fracture symptoms minimum: an unpleasant feeling in the anus during and after defecation and sometimes imperceptible drop of blood. Especially difficult to differentiate between "early" fissure with hemorrhoids. The trauma of the mucous membrane of solid fecal lumps often atsya in areas of the anal canal, which contains the main internal hemorrhoids because of thinned wall units is an inner wall of the anal canal.
With the formation of the soft rattles and then a dense, often because of the raised edges of the crack-sores appear: pain, cramps, bleeding.The first symptom of trauma to explain the bare nerve endings bottom crack (VB Zayratyan), the second - a reflex contraction of the internal sphincter, which arises as a response na.bolevoy momentum, and the third - the bleeding that occurs due to direct injury to vessel walls and bottom of the crack. Bleeding while small (as compared with hemorrhoids) and it is often the differential diagnostic test. Note that the crack is often coexists with hemorrhoids, and this combination is a typical (Iiazarov LV, RV Orgusyan). Irritation of nerve endings and pain in the presence of a crack caused by prolonged spasm of the anal sphincter, which helps: violation venoznogo outflow, stagnation of blood in the hemorrhoidal veins, hypoxia and the weakening of the venous wall.
The surgical treatment of this disease can be skipped by the way, can be found at proktolog.be. There were publications about plastic anal fissures various synthetic plenkamy and medical glue toSongs (Nazarov, L. et al., 1986). We describe plastic surgery to the anus in purulent processes. The elimination of spasm of the sphincter during anal fissures can be achieved not only by cutting the internal sphincter, but closing the cracks and healthy tissue thereby eliminating the constant center of irritation, which, in fact, istsya source of pain, and therefore the spasm of the sphincter.
