Causes and current classification of anal pain

The disease is not classified as dangerous or developing, but it causes a lot of trouble. Occurs regardless of gender and age in approximately 6.5% of the population.

The main characteristic is uncontrolled contraction of the anus, as well as the rectum. Painful sensations spread to the peritoneum and lower back. Rectal neuralgia is not accompanied by mechanical damage to organs, being exclusively a problem of the nervous system.

Causes

At the moment, anococcygeus pain has not been sufficiently studied, but experts identify possible provoking factors:

• bruised tailbone;
• fracture (even an old one);
• nervous disorders in the muscle tissues of the pelvic and retroanal areas;
• pathological changes in the musculoskeletal system in this area;
• neuralgic diseases of the spine;
• problems in the intestines (hemorrhoids, fissures, etc.);
• organ prolapse;
• tense mental states;
• problems with bowel movements (frequent constipation, diarrhea).

Symptoms

The main indicator of the presence of a problem is severe pain in the rectum, interfering with normal life activities. These signs appear in:

• coccyx (called “coccydynia”);
• anus (anal neuralgia). Usually they have no prerequisites for their appearance.

The pain may:

• be a constant companion of the victim;
• occur suddenly and continue for any time, but usually no more than half an hour and at night.

The pain can be either dull or stabbing. Sometimes they are of such a nature that it is impossible to determine the exact location.

Neuralgia is accompanied by:

• spasms;
• burning in the tailbone;
• heaviness in the stomach;
• priapism;
• pale skin;
• increased sweating.

Anorectal pain (neuralgia) adds the following zones to the painful areas described above:

• buttocks;
• vagina;
• hips;
• sacral region.

Most often occurs in women over 50 who suffer from:

If the underlying disease is persistent cancerophobia, then the patient is indicated for surgical intervention due to organic factors.

Classification

Doctors identify several classification bases, each of which describes the nature of the disease:

• in the coccyx area – coccydynia;
• in the anus - anorectal syndrome.

• primary;
• secondary. It is a symptom of other diseases, mainly in neighboring organs (prostatitis, acute urethritis, problems “on the female side”, etc.).

• Night. The pain occurs at night and lasts for an indefinite period of time. Additional localization: in the perineum, pelvic floor.
• Spastic. Determined by the presence of gastrointestinal diseases and stool disorders.
• Anusolgia (“flying proctalgia”). It is distinguished from the nocturnal type by a known cause: back injuries, infectious diseases of the urinary system, and sometimes constipation.

Diagnostics

Anococcygeal pain syndrome is made as a diagnosis only after excluding the possibility of organic pathologies:

• problems with the intestines - hemorrhoids, anal fissures, etc.
• diseases of the reproductive system – endometritis, prostatitis, etc.
• rheumatological diseases – radiculitis, sciatica.
• neuralgia.

• If the examination establishes that the cause of the painful sensations is not a disease of a certain organ, then a diagnosis of “ancoccygeal syndrome” is made.
• The examination is carried out by a proctologist and gynecologist.
• The proctologist determines the absence of:

• damage to the anus;
• foci of inflammation;
• injuries of the sacrum or coccyx;
• muscle spasm in this area.

A gynecologist is recommended for women to analyze the condition of the reproductive organs.

Laboratory tests are required. Standard procedures include:

• coprogram;
• feces for testing bacteria and the presence of blood in the composition;
• general urine analysis;
• gynecological tests for both sexes.

For a full diagnosis, consultations with a urologist, traumatologist, andrologist, neurologist, and psychotherapist are often necessary. Only after their conclusions does the attending physician make a final decision regarding the nature of the disease.

Sigmoidoscopy and anoscopy

Many additional studies are aimed at excluding possible other causes of pain. These include:

• sigmoidoscopy – study of the condition of the large intestine;
• anoscopy – analysis of the health of the anal canal.

Both procedures provide information about:

• the condition of the internal mucous surfaces;
• the presence of hemorrhoids and polyps;
• the presence of papillitis.

Irrigography

At its core, it is an X-ray of the intestine. Finds:

• tumor formations;
• abnormal narrowing;
• problems in the coccyx, sacral area, hip joint.

Electrophysiological and ultrasound examination

The first looks for muscle spasms, collects data on intestinal motility and functionality. The second allows you to “see” the organs in the pelvic area, especially the genitals.

Treatment

The effectiveness of therapy is determined by:

• completeness of the examination;
• correct diagnosis;
• correct identification of the root cause.

Treatment is carried out in 3 areas:

• Etiological. They try to rid the patient of the factors that provoke the disease.
• Pathogenetic. If possible, the development of the problem is slowed down.
• Symptomatic. First of all, pain relief.

A popular method is physiotherapy:

• laser radiation;
• UZ;
• UHF;
• mud treatment;
• massage.

Local preparations include suppositories, microenemas with painkillers and anti-inflammatory substances.

Since a common cause is an unstable psychological state, consultations with specialists in this field are often prescribed.

Analgesic methods

Treatment of pain, especially of unknown origin, is one of the areas for study in modern medicine. There are medical institutions all over the planet that are engaged in the prevention and relief of their patients from syndromes of this kind.

Doctors prefer not narcotic drugs, but various analgesics:

• Novocaine blocks nerve transmissions;
• local anesthesia relieves pain;
• hot applications relieve discomfort.

1. Cortisone has now proven its own ineffectiveness and the harm it causes to patients.
2. Placebo is applicable for psychogenic origin of the syndrome.
3. Sedatives and tranquilizers are prescribed for those suffering from:

• depression;
• anxiety;
• neurotic conditions.

Surgical intervention

Indicated in the most extreme cases if:

• coccydynia appeared only due to the injury;
• there is a separation of the tip of the coccyx.

In this situation, the operation is called extirpation. During the procedure, the coccyx is fixed at the sacrum.

Prevention and prognosis

With anococcygeus pain, it is often difficult to determine the cause of the discomfort, as well as to find a pattern in the occurrence of attacks. Recovery is possible only with a correct diagnosis and varied treatment prescribed by the doctor. The most likely “causative agent” can be considered the emotional state of the patient, which is regulated by appropriate drugs and techniques.

If the root cause is not injury or pathology of the spinal column or pelvic bones, then anococcygeus syndrome does not lead to complications.

It is impossible to single out preventive measures. Doctors advise to be attentive to emerging symptoms and try to rearrange your life in such a way as to reduce the intensity of their manifestation.

The usual rules are:

• active lifestyle, regular non-exhausting sports, walks;
• prevention of spinal diseases and elimination of existing problems;
• treatment of the gastrointestinal tract, especially the intestines;
• proper nutrition with healthy foods.

The main danger of neuralgia is unpredictable pain, which can last up to 30 minutes and interfere with normal life. Complex therapy helps suppress symptoms, but only a reasonable attitude towards one’s health can help reduce the syndrome. Prevention available to everyone is a healthy lifestyle and timely treatment of the spine and internal organs.

Source: http://NashiNervy.ru/perifericheskaya-nervnaya-sistema/diagnostika-i-lechenie-anorektalnoj-nevralgii.html

Causes and symptoms of anal fissure

Anal fissures are diagnosed in 20% of patients who turn to proctologists with complaints of discomfort in the rectal area. Most often, women of reproductive age face this problem, but anyone, including a child, can suffer from it.

The development of this problem is facilitated by a whole range of different factors, but there are the main causes of anal fissures:

• Regular bowel irregularities – prolonged constipation or diarrhea;
• Failure to comply with personal hygiene rules. Cleansing procedures must be carried out after each trip to the toilet. Otherwise, diaper rash and inflammation appear on the intestinal mucosa, which lead to its rupture;
• Mechanical damage resulting from the use of rough and low-quality toilet paper and other similar products;
• Violation of normal sphincter spasms;
• Pregnancy and difficult childbirth - in this case, the development of an anal fissure is caused by strong pressure on the pelvis and compressed intestines;
• Anatomical features of the structure of the genital organs;
• Medical examinations (colonoscopy, rectoscopy, etc.) - most likely, we are talking about violations of the rules of the procedure and the unprofessionalism of doctors;
• Advanced hemorrhoids – very often causes symptoms of rectal fissure;
• Addiction to spicy food and alcohol;
• Lifting weights;
• Non-traditional sexual contacts (anal);
• Various pathologies of the central nervous system;
• Crohn's disease;
• Poor nutrition, which causes drying out of the intestinal contents;
• Disruption of natural blood flow in the pelvic area or blood stagnation can occur as a result of a sedentary lifestyle or characteristics of professional activity;
• Rapid or incorrect administration of the enema;
• Refusal of rectal suppositories and laxatives during the first stool after childbirth;
• Poor chewing of food - undigested pieces can damage the intestinal walls during bowel movements
• Inflammatory processes during proctitis - cause a decrease in the strength of the tissues of the anus and damage to them by feces;
• Excessive straining during bowel movements;
• Vascular disorders of the walls of the rectum;
• Frequent heavy physical activity;
• Diseases of the gastrointestinal tract.

Signs of anal fissures

Anal fissure can be acute or chronic. Each of these forms has its own symptoms.

How does the acute form manifest itself?

With this type of pathology, the symptoms of a fissure in the anus manifest themselves quite clearly. The patient is concerned about:

• Burning, throbbing and strong, but not long-lasting pain. Pain appears either during defecation or within a quarter of an hour after its completion;
• Constipation caused by sphincter spasms and the patient's fear of pain or discomfort when going to the toilet;
• Minor discharge of blood that occurs as a result of the passage of dense stool.

How to recognize chronic pathology?

Signs of an anal fissure, which occurs in a chronic form, look something like this:

• The pain becomes stronger and occurs not only during bowel movements, but also throughout the day. It hurts a person to sit, stand and even lie down - this interferes with healthy sleep and leads to insomnia and increased irritability;
• Itching in the sphincter area;
• Severe stool phobia;
• Trace bleeding;
• Pus may be discharged from the anus.

Possible complications

You already know the causes of anal fissure. It remains to be seen what health problems it can lead to if you do not consult a doctor in time and start therapy.

Without proper treatment, inflammation increases and spreads to healthy tissue. The main risk of this phenomenon is infection of the intestinal walls (the crack goes up). Against this background, paraproctitis may occur, a serious disease characterized by inflammation of fatty tissue concentrated in the rectum and around the anus.

At the same time, the patient begins to suffer from severe pain and constant heavy bleeding, fraught with the loss of large amounts of blood and the development of anemia. Both women and men suffer from such complications equally. In the latter case, there is a risk that the infection will spread to the prostate gland and lead to the development of prostatitis.

Other complications also include the appearance of fistulas in the anus and the development of colitis, inflammation of the inner lining of the large intestine. But the biggest problem can be called, without exaggeration, the huge risk of malignancy of the fissure and the inflamed tissues surrounding it. According to statistics, in 20% of cases the cause of rectal cancer is an anal fissure.

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Next you should read: Nutrition rules, diet for anal fissure

Causes of anal fissures

Source: https://proktoinfo.ru/treshini-zadnego-prohoda/prichiny-poyavleniya-i-simptomy-analnoj-treshchiny

Causes and treatment of pain in the anus in women - when to see a doctor?

Pain in the anus in a woman occurs for various reasons. This is due to the presence of nerve endings in this area.

Therefore, even minor cracks that appear in the anus cause uncomfortable and even painful sensations.

Symptoms and signs

Pain in the anus in women can be different - dull and sharp, cramping and constant, burning and cutting, intensifying at the time of bowel movement.

The following signs may accompany discomfort::

• severe itching;
• diarrhea or constipation;
• bloating;
• purulent discharge;
• symptoms of intoxication;
• bad feeling;
• bleeding;
• anemia;
• deceptive urge to defecate;
• sensation of a foreign object in the rectum.

If you notice at least one symptom, you should immediately go to the doctor, since the source of pain in the anus can be dangerous diseases.

Why does pain occur?

Let's look at the main causes of pain in the anus in women and tell you when treatment is necessary.

Cracks in the wall of the rectum

Discomfort that increases with the passage of feces indicates that a crack has formed on the wall of the rectum .

Usually the phenomenon makes itself felt only during bowel movements. This happens at the moment of pushing out a too dense fecal bolus.

In rare cases, the rectal mucosa can be damaged by foreign objects that entered the gastrointestinal tract with food and, without being digested, were excreted.

For example, fruit pits, seed husks, etc. Diarrhea can also cause discomfort in the anus.

• First, you need to establish the cause of the diarrhea and eliminate it, and only after that begin to treat the inflammation that has arisen in the anus.
• The source of persistent diarrhea may be the development of diverticulitis (an inflammatory bowel disease), colitis, polyps or tumors.
• Painful sensations that bother a woman for a long time and intensify at the time of bowel movement indicate that the resulting fissure has become inflamed and has acquired an aggravated form .

The pain that occurs due to the formation of a crack is much more piercing than with hemorrhoids. In rare cases, it becomes so intense that it can cause screaming.

There is a delay in defecation, resulting in constipation.

Often women experience spasms and pain in the anus, which radiate to the perineum and sacrum.

The functioning of the genitourinary system is disrupted, which leads to difficulty urinating and disruption of the menstrual cycle.

For some women, the discomfort lasts for a long time. The reason is regular damage to the wall of the rectum ; spasms of the sphincter muscles last longer and longer.

1. Sometimes the pain may linger until the next act of bowel movement follows.
2. Until the main cause of discomfort in the anus is eliminated, that is, the fissure, the sensations will become more and more intense, and will soon become completely unbearable.
3. Cracks in the anus may be accompanied by the following symptoms:

• piercing pain during bowel movements;
• discharge of a small amount of mucus with blood clots.

Cracks often appear on the back wall of the anal canal, sometimes on the front, and very rarely on both at the same time.

The most serious disease developing in the anal area is considered to be damage to the walls (wounds, cracks) that has spread throughout the entire area of ​​the anal canal. Then we can talk about the presence of oncology.

Cancer

• Cancer that develops in the rectum does not go away without clinical signs.
• The most important symptom of oncology, which cannot be ignored, is the release of bright scarlet blood clots along with stool .
• The second, no less significant sign is piercing pain.
• The sensations usually occur during the passage of feces, and do not subside for a long time, but, on the contrary, intensify and become regular.
• Sometimes the pain can be transmitted to the genitals, thighs, and lower abdomen.

Perineal injury

Pain in the anal area may not always indicate oncology.

Many people complain of discomfort due to regular bowel movements of hard stool.

Perineal injuries can also cause pain in women in the anus. These are falls, bruises, blows .

Dangerous diseases

There are also more serious sources that cause discomfort in the anus in women. This:

• venereal diseases;
• diseases of the urinary system;
• acute appendicitis;
• diseases of the genital organs;
• abscesses (purulent inflammations).

Often, discomfort and pain in the anal area can appear in older women who have undergone more than 3 births.

Haemorrhoids

Hemorrhoids are a disease associated with the dilation of the veins of the rectum and the formation of nodes. More than 15% of the entire adult population suffers from it.

Causes of hemorrhoids:

• frequent consumption of alcoholic beverages and irritating foods;
• repeated pregnancies;
• heavy physical activity;
• systematically occurring constipation.

The disease develops very quickly. The main clinical sign is an increase in pain in the anal area.

In rare cases, the sensations may be piercing in nature. They usually intensify during fecal excretion, as well as in a resting position and when walking.

Hemorrhoids may be accompanied by an increase in temperature and difficulty urinating.

Acute thrombosis of hemorrhoids

When blood circulation is impaired, blood stagnates, hemorrhoids increase in size and lead to pain in the anal area. As a result, a blood clot may form in the node.

Symptoms of the disease:

• sharp piercing pain in the anus during bowel movements;
• bleeding;
• the anus is swollen;
• in rare cases, the hemorrhoidal node falls out and becomes dark red;
• necrosis (death of cells and tissues) of the mucosa.

Paraproctitis

Paraproctitis is an inflammatory process that develops in the anal area. The cause of the disease is bacteria that penetrate as a result of scratching, injuries, cracks, etc.

Pain in this case occurs during bowel movements and can become unbearable. A swelling in the form of an abscess appears in the area of ​​the posterior sphincter and buttocks .

If you do not open it in time, it may break through.

Helminths

Parasites can also cause discomfort in the anus. It manifests itself in different ways, depending on the severity of the problem.

The sensations are often accompanied by fever, chills, itching, burning, rash in the anus and deterioration of the general condition.

If it hurts during pregnancy

The sensations can be triggered by an enlarged uterus , which puts pressure on all nearby organs, including the rectum. At the same time, constipation develops, which further increases the discomfort.

The cause of pain can be a change in the shape of the pregnant woman’s pelvis, injuries, or previous operations in the anus.

The sensations do not cause any harm to either the mother or the child. However, if the pain is accompanied by purulent or bloody discharge, then in this case you need to consult a doctor.

When is it okay to help yourself?

Can be used as symptomatic drugs:

• ointments (heparin, Vishnevsky, “Proctosan”, “Posterizan”, “Fleming”);
• creams (“Zdorov”, “Troxerutin”, “Relief”).

Medicines must have anti-inflammatory and analgesic effects. You should also fight constipation.

Laxatives will help in this case.:

• "Senade";
• "Duphalac" - can be used by pregnant women;
• magnesium sulfate powder;
• suppositories "Glycerin";
• "Lavacol", etc.

It is recommended to follow a diet.

When you need a doctor's help

Unfortunately, many women are embarrassed to consult a doctor with such a problem . The pain becomes unbearable, and accompanying diseases become chronic.

If you experience discomfort in the area of ​​the posterior orifice, you should urgently visit a proctologist.

This applies in particular to cases where:

• bloody or purulent discharge appears during bowel movements;
• the stool becomes black;
• feces become tarry;
• the pain lasts more than a week;
• there is a family history of rectal or colon cancer.

A timely diagnosis will help eliminate the cause of discomfort in the posterior orifice.

In serious situations, the doctor will prescribe:

• antibiotics;
• drugs affecting veins;
• hemostatic agents, etc.

Treatment will depend on the severity of the problem.

Preventive measures and additional recommendations

To prevent such an unpleasant problem from arising, you should follow some recommendations .

Eliminate rough, spicy foods from your diet. To avoid constipation, eat foods containing fiber (bran, beans, apples, grapefruit, peanuts, almonds, raisins, etc.).

Maintain anal hygiene. After each bowel movement, rinse the anus with warm water. After bowel movements, use soft toilet paper.

Eliminate constipation in a timely manner by taking laxatives.

If discomfort in the anus occurs in women, the cause should be immediately determined, since the source may be a dangerous disease.

Source: https://beautyladi.ru/bol-v-zadnem-proxode/

Anal fissure

It occurs quite often - for every 40-50 healthy people there is one patient with an anal fissure. For many, this disease is combined with hemorrhoids. Most often, an anal fissure is located on the back wall of the anus. It can occur at any age, but most often in young people.

Causes of anal fissure

• Most often, it is not possible to determine the exact cause of an anal fissure. It is believed that the development of the disease can be caused by: • disturbances in blood flow in the walls of the anus (in people with heart and vascular diseases, in those who have to sit or stand in a monotonous position for a long time);
• • prolonged constipation or diarrhea;
• • diseases of the digestive system: gastritis, colitis, cholecystitis;
• • woman's injuries during childbirth.

• inflammation of the mucous membrane of the rectum and anus; • injuries to the mucous membrane (including during anal sex, medical procedures); • consumption of large amounts of spicy food and alcohol; • heavy physical activity;

Signs of an anal fissure

The disease begins with sudden severe pain in the anus after visiting the toilet. Bright scarlet blood appears in the stool. If an anal fissure is combined with hemorrhoids, then the first sign of the disease may be prolapse of nodes and severe bleeding. In response to pain, the muscles of the anus contract and become tense, and this further intensifies the pain.

Usually the pain goes away quickly and the bleeding stops.

If you do not see a doctor within 3-4 weeks from the onset of the first symptoms, the anal fissure becomes chronic. The pain decreases, but becomes constant.

A small amount of blood is constantly released from the anus. The patient is bothered by severe itching in the anus.

Diagnosis of anal fissure

The doctor makes the diagnosis after examining the patient's anus. Sometimes they resort to a digital examination of the rectum: the proctologist asks the patient to stand on all fours, leaning on the couch with his knees and elbows, and inserts a finger into the anus in order to feel the mucous membrane and assess its condition.

A sigmoidoscopy may be prescribed - an endoscopic examination of the anus and rectum.

Complications of anal fissure

The most severe complication of an anal fissure is suppuration and fistula formation. At the same time, the patient’s well-being deteriorates greatly, and the body temperature rises.

Surgery and antibiotic treatment are required. Another complication is scarring, narrowing and hardening of the anal muscle sphincter due to constant tension.

This manifests itself in the form of constant long-term constipation.

What can you do?

If symptoms of an anal fissure appear, you should consult a proctologist as soon as possible. In the acute form, the disease can be treated without surgery. After 3 - 4 weeks, and sometimes earlier, the anal fissure becomes chronic, and to eliminate it it is necessary to resort to a surgical method.

What can a doctor do?

Treatment of anal fissure begins with conservative methods: • Normalization of stool. For this, various dietary supplements are used. • Diet.

It is necessary to exclude from the diet foods that can cause irritation of the rectum: spicy, fried, sour, salty, alcohol. • Pain-relieving suppositories and ointments.

They are used after a warm sitz bath (water temperature 36 - 38⁰C).

Usually improvement occurs within 2 to 3 weeks. If this does not happen, surgical treatment is resorted to.

Types of operations for anal fissure: • Excision with a scalpel. The surgeon either excises only the mucous membrane or makes an incision on the anal sphincter, after which it relaxes.

After the operation, you must take warm sitz baths for a week and apply medicinal ointments to the anus. • A more modern technique is radio wave surgery. Excision of anal fissure is carried out in a non-contact manner using high frequency radio waves.

This minimizes the risk of bleeding and infection and shortens the rehabilitation period.

Prevention of anal fissure

Prevention of anal fissure consists of a balanced diet, an active lifestyle, and timely treatment of diseases accompanied by constipation and diarrhea. It is necessary to prevent stagnation of blood in the pelvic vessels: morning jogging and sports will help with this.

The material was prepared by the editors of the Mail.ru Health project.

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Source: https://health.mail.ru/disease/analnaya_treshhina/

Pain in the anus: causes of the disease, main symptoms, treatment and prevention

Proctalgia is a pain syndrome localized in the anus and rectum, caused by muscle spasm.

The anus is the final section of the digestive tract. Many diseases can signal themselves through pain in this area.

Proctalgia can be caused by stress, physical tension or psychological distress. Pain can develop with various proctological diseases: tumor lesions of the anal area, inflammation of the rectum, hemorrhoids, granulomatous enteritis, anal fissures.

Sometimes you can get rid of such pain only after a specialist understands their causes in detail.

It is possible to identify only two reasons for the development of pain, localized in the anus, and not associated with clinical disorders in the patient’s body. Sometimes such pain develops as a result of prolonged sitting on a hard chair. This disorder affects office workers who spend most of their time sitting.

The pain may be associated with spasm of the muscles around the anus. This phenomenon occurs at night and is diagnosed mainly in adolescents. Elderly people are not susceptible to this disorder.

Symptoms

This disorder is caused by the sudden development of pain, it can have varying intensity and duration.

An attack can last from a minute or longer, the pain can radiate to the stomach, perineum or tailbone. The pain can be stabbing, sharp, spastic in nature.

It may be associated with defecation and may disappear on its own or after a warm bath. Sometimes such pain may not be controlled by painkillers.

The pain can be systematic, which turns the patient’s life into torture.

• Such pain can be quite pronounced and cause severe suffering to a person.
• Proctalgia is characterized by a long, wave-like course: with this disorder, periods of exacerbation alternate with periods of stable remission.
• Why pain in the anus occurs has not yet been established, but the disorder is believed to be of a neuropsychiatric nature.

Diagnostics

With such localization of pain, the patient needs to consult a coloproctologist. In this case, the patient undergoes a full examination, during which the patient is excluded from somatic diseases.

When contacting a specialist, the doctor conducts a visual and digital examination. If necessary, the patient undergoes sigmoidoscopy or ultrasound examination of the pelvic organs, kidneys and bladder.

Treatment

Based on the data obtained during the examination, the patient may be prescribed drug therapy, a blockade, or physical therapy.

In case of severe pain, to alleviate the condition, the patient is prescribed a novocaine blockade, as well as a microenema with anesthetics or sea buckthorn oil.

Prevention

Timely treatment of all diseases of the urinary and digestive systems is of great importance for the prevention of pain in the anus.

Source: https://www.obozrevatel.com/health/bolezni/bol-v-zadnem-prohode.htm

Anal fissure

The first mention
in Russian of an anal fissure
was given in 1863 in
G. Petrov’s doctoral dissertation “On fissures in
the anus.”

Etiology and
pathogenesis of anal fissure

The cause of
anal fissure is mechanical
damage to the mucous membrane of the anal
canal by solid particles of feces (bone,
seed husks, fruit seeds, etc.).

Particularly susceptible to trauma
are loose, edematous mucous membranes with
reduced elastic properties,
as occurs with chronic proctitis,
proctosigmoiditis, as well as enterocolitis
, etc.

inflammatory diseases of the small
and large intestine.

The immediate
cause of rupture of the mucous membrane
of the anal canal and the formation of a fissure
is usually constipation.
An anal fissure that exists for up to 1 month is called acute.
Chronic anal fissure
is characterized by a disease duration of more than 1 month.

Severe pain at
the moment of rupture of the mucous membrane during
the passage of a dense fecal lump
causes a sharp spasm of the anal sphincter
.
In the presence of a chronic fissure, the sphincter is in a state of increased
tone and between painful attacks.
Normally, the sphincter tone is 500-550 grams.

In patients suffering from chronic
anal fissure, the sphincter tone at
rest is 800-900 grams, and during
maximum spasm during the period of pain -
up to 1000 grams.
Increased sphincter tone increases pain, causes constipation, and interferes
with the healing of the fissure.
A vicious circle arises .

In addition, prolonged tonic
contraction of the sphincter muscle causes
the replacement of its fibers with connective
tissue.
Sphincter fibrosis occurs, which aggravates existing constipation.

Morphology
of anal fissure

Its length is usually
1.0-1.5 cm, width 2-4 mm, depth
2-3 mm.
If a crack exists for several months, as a result of chronic
inflammation, its walls and bottom become covered
with granulations, which over time
turn into whitish scars.
At the outer and sometimes at the inner
corners of the crack, so-called
“signal” or “sentinel” tubercles are formed.

1-2 mm
outgrowths mucous membrane.

• 
  Chronic anal fissure clinic
• Chronic
  anal fissure manifests itself with a typical
  clinical picture
• Complaints:

• sharp, “dagger” pain in the anus with irradiation to the sacrum and perineum during and after defecation;
• slight bleeding during bowel movements, often in the form of a scarlet stripe on the stool;
• constipation – defecation once every 2-3 days. The patient tends to hold stool to avoid pain.
• signs of concomitant colitis - flatulence after eating rough spicy food, milk; periodic cramping abdominal pain, often without clear localization; alternation of constipation with diarrhea, etc.
• signs of concomitant gastritis, gestroduodenitis, etc.

Anamnesis

The course of the disease
ranges from several months to several
years.
Often - unsuccessful outpatient conservative treatment by a general surgeon
.

A triad of symptoms
(according to V.D. Fedorov): 1) pain in the anus
during and after defecation;
2) bleeding during defecation in the form of a scarlet stripe
on the stool;
3) sphincter spasm. Often a combination of signs of chronic anal
fissure and chronic hemorrhoids.

Diagnosis
of anal fissure

An anal fissure
is detected by examining the anus.
It is necessary to move apart the perianal
radial folds of skin.
The crack is visible at the border of the skin and mucous membrane in the form of
a soft tissue defect, a slit-like
or triangular “ulcer”.

Rice.
13. The most common location of a chronic anal
fissure is around the circumference of the anal canal

The more frequent
location of the fissure at 6 and 12 o'clock
is explained, firstly, by the worse conditions
of blood supply to the mucous membrane in
these areas - here ischemia occurs more easily
with sphincter spasm;
secondly, the main pressure of feces during evacuation of the contents of the ampoule falls on the posterior wall of the anal canal and it is
more often damaged.

Treatment of anal
fissure

Acute
anal fissure is treated conservatively:
diet (exclusion of spicy foods and alcohol,
intake of large amounts of coarse
fiber), daily cleansing
enemas, antispasmodics, non-steroidal
anti-inflammatory drugs,
analgesics, drugs of the methyluracil

These
medications are used per
os and in the form of anal suppositories.

Therapeutic microenemas with antiseptics
(furacillin, 0.3% collargol solution),
official ointments for rectal
administration (ultraproct, proctiglivenol,
hepatrombin, preparation N) and physiotherapy are used

1. If
   conservative treatment fails within 2-3
   weeks, as well as with chronic anal
   fissure, surgical treatment is used.
2. Radical
   surgical treatment
3. Indications:
   chronic anal fissure.

Contraindications:
severe concomitant somatic
pathology.
Anesthesia: anesthesia, spinal anesthesia.
It is carried out in a hospital as planned.
Pain relief – intravenous, mask
anesthesia, SPA.

Excision of a chronic anal
fissure into the lumen of the rectum according to
Gabriel and posterior dosed
sphincterotomy
are performed Stages of the operation.

-Divulsion of the
anus (Fig. 14 - A),

- Excision of anal
fissure (Fig. 14 - B),

- Posterior dosed
sphincterotomy (Fig. 14 - B).

A	B
	IN

Rice.
14. Excision of anal fissure according to Gabriel (Iz Ryzhikh
A.N., 1968).

Lateral
subcutaneous sphincterotomy is also used.
Dosed sphincterotomy causes short-term paresis of the anal sphincters, thereby achieving
peace of the anal sphincter.
Conditions for crack healing become more
favorable.

In men,
the sphincter is cut to a depth of 0.8 cm, in women - 0.5
cm.

When chronic
combined hemorrhoids (with indications for
surgical treatment) and chronic anal

combined operation is performed: hemorrhoidectomy with complete

anal mucosa and excision of the fissure into the lumen

dosed sphincterotomy.
Disadvantages of surgical intervention:
Prolonged pain syndrome.
Wound
healing long.
Hospital stay – at least 6-7 days.
Incapacity for work – up to 3 weeks.

• In this regard,
  
  infrared coagulation
  now increasingly .
• Infrared
  photocoagulation of chronic anal
  fissure
• Indications: acute
  and chronic anal fissure
• Contraindications:
  none.

Anesthesia:
anesthesia, spinal anesthesia.
It is carried out in a hospital as planned
.
Apparatus: infrared coagulator (Fig. 6).

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Source: https://studfile.net/preview/2784690/page:9/

Pain - definition and types, classification and types of pain

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Pain is an important adaptive reaction of the body, which serves as an alarm signal. However, when pain becomes chronic, it loses its physiological significance and can be considered a pathology.

Pain is an integrative function of the body, mobilizing various functional systems to protect against the effects of a damaging factor.

It manifests itself as vegetosomatic reactions and is characterized by certain psycho-emotional changes.

• The term "pain" has several definitions:  
• Thus, pain is both a warning and a protective reaction.

- this is a unique psychophysiological state that occurs as a result of exposure to super-strong or destructive stimuli that cause organic or functional disorders in the body; - in a narrower sense, pain (dolor) is a subjective painful sensation that arises as a result of exposure to these super-strong stimuli; — pain is a physiological phenomenon that informs us about harmful effects that damage or pose a potential danger to the body.

The International Association for the Study of Pain gives the following definition of pain (Merskey, Bogduk, 1994): Pain is an unpleasant sensation and emotional experience associated with actual and potential tissue damage or a condition described in terms of such damage.

The phenomenon of pain is not limited solely to organic or functional disorders at the site of its localization; pain also affects the functioning of the body as an individual. Over the years, researchers have described an untold number of adverse physiological and psychological consequences of unrelieved pain.

The physiological consequences of untreated pain of any location can include everything from deterioration of the gastrointestinal tract and respiratory system to increased metabolic processes, increased tumor growth and metastases, decreased immunity and prolongation of healing time, insomnia, increased blood clotting, loss of appetite and decreased ability to work. The psychological consequences of pain can manifest themselves in the form of anger, irritability, feelings of fear and anxiety, resentment, discouragement, despondency, depression, solitude, loss of interest in life, decreased ability to fulfill family responsibilities, decreased sexual activity, which leads to family conflicts and even to a request for euthanasia. Psychological and emotional effects often influence the patient's subjective response, exaggerating or downplaying the significance of pain.

In addition, the degree of self-control of pain and illness by the patient, the degree of psychosocial isolation, the quality of social support and, finally, the patient’s knowledge of the causes of pain and its consequences may play a certain role in the severity of the psychological consequences of pain.

This means that the effectiveness of diagnosis and treatment is determined not only by the ability to identify the etiopathogenetic mechanisms of a somatic condition manifested or accompanied by pain, but also by the ability to see behind these manifestations the problems of limiting the patient’s usual life.

A significant number of works, including monographs, are devoted to the study of the causes and pathogenesis of pain and pain syndromes. Pain has been studied as a scientific phenomenon for over a hundred years.

There are physiological and pathological pain.

Physiological pain occurs at the moment of perception of sensations by pain receptors, it is characterized by a short duration and is directly dependent on the strength and duration of the damaging factor. The behavioral reaction in this case interrupts the connection with the source of damage. Pathological pain can occur in both receptors and nerve fibers; it is associated with prolonged healing and is more destructive due to the potential threat of disruption of the normal psychological and social existence of the individual; the behavioral reaction in this case is the appearance of anxiety, depression, depression, which aggravates somatic pathology. Examples of pathological pain: pain at the site of inflammation, neuropathic pain, deafferentation pain, central pain. Each type of pathological pain has clinical features that make it possible to recognize its causes, mechanisms and localization.

Types of pain

There are two types of pain.

The first type is acute pain caused by tissue damage that decreases as it heals.

Acute pain has a sudden onset, short duration, clear localization, and appears when exposed to intense mechanical, thermal or chemical factors.

It can be caused by infection, injury or surgery, lasts for hours or days and is often accompanied by symptoms such as rapid heartbeat, sweating, paleness and insomnia.

Acute pain (or nociceptive) is pain that is associated with the activation of nociceptors after tissue damage, corresponds to the degree of tissue damage and the duration of action of the damaging factors, and then completely regresses after healing.

The second type - chronic pain develops as a result of damage or inflammation of tissue or nerve fiber, it persists or recurs for months or even years after healing, does not have a protective function and causes suffering to the patient, it is not accompanied by signs characteristic of acute pain.

Unbearable chronic pain has a negative impact on a person's psychological, social and spiritual life. With continuous stimulation of pain receptors, their sensitivity threshold decreases over time, and non-painful impulses also begin to cause pain. Researchers associate the development of chronic pain with untreated acute pain, emphasizing the need for adequate treatment. Untreated pain not only places a financial burden on the patient and family, but also imposes enormous costs on society and the health care system, including longer hospital stays, decreased productivity, and multiple visits to outpatient clinics and emergency rooms. Chronic pain is the most common common cause of long-term partial or total disability. There are several classifications of pain, one of them, see table. 1.

Table 1. Pathophysiological classification of chronic pain  

Nociceptive pain    3. Ulceration of the skin and mucous membrane Neuropathic pain   Mixed or indeterminate pathophysiology     1. Arthropathy (rheumatoid arthritis, osteoarthritis, gout, post-traumatic arthropathy, mechanical cervical and spinal syndromes) 2. Myalgia (myofascial pain syndrome) 4. Non-articular inflammatory disorders (polymyalgia rheumatica) 5. Ischemic disorders 6. Visceral pain (pain from internal organs) or visceral pleura) 1. Postherpetic neuralgia 2. Trigeminal neuralgia 3. Painful diabetic polyneuropathy 4. Post-traumatic pain 5. Post-amputation pain 6. Myelopathic or radiculopathic pain (spinal stenosis, arachnoiditis, glove-type radicular syndrome) 7. Atypical facial pain 8 Pain syndromes (complex peripheral pain syndrome) 1. Chronic recurring headaches (with increased blood pressure, migraine, mixed headaches) 2. Vasculopathic pain syndromes (painful vasculitis) 3. Psychosomatic pain syndrome 4. Somatic disorders 5. Hysterical reactions

Classification of pain

A pathogenetic classification of pain has been proposed (Limansky, 1986), where it is divided into somatic, visceral, neuropathic and mixed. Somatic pain occurs when the skin of the body is damaged or stimulated, as well as when deeper structures such as muscles, joints and bones are damaged.

Bone metastases and surgical interventions are common causes of somatic pain in patients suffering from tumors. Somatic pain is usually constant and quite clearly limited; it is described as throbbing pain, gnawing pain, etc. Visceral pain is caused by stretching, compression, inflammation or other irritation of internal organs.

It is described as deep, compressive, generalized and may radiate into the skin. Visceral pain is usually constant, and it is difficult for the patient to establish its localization. Neuropathic (or deafferentation) pain occurs when nerves are damaged or irritated.

It may be constant or intermittent, sometimes shooting, and is usually described as sharp, stabbing, cutting, burning or an unpleasant sensation. In general, neuropathic pain is the most severe and difficult to treat compared to other types of pain. Clinically, pain can be classified as follows: nocigenic, neurogenic, psychogenic.

This classification may be useful for initial therapy, however, in the future, such a division is impossible due to the close combination of these pains. Nocigenic pain occurs when skin nociceptors, deep tissue nociceptors, or internal organs are irritated.

The impulses that appear in this case follow classical anatomical pathways, reaching the higher parts of the nervous system, are reflected by consciousness and form the sensation of pain.

Pain from internal organ injury is a consequence of rapid contraction, spasm, or stretching of smooth muscles, since smooth muscles themselves are insensitive to heat, cold, or cut.

Pain from internal organs with sympathetic innervation can be felt in certain zones on the surface of the body (Zakharyin-Ged zones) - this is referred pain.

The most famous examples of such pain are pain in the right shoulder and right side of the neck with gallbladder disease, pain in the lower back with bladder disease, and, finally, pain in the left arm and left side of the chest with heart disease. The neuroanatomical basis of this phenomenon is not entirely understood. A possible explanation is that the segmental innervation of internal organs is the same as that of distant areas of the body surface, but this does not explain the reason for the reflection of pain from the organ to the body surface. Nocigenic pain is therapeutically sensitive to morphine and other narcotic analgesics.

Neurogenic pain

This type of pain can be defined as pain due to damage to the peripheral or central nervous system and is not explained by irritation of nociceptors. Neurogenic pain has many clinical forms.

These include some lesions of the peripheral nervous system, such as postherpetic neuralgia, diabetic neuropathy, incomplete damage to the peripheral nerve, especially the median and ulnar nerve (reflex sympathetic dystrophy), and separation of the branches of the brachial plexus.

Neurogenic pain due to damage to the central nervous system is usually due to cerebrovascular accident - this is known under the classical name of “thalamic syndrome”, although studies (Bowsher et al.

, 1984) show that in most cases the lesions are located in areas other than the thalamus. Many pains are mixed and clinically manifest as nocigenic and neurogenic elements.

For example, tumors cause both tissue damage and nerve compression; in diabetes, nocigenic pain occurs due to damage to peripheral vessels, and neurogenic pain occurs due to neuropathy; with herniated intervertebral discs compressing a nerve root, the pain syndrome includes a burning and shooting neurogenic element.

Psychogenic pain

The statement that pain can be exclusively psychogenic in origin is debatable. It is widely known that the patient's personality shapes the pain experience. It is enhanced in hysterical individuals, and more accurately reflects reality in non-hysterical patients.

It is known that people of different ethnic groups differ in their perception of postoperative pain. Patients of European descent report less intense pain than American blacks or Hispanics. They also have lower pain intensity compared to Asians, although these differences are not very significant (Faucett et al., 1994).

Some people are more resistant to developing neurogenic pain. Since this tendency has the aforementioned ethnic and cultural characteristics, it appears to be innate. This is why the prospects for research aimed at localizing and isolating the “pain gene” are so tempting (Rappaport, 1996).

Any chronic disease or illness accompanied by pain affects the emotions and behavior of the individual. Pain often leads to anxiety and tension, which themselves increase the perception of pain. This explains the importance of psychotherapy in pain control.

Treatment is effective if it takes into account psychological and other factors.

systems (environmental, psychophysiological, behavioral response) that potentially influence pain perception (Cameron, 1982). The discussion of the psychological factor of chronic pain is based on the theory of psychoanalysis, from behavioral, cognitive and psychophysiological positions (Gamsa, 1994).

G.I. Lysenko, V.I. Tkachenko

Published by Konstantin Mokanov

Source: https://medbe.ru/esli_bolit/o-boli/opredelenie-boli-ee-tipy-klassifikatsiya/