Anal fissure: pain during defecation and treatment in Tashkent

Other names: Трещина заднего прохода, анальная фиссура, трещина прямой кишки

An anal fissure is a linear rupture of the anal mucosa. Despite its small size, it causes pain that patients describe as one of the worst in their lives: a feeling of broken glass during and after bowel movements. The basis is a vicious circle: the fissure causes pain, the pain causes sphincter spasm, the spasm impairs blood supply, and the fissure does not heal. Because of fear of pain, a person puts off going to the toilet, the stool becomes even harder - and everything repeats. It is impossible to break this circle without relieving the spasm and softening the stool.

🧾 МКБ-10: K60 🏥 Where it is treated: 6 Pain like broken glassCircle: pain → spasm → non-healingThe stool should be soft

👨‍⚕️ Which doctor

Proctologist

🔬 Diagnostics

Inspection

💊 Treatment

Soft stools, spasm relief, healing agents

📈 Prognosis

Acute heals in 4–6 weeks

⚠️ At risk

Constipation, hard stools, childbirth

⏱ When to see a doctor

Planned, but not worth postponing

🚨 See a doctor urgently

With these signs do not wait for a scheduled appointment — the condition requires emergency care.

Трещина не на 6 или 12 часах условного циферблата — необычная локализация
Множественные трещины, подрытые края
Гнойное отделяемое, повышение температуры — возможен парапроктит
Трещина, не заживающая более 6–8 недель
Сочетание с диареей, слизью и кровью — исключить disease Крона
Похудение и анемия

How it manifests itself

Sharp pain during bowel movements and for several minutes to several hours afterward
Scarlet blood in a small amount - on paper or in a stripe on the stool
Sphincter spasm, feeling of constriction
Fear of defecation, due to which a person deliberately postpones it
In case of a chronic fissure, there is a dense skin tubercle (“sentinel tubercle”) at its edge

Отличие от геморроя: при геморрое основная жалоба — кровь и выпадение узлов, боль умеренная или отсутствует. При трещине на первом месте — очень сильная боль, а крови мало.

Treatment: three essential components

Мягкий стул. Клетчатка 25–30 г в сутки, псиллиум, достаточно воды, при необходимости — осмотические слабительные. Это не «дополнение», а условие заживления.
Снятие спазма сфинктера. Тёплые сидячие ванночки по 10–15 минут 2–3 раза в день, особенно после дефекации; препараты, расслабляющие сфинктер, по назначению врача.
Местное лечение: заживляющие и обезболивающие средства.

If all three points are followed, an acute fissure heals in most patients in 4–6 weeks. The mistake most often is that they treat only with ointment, without adjusting the stool and without relieving the spasm.

If it doesn't heal

A crack that exists for more than 6–8 weeks, with dense edges and a guard tubercle is considered chronic.
Injections of botulinum toxin into the sphincter - temporarily relieve spasm and allow the crack to heal
Excision of a crack - removal of scarred edges
Lateral sphincterotomy - dissection of part of the internal sphincter; the most effective method, but requires an experienced surgeon due to the risk of continence failure
Be sure to exclude Crohn's disease, syphilis, HIV and tuberculosis in case of an atypical or persistent fissure

Prevention

Avoid constipation: fiber, water, movement
Don't push or linger on the toilet
Footrest for physiological posture
Washing with cool water instead of rough paper
Do not tolerate the urge to defecate
After childbirth - special attention to stool in the first weeks

Frequently asked questions: Anal fissure

How is it different from hemorrhoids?+

With a fissure, the main thing is very severe pain during bowel movements, and there is little blood. With hemorrhoids, the main causes are blood and prolapse of nodes, and pain is usually moderate or absent, except in cases of thrombosis.

Why doesn't the ointment help?+

Because ointment is only one of three components of treatment. Without soft stool and relief of sphincter spasm, the fissure will not heal: trauma and poor blood supply remain.

How long does it take for a crack to heal?+

An acute crack, with proper treatment, heals in 4–6 weeks. If this does not happen within 6–8 weeks, it is considered chronic and requires other methods.

Do you need laxatives?+

Often yes, for the period of treatment. Osmotic laxatives and psyllium, which soften the stool rather than stimulate the bowels, are preferred. They are prescribed by a doctor.

Is surgery necessary?+

No, most acute cracks heal conservatively. Surgery is discussed for chronic fissures that do not respond to treatment, and gives a good result.

The information on this page is for reference only and does not replace a doctor consultation. Only a qualified specialist can make a diagnosis and prescribe treatment after an in-person examination.