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Proctal crack – defect mucous between the gear line and edge of the proctal channel. Most often such defect happens in the form of a gap, a wound or an ulcer linear or squared, not exceeding 1-2 cm in length. The crack more often on a back commissure of the proctal channel is localized, is much more rare on a lobby and sidewalls. The disease takes the third place on frequency among diseases of a large intestine after colitis and hemorrhoids. 60% of patients of the woman of working-age. In the proctal channel frequent ponosa, locks, hard physical work, long sitting or standing, reception of spicy food and alcohol are considered as origins of cracks. Mechanical damages, vascular disorders, changes of a perianal epithelium also can belong to origins.
Symptoms of a proctal crack
The main symptom emergence of this defect pain in time and after defecation which continues of several minutes till a couple of hours. The ulcer or a wound causes a spasm of a sphincter which in turn does not allow it to begin to live, thereby strengthening painful feelings. Duration of a current and long treatment of a proctal crack are connected with it. On duration of a disease distinguish acute and chronic stages. At disease about one month it is considered that the acute stage proceeds, over one month there comes the chronic stage.
The acute proctal crack is characteristic pain at defecation. Patients aim to delay time of the following defecation, than cause emergence of locks. The lock in turn complicates disease. The acute proctal crack has the slit-like form with smooth edges. A bottom of a crack is muscular tissue of a sphincter. Gradually with disease the bottom and edges of a crack become covered by a fibrous plaque. Such symptoms of a proctal crack as insignificant bleedings and a spasm at defecation arises from traumatizing walls of a crack.
The chronic proctal crack forms owing to trophic changes of fabric at the edges of a wound or an ulcer. In the field of a crack from the inner and outer edge there are hillocks of excess fabric which in turn can form a fibrous polyp. The chronic proctal crack is characterized by long pain after defecation. Bleedings are small, as well as at an acute crack. Plentiful bleedings can demonstrate existence of other associated diseases, it can be hemorrhoids, fistula of a rectum or a tumor. The illness can be followed by a proctal itch, a proctitis, a proctosigmoiditis.
Proctal cracks with hemorrhoids
Very often there is a situation when the proctal crack in passing is complicated by hemorrhoids. Long pain which can remain before the following defecation acts as symptoms of a disease. More severe bleedings, than at usual disease. In such cases treatment is carried out surgically, removal of hemorrhoidal nodes and excision of a site on which the crack is located. At the same time the current of the postoperative period does not differ from postoperative rehabilitation at the operated hemorrhoids.
The expressed pain syndrome, constant bleeding and acute paraproctitis can be complication at a proctal crack. The paraproctitis arises owing to hit of an infection in a pararectal fat through defect of a mucous membrane.
Treatment of a proctal crack
For successful treatment it is important to adhere to recommendations of the doctor about hygiene, exercise stresses and food. The acute proctal crack without the expressed pain syndrome successfully is treated conservatively. At the same time acute products, alcohol are excluded from a diet of the patient.
Oil enemas for simplification of defecation are appointed. Without implementation of doctor's instructions medicamentous therapy will not bring recovery and the chronic proctal crack is formed.
Treatment of a proctal crack at a chronic stage is carried out by a radical method. Surgical treatment consists in excision of a crack with education on its place of a tidy wound. After excision of cicatricial changes medicamentous therapy for fast healing of a postoperative wound is carried out.
At severe pains and a spasm of a sphincter apply a semi-operational method. In the soft tissues located between a sacrum and a tailbone the anesthetic injection for relaxation and anesthesia of all area of a rectum becomes. Then for 5-7 minutes the special pnevmobalonchik for a spasmolysis is entered into the proctal canal. At early stages after such procedure the proctal crack begins to live independently within a week.