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Spasms in the rectum. Causes and treatment of spasm of the sphincter of the rectum. Microclysters with chamomile pharmacy

Difficulty in normal bowel movement due to the involuntarily arising strong compression of the rectal sphincter muscles before the onset of defecation or immediately after the beginning of the release of feces is one of the urgent problems of a modern person.

What is the anal sphincter

The anal sphincter, whose main function is to control the process of removing the contents of the intestine to the outside, consists of an inner and outer parts. The muscles of the outer part encircle the lower part of the internal sphincter. The sphincters are in close contact, but there is a clear border between them.

The outer, or outer, portion of the rectal sphincter is a ring-shaped structure of striated musculature that surrounds the anus canal in the rectum. Its circumference is 8-10 cm, its thickness is up to 2.5 cm. The striated deep muscles of the sphincter then pass into the fibers of the pubic-rectal muscle. The superficial elliptical muscle attaches to the coccyx. Subcutaneous muscles are circular muscles.
A person with the help of consciousness can control the external sphincter. The muscles of the external sphincter of the anus have stretch receptors. With their help, a healthy person can easily control the passage of feces through this sphincter.
The inner part, or internal sphincter of the anus, is a ring-shaped smooth muscle structure that surrounds the anal canal. It originates from the inner muscle layer of the smooth muscles of the rectum and connects in the lower part with the skin of the anus. The thickness of the internal sphincter is 0.5 cm, and the length is up to 3 cm.
A person cannot control the internal anal sphincter with the help of consciousness; it relaxes and contracts reflexively when irritated by the feces of the rectum. Its main function is valve. It does not allow gases and liquid fractions to pass through the anus, when a person does not specifically push to free the intestines from them.

Anal sphincter function defects

Functional insufficiency of this sphincter can manifest itself in the form of its insufficiency or spasm.
Insufficiency is a violation of the possibility of voluntary retention of feces. Normally, the sphincter can hold the contents in the rectum when changing body position, sneezing, coughing, and physical effort.
Spasm, or painful compression, of the rectal sphincter occurs, as a rule, with anal fissures.

However, another pathology of the gastrointestinal tract can provoke its appearance. For example, in patients with gastritis with high acidity, the stomach secretes an excess amount of hydrochloric acid. As a result, the food lump entering the intestines from the stomach contains an overly acidic environment. The intestine may not be able to normalize its acidity, which ultimately causes the development of spastic colitis and spasm of the anal sphincter.

For effective treatment of hemorrhoids, our readers advise. It is a natural remedy that quickly relieves pain and itching, and promotes healing of anal fissures and hemorrhoids. The preparation contains only natural ingredients with maximum efficiency. The tool has no contraindications, the effectiveness and safety of the drug has been proven by clinical studies at the Research Institute of Proctology.

The mechanism of development of spasm

With irritation of the nerve endings of the damaged or inflamed rectal mucosa, especially in the case of an anal fissure that has existed for a long time, sharp painful sensations are caused. The result of pain is spasm of the muscles of the sphincter of the anus. In this case, the spasm creates a vicious circle: the feces falling into the anal fissure cause inflammation and pain, and the pain then leads to the development of spasm, which intensifies the pain and leads to even greater spasm. Thus, symptoms can exacerbate themselves until this vicious circle is broken.
The most common cause of damage to the mucous membrane, leading to over-irritation of nerve endings, is trauma. Often the reason for this is hemorrhoids, especially in the case of internal localization of hemorrhoids. Also, the cause of such a spasm can be paraproctitis - a purulent inflammation that develops in the fatty tissue around the rectum:

The clinical picture of spasm

The main symptom of spasm of the rectal sphincter is pain in the anus, appearing or worsening during bowel movements.
Other symptoms are not specific to the spasm. The presence of a defect in the mucous membrane with an anal fissure leads to its constant injury by feces, which is often accompanied by bleeding. On the other hand, the spasm causes squeezing of the blood vessels by the muscular structures of the rectum, reducing bleeding and leading to its rapid stopping.
In addition, pain forces the patient to postpone bowel movement as much as possible, and this provokes the development of constipation.

Anal sphincter spasm treatment

It is possible to stop the symptoms of spasm with the help of local anesthetics in the form of rectal suppositories, warm sitz baths, taking antispasmodics and analgesics.
Medicines containing nitroglycerin are good for relaxing the anal sphincter. To relieve spasm, 0.4% nitroglycerin ointment is widely used.
In the bath water, you can add decoctions of plants that have an analgesic, antispasmodic and anti-inflammatory effect, that is, they help to completely eliminate the symptoms and also help eliminate their causes: chamomile and sage herbs, oak bark.
All manipulations aimed at stopping the spasm must be performed after thorough toilet of the rectal sphincter area.

Removing the spasm is not sufficient to get rid of this pathology completely. Patients with spasm of the anal sphincter need to treat the pathology that caused it. As a rule, this is a fissure of the rectum.

Often, the intervention of a surgeon is required to treat it. However, treatment for such cracks always begins with a conservative method. Sometimes it is enough to normalize stool consistency and frequency with the help of a special diet and laxative medications.
Surgical intervention is inevitable only in cases where the cause of the spasm is paraproctitis. Surgical help is always needed to remove purulent contents.

Today we would like to discuss a delicate issue. The work of the digestive tract largely determines our well-being, vigor and good mood. Moreover, it is important not only proper nutrition, but also stable emptying so that the body does not send waste products. It is very good if you have never encountered such problems, and the morning toilet does not cause unpleasant associations. But most people know firsthand what a sphincter spasm is. Symptoms are extremely unpleasant, these are pain and distension in the lower abdomen, which are difficult to cope with without taking antispasmodic drugs. Today we will talk about this phenomenon and how to deal with it in a little more detail.

A little about the physiological characteristics

What is the rectal sphincter? It is a muscle element. It is located directly in the rectum and is designed to regulate the excretion of feces. On the one hand, it performs a locking function, and when a sufficient accumulation of masses occurs, it opens. This is usually a controlled process. The rectal sphincter opens exclusively in the right place (in the toilet), and not on the way home from work.

In order for the sphincter to work smoothly, its surface is lined with a large number of receptor cells, and the inner part is smooth muscle muscles that form a ring. While the child is small, it works in a natural mode, that is, immediately after the emerging need, bowel emptying follows. As you grow older and potty trained, your rectal sphincter becomes more and more trained, effectively controlling feces and gas.

What is a sphincter spasm

This is not a disease, but only its manifestation, so doctors will have to carry out a full diagnosis in order to determine what caused this phenomenon. And we will start by telling you what characterizes the spasm of the rectal sphincter. Symptoms are primarily pain. It is caused not by inflammation, but by painful contraction of the muscles, which is of a psychological or somatogenic nature.

A similar picture is typical for most proctological pathologies, therefore, if doctors talk about spasm of the rectal sphincter, they mean that there are no organic lesions of this segment of the intestine. That is, there is pain of undiagnosed etiology.

Features of the disease

Not only is the diagnosis difficult. Diseases with such symptoms are usually long-term and rather difficult. We cannot stop the intestines during its treatment, even with a sparing diet, the load on it still remains. And constant pain, which is difficult to relieve even with strong drugs, is physically and psychologically exhausting. Often, terrible diagnoses come to mind, most often of an oncological nature, which further aggravates his condition.

Learn more about symptoms

How can you suspect that you have spasm of the rectal sphincter? Simple enough. Severe, paroxysmal pain will not allow you to be mistaken. In this case, the following signs are observed:

• Acute paroxysmal pain that radiates to the perineum. In this regard, patients tend to attribute the symptoms to chronic renal diseases, problems of the pelvic organs.
• Note that pain may accompany or separate from the act of defecation.
• Most often, after taking a bath, the pain subsides significantly, although it may not completely go away.
• An important point is the reason why the spasm occurs. This is the key to the solution, as well as the appointment of adequate treatment. Most often, it is not even provoked by somatogenic diseases, but by psycho-emotional: experiences, chronic stress and neurological problems, as well as inadequate physical activity.

What everyone needs to know

We have already touched on this issue a little, but it is extremely important to deal with this point in more detail. Treatment of the sphincter of the rectum, or rather its effectiveness, directly depends on how much the doctor figured out the reasons. What causes the spasm? This is a smooth muscle contraction. This can involve the external or internal sphincter. But that's half the problem. With the contraction of smooth muscles, pulling, sometimes pulsating pains occur, varying in duration and intensity, since nerves and blood vessels are pinched.

Most often, this pathology occurs in middle-aged people. At the same time, there is no division into men and women, everyone is susceptible to ailment. Why is this particular part of the intestine prone to spasms? This is due to good innervation. What can be attributed here:

• constipation;
• inflammation;
• violation of the integrity of the mucous membrane;
• varicose veins or blood vessels.

As a result, the patient feels severe pain that is difficult to correct with medication.

Risk group

Before talking about how to remove the rectum, we will dwell on one more point. There is a certain group of patients in whom the risk of this pathology is more likely. These are the people:

• mentally unbalanced;
• suffering from CNS pathology.

As a result of the above pathologies, a spasm develops, which increases emotional lability and, as a result, pain. In addition, this syndrome can be caused by various disorders of innervation. This is a consequence of trauma or difficult childbirth. Often, spasm of the anal sphincters develops in emotionally unstable women. Men fall into this category less often, although gender, as we have already mentioned, is not predominant.

Types of spasms

Most often, problems arise when the internal sphincter of the rectum spasms. First of all, they can be divided according to the time of the attack:

• quickly passing;
• long-term.

Usually mild pathology is simultaneously and quickly passing. At the same time, the use of serious drugs is not required to alleviate the condition. The disorder manifests itself in the form of sudden pulling or stitching pains. Very often, patients experience severe discomfort in the perineal region. Moreover, some of them begin to ineffectually treat fictional diseases of the prostate gland, kidneys and uterus. Once again, I would like to remind you that any therapy begins with an adequate diagnosis. Without this, it is not only ineffective, but also dangerous.

Long-term pains of unexplained etiology practically do not respond to pain relief, and attacks can last for several days. Moreover, an uneven course is characteristic, after some time the frequency of attacks increases. In this case, the factors that cause exacerbation of pain are not fully defined. However, doctors have long noted that a patient's emotional state greatly affects the state of his intestines. Stress and anxiety instantly aggravate the situation.

There is a classification by etiological factor. In this case, there are:

• Primary spasm. If you compare two photos of the sphincter of the rectum - spasmodic and absolutely healthy - you will notice that they are not much different. In our case, it's just a muscle spasm, which most often develops against a background of stress and goes away after the situation has returned to normal.
• Secondary. This violation does not appear by itself, but develops against the background of certain pathologies of the rectum. These include hemorrhoids and fissures, Crohn's disease and tumors in the anal canal.

Any problems with the intestines require attention, timely consultation with specialists. The earlier the cause is determined, the more effective the therapeutic effect will be.

First visit to the doctor

It all starts with an examination. Anamnesis is important. Quite often, primary diseases are determined in patients, which led to such a development of events. These are traumas and various operations. Even more often, diseases of the rectum and organs of the genitourinary system become the root cause. Do not forget that the smooth muscle muscles of our body are interconnected, therefore, primary proctology is combined with muscle spasms of other organs. What does the diagnosis include:

• visual inspection;
• palpation of the anus;
• examination of the walls of the rectum;
• examination of the colon with a colonoscopy.

What to do

So the sphincter of the rectum will not work overnight, you will have to follow a number of doctor's recommendations in order to improve the condition. The choice of treatment methods will depend on the general and psychological state of the patient, the presence of somatic diseases.

But the first task of the doctor is to relieve spasm of the rectal sphincter. Treatment should begin with elimination of the disorder and elimination of inflammation. For this purpose, antispasmodics and pain relievers are prescribed. If necessary, antibacterial agents are prescribed, and laxatives for constipation.

Relaxation of the sphincter

This is the goal of the patient and the doctor, which is not always easy to achieve with drugs alone. Thermal procedures, as well as physiotherapy methods of treatment, help very well in this case. In parallel, it is imperative to carry out anesthesia with the help of antispasmodics and analgesic suppositories. It is best to use "Relief Advance", "Procto-glivenol", "Venoruton", "Ultraproct", "Proterisan Forte", candles with belladonna and sea buckthorn oil. Of the antispasmodics, No-shpa is most often used, as well as warm sitz baths.

Solving Constipation Problems

It is very important to pay close attention to the toilet. It is imperative to keep your anus area perfectly clean. Every morning you need to wash yourself using a shower. It is good to repeat the procedure after each bowel movement so as not to irritate the mucous membrane by rubbing. A proper diet is one of the most important factors. Food should be as gentle as possible in order to reduce the load on the non-digestive tract. Everything is quite simple here: fatty, sweet, fried and spicy should be excluded from the diet. The basis is soups and lean cereals, baked fruits and vegetables. Follow your drinking regime.

Surgery

If alternative treatment does not work, then more drastic measures will have to be chosen. At first, doctors use various medications as well as conservative treatments. If the attacks become more frequent, and serious complications also join, then there is no choice. In this case, they resort to surgical intervention - sphincterotomy. It consists in partial excision of the anal sphincter muscles. This causes the smooth muscles to relax and the pain is significantly reduced. The cause is not eliminated, but the patient still gets a good result.

Traditional methods of treatment

If the situation has not gone too far, then you can use herbal medicine recipes. In this case, it is recommended to treat spasms of the anal sphincter with decoctions of medicinal herbs or a solution of potassium permanganate. The treatment regimen includes enemas and microclysters, tampons and suppositories.

A sitz bath is a snap to prepare. To do this, pour some warm water into a basin, add potassium permanganate. The procedure must be repeated for at least 7-10 days. Baths with a decoction or infusion of medicinal plants, which have an antispasmodic or calming effect, help a lot. These are chamomile and yarrow, St. John's wort and oak bark, calendula. Plants can be mixed or alternated. A decoction of medicinal herbs is used to prepare enemas and tampons.

Sphincter weakness

This is the exact opposite situation to the one we considered above. If before that we discussed how to relax the sphincter of the rectum, normalize the waste of gases and feces and relieve pain, now we need to pay attention to what to do when the same locking ring is loosened. Weak rectal sphincter results in liquid or hard feces.

Treatment requires taking into account the individual characteristics of a person, as well as violations. As a rule, if the sphincter of the rectum is relaxed, a special diet, electrical stimulation and physiotherapy exercises are prescribed. In this case, drug therapy should be aimed at treating inflammatory diseases and dysbiosis.

If the sphincter is weakened due to organic reasons, surgery is necessary, namely sphincteroplasty. After this operation, long-term restorative treatment is required with the obligatory adherence to a diet.

Instead of a conclusion

The health of our intestines depends a lot on ourselves. A correct diet, an optimal balance of physical activity and rest, avoiding serious stress - all these are the main methods of preventing diseases of the digestive system in general and the intestines in particular. Excessive stress, as well as weakness of the rectal sphincter, can be the result of a number of serious ailments, each of which requires careful attention and medical support.

Polina Kuchina

Hello, we operated on an anal fissure in January, a month after the operation, the spasm of the anal sphincter returned. Some proctologists said that the fissure healed, others that 0.5 cm remained, in the city center they had anococcygeal pain syndrome. I used various ointments, the spasm persists until still, periodically pinches in the anal canal. The situation is complicated by the fact that since November the pelvic floor muscles began to relax and now there is an exit of the vaginal walls during defecation, the spasm of the sphincter aggravates prolapse. How to relieve a spasm if the blockage can lower the pelvic floor even more ...

Hello Polina. Your case is not easy to supervise. And he is not suitable for trial in absentia. I believe that it is necessary to proceed as follows: he must exclude the presence of a crack, if it is not there, then he must explain the sphincterospasm. If none of the proctological problems explains sphincterospasm, then it is necessary to connect several questions for consultations: is it similar to chronic pelvic pain syndrome, can there be sphincterospasm for a neurological reason, what are the neurological reasons for the rapid progression of pelvic floor muscle weakness and vaginal prolapse ... Therefore, the work must be painstaking and analytical. You need to decide on a doctor who could supervise you and coordinate the actions of other doctors. To relieve a spasm - without understanding the reason - it is difficult to remove. We need to figure out the reason. There are also medicinal methods of influencing the spasm. There are botulinum toxin (Botox) injections. But it is important to clearly define the nature of the changes, and only then carry out the treatment. Evgeny Borisovich Golovko, consultant physician [email protected]

Polina Kuchina

Thank you for your answer, did the MRI consequences of a fracture of the tailbone-2 small cystic formations in the damaged area, edema of the bone marrow and tissue, osteochondrosis L5-S1, S4-S5. Neurologists say that this cannot be the cause of prolapse and spasm. Although this statement is very strange .... the proctologist tells me that maybe osteopaths also have the same opinion. Recently I visited the proctologist again, there is no crack, there is no spasm, and it is very difficult to go to the toilet (I drink phytomucil and duphalac), the sphincter does not open more than 1, 5 cm, further, it hurts, is it really not a spasm? Earlier (before the disease, a year ago) with constipation, even if there was no urge, it was stretched by 3-4 cm and it did not hurt.

Hello Polina, sorry for the late reply, I was on vacation. Unfortunately, analyzing your situation reveals many factors that can be blamed for the formation of pain and discomfort. And in absentia it is impossible to make a decision on the connection of any changes with certain manifestations. In such a situation, I would again conduct a study of the anal canal with an anoscope and a rectal mirror to completely exclude the pathology of the anal canal, which causes spasm. And then I would act on the basis of the findings with a thorough examination of the anal canal. If, nevertheless, pathology is detected in the canal, then the treatment of the proctologist will give a result. At the expense of the prolapse of the pelvic organs, I recommend working with a gynecologist to develop a course of exercise therapy for the prevention of prolapse. In my opinion, MRI should give an answer about the presence of compression of nerve formations. If they (MRI doctors) ascertain only bone and disc changes and do not report possible compression, then it is unclear how the doctor should act. After all, the doctor must know whether there is involvement of nerve formations or not. Could there be a connection with nerve pathology and prolapse due to nerve pathology or not? Until these questions are answered, it is difficult to interpret the situation. I recommend that you discuss the comments received with your doctors and develop the next block of consultative and diagnostic help. Evgeny Borisovich Golovko, consultant physician [email protected]

At the same time, no matter how hard you try, the muscles of the rectal sphincter contract against your will, worsening the condition without this painful anus. This phenomenon is especially pronounced in the presence of an anal fissure, but it is also present in hemorrhoids.

It turns out to be some kind of vicious vicious circle: abnormal muscle contraction interferes with defecation, making it often impossible.

Due to delays in emptying, the stool hardens and further injures the rectum. An increase in rectal trauma leads to an increase in pain during emptying and an aggravation of spasm.

In addition, with a spasm of the sphincter of the rectum, the blood supply is significantly impaired, which leads to a longer non-healing of the anal fissure or bleeding hemorrhoidal lump.

To solve this emptying problem, let's sort it all out.

In our case, a spasm is an involuntary contraction of the rectal sphincter muscles, usually accompanied by a sharp and aching pain.

We feel pain due to the fact that the sphincter muscles squeeze the blood vessels, blood circulation is disturbed, the cells of the anus lack oxygen and nutrients.

Also, the cells are slagged with wastes of their vital activity, which are not excreted by the blood due to circulatory disorders. Cells send a signal to our brain about this problem, which we feel in the form of pain.

With a spasm, the muscles of the internal sphincter of the rectum are compressed. There is also an external sphincter, but we are not interested in it. The sphincter of the anus is a muscle structure that surrounds the anal canal.

Designations in the figure:

1. Peritoneum
2. Rectum
3. Anal canal
4. Internal sphincter of the anus
5. External sphincter of the anus
6. Anus

The sphincter of the anus is not at all controlled by a person's consciousness. Its contractions and relaxation occur involuntarily. The internal sphincter of the anus serves to prevent accidental emptying by locking the anus.

Sometimes the spasm of the sphincter interferes with urination while sitting because it is very painful.

To solve the problem of involuntary contraction of the rectal muscles, I suggest trying a simple technique.

1. Feel the urge to use the toilet - be sure to drink a glass of unboiled clean water. Water is the best laxative, it will improve intestinal motility.

2. Mentally say to yourself: “Today I will empty the intestines according to a new technique. The defecation will pass quickly and without any spasms. I will succeed, because this technique really helps. "

3. Going to the toilet, take a few deep breaths and exhalations to improve intestinal motility.

4. Sit on the toilet as usual and immediately bend forward, spreading your legs wider, reaching with your hands to the floor. If you have high blood pressure, gently and gently tilt your head back.

When stool comes out, try not to strain the rectal muscles, be completely relaxed.

5. To accelerate the release of feces, you can raise the right hand upward while turning the body. With this movement, you squeeze the colon and improve peristalsis.

If you feel an increase in soreness, then lower your hand down. The soreness has diminished, try again to raise your arm and turn your torso.

6. In this position are until the end of bowel movements. If possible, try squatting.

If you are young, then climb onto the toilet with your feet on it. Or adjust the chairs as shown below. Squatting spasm of the sphincter muscles is difficult.

7. You also need to get up from the toilet without straightening your torso up. Move the center of gravity to your hands, you can rest your hands on the floor, and lift your pelvis up from the toilet.

You should straighten your legs, and the body is tilted down as much as possible, i.e. you got off the toilet, leaning towards the floor.

Only then use the toilet paper as directed.

This is not very convenient, but it will prevent the occurrence of rectal spasm after a bowel movement, since the legs are already straightened.

8. Defecation in the new position is slower than in the usual upright position of the trunk. But you should strive to spend as little time emptying as possible. The ideal emptying time is no more than one minute.

If you're having trouble with constipation, read my article on getting rid of constipation.

You should try my technique in practice and find for yourself the best option for emptying without spasm of the sphincter, because we are all different, right?

Best regards, Sergei.

antigemoroj.com

Causes

The causes of cracks near the anus are very simple:

• Chronic constipation, forcing a person to strain excessively, increasing pressure in the rectum.
• Mechanical trauma by hard feces, poor quality toilet paper, anal sex practices, and instrumental examination of the rectum.
• In childbirth during the period of attempts, a crack in the anus or rectal mucosa is an unfavorable sign, since it can become a harbinger of a 4th degree perineal rupture.
• Insufficient hygiene, diaper rash can also lead to cracks.
• Inflammatory changes in the intestinal mucosa against the background of proctitis, diarrhea, dysbiosis, helminthic invasion can also manifest as cracks, which, in this case, will be only one of the manifestations of the underlying pathology.

Crack symptoms

• The deeper the crack, the stronger the pain. At first, it appears only during bowel movements or mechanical irritation. Later, as the inflammation joins, the painful sensations can become permanent and disturb the person without any irritation of the problem area. The nature of the pain can be pinching, burning, stabbing or pulling and pressing with significant edema and a chronic inflammatory process. In a chronic fissure, there is also a spasm of the obturator muscle of the rectum, which increases the pain during bowel movements.


• Itching and discomfort are triggered by tight, uncomfortable or synthetic underwear, prolonged sitting, constipation, or loose stools. The longer the crack, the wider the itchy area and the more pronounced the discomfort.
• The release of scarlet blood, not mixed with feces, during bowel movements or straining is the result of destruction of the walls of the capillaries in the anal region (see the causes of blood in the feces). If the crack is very deep, then the veins may also be damaged, then dark venous blood will appear and the bleeding will be similar to hemorrhoidal (continuous and voluminous, see bleeding from the anus).

The appearance of the listed symptoms - discomfort, itching in the anus, pain, blood during bowel movements, can also occur in more serious diseases, such as hemorrhoids, inflammatory and oncological processes in the intestine, therefore, rectoscopy is required to establish a diagnosis.

Treatment of a crack in the anus

A fissure of the rectal mucosa is a significant discomfort in everyday life, but there is nothing fatal about it - it is just a longitudinal rupture and the result of mechanical trauma.

And, although they are found in conditions close to unsanitary, they become inflamed and can easily become infected, for example, E. coli, this happens very rarely, and the fissure heals safely with proper care and treatment. However, for this it is necessary to observe some rules and eliminate the factors that provoke the formation of a crack and maintain its existence.

• Lead an active lifestyle, avoiding prolonged sitting positions. Walk more, engage in physiotherapy exercises.
• Fight constipation (see all suppositories for constipation), avoiding stool retention for more than two days. Timely correct dysbiosis and treat intestinal infections with diarrhea.
• Use normal toilet paper and wash with cool water after a bowel movement.
• Do not get involved in unconventional sex or use quality lubricants.

Diet for cracks

Dietary measures are reduced to the selection of a table that normalizes the regularity of the stool. It is also important to exclude fried foods, spices and alcohol (see diet for hemorrhoids and cracks).

For constipation, a contrasting breakfast is useful (a glass of cool juice, after 20 minutes - hot oatmeal), a fasting intake of a dessert spoon of sunflower or olive oil, beets in all forms, bran bread, cereals, apples, drinking plenty of fluids (at least 3 liters per day) and soups for dinner.

Diarrhea requires limiting cabbage, legumes, fresh vegetables and fruits (fiber), yeast baked goods, and whole milk.

What drugs are used to treat rectal fissures

It is customary to heal sharp cracks with the help of various forms of drugs, that is, they should be conducted conservatively. In the arsenal of a proctologist (a doctor dealing with rectal problems) today there are ointments, creams, gels and suppositories. Also, sometimes they resort to pills.

Baths

Antiseptic and anti-inflammatory sitz baths are prescribed before the introduction of local drugs after bowel movements. With cracks, the temperature of the solution is 30 degrees Celsius, the duration is 10-15 minutes.

• As a medicinal solution, a decoction of chamomile and oak bark is used (separately or in a 2 to 1 ratio). Chamomile suppresses inflammation in tissues, making healing easier. Oak bark has an astringent effect, drying the crack. You can also use decoctions of calendula or yarrow.
• Less often they use a weak solution of potassium permanganate (pale pink) as an antiseptic.

Ointments, creams

An ointment for cracks should contain a greasy base, not irritate the skin and mucous membranes, and, ideally, combine anti-inflammatory and tissue healing properties. The ointment is injected 1-2 times a day after bowel movement and a ten-minute bath in the amount of one centimeter. The average duration of the course of treatment with ointments for acute fissures is 7-10 days. Most drugs for cracks are also used to treat hemorrhoids (see the list of all hemorrhoid ointments).

• Ultraproject 420-500 rubles - a combination of the glucocorticoid fluocortolone and the local anesthetic cinchocaine. It has anti-inflammatory, antipruritic and analgesic effects.


• Aurobin 190-230 RUB - a combination of prednisolone (anti-inflammatory and anti-allergic effect) with lidocaine hydrochloride (local anesthesia) and dexpanthenol (acceleration of healing and restoration of skin and mucous membranes). The drug is contraindicated in pregnant women, lactating women, persons with bacterial or viral inflammations or intolerance to the components of the ointment.
• Dexpanthenol, Bepanten, Pantesol 70-120 rubles - ointments and creams based on pantothenic acid, which affects protein and fat metabolism and accelerates healing.
• Solcoseryl 160-180 rub. in the form of an ointment or gel, it accelerates the absorption of glucose by tissues, thereby improving tissue nutrition.
• Actovegin 100-120-180 rubles. improves cellular respiration and glucose utilization, promoting tissue recovery.
• Methyluracil 60-80 rubles - a medicine that combines the properties of an anabolic and an anti-inflammatory agent, an immunomodulator.
• Proctosan 230-270 rub. contains bismuth subgallate, titanium dioxide, lidocaine and befexamac. Dries and heals the crack.
• Emla 1400-1600 rubles - local anesthetic based on lidocaine and prilocaine. The drug is indicated for spasm of the anal sphincter against a background of chronic fissure. May cause slowing heart rate and allergies.


• Catejel 120-140 rub. combines lidocaine and chlorhexidine antiseptic. The indications are similar to the emle.
• Levomekol 80-120 rub. - antibacterial chloramphenicol and methyluracil, which accelerates crack closure. The drug is indicated for chronic or inflamed fissures. It should be remembered that long-term use can be complicated by anemia and a decrease in blood leukocytes. Levomekol ointment is contraindicated for nursing.
• Nitroglycerin I ointment 0.2% dilates blood vessels and relieves sphincter spasm. Prepared according to the recipe.

Suppositories

Suppositories are a convenient dosage form that allows the main drug to be rapidly absorbed into the veins of the hemorrhoidal plexus. In addition, candles are made on the basis of cocoa butter or other neutral fat, which simultaneously play the role of a laxative. When there is a chronic fissure of the anus, combined suppositories are used, containing pain relievers and antispasmodics. Preparations in suppositories are used twice a day after a bowel movement.

For more information on instructions for the drugs, read the article candles from cracks and hemorrhoids.

The role of laxatives in treatment

By making the stool softer and stool daily, one of the main reasons why a fissure occurs around the anus can be eliminated. Medicines that facilitate bowel movements are divided into the following groups.

• Emollients (vaseline and sea buckthorn oils, Norgalax). At home, for problems with the anal sphincter, counter microclysters are used 10 minutes before emptying (100 ml of pasteurized sunflower oil and 200 ml of boiled water at room temperature).
• Means that increase the volume of intestinal contents: vegetable based on agar or psyllium (Naturolax, Mukofalk, Fiberlex), based on cellulose (Fiberal, Fibercon).
• Polyhydric alcohols: Duphalac, Normase, Lactulose (standard, non-irritating to the intestines), Sorbitol, Macrogol, Lactiol (see all laxatives).

Cracked anus in a child

The immaturity of the child's digestive tract determines the ease with which they have various intestinal dysfunctions and, as a result, cracks appear in the anus. If in babies under one year old, most often a crack is the result of diarrhea against the background of dysbiosis or intestinal infections, then in older children, like in adults, the main problem is associated with constipation, including of neurogenic origin.

Therefore, in parallel with the beginning of the treatment of anal fissures, it is worth taking care of the normalization of intestinal motility and the correction of dysbiosis. Without the elimination of these moments, the treatment of the crack can be difficult and prolonged, which contributes to the chronicity of the process and translates it into the category of surgical problems.

When a sharp crack appears in the anus, the child becomes restless (or cries) when trying to poop. During or after a bowel movement, drops of bright red blood may be released. When these symptoms appear, it is worth showing the child to a pediatrician or pediatric surgeon.

So, the drugs of choice for the treatment of anal fissures are:

• children - candles with sea buckthorn
• adults - Dexpanthenol, Methyluracil, Aurobin (not pregnant)
• as a pain reliever - Anusol

How to heal an anal fissure after childbirth

Childbirth may be the cause of a crack in the anus. During the period of perspiration, the pressure in the rectum increases and the perineal tissue is stretched. Since a crack in childbirth is a trifle that is not considered, all problems begin after a couple of days, when pain occurs during bowel movements. Here you have to resort to laxatives and drugs that are either not absorbed into the bloodstream, or do not penetrate into milk. The most important thing is to get to a specialist doctor as soon as possible in order to get competent recommendations and not to miss hemorrhoids under the mask of an anal fissure.

In general, the tactics of treatment are the same as in children under one year old (Duphalac, suppositories with sea buckthorn, Methyluracil). Can be added Posterisan in candles, Emla for the skin of the perianal area, Katejel gel.

The healing of anal fissures, which exist for more than three months, is very difficult due to keratinization of the edges of the defect and a decrease in metabolic processes in the tissues. In such a situation, various options for surgical treatment are indicated.

Operative treatment

• Devulsion - manipulation of the devulsion of the anus can be a compromise option between operative and conservative treatment. At the same time, under anesthesia, the spasmodic sphincter is expanded, which solves some of the problems. This procedure is not performed on the elderly.
• Cryodestruction - there is a variant of cryodestruction of a crack with liquid nitrogen, which is expensive and does not always radically solve the situation (it is difficult to achieve clear freezing of only pathologically altered tissues).
• Sphincterotomy - a classic surgical intervention involves excision of a crack along a plane within healthy tissues. If the crack is combined with spasm of the sphincter, then it is dissected from the inside (sphincterotomy operation). The time for wound healing is 5-6 days. Up to this point, dressings are made with Levomekol.

Thus, the treatment of an acute fissure of the anus should be started at the first manifestations. In this case, it is very important to consult a doctor, since symptoms similar to a fissure give hemorrhoidal enlargement of the veins of the rectum and tumors (see which doctor to contact for hemorrhoids and fissures).

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Varieties of pathology

By duration

This ailment can have a different nature of duration. Distinguish between fast and long-term proctology. With a rapid disease, there is a quick and sharp pain of an aching or stabbing nature in the anus. Often, painful sensations are transmitted to the hip region and tailbone. The patient complains of discomfort in the perineal region. Because of such symptoms, patients rarely confuse sphincter spasm with diseases of the genitourinary system or diseases of the prostate gland, kidneys.

Prolonged proctalgia is characterized by prolonged paroxysmal pain in the anus.

In the case of prolonged proctalgia, pain bothers for a long time, sometimes even painkillers do not help. Over time, pains can disappear by themselves, and then return again with renewed vigor. The factors that lead to such a pathology often lie in the psycho-emotional state of a person (frequent stress, psychological disorders, etc.). In any case, it is extremely difficult to cope with this ailment on your own and it is necessary to consult a proctologist and correct treatment.

Due to the occurrence

Doctors distinguish between primary and secondary proctalgia, depending on the underlying causes of the disease. In the first case, the disease is extremely rare and occurs due to neurotic spasms of the posterior foramen and coccygeal muscle. Secondary proctalgia is facilitated by various pathologies of the rectum: hemorrhoids, cracks, tumors that arise in the anal canal. In any case, it is necessary not to delay the diagnosis and start the fight against the symptoms and foci of the disease in time.

Causes of spasms of the sphincter of the rectum

The cause of the disease can be an injury to the anus.

To find out the source of the spasms that arise, you must first understand the structure and function of the anus. There is an external and internal sphincter. The outer part consists of many receptor cells that control and influence the act of defecation. The inner part consists of fibers, it is smooth muscle muscles that a person is unable to control. The musculature is ring-shaped. With the help of the inner part of the sphincter, feces and gases are contained. If this muscle and all internal muscles are damaged, spasms and sphincter insufficiency occur.

It is very important to determine the source of the disease and to know. how to relax the sphincter of the rectum. The disease is more likely to affect people of age due to weak muscles. An unstable emotional state leads to a spasm. Very often women who are prone to hysteria suffer from this ailment. Sphincter spasms occur due to the presence of trauma to the anus, namely:

• cracks;
• hemorrhoids and hemorrhoidal lump;
• tumors;
• cholelithiasis;
• duodenal ulcer;
• pancreatitis.

All these reasons are related to secondary proctalgia. At the same time, the organic state changes and violations occur in the anus zone. Reasons of this nature include trauma to the anus (difficult childbirth, underwent surgery in the anus). It also happens that the focus of spasms lies in the increased localization of nerve endings in the anus.

The main symptoms

The most common symptoms are pain when the rectum is empty.

Painful sensations can be of different nature and intensity, it all depends on the type of disease. Sometimes the pain disturbs not only the anal passage, but also extends to the coccygeal area, hip joints and perineum. Painful sensations often occur during bowel movements, but in some cases they bother and just like that. Pain syndrome can disappear after a bowel movement or taking a warm bath.

Sphincteritis of the rectum also occurs not only during the act of defecation, but also in the case of prolonged stress. The situation may also be complicated by the fact that, due to the already existing spasm of the hole, the person begins to worry, which aggravates the situation. Due to the inability to go to the toilet normally, the patient develops mental disorders, he becomes emotionally unstable. Often the patient complains of colic, severe pain of a stretching nature. Due to the fact that the painful sensations are very strong, it can be difficult for a person to determine the exact place of their appearance. Therefore, it is often perceived as a disease of the genitourinary system and the wrong ailment is treated.

If the treatment is started on time, then the pain symptoms disappear very quickly.

When spasms occur due to hemorrhoids, if there is a crack or other diseases and injuries of the anus, then the pain is associated precisely with the act of defecation. It arises from the moment when the desire to empty itself appears and can last another day. A person experiences fear of going to the toilet, tries to postpone it until later, than provokes constipation. It is important not to postpone going to the doctor if you find these symptoms. It is necessary to start treatment on time and eliminate the sphincter deficiency, which leads to spasms.

Diagnostics

If you suspect a rectal disease, you need to contact a proctologist.

First of all, the doctor is interested in the patient's complaints in order to learn more about the lifestyle and find out what the disease is. Perhaps there are bowel diseases or the patient is worried about frequent colic, in which case the treatment will be comprehensive. Often, previously received injuries are the root cause of the spasms that have arisen. The doctor finds out whether there are diseases of the rectum or genitourinary system, whether the patient suffers from mental disorders or diseases of the nervous system.

If the focus of the disease lies in the primary proctalgia, which is associated with spasms of the smooth muscles of other internal organs, then the patient unknowingly turns to other specialists and undergoes the wrong treatment. If colic is found in the anus or painful sensations in the external sphincter, it is necessary first of all to consult a proctologist. The doctor will examine the anus, conduct an in-depth examination of the walls of the rectum using retroscopy. If necessary, he will prescribe a colonoscopy of the colon. If mental disorders are noticed, the patient is sent for consultation with a psychologist or psychotherapist.

Treatment methods

Self-medication can cause irreparable harm to the health of the entire body.

Depending on the course of the disease, the symptoms present, the doctor prescribes treatment. In no case should you self-medicate, diagnostics and therapy should be prescribed by an experienced specialist. If the sphincter insufficiency is prolonged and aggravated, then surgical intervention is necessary. At the initial stage, drug therapy or the use of folk remedies that are aimed at relieving pain is suitable.

Conservative therapy

This therapy is aimed at eliminating not only the symptoms, but also the focus of the disease. Medicines are able to eliminate inflammation and defects of the mucous membrane. To reduce spasms, antispasmodics, pain relievers are prescribed. If the situation is complicated, then the doctor prescribes funds that include mild antibiotics. To eliminate constipation, it is necessary to take laxatives, but they should not be abused either.

Only complex treatment will give the expected effect.

For treatment, rectal suppositories or ointments are used ("Relief Advance", "Procto-glivenol", "Ultraproct" and others). There are also candles containing natural ingredients (belladonna, sea buckthorn). To relax and relieve cramps, take a warm bath. Doctors also prescribe procedures such as electrosleep, microclysters using anti-inflammatory oil agents. The root cause of constipation can be colic or intestinal dysbiosis, so it is worthwhile to deal with their treatment.

Operative therapy

If conservative therapy has not brought the desired result, and spasms continue to bother you and sphincter insufficiency is noticed, in this case, surgical intervention is necessary. This procedure is called a sphincterotomy. With its help, the muscles of the external sphincter are partially dissected, thereby relaxing the smooth muscles of the muscles. This procedure is more aimed at relieving pain.

Traditional methods

In folk medicine, herbal enemas and thermal baths are used. Chamomile is best for making an enema. The recipe is simple: you need to pour one tablespoon of medicinal chamomile flowers with boiled water (200 ml) and leave to infuse for more than an hour. An enema is filled with such a decoction and used for 10 days.

Warm baths with a small amount of potassium permanganate also bring a noticeable effect. The method is used twice a day for half an hour, therapy lasts for 2 weeks. The most suitable time for the procedure is evening, the bath will help relieve spasms and relax the external sphincter. Do not forget that folk remedies can be used only with the permission of a doctor, so as not to cause even greater harm to health.

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What is anal fissure?

A rectal fissure is a tear in the mucous membrane in the anus. The damage occurs in a tissue called adenorma. It lines the anus and contains a large number of sensitive nerve endings and small blood vessels. That is why anal fissures are very painful and their appearance is often accompanied by bleeding.

In the acute development of the disease, the crack looks like a linear rupture; in the chronic course of the disease, due to inflammation and tissue edema, the rupture takes the form of a deep ulcer. The tears most often appear in the front or back of the anus and are from a few millimeters to 2 cm long. A fissure is considered "acute" if the disease lasts no more than 6 weeks. An anal fissure that takes longer to heal is considered chronic.

The reasons for the development of the disease

Specialists proctologists identify several main causes of anal fissures:

1. Mechanical injury. It can occur due to the passage of compacted feces with constipation or as a result of a foreign body entering the rectum. Sometimes anal intercourse is the cause of injury.
2. Inflammatory diseases of the gastrointestinal tract. The risk of a crack is significantly increased with cholecystitis, gastritis. Often the cause of the disease is constipation or diarrhea, which causes irritation of the mucous membranes and bacterial contamination of erosions.
3. Haemorrhoids. Hemorrhoids are easily injured during defecation, and due to circulatory disorders, thrombosis and blood stagnation, the walls of the anus are significantly weakened, which leads to the appearance of anal fissures.
4. Pregnancy and childbirth. During pregnancy, the uterus constantly presses on the perineum. This disrupts the nutrition of the mucous membrane and leads to increased vulnerability of the rectum.
5. Pathological spasm of the rectum. The prolonged increased tone of the rectum leads to its exsanguination and disturbance of innervation. In this case, the disease takes on a chronic form.
6. Sedentary lifestyle or, on the contrary, excessive physical activity
7. Weakening of the pelvic muscles
8. Frequent and uncontrolled use of laxatives

In children, most often the appearance of an anal fissure is associated with a disease with helminthic invasions (helminthiasis). The worms lay eggs in the anus, causing severe itching, and the lower intestine becomes inflamed and swollen. A child, scratching the anal area, can injure the mucous membrane, and with the act of defecation, the gap will worsen.

Symptoms

The main symptom of anal fissure is severe pain in the anus, which appears during bowel movement and continues for some time after a bowel movement. With a chronic anal fissure, the pain is less intense, but more prolonged and can occur not only during bowel movements, but also during prolonged sitting.

Another symptom of both acute and chronic anal fissure is bleeding from the anus. The bleeding is usually light, the blood is scarlet. Its appearance is due to the fact that dense feces injure the damaged parts of the intestine.

A characteristic symptom of the disease is difficulty in defecation caused by intense pain. The pain during the passage of hardened stool can be so severe that an anal spasm can reflexively occur. In the chronic course of the disease, there may be a fear of defecation, which only complicates the patient's position due to constipation. In advanced cases, when the bowel is emptied from the anus, pus may be released.

Painful sensations give a person significant discomfort, cause irritability and insomnia. Pain in the perineum and sacrum can often occur, leading to urinary problems.

Treatment - basic methods

Anal fissure treatment consists of a whole range of measures. This is adherence to a special diet, the use of medications (suppositories, ointments) and, if necessary, surgical treatment. The purpose of the therapeutic measures carried out is:

• Elimination of pain
• Relief of constipation or elimination of chronic diarrhea
• Removal of inflammation and healing of mucous membranes
• Treatment of diseases associated with pathology

In order to establish regular soft stools, the patient is prescribed a dairy-vegetable diet. Vegetables and fruits contain fiber, which increases intestinal motility and helps the body eliminate waste products. Dairy products containing beneficial lactobacilli help restore normal microflora. Flour, spicy, salty, fried foods and alcoholic beverages are excluded from the diet.

For breakfast, patients are advised to eat vegetable salads seasoned with vegetable oil. This will make the gastrointestinal tract work actively and relieve constipation. During the day, it is useful to eat apples, carrots, boiled beets, dried apricots, and prunes. For constipation, ordinary fish oil helps, in addition, doctors advise taking drugs containing lactulose (dufalak, prelaxan) and probiotics (lactobacterin, linex).

Treatment of rectal fissures with drugs

With the conservative method of treating cracks, pain relievers and anti-inflammatory drugs (rectal suppositories, ointments and gels) are effective. Microclysters with a weak antiseptic solution and warm sitz baths give a positive result. It is recommended to add decoctions of herbs to warm water: chamomile, yarrow, sage.

Local anesthetics (Relief suppositories) and antispasmodics (No-shpa) help relieve spasm of the sphincter. The inflammation is perfectly removed by suppositories with sea buckthorn, methyluracil or benzocaine, rectal suppositories Hepatrombin G. To facilitate bowel movements and healing of mucous membranes, suppositories with glycerin are prescribed. In most cases, drug therapy is beneficial.

But in some cases, in the chronic course of the disease, which is accompanied by the growth of scar tissue, more radical measures are needed. In these cases, doctors are forced to resort to surgical methods of treatment.

Anal Fissure Surgical Treatment - Excision Surgery

In the case of a persistent chronic course of the disease and with the formation of a significant defect in the mucous membrane, they resort to the classical surgical operation, which is performed under general anesthesia. Its essence consists in dissection of the sphincter and excision of the crack, followed by suturing of the wound. After the operation, anti-inflammatory therapy is carried out for a month. In this case, it is imperative to follow a diet that helps to achieve soft stools and eliminate constipation.

In milder cases, the operation to eliminate the anal fissure is carried out with modern minimally invasive methods, which include the cryodestruction procedure and the operation with a surgical laser. These are bloodless operations that do not require general anesthesia and a long recovery period in a hospital. Let's take a closer look at how the laser treatment procedure is performed.

This operation involves excision of the crack with a semiconductor surgical laser. The operation is performed under local anesthesia. A rectal speculum and a tampon soaked in an antiseptic are introduced into the patient's anus. The crack is grasped with a clamp and excised using a laser. When sphincter spasms appear, a sphincterotomy is performed.

Dissection of the muscle fibers of the anus excludes the occurrence of relapses. After the procedure, a tampon soaked in antiseptics is inserted into the anus, after each bowel movement, an antiseptic treatment is performed and the patient's nutrition and stool are monitored.

Improvement in the patient's condition is noted already on the next day after the operation, and complete wound healing occurs in a month. The advantages of the laser method are the short duration of the operation, minimal trauma and blood loss, insignificance of pain and absence of edema in the postoperative period. In addition, the likelihood of complications and relapses of the disease decreases, and a rapid recovery of the patient's health and ability to work is noted.

In any case, be it a conservative or surgical method, the method of treatment is selected by a specialist individually, taking into account the patient's condition and the stage of the disease. If symptoms of the disease occur, it is better not to self-medicate, but to seek advice from a proctologist in time, he will help to avoid unwanted complications and cope with the disease.

Folk remedies

In the treatment of rectal fissures, folk remedies give a good effect in combination with drugs. Various herbal decoctions, infusions, medicinal baths, microclysters are widely used. To improve the digestive tract, they brew and drink medicinal teas based on chamomile, St. John's wort, and sage. Bran, fish oil, plant foods and dairy products help fight long-term constipation.

1. Healing bath. For its preparation, 4 heads of onions are poured into 500 ml. milk, and simmer. The hot broth is poured into a container, which is closed with a lid with a hole. To avoid burns, make sure that the steam is not too hot. The patient should be positioned over the hole so that the vapors enter the affected area. The procedure can be done once a week, it is enough to sit over the steam for 10-15 minutes.
2. Infusion of sweet clover. To prepare it, a tablespoon of herbs is steamed with 200 ml of boiling water and let it brew for two hours. The infusion is drunk warm, 1/3 cup three times a day.
3. Quince poultices. They are considered the most effective remedy, giving a quick cure. Wet poultices are made from quince pulp or quince juice. The procedure can be done daily.
4. Herbal candles. Recommended for the treatment of advanced rectal fissures. For the preparation of candles, take a teaspoon of plantain, motherwort, chamomile flowers. Melt about 150 g of beeswax, pour the prepared herbal mixture into it and stir thoroughly. From the resulting mass, 10 pieces of candles are made. They relieve itching and inflammation well. Store candles in the refrigerator.

Separately, it is necessary to dwell on the need to comply with mandatory hygiene measures in the treatment of anal fissures. After each bowel movement, wash the anus with cool water and use only soft toilet paper. With exacerbations of the disease, it is recommended to completely abandon toilet paper, replacing it with washing.

Is a pathological condition in which involuntary painful contractions of the smooth muscles surrounding the anus are observed. It can develop with some injuries and diseases of the rectum and anus region, disorders of innervation, autonomic disorders and emotional instability. Spasm of the anal sphincter is accompanied by pain radiating to the tailbone, abdomen, perineum, etc. It is diagnosed on the basis of complaints, history, rectal examination, sigmoidoscopy, colonoscopy and irrigoscopy. Treatment - diet, antispasmodics, analgesics, physiotherapy, surgery.

ICD-10

K59.4

General information

Spasm of the anal sphincter is a fairly common pathological condition resulting from disorders of innervation and autonomic regulation, traumatic injuries, operations, chronic diseases, or severe emotional instability. The main symptom of spasm of the anal sphincter is pain in the anus (proctalgia) of varying duration and intensity. Mostly middle-aged people suffer, the disease is equally common in patients of both sexes.

Spasm of the anal sphincter tends to linger. It negatively affects the quality of life, is accompanied by emotional and mental exhaustion. Carcinophobia is possible, due to the initial mental instability and the tendency of many patients to neurotic reactions. Treatment of spasm of the anal sphincter is mainly carried out by specialists in the field of clinical proctology. In the presence of severe mental disorders, the participation of a psychologist or psychotherapist is required.

Causes

Spasm of the anal sphincter belongs to the category of polyetiological diseases and can be primary or secondary. In the absence of organic changes, they speak of a primary disorder. Viscero-neurotic disorders and mental instability become the cause of the development of the primary spasm of the anal sphincter. The disease is often detected in persons with a pronounced hysterical component, neurasthenia, increased emotional lability and vegetative-vascular dystonia.

Secondary spasm of the anal sphincter occurs against the background of conditions accompanied by the appearance of organic changes and functional disorders in the anus and lower rectum. Among the common reasons for the development of this pathology are such chronic diseases of the anus as hemorrhoids and anal fissure. In addition, spasm of the anal sphincter can be triggered by inflammatory processes in the lower intestines (Crohn's disease, ulcerative colitis), benign and malignant tumors of the rectum, constipation, injuries of the sacrum and coccyx area, complicated childbirth, surgical interventions and adhesions in the pelvic area.

Pathogenesis

The posterior wall of the rectum contains a large number of nerve endings and blood vessels. Disturbances in the normal functioning of this part of the intestine are accompanied by the emergence of many nerve impulses that cause reflex contraction of smooth muscles surrounding the external and internal sphincters of the anus. With intensive stimulation of this reflexogenic zone, individual contractions can turn into spasms of the anal sphincter of varying duration. Such spasms, in turn, entail a violation of the blood supply to the rectum and surrounding tissues, cause even more irritation of the nerve endings and aggravate muscle contraction, which provokes a "vicious circle".

Symptoms

Typical manifestations of spasm of the anal sphincter are pains of varying duration and intensity, radiating to the coccyx, perineum, hip joints or the lower abdomen. Pain with spasm paroxysmal, may appear during bowel movements or occur without a visible connection with the condition of the rectum (emptied or not emptied) and other circumstances. The low efficiency of analgesics is noted, while the pain syndrome often disappears or weakens after the completion of bowel movements or taking a warm bath.

Spasm of the anal sphincter can be provoked not only by the act of defecation, but also by chronic stress, acute emotional and psychological stress, overwork, heavy physical exertion and some neurological diseases. At the same time, the spasm of the anal sphincter often itself becomes the impetus for the occurrence of prolonged stress, increased emotional instability and the development of mental disorders of the neurotic level.

Depending on the type of pain syndrome, two forms of spasm of the anal sphincter are distinguished: with prolonged and short-term proctalgia. With short-term proctalgia, pain is strong, pulling or stabbing. Due to the high intensity of the pain syndrome and its irradiation to neighboring anatomical regions, patients suffering from spasm of the anal sphincter often find it difficult to determine the localization of pain and may regard this symptom as a manifestation of diseases of the reproductive or urinary system. With prolonged proctalgia, pain is usually less intense, poorly controlled by analgesics.

With a secondary spasm of the anal sphincter, which has arisen against the background of hemorrhoids, anal fissure and other diseases, as a rule, there is a clear connection between proctalgia and the act of defecation. The pain appears with the urge to stool, increases with straining and persists for several hours (sometimes up to a day or more) after the end of bowel movements. Constant pain negatively affects the quality of life of patients with anal spasm and can cause fear of defecation, which causes patients to “postpone” going to the toilet. This further aggravates the violations that have arisen.

With a primary spasm of the anal sphincter, the relationship with the act of defecation is less clear. Pain often appears at night or in the morning. Patients develop insomnia. The unreasonableness of the appearance of pain syndrome, sleep disturbances, initial emotional instability and a predisposition to neurotic disorders create a psychoemotional mood that contributes to the occurrence of carcinophobia and disorders of the hypochondriac spectrum.

Diagnostics

When diagnosing spasm of the anal sphincter, it is of great importance to carefully collect complaints, find out the history of life and disease. When collecting complaints, a proctologist-specialist pays attention to the nature of the pain syndrome, its connection with the act of defecation and the time of day. When clarifying the life history of patients with suspected spasm of the anal sphincter, the focus is on the presence of chronic pathology of the colon and anus, previous operations and injuries of this anatomical region, vegetative-vascular dystonia, neurotic disorders and emotional lability.

In a number of cases, it is possible to establish that, despite the absence of diagnosed autonomic and mental disorders, in the life history of patients suffering from spasm of the anal sphincter, recurrent spasms of smooth muscles of various organs are traced, for which patients in the past turned to gastroenterologists, pulmonologists, otolaryngologists and others. specialists. The examination plan for suspected spasm of the anal sphincter includes rectal examination and sigmoidoscopy. If you suspect the presence of pathological changes in the upper parts of the large intestine, an irrigoscopy and colonoscopy are prescribed. With pronounced psychoemotional disorders, patients are referred for consultation to a psychologist or psychotherapist.

Anal sphincter spasm treatment

Treatment may include diet, medication, physiotherapy, and surgery. Therapeutic tactics are determined individually, taking into account the cause of development, the severity and duration of the disease, the somatic and psychological state of the patient. The patient is advised to give up fatty and spicy foods that irritate the intestinal wall, it is advised to carefully follow the rules of personal hygiene and avoid injury to the perianal zone with coarse toilet paper.

If necessary, carry out antibiotic therapy. Antispasmodics and analgesics are prescribed (mainly in the form of suppositories, creams and microclysters). Laxatives are prescribed for constipation. To eliminate the spasm of the anal sphincter, thermal procedures, electrosleep, UHF, darsonvalization and other physiotherapeutic techniques are used. If conservative therapy is ineffective, sphincterotomy is performed with partial excision of the smooth muscles surrounding the anus.