We enrolled 45 patients undergone to fissurectomy and anoplasty with V–Y cutaneous flap advancement and 30 UI botulinum toxin injection. The aim of our study is to evaluate the long-term results of fissurectomy and anoplasty with V–Y cutaneous flap advancement associated to 30 UI of botulinum toxin injection for CAPF with IAS hypertonia. Due to the high rate of anal incontinence after LIS, the employment of sphincter preserving surgical techniques associated to pharmacological sphincterotomy appears more sensible. The treatment of this disease aimed to reduce IAS hypertonia. CAF of the posterior commissure (CAPF) are often characterized by internal anal sphincter (IAS) hypertonia. An X-ray will show this and extra bran (flax, psyllium or Benefibre) and water is the treatment of choice to prevent complications such as the dangerous inflammation that can occur (diverticulitis).Chronic anal fissure’s (CAF) etiopathogenesis remain unclear. This can often be determined by history alone and taking bran (or flax or psyllium or Benefibre) and water helps but does not completely relieve the condition.ĭiverticulosis is pockets in the colon resulting from lack of fibre in the diet and is characterized by stools that resemble rabbit pellets and constipation. The commonest cause of bowel symptoms is Irritable Bowel Syndrome which is characterized by periodic cramps and abdominal pains relieved by bowel movements. Inflammatory bowel disease is also associated with haemorrhoids and fissures and fistulas and is picked up from the history and sigmoidoscopy in most patients. If this fails, yoghurt may help or taking one or two capsules of Lactobacillus Bulgaris daily. Instead take two tablespoons daily of Bran or Flax or Psyllium or Benefibre plus 7 to 8 large glasses of water. The best way to treat this is to stop taking laxatives long term (Senna and Cascara use will lead to a lazy bowel). The most important is cancer which we found in 0.2% of patients with haemorrhoids using a combination of sigmoidoscopy, stool testing and where indicated colonoscopy.Ĭonstipation can be a chronic and difficult problem. Sometimes it is big enough that it should be removed under local anaesthetic after the fissure has healed. If it is removed without treating the fissure it comes back. The fissure is treated first and the tag shrinks and often disappears. This is at the outside of a fissure and “guards” the fissure. Although they are not dangerous, it is difficult to keep clean with these and they can be removed under local anaesthetic.īecause there are a lot of nerves in the area, it is painful for several days after removal and a local anaesthetic cream is used to help.Ī sentinel tag is again a skin lump at the outside of the anus. Skin tags are the expanded skin on the outside of the anus when haemorrhoids have been ignored for a long time. Avoiding surgery leads to recurrent abscesses. This tract crosses the sphincter and needs carefully removed so that there is no continence problem. 50% of these abscesses heal without problems, but in the other 50% a worm like track to the inside of the anus persists. The pus requires immediate drainage usually under a local anaesthetic. These can be very dangerous because they can develop into a large abscess in a space on each side of the anus called the ischio-rectal fossa. These can be ordinary boils, but often they are an infected anal gland from the 20 or so in the area of the anus. Usually treating the fissure relieves the pruritus completely but sometimes special diet modifications or creams with an anti-fungal like Canesten are used.Ībscesses occur around the anus. Sometimes it is due to an allergy or a fungal infection. Often this is associated with an anal fissure, which discharges some fluid in the area. Pruritus ani is an itchy rash around the anus.
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