Анальная трещина в хронической форме ее развития представляет собой состояние, которое характеризуется наличием явных дефектов на слизистой анального отверстия. Повреждение такого плана образуется на задней или средней стенках, приносит серьезный дискомфорт человеку, а также относится к категории самых распространенных опасных заболеваний в области проктологии.
Развитие хронической формы врачей диагностируется сразу после довольно длительной терапии острого симптомного проявления раны не наступил положительный итог, если время между обострениями становится все меньше, а также, если долгое время заболевание не подвергалось излечению.
Чаще всего с проблемой сталкиваются женщины, хроническая анальная трещина у них, как опасная патология, по популярности занимает третье место после таких заболеваний, как геморрой и такие образования, как полипы.
Особенности появления и развития
Размер анальных трещин разный – от 0,5 до 2,5 мм. Основания для появления ран бывают самыми разными, их можно разделить на причины механического плана и физиологического. Есть также определенное сочетание причин, которые способствуют образованию слизистой. Среди основных причин появления и образования трещин можно выделить:
Последствия родовой деятельности. Трещины являются последствием напряжения в анальном отверстия. Именно это и является основанием для того, чтобы судить о популярности заболевания среди женщин.- Нарушение общей техники по соблюдению послеродового периода.
- Во многих случаях слизистая может разорваться по причине прохождения по прямой кишке твердого кала.
- Разного рода травматические повреждения, которые могут быть получены в процессе анального секса.
- Дефекация с сильным натуживанием, что характерно для людей, страдающих запором.
- Сильный сбой в работе сосудистой системы. Довольно часто к появлению ранок приводят застои крови.
- Наличие таких заболеваний, как геморрой, сильный атеросклероз, тромбофлебит, аневризма и системный васкулит.
- Повышенное давление в кишке, что характерно для мероприятий, связанных с поднятием тяжелого веса.
- Нарушения перианального эпителия. Большая трещина может появиться по причине патологических процессов. Это может быть быстрое ороговение эпителия и замедление образования новых.
- Поражение целостности тканей сфинктера. Это такие процессы, которые связаны с питанием тканей, что в состоянии привести к появлению такой опасной среды, оказывающейся комфортной для развития губительной флоры.
Если говорить о системе развития трещины, можно отметить, что изначально она характеризуется повреждением кожи внутри кишки, но имеет четкое дно и характерные пологие края. Как только задняя анальная трещина приобретает хроническую форму, поражаются уже более глубокие слои эпителия. Одновременно с этим можно отметить появление бугорков, которые могут напоминать небольшие полипы. Прямо пропорционально увеличению трещины, увеличиваются характерные для нее симптомы.
Симптомы
Признаки характеризуются самыми разными проявлениями. Среди самых распространенных симптомов образования и развития трещины можно отметить:
- Сильная боль при дефекации;
- Обострение болевых ощущений при натуживании;
- Снижение нормального тонуса в области сфинктера;
- Кровь на туалетной бумаге и на кале;
- Приподнятость и сильное уплотнение краев поражения;
- Постепенно подкожная ткань сфинктера заменяется соединительной;
- Вторичные разрывы трещины, что особенно характерно при смене диеты.
Общая сложность и долговременность терапии основана на определенных особенностях работы сфинктера. По причине его подвижности рана на слизистой поверхности прямой кишки заживает и затягивается намного медленнее. Это вызывает определенные болевые ощущения, которые в свою очередь вызывают еще большее напряжение сфинктера, на основании чего получается некоторый замкнутый круг.
При хронической форме патологии боль немного ослабевает, что вызвано не заживлением, но определенной способностью организма при болезни запускать незначительные адаптационные процессы. Надеяться на самостоятельное заживление трещины не стоит, без должного лечения проблема будет только усиливаться, трещина будет углубляться и увеличиваться в размерах.
Осложнения
Лечение трещины в ее хронической форме должен назначать исключительно специалист. Отсутствие лечения, а также пренебрежение советами профессионала может привести к определенным осложнениям.
Самой главной опасностью является инфицирование ранки каловыми массами и последующее образование гнойного свища. Подобное воспаление довольно часто сопровождается сильным зудом. Если хроническая трещина появляется у женщин, это может спровоцировать нарушение цикла. Многие пациенты отмечают тот факт, что соединительная ткань совершенно не подвергается растяжению, на основании чего просвет все сложнее расширяется. По этой причине у человека могут развиться хронические запоры.
Диагностика анальной трещины
Трещины, которые развиваются в хронической форме и не подвергающиеся лечению, обязательно должны быть тщательно обследованы. Подобная точность основана на том, что некоторые признаки трещин могут быть схожими с иными заболеваниями. Проктолог может максимально точно диагностировать патологию только после сбора тщательного анамнеза, а также после проведенного профессионального осмотра. При обнаружении трещины врач внимательно изучает ее форму, края, а также дно.
В обязательном порядке проводятся общие анализы крови, кала, сдается криптограмма. Не менее важно при тщательном обследовании пройти такие процедуры, как:
- Аноскопия.
- Ультразвуковое исследование.
- Ирригоскопия.
- Ректоскопия.
Благодаря данным исследованиям специалист получает максимально подробную и четкую картину имеющейся патологии. Также это идеальная возможность для исключения иных схожих по симптомам заболеваний. В процессе обследования специалист стремится исключить такие патологии, как тромбофлебит, болезнь Крона, проктит, сифилитическая язва, свищи, туберкулез кишечника. Это важная процедура, которая поможет назначить такое лечение, которое окажется максимально эффективным именно для хронической трещины.
Медикаментозное лечение
Лечение хронической анальной трещины представляет собой определенную сложность, так как частое спазмирование сфинктера в состоянии привести к разрывам вторичного и третичного характера. Все это препятствует заживлению тканей. В качестве медицинского профессионального лечения проводятся следующие мероприятия:
- Методы консервативной терапии;
- Параректальные блокады;
- Оперативные методы лечения.
Если ранее именно параректальная блокада решала вопрос, связанный с устранением боли, то сейчас многие профессионалы выбирают грамотно подобранное оперативное и консервативное лечение. К последнему варианту терапии можно отнести диетическое питание, физиотерапию, комбинацию мазей и свечей, мягкие слабительные средства, которые нужны для смягчения стула.
Грамотно разработанная лекарственная терапия подбирается так, чтобы максимально эффективно устранить такое явление, как спазмирование. Она нужна для ускорения заживляющих процессов, удаления инфекционной микрофлоры, размягчения стула. Важно добиться снижения давления на сфинктерные стенки, которое поможет избежать вторичных разрывов заживающих стенок. При разработке качественного лечения специалист назначает следующие препараты:
- Свечи, которые характеризуются ранозаживляющим, анальгетическим и противовоспалительным действием. Они могут быть антигистаминными, а также иммуностимулирующими.
- Крема и мази с выраженным заживляющим, сосудосуживающим, противозудным и обезболивающим эффектом.
- Таблетки с небольшим слабительным эффектом и инъекции, обладающие высоким противовоспалительным действием.
- Витамины.
- Лекарственные средства, направленные на снятие сильного спазмирования сфинктера.
- При запущенных формах назначается лечение анальной хронической трещины лазером.
В обязательном порядке врач назначает разные физиотерапевтические процедуры, среди которых большой популярностью пользуются ванночки с настоем ромашки. Подобные ванны стоит делать после полного опорожнения и очищения кишечника. В процессе ванночек в воду можно добавлять не только ромашку, но также марганцовку, обладающую идеальным противовоспалительным и противомикробным действием. Средняя температуры воды при проведении процедур должна составлять примерно 37 градусов.
Диета для лечения анальных трещин
Не менее важна и эффективна при устранении хронической трещины анального отверстия грамотно построенная диета. Ее назначает специалист одновременно с лекарственной терапией, потому все рекомендации требуется очень тщательно соблюдать. По большей части такая диета касается особенностей выбора продуктов. Оптимально подойдут все виды кисломолочных продуктов, которые известны своей способностью нормализовать работу кишечника.
Одновременно с этим в рацион нужно включить продукты, в которых содержится клетчатка. Предпочтение стоит отдать свекле и моркови, а также подойдет чернослив и обычные пшеничные отруби. Это полезные продукты, но с ними важно не переусердствовать, так как большое их количество может привести к процессу дискомфортного газообразования.
Необходимо увеличить в своем питании количество продуктов, богатых белком. Это может быть отварное мясо, яйца, а также мясные бульоны. Полезно пить воду в дневном объеме до 2,5 литров. Профессионалы рекомендуют убрать из рациона острые, кислые, соленые и копченые блюда.
Оперативное вмешательство
Грамотно подобранное оперативное лечение, по большей части направляется на рассечение сфинктера. Это дает возможность устранить сильное спазмирование. Подобные методики лечения показаны, если патология приобрела запущенную форму, если проведенная лекарственная терапия не дала нужного результата. В данном случае пациент направляется в стационар, а время лечения зависит от выбранной операции, то есть занимает от 3 до 7 дней.
После того, как было проведения рассечение, рану требуется обрабатывать специальными антибактериальными и противовоспалительными мазями. Накладывается повязка, а также назначается прием препаратов, которые помогают быстро заживить рану, образовавшуюся в ходе операции или иного хирургического вмешательства.
Народные методики лечения
Разные народные методики направленные на устранение хронической анальной трещины могут быть использованы в качестве дополнительной терапии. Стоит обратить внимание на микроклизмы с такими составами, которые эффективно и мягко отводят каловые массы. В данном случае можно использовать масло облепихи и календулы. Раствор для подобной клизмы можно приготовить следующим методом:
- Ложка календулы заливается 100 мл кипятка и еще раз доводится до кипения.
- Отвар должен остыть до приятной комнатной температуры.
- Все смешивается с маслом облепихи, взятой в объеме двух ложек.
Такая клизма делается каждый день до тех пор, пока не будут устранены все признаки приносящей дискомфорт трещины. Данная процедура направлена на полное устранение процесса воспаления, а также на удаление патогенных микроорганизмов. Клизма эффективно повышает регенерацию и запускает местный иммунитет.
Можно использовать специальные настои для принятия ванн. Для этой цели необходимо использовать травы календулы, ромашки, зверобоя, шалфея. Чтобы приготовить полезный настой потребуется смешать все травы в количестве по 20 грамм каждой. Смесь заливается 1,5 литрами горячей воды. Полученный настой оставляется примерно на три часа, а потом все требуется тщательно процедить и вылить в ванную, наполненную такой водой, температура которой является комфортной. Ванночка принимается на протяжении получаса.
Хорошо помогают справиться с патологией компрессы, выполненные на основе моркови, свеклы, свиного сала. Продукты требуется просто протереть на терке и смешать с жиром или салом. Такой компресс нужно прикладывать к анальному отверстию на 20 минут каждый день. Можно быстро снять сильное воспаление, устранить разные патогенные организмы, а также компрессы помогают ускорить процесс заживления тканей.
Многие практикуют применение ледяных свечей. Для приготовления свечи от хронической анальной трещины потребуется взять травы – пижма, ромашка, календула, лист брусники, кора дуба – смешать в равном количестве и измельчить. Стакан приготовленной смеси требуется залить литром кипятка. Отвар некоторое время настаивается, после остывания заливается в резиновую перчатку и в морозильную камеру. Готовые свечи ставятся на всю ночь, а общее время лечения составляет месяц.
Если есть некоторые проблемы с дефекацией, стоит на ночь выпивать стакан кефира, в котором предварительно размешивается ложка масла. Данная процедура в состоянии гарантировать ежедневный стул нормальной структуры, которая не будет травмировать трещину.
Подводя итоги
В качестве заключения стоит отметить, что намного проще защитить себя от появления трещины, чем потом заниматься ее лечением. Чтобы предотвратить появление патологии первичного или вторичного характера стоит максимально тщательно следить за личной гигиеной половых органов. Требуется соблюдать диету, которая прописывается специалистом. Грамотная диета поможет снизить вес и нормализовать стул.
Важно постоянно заниматься физическими упражнениями, которые будут значительно улучшать общее состояние мышц в области таза и кровообращение. Оптимально подойдет плавание, а также разные упражнения на растяжку. В процессе лечения и всей последующей жизни необходимо избегать сильного переохлаждения, так как это может вызвать сильный рост патогенной микрофлоры.
Версия: Справочник заболеваний MedElement
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Классификация
Трещины заднего прохода разделяют на:
1. Острые трещины ("Острая трещина заднего прохода" — K60.0). Острая трещина заживает в течение 1-2 недель. Имеет линейную или щелевидную форму; мягкие ровные края.
Этиология и патогенез
Точные причины развития анальных трещин неизвестны, но инициирующим фактором считается травма при трудном прохождении каловых масс. Однако у многих людей, страдающих запорами, анальные трещины либо не появляются, либо быстро заживают.
Наряду с запором и затрудненной дефекацией этиологически значимыми состояниями могут считаться поносы.
Эпидемиология
Возраст: трудоспособный возраст
Признак распространенности: Редко
Соотношение полов(м/ж): 0.5
Данные по эпидемиологии анальных трещин различны.
По мнению зарубежных исследователей, распространенность во взрослой популяции составляет около 0,3%. По данным исследователей РФ, заболевание составляет 10 -11,7 % в структуре проктологических заболеваний.
Пол. По данным западных исследователей, различий в заболеваемости между полами не наблюдается, хотя передняя трещина чаще развивается у женщин (25%), чем у мужчин (8%). По данным российских исследователей, женщины страдают примерно в 2 раза чаще, чем мужчины (Семионкин, 2004).
Возраст. Подавляющее большинство пациентов находятся в трудоспособном возрасте — 20-60 лет, с пиком заболеваемости до 45 лет. Заболевание может встречаться и у пожилых людей.
Факторы и группы риска
Клиническая картина
Клинические критерии диагностики
Cимптомы, течение
Для анальной трещины характерна триада симптомов:
— боль во время или после акта дефекации (у 90% пациентов);
— незначительное кровотечение (60% пациентов);
— спазм анального сфинктера (70% пациентов).
Боль при острой трещине характеризуется как нестерпимая, острейшая, жгучая. Боль связана с актом дефекации и длится после него до нескольких часов. Она может иррадиировать в поясницу, реже — в низ живота. Иногда боль рефлекторно вызывает расстройство мочеиспускания. Кровотечения необильные и отмечаются в виде узкой полоски крови на кале.
Дополнительные симптомы:
— зуд в анальной области (20% пациентов);
— боязнь акта дефекации (стулобоязнь) — чувствительность признака не уточнена;
— ощущения разрыва ткани ануса (60% пациентов);
— интермиттирующие (непостоянные) симптомы (у 60% пациентов).
Физикальный осмотр
Осмотр проводится в положении пациента на левом боку с приведенными к туловищу ногами или в гинекологическом кресле в положении на спине. Трещина (или ее часть) видна при раздвижении ягодиц.
Острая трещина имеет гладкие ровные края, дно ее представлено мышечной тканью анального сфинктера. С течением времени дно и края трещины покрываются грануляционной тканью с фиброзным налетом. В дальнейшем, что характерно для хронической трещины, по краям происходит разрастание соединительной ткани, а в тканях, окружающих ее, развиваются воспалительные и трофические изменения.
В области внутреннего, а иногда и наружного, краев появляются участки избыточной ткани — анальные бугорки (приблизительно в 20% случаев).
В воспалительные и трофические изменения вовлекаются нервные окончания на дне трещины, способствуя возникновению незаживающей язвы.
Пальцевое исследование прямой кишки невозможно или затруднено вследствие спазма анального сфинктера и выраженной боли. В этом случае исследование следует временно отложить или провести под местной анестезией.
Диагностика
Диагноз устанавливается клинически. Дополнительные (инструментальные) методы диагностики применяются у ограниченной группы лиц по показаниям.
3. УЗИ сфинктеров (особенно внутреннего) осуществляется с целью выявления дефектов. Традиционно применяется у женщин с развившимися трещинами во время беременности или имевшими акушерские травмы (разрывы).
Лабораторная диагностика
Дифференциальный диагноз
4. ВИЧ-инфекция. Установленный диагноз ВИЧ-инфекции или факторы риска (высокая вирусная нагрузка у матери, совместное использование игл при в/в употреблении наркотиков, не использование средств защиты при сексуальных контактах). Диагноз подтверждается лабораторными методами.
6. Сифилис. Незаживающие трещины. Выявление принадлежности к группе риска (половой контакт с инфицированным человеком, проституция, промискуитет , сифилис у матери, наличие других ЗППП). Диагноз подтверждается рентгенологически.
Осложнения
Осложнения оперативного вмешательства:
— задержка мочи;
Анальная трещина (или трещина анального прохода или фиссура) представляет собой спонтанно возникающий линейный или повреждение слизистой оболочки анального канала прямой кишки и является одним из самых распространенных проктологических заболеваний.
Различают острую и хроническую стадии заболевания.
Острая анальная трещина при отсутствии лечения с момента первого эпизода болевого синдрома более трех месяцев, как правило, переходит в хроническую форму. При хронической анальной трещине, слизистая по краям утолщается, формируются наружные (кожные) и внутренние (фиброзный полип анального канала) сторожевые бугорки и медикаментозного лечения уже недостаточно.
Причины анальной трещины
- недостаточное употребление , жирная богатая углеводами пища, острая пища и злоупотребление алкоголем
- запоры или диарея
- беременность и роды
- занятия определенными видами спорта (велосипедный спорт)
- механическое повреждение слизистой прямой кишки (в том числе при занятиях анальным сексом)
- острый геморрой, криптит и другие проктологические заболевания
- тяжелый физический труд
Трещина: симптомы и признаки
- боли в области заднего прохода вовремя и после дефекации
- выделения крови во время дефекации в виде помарок на стуле и туалетной бумаге
- спазм внутреннего сфинктера
- чувство дискомфорта, зуда, жжения в анальной области
Обратите внимание
Такие симптомы, как боль и кровь при дефекации, могут так же свидетельствовать о наличии онкологического процесса. Поэтому не занимайтесь самолечением, а вовремя обратитесь к врачу. При неадекватном лечении анальной трещины, возможно развитие осложнений таких как парапроктит – острое или хроническое воспаление клетчатки. Парапроктит – одно из самых частых проктологических заболеваний (20-40 % всех болезней прямой кишки).
Своевременно начав лечение в нашем центре, можно обойтись малоинвазивными консервативными методами без боли и дискомфорта.
Как проходит лечение анальной трещины в «GRAND MEDICA»?
Для диагностики геморроя на первичной консультации врач колопроктолог проводит визуальный осмотр, пальцевое обследование, аноскопию и по показаниям ректороманоскопию (безболезненные инструментальные исследования). Анальная трещина – это разрыв кожи вокруг заднего прохода. Это общая проблема, которая может вызвать сильную боль, особенно после акта дефекации. Такое состояние связано со спазмом внутреннего анального сфинктера. Спазм уменьшает приток крови к зоне повреждения и мешает заживлению. Цель лечения – разорвать этот патологический цикл и ускорить заживление.
Консервативное лечение
Оперативное лечение эффективно для лечения анальных трещин, но оно назначается обычно пациентам, которым не помогли нехирургические методики лечения. Альтернативой хирургическому лечению могут быть слабительные, мази, инъекции ботулотоксина, питание с большим количеством клетчатки и большее употребление воды. Первично для лечения анальных трещин используют мази для расслабления анального сфинктера и уменьшения боли, таким образом способствуя заживлению. Однако, для некоторых людей применение мазей неудобно и стеснительно, а у некоторых пациентов развивается головная боль порой такая сильная, что это является причиной для прекращения лечения мазями.
Химическая сфинктеротомия (инъекция ботулотоксина)
Выполнение инъекции ботулотоксина в мышцу анального сфинктера расслабляет мышцу в достаточной мере для предотвращения спазма и боли, приводит к заживлению трещины. Данная процедура выполняется под аппликационной анестезией, в рамках амбулаторной помощи. Главное преимущество применения инъекции ботулотоксина это возможность избежать боковой сфинктеротомии (рассечения сфинктера), при которой рассекается часть боковых волокон мышцы сфинктера; у этой процедуры очень маленький риск постоянного недержания. Большинству пациентов становится лучше после инъекции ботулотоксина. Очень редко, но некоторым пациентам необходима повторная инъекция ботулотоксина через 2-3 месяца.
Латеральная сфинктеротомия
Сфинктеротомия обозначает рассечение сфинктера. Операция выполняется под общей анестезией. Врачом будет сделан небольшой разрез на коже недалеко от заднего прохода. Затем он перережет нижнюю часть мышцы внутреннего сфинктера. Это ослабит спазм, улучшит кровообращение для заживления трещины Перерезание сфинктера создает постоянный эффект, и одним из рисков этой процедуры является ослабление силы мышцы. Именно поэтому у части пациентов развивается потеря контроля, что проявляется как недержание газов или просачивание кала.
Иссечение трещины
- Наличие высокого риска развития анального недержания после сфинктеротомии;
- Разрывы промежности во время родов у женщин;
- Клинические признаки опущения тазового дна;
- Возраст старше 60 лет;
- Наличие выпадающего внутреннего сторожевого бугорка;
При помощи электрокоагулятора производят разрез слизистой и кожи вокруг трещины. Затем плоско, вдоль проекции мышечных волокон сфинктера иссекают в пределах здоровых тканей трещину с криптой, сторожевым бугорком и гипертрофированным анальным сосочком. Иссечение производят в виде треугольника, обращенного вершиной в кишку, основанием на перианальную кожу или в виде эллипса.
После выписки из стационара
Для быстрейшего заживления вы должны соблюдать постельный режим первые несколько дней, ходить как можно меньше. Рана может заживать в течение нескольких недель, поэтому нужно будет носить прокладку. Регулярные упражнения помогут вам быстрее вернуться к привычной активности. Надо спросить у врачей: какими упражнениями заниматься и когда начинать их делать. Выздоровление после операции очень индивидуально. Кто-то ощущает сильную боль и отечность, а у кого- то этот дискомфорт минимален. Проконсультируйтесь на счет обезболивающих и слабительных, чтобы не допустить запора.
Любая боль, вызванная трещиной, должна проходить быстро. Обычно возврат к работе происходит в течение нескольких дней, в зависимости от вашего рода деятельности.
Если вдруг к несчастью, вы ощущаете сильную боль в животе или у вас сильное кровотечение, пожалуйста, немедленно обратитесь в клинику по телефону 8 (3843) 99-40-40 или на станцию скорой помощи, обязательно уведомив их, что вам была сделана операция.
В послеоперационном периоде до момента заживления ран, пациентам требуется производить регулярную санацию анальной области с использованием сидячих ванночек со слабым раствором перманганата калия или ромашки Выполнять ежедневные перевязки с использованием мазевых основ (которые Вам индивидуально подберет наш специалист), обладающих противовоспалительным и ранозаживляющим действием.
Необходим еженедельный врачебный контроль за течением раневого процесса до полного заживления ран На период заживления ран требуется соблюдение диеты богатой растительной клетчаткой, прием пищевых волокон (как вариант препараты семян подорожника) для смягчения стула.
Диета № 3 по М. И. Певзнеру
Технология приготовления: пищу готовят в основном неизмельченной, варят в воде или на пару, запекают.Овощи и плоды употребляют как в сыром, так и в вареном виде. Еда преимущественно должна состоять из овощей, свежих и сушеных плодов, хлебопродуктов, круп, кисломолочных напитков.
Разрешаются:
Хлеб – пшеничный из муки грубого помола: «докторский», «здоровье», хрустящие хлебцы (размоченные), ржаной. Печенье сухое, несдобная выпечка.
Супы – преимущественно из овощей на мясном бульоне, холодные фруктовые и овощные супы, борщи, свекольники, щи из свежей капусты.
Мясо и птица – нежирные сорта различных видов мяса, курица, индейка вареные или запеченные, куском или рубленые. Сосиски молочные.
Рыба – нежирные виды, отварная или запеченная; блюда из морских продуктов.
Блюда и гарниры из овощей – различные виды овощей и зелени, некислая квашеная капуста, особенно рекомендуется свекла. Блюда и гарниры из муки, крупы, бобовых, рассыпчатые и полувязкие каши, пудинги, запеканки. Макаронные изделия, отварные и в виде запеканок, особенно рекомендуются блюда из гречневой крупы. Из бобовых: зеленый горошек, соевый творог.
Яйца – не более одного яйца в день, лучше добавлять в блюда.
Фрукты, ягоды, сладкие блюда и сахаристые продукты – особенно рекомендуются дыни, слива, инжир, абрикосы, чернослив, сахар, варенье, особенно рябиновое, мед, компоты (особенно из ревеня), муссы, фруктовые конфеты.
Молоко, молочные продукты и блюда из них – молоко (при переносимости – сладкое), сметана, творог, простокваша, одно- и двухдневный кефир, ацидофильное молоко, сыры.
Соусы и пряности – молочные, сметанные на овощном отваре, фруктово-ягодные подливки.
Жиры – масло сливочное, растительные масла из блюд.
Закуски – салаты из сырых овощей, винегреты с растительным маслом, икра овощная, фруктовые салаты, сыр неострый, ветчина нежирная, сельдь вымоченная, мясо и рыба заливные.
Напитки – чай, кофе из заменителей, отвар из шиповника и пшеничных отрубей, соки фруктовые и овощные (из слив, абрикосов, моркови, томатов).
Запрещаются:
Хлеб из муки высших сортов, слоеное и сдобное тесто, жирные сорта мяса и рыбы, утка, гусь, копчености из мяса и рыбы,консервы рыбные и мясные, (рис и манную крупу ограничить), редька,редис, чеснок, лук, репа, грибы, кисель, черника, айва, кизил, шоколад изделия с кремом, острые и жирные соусы, хрен, горчица, перец, какао, черный кофе, крепкий чай, животные и кулинарные жиры, алкогольные напитки.
Колопроктологическая служба клиники располагает самым современным оборудованием и технологиями для диагностики и лечения большого спектра заболеваний толстой и прямой кишки.
Запишитесь на прием к проктологу по телефону 8 (3843) 99-40-40 или оставьте заявку на сайте.
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