- Боль в области анального отверстия
- Боль при дефекации
- Затрудненность дефекации
- Кровотечение из заднего прохода при дефекации
- Кровь в кале
- Нарушение сна
- Раздражительность
- Спазм анального отверстия
Трещина прямой кишки соответствует также и таким определениям актуального для нее патологического процесса, как трещина заднего прохода или анальная трещина. Трещина прямой кишки, симптомы которой проявляются в результате разрыва слизистой прямой кишки (в большей или меньшей степени), в большинстве случаев диагностируется у тех пациентов, для которых актуальна проблема хронических запоров или поносов, предпочтение анального секса традиционному, а также малоактивный образ жизни.
Общее описание
Анальная трещина выступает в качестве линейного дефекта, образуемого на слизистой анального канала. Как правило, конкретная область ее расположения в анальном отверстии приходится на заднюю линию или на переднюю среднюю линию (в последнем случае чаще всего этот дефект отмечается у женщин). Указанные варианты поражения связаны с оголением чувствительных нервных окончаний, в результате чего сфинктер заднего прохода подвергается резкому спазмированию, а это, в свою очередь, приводит к появлению боли при дефекации. Все это, прежде всего, связано с актуальной для больного проблемой плотного стула или запора, и если такая проблема не устраняется, то травмирование слизистой оболочки приобретает постоянный характер. На фоне этого появляется стойкий болевой синдром в сочетании со спазмом со стороны сфинктера. В итоге возможность заживления образуемой таким образом трещины исключается, более того, из-за присутствия в прямой кишке патогенной микрофлоры, образуемая рана постоянно инфицируется.
Перечисленные особенности течения процесса, актуального для образования анальной трещины, приводят к тому, что активная форма воспалительного процесса в области поражения постоянно поддерживается. С течением времени, и, соответственно, с прогрессированием процесса, края трещины утолщаются, в глубине она увеличивается в размерах. Нервные окончания на фоне этих процессов становятся еще менее защищенными в отношении такого воздействия, в результате чего осуществляется переход заболевания в хроническую форму течения.
Если анальная трещина в своем появлении сочетается с хронической формой течения геморроя, то в этом случае ее расположение может приходиться на область боковых стенок анального канала. В целом при таком варианте течения заболевания его картина, как можно понять, еще более усложняется в особенностях актуальных процессов. Геморрой становится причиной ухудшения в слизистой анального канала кровообращения, что, в свою очередь, обуславливает снижение его способности к регенерации, то есть к заживлению и восстановлению.
Как вы уже могли догадаться из описаний процессов, раскрытых выше, в зависимости от особенностей проявления, анальная трещина может быть острой (в этом случае длительность заболевания составляет не более 4 недель), а также хронической (в этом случае, соответственно, рассматривается более длительное течение).
Нормализация стула и применение соответствующей обезболивающей терапии определяет для больных возможность ремиссии заболевания, длительностью в месяцы, а в некоторых случаях и в годы. Тем ни менее, уже наступление первого поноса или запора в рамках периода «затишья» может стать причиной повторного возникновения анальной трещины.
Линейный разрыв (в некоторых случаях он, кстати, может иметь треугольную или овальную форму), актуальный для данной патологии, иначе можно определить как растрескивание слизистой прямой кишки. Что касается размеров этого разрыва, то в длину он может достигать 2 сантиметров. Следует отметить, что трещина прямой кишки – одно из самых распространенных заболеваний, диагностируемых в области проктологии, его частота в среднем определяется в 10-20% в числе существующих заболеваний, актуальных для поражаемой области (т.е. прямой кишки). Относительно подверженности возникновению трещины прямой кишки можно отметить, что встречается она и у детей, и у мужчин, и у женщин. Фактор подверженности к возникновению анальной трещины рассматривается в комплексе с причинами, провоцирующими ее формирование.
Причины трещины прямой кишки
Появлению острой анальной трещины могут сопутствовать следующие причины:
- Нарушение кровоснабжения области анального отверстия. В этом случае рассматриваются варианты, при которых застой крови происходит в области прямой кишки на фоне малоподвижного образа жизни пациентов, особенностей профессиональной деятельности (сидячее положение), и т.д.
- Механическое травмирование анального отверстия. В этом случае речь идет о поражении области прямой кишки на фоне частых запоров или, наоборот, поносов. Отдельно рассматриваются осложнения на фоне родов у женщин, провоцирующие подобное травмирование, а также предпочтение нетрадиционных форм половых сношений (анальный секс).
- Геморрой. Уже отмеченное нами выше, это заболевание характеризуется тем, что геморроидальные узлы приводят к ослаблению стенок заднего прохода, без труда подвергаясь травмированию при дефекации. Анальные трещины при геморрое обуславливаются нарушением в области заднего прохода кровообращения (в форме тромбоза, застоя крови).
- Нарушения, связанные с иннервацией области прямой кишки. В данном случае рассматривается нарушение в виде длительного спазмирования сфинктера, возникшего в результате актуальной для пациента патологии ЦНС.
- Анатомические особенности. Строение прямой кишки также определяет возможную предрасположенность к появлению трещины в ней. Трещина прямой кишки у женщин из-за тех особенностей, которые актуальны в целом в строении женских половых органов, возникает со стороны передней части анального отверстия. Учитывая это, соответственно, трещина прямой кишки передней части анального отверстия – форма заболевания, при которой за счет анатомических особенностей предрасположенность к его возникновению определена именно под соответствующий пол пациентов.
Следует в отдельности отметить, что преимущественно трещина заднего прохода обуславливается сочетанием одновременного воздействия нескольких причин или факторов.
Трещина прямой кишки: особенности острой и хронической форм
Как мы уже выделили, анальные трещины могут, как и ряд других заболеваний, проявляться в острой и хронической форме собственного течения, определить конкретную форму можно на основании длительности проявлений, сопутствующих заболеванию, временные интервалы мы также отметили выше. Острая форма течения характеризуется спонтанностью возникновения в результате разрыва слизистой прямой кишки, чему может сопутствовать процесс прохождения при запоре каловых масс высокой степени плотности. Заживление острых анальных трещин зачастую происходит в течение срока 1-2 дней, причем без необходимости какого-либо их лечения.
Куда более серьезный вариант трещины прямой кишки – хроническая форма заболевания. Такие трещины выступают в качестве варианта продолжения острой формы, на фоне которой, собственно, они и развиваются, точнее – на фоне трещин полностью не закрывшихся и подвергшихся повторному травмированию посредством того или иного фактора воздействия. Преобразование в хроническую форму протекает при еще большем их расширении и инфицировании микробами, которые в обильном количестве находятся на стенках прямой кишки. Стенки хронических трещин обладают высокой плотностью, процесс их закрытия (заживления) является длительным и осложненным за счет постоянного воздействия на пораженную область.
Трещина прямой кишки: симптомы
Клиника анальной трещины располагает весьма характерными проявлениями. В качестве основных признаков этого заболевания выделяют триаду симптомов, в частности это боль в области заднего прохода, выраженная спазмированность анального сфинктера, а также кровотечение, возникающее непосредственно из заднего прохода. Если рассматривается течение заболевания в сочетании с геморроем, то к перечисленным признакам присоединяется и такой симптом как выпадение геморроидальных узлов в сочетании с массивным кровотечением из заднего прохода.
Симптомы острой анальной трещины
Боль в области заднего прохода является ведущим симптомом из перечисленных в общем описании вариантов. В рамках данной формы проявления заболевания боль достаточно сильная, но непродолжительная. Появление боли отмечается только в процессе дефекации (опорожнение кишечника, стул), а также примерно в течение 15 минут после ее завершения. В основном выявление участка болезненности происходит при острой анальной трещине в области задней стенки прямой кишки.
Спазмированность анального отверстия (сфинктера) аналогично болевым ощущениям при этой форме течения заболевания имеет достаточно интенсивный характер проявления. Проявляется спазм в виде болезненности, сочетающейся с ощущением затрудненности, сопутствующей процессу дефекации.
Кровотечение из заднего прохода имеет незначительный характер выраженности. Возникают такие кровотечения при дефекации, что объясняется прохождением каловых масс высокой степени плотности.
Помимо перечисленных симптомов в качестве их дополнения выделяется затрудненность акта дефекации.
Симптомы хронической трещины прямой кишки
В данной форме симптоматика аналогична форме острой, однако некоторые отличия, тем ни менее, имеются. Так, боль в области заднего прохода в данном случае отличается от случая острого течения заболевания. Длительность болевых ощущений здесь увеличивается, усиление их происходит при вынужденной необходимости принятия сидячего положения в рамках длительного периода времени. Проявление болевых ощущений в данном случае определяет серьезный дискомфорт, ввиду чего больные становятся раздражительными, у них появляются проблемы со сном.
Помимо болевых ощущений у больных также формируется своеобразный страх, касающийся дефекации, нередко на этом фоне начинается прием ими слабительных во избежание запоров и сопутствующей их состоянию симптоматики.
Здесь также развиваются кровотечения, возникающие из заднего прохода, в особенности актуальны они при запорах. Помимо крови из анального отверстия также начинает выделяться гной. Что касается спазмированности сфинктера, то она в данном случае менее выражена, чем при остром течении заболевания.
Трещина прямой кишки у ребенка: симптомы
Трещина прямой кишки может развиться у ребенка главным образом по причине запора. Заболевание проявляется в острой форме, его основные симптомы заключаются в появлении болезненности при дефекации, а также следы крови, которые можно обнаружить на туалетной бумаге и на кале.
В подавляющем большинстве случаев у детей это заболевание проходит без необходимости лечения, то есть самостоятельно, а единственным аспектом, касающимся его исключения, является необходимость нормализации стула.
Трещина прямой кишки при беременности
Женщины в особенности предрасположены к появлению проблем со стулом и к запорам в частности, если сравнивать эту ситуацию с мужской предрасположенностью. А если рассматривать период беременности и родов, то здесь еще более велик риск подобных изменений. Появление анальной трещины обуславливается у беременных воздействием ряда специфических факторов внешнего и внутреннего масштаба, выделим их ниже:
- Увеличение матки. На фоне этого изменения в женском организме при беременности происходит сдавление вен в области таза, а вместе с ним – и нарушение оттока крови со стороны прямой кишки. Из-за застоя крови в венах прямой кишки, в свою очередь, при одновременном воздействии гормонов, актуальном в рамках рассматриваемого периода, развивается отечность тканей, чему также сопутствует повышение их восприимчивости к негативному воздействию.
- Гормональные изменения. Снижение тонуса матки при беременности происходит под воздействием измененного состояния гормонального фона, наряду с этим влияние гормонов распространяется и к другим гладкомышечным органам, к ним, как вы уже, вероятно, поняли, относится также и кишечник. Из-за запоров и слабой перистальтики при беременности и происходит формирование анальной трещины.
- Пищевые пристрастия. Из-за изменений питания беременных женщин и появления у них специфических пристрастий, в том числе касающихся сладостей и рафинированных продуктов, развиваются нарушения в пищеварении, на фоне которых, в свою очередь, повышается риск развития трещины прямой кишки.
- Пониженная физическая активность. Ее в должной мере сохранять становится трудно, в особенности после 30 недели, ввиду чего со стулом возникают соответствующие проблемы, которые, как мы уже не раз отмечали, приводят к развитию рассматриваемого нами процесса.
Следует отметить, что трещина прямой кишки после родов также является не менее распространенным вариантом ее проявления. Причины трещины прямой кишки в этом случае неясны, однако предполагается, что свою и, вполне возможно, что немалую роль здесь играет сам процесс родовой деятельности с сопутствующим резким напряжением тканей в данной области, возникающим в момент прохождения через тазовое дно плода и его головки.
В некоторых случаях появляется анальная трещина и через определенное время после рождения ребенка. Обуславливается это часто возникающий после родов запор, связанный с тем, что женщина испытывает определенный страх перед актом дефекации. Последующее прохождение кала повышенной плотности приводит к поражению и без того подверженных ранению тканей.
Осложнения
Осложнения, которые могут возникнуть при трещине прямой кишки, прежде всего, заключаются в возможности инфицирования при развитии восходящего воспаления, что определяет вероятность его продвижения по кишечнику вверх. В частности опасность этого процесса определена для слизистой его оболочки в области терминальных отделов, к таким отделам относятся сигмовидная и прямая кишки, а также сфинктер. На фоне воздействия, оказываемого проникновением инфекции в среду глубоких слоев, нередко развивается парапроктит, при котором, в свою очередь, происходит воспаление жировой клетчатки, сосредоточенной в окружении прямой кишки.
Также осложнения анальных трещин могут заключаться в возникновении сильных кровотечений. Кроме того, даже на фоне незначительных кровопотерь у пациентов со временем развивается анемия.
Определенная опасность существует и отдельно для мужчин, заключается она в распространении инфекции к предстательной железе, на фоне чего, соответственно, развивается простатит.
Диагностика
Выявить наличие у больного трещины прямой кишки, как правило, не составляет труда. Дифференцировать это заболевание необходимо, прежде всего, от свища прямой кишки (внутренняя форма проявления). В рамках этой патологии отсутствует спазмирование, интенсивность болевого синдрома выражена не столь интенсивно, а в качестве основного проявления симптоматики учитывается выделение из ануса гноя. При ощупывании дефекта области слизистой определяется незначительная болезненность, а в области ее дна выявляется свищевая полость в виде характерного углубления.
Помимо свища прямой кишки также следует исключить связь проявлений, характеризующих на основании симптоматики трещину прямой кишки, с инфекциями, поражающими прямую кишку (паразитарная или грибковая форма заражения, болезнь Крона с сопутствующим поражением области прямой кишки, туберкулезное или сифилитическое поражение). Для исключения этих вариантов тщательно производится сбор анамнеза, определяются причины возникновения и сроки по заболеванию, а также характеризующие его особенности течения.
При подозрительном анамнезе по части возможной актуальности ВИЧ-инфекции (на фоне гомосексуализма, беспорядочности половой жизни и наркомании) у больных также могут присутствовать заболевания, течение которых поражает прямую кишку, что непосредственным образом связано в этом случае именно с ВИЧ. Зачастую у больных при наличии анальных трещин в этом случае вырисовывается несколько необычная по характеру картина их проявлений.
Основные методы диагностики:
- наружный осмотр (во многих случаях дает возможность определить наличие анальной трещины (ее части); внешне анальная трещина – продольная или треугольная красная язва);
- пальцевое обследование области прямой кишки (прощупывание стенок кишки, определение степени спазмирования сфинктера);
- ректороманоскопия (наиболее достоверный метод проведения исследования данной области с возможностью обследования слизистой кишки в рамках расстояния от анального отверстия в пределах до 30 см);
- аноскопия (обследование, при котором осмотру подлежит конечный отдел прямой кишки).
Лечение
В лечении трещины заднего прохода ориентируются на достижение результатов по части нормализации стула, снижения болевых ощущений, заживления пораженной области, а также на то, чтобы снизить повышенный в данном случае тонус сфинктера. Используются два варианта лечения, лечение хирургическое и лечение нехирургическое.
В рамках мер хирургического лечения применяется метод иссечения трещины, а также сфинктеротомия, особенность их реализации заключается собственно в рассечении одной из порций области анального сфинктера. Такого рода вмешательство определяет возможность достижения требуемого расслабления сфинктера, устранения болевого синдрома и создания таких условия, в рамках которых возможным станет заживление. За счет пересечения данной мышцы нарушений в удержании кала не возникает, пребывание больного в условиях стационара не требует дополнительного времени.
Что касается нехирургического лечения, то в нем, прежде всего, ориентируются на следующие меры: нормализация стула, сидячие ванночки, диетотерапия, прием препаратов для снятия спазма указанной области. За счет мер консервативной терапии, применимых в этом случае, выздоровление возможно примерно в 70% случаев.
Что касается такого вопроса как профилактика трещины прямой кишки, то она заключается в соблюдении пациентами принципов правильного питания и активного образа жизни, а также в своевременности лечения любого типа нарушений, связанных со стулом. Исключение застойных явлений, возникающих в области таза, достигается за счет регулярных прогулок, физкультуры и ходьбы. Анальный секс по причине серьезных рисков, наносимых данной области, необходимо исключить.
Прогноз при трещине прямой кишки определяет возможность излечения в рамках 60-90% общего числа случаев заболевания при условии современного его выявления и применении адекватных мер терапии в его адрес. Народные средства при трещине прямой кишки, любого типа самолечение, а также неправильно назначенное врачом лечение – все это может стать причиной хронизации процесса, за счет чего, соответственно, прогноз определяет негативные последствия, сводя в большинстве случаев последующее лечение к необходимости реализации мер хирургического вмешательства. В большинстве случаев такая мера как хирургическое иссечение анальной трещины позволяет достичь полного выздоровления больного.
При появлении симптомов, указывающих на возможное наличие трещины прямой кишки, необходимо обратиться к проктологу (хирургу-проктологу) или к хирургу.
Зачастую к проктологу больные обращаются по поводу трещины прямой кишки. Данная патология выражена дефектом слизистой оболочки в анальной области прямой кишки.
По этой причине нередко болезнь называют анальной трещиной. Встречается подобный недуг чаще у женщин, что обусловлено некоторыми анатомическими особенностями. Дефект может быть размером от нескольких миллиметров до 2 см и больше.
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Причины и факторы
Прежде чем выделить причины трещины прямой кишки, хочется остановиться на факторах, способствующих возникновению дефекта. Это могут быть заболевания нижних отделов кишечника, нарушения в диете, частые запоры (о лечении запоров) и нетрадиционный секс.
А теперь остановимся на причинах. Следует заметить, что анальная трещина может образоваться по следующим причинам:
- перенапряжение во время родовых схваток;
- в послеродовом периоде неправильное ведение пациентки, когда первый стул проходит самостоятельно, а не вызывается клизмой либо слабительным;
- запоры и затрудненный акт дефекации;
- повреждение анального канала каловыми массами, что нередко сопровождается инфицированием травмированной зоны;
- травмы механического характера, связанные с неправильной постановкой клизмы или введения медицинского инструментария;
- такие сосудистые нарушения, как флебиты, геморрой, васкулиты в области прямой кишки и малом тазу;
- искусственно повышенное давление в самой прямой кишке в момент поднятия тяжестей;
- поражение сфинктера анального прохода, нарушающее питание тканей в этом отделе.
Нередко трещина в заднем проходе возникает в результате сочетания сразу нескольких причин, то есть механическая травма может сопровождаться воспалительным процессом кишечника.
Трещина прямой кишки может проявляться в хронической и острой форме. Для патологии характерны боли, усиливающиеся во время дефекации. Правда ее интенсивность не длится свыше 15 минут.
При хроническом течении боли не такие сильные, но более продолжительные. Причем боль может возникать, если человек долго сидит. Если обобщить все признаки, то типичные симптомы трещины прямой кишки таковы:
- болезненные ощущения в анальной зоне;
- спазмированние сфинктера;
- запоры;
- появление примеси крови в кале или кровотечение из анального канала.
При инфицировании трещины прямой кишки нередко появляется зуд. Особенно часто этот признак наблюдается у детей.
Методы лечения и диета
Сразу хочется обратить внимание на то, что лечение трещины прямой кишки осуществляется комплексно.
Если болезнь не запущена, то помогают консервативные методы, а в осложненных случаях приходиться прибегать к операции.
Большое значение при анальной трещине имеет правильный выбор диеты. Питание должно быть одновременно щадящим и полноценным. В рационе обязательны фрукты с овощами, поскольку они содержат много клетчатки, которая улучшает функции кишечника и способствуют размягчению кала. Этот фактор является основополагающим в лечении анальной трещины.
Следует ограничить острые, соленые блюда, пряности, копчености и алкоголь. Всевозможные фаст-фуды и полуфабрикаты рекомендуется исключить полностью. Лучше отдать предпочтение овощным блюдам.
От продуктов, которые могут спровоцировать запоры, тоже лучше отказаться. Это яйца, творог, жирные сорта рыбы и мяса.
Немаловажное значение имеет поза при дефекации. Она должна быть правильной — спина должна быть выпрямлена, а коленки чуть приподняты над уровнем таза. В этом случае происходит выпрямление анально-ректального угла и каловые массы более свободно покидают задний проход.
Вообще в идеале нормальным, физиологически обоснованным положением человека при акте дефекации является поза на корточках, когда таз и задний проход опущены вниз, бедра прижаты к животу. При этом прилагается меньше усилий для изгнания каловых масс из прямой кишки.
О значении правильной позы в процессе дефекации свидетельствует статистика: люди, живущие в условиях, лишенных современного комфорта, болеют патологией прямой кишки значительно реже, длительность акта дефекации у них намного короче (примерно 5-7 минут и за одно-два натуживания). Кроме того, поза сидя на корточках обеспечивает самое низкое положение ануса по отношению к телу и максимальное раздвигание ягодиц.
Народные рецепты лечения анальной трещины
Сегодня народное лечение трещины прямой кишки широко применяется совместно с фармацевтическими средствами. Такое сочетание отличается высокой эффективностью и помогает снизить лекарственную нагрузку, оказываемую на организм.
Методик для домашнего применения много. Это настои, отвары, лечебные чаи, ванночки.
Сидячие ванночки
Рекомендуется делать после очистительной клизмы. В тазик налить воду ( температура 35-36C), растворить марганцовку, чтобы получился насыщенный розовый цвет. Нужно присесть на корточки так, чтобы анальный проход свободно омывался в растворе.
Время процедуры – 10-15 минут. По окончании манипуляции ввести в анальное отверстие свечу либо смазать его противовоспалительной мазью. При обострении болезни, можно повторить процедуру перед сном.
Можно делать лечебные ванночки с молочно-луковым отваром. Для этих целей четыре средних луковицы нужно отварить в 500 мл молока. Отвар готовится на слабом огне примерно полчаса, причем крышка должна быть закрыта.
Еще горячий раствор затем сливают в сосуд, имеющий небольшое отверстие. Нужно постараться сесть так, чтобы пар из отверстия попадал непосредственно на пораженную область. Делать процедуру можно раз в неделю.
Целебные свечи
Активно применяется в народной практике обычный картофель. Из сырого корнеплода необходимо вырезать кусочек в форме ректальной свечи и осторожно ввести в анальный канал. Картофельный сок восстанавливает ткань и снимает воспаление.
В домашних условиях несложно приготовить свечи из лекарственных трав. Для этого надо взять поровну (по 1 ч. л.) цветков ромашки, травы подорожника и пустырника. Травы измельчить в порошок (можно в кофемолке) и перемешать вместе с пчелиным воском, который нужно предварительно растопить.
Из полученной смеси изготовить свечи и поместить их в холодильник на хранение. При обострении можно использовать до 3-х раз в день.
Лечебные клизмы
Для процедуры необходим такой состав:
- сок алоэ (рекомендуется использовать растение старше трех лет) – 1 ст. л.;
- рыбий жир – 1 ст. л.;
- сырое яйцо – 1 шт.
Все компонента тщательно перемешать, а затем влить в маленькую спринцовку и аккуратно ввести средство в прямую кишку.Рассчитан курс на 10-15 лечебных клизм.
Травяные отвары
Эффективно лечение в домашних условиях с применением трав. Помогает избавиться от анальной трещины средство, состоящее из 1 части чистотела большого и следующих трав, взятых по 3 части: тысячелистник, зверобой, цветы ромашки лекарственной.
Компоненты хорошо перемешать, взять 2 л. ст. смеси, залить ее стаканом кипятка, на 2-3 часа поставить в тепло. Посуду с раствором необходимо укутать полотенцем. После того, как настоится раствор, его можно пить по 100-150 мл до 4-х раз.
При лечении анальных трещин часто используется одуванчик. Из корня этого растения нужно приготовить порошок и трижды в день принимать его по 1 ложке чайной. Поможет усилить лечебный эффект настой травы тысячелистника, которым просто запивают порошок.
Настой готовится в пропорции: 2 ч. л. измельченной травы на стакан кипятка. Раствор до приема должен настояться (1/2 часа), потом его можно процедить. Принимать в теплом виде. Средство отлично помогает при запущенной трещине заднего прохода.
Профилактические мероприятия
Средства народной медицины нередко используют в профилактических целях. Вообще, профилактика анальных трещин состоит в строгом соблюдении диеты, режима дня и гигиенических норм. Необходимо после каждой дефекации подмываться, заменив этой процедурой применение туалетной бумаги.
Если работа сидячая, необходимо периодически делать небольшие перерывы, чтобы размяться. Такие разминки нужны для восстановления нормального кровообращения в малом тазу. Нельзя относиться легкомысленно к поднятию тяжестей, а также повышенным физическим нагрузкам.
Анальные трещины представляют собой дефекты слизистой оболочки задней, реже передней стенки толстой кишки. Достаточно редко образуется боковая анальная трещина или две вместе – задняя и передняя. В зависимости от срока заболевания различается острая анальная трещина и хроническая.
Причины
Трещина прямой кишки появляются у женщин, мужчин, детей разного возраста. Причины следующие:
- запоры свыше 2 – 3 дней;
- прямая травма слизистой оболочки;
- продолжительные поносы;
- алкоголь, острая пища;
- болезнь Крона – воспалительное гранулематозное заболевание кишечника;
- инструментальное обследование прямой кишки — ректороманоскопия, колоноскопия;
- кишечные инфекционные заболевания – дизентерия, колиты;
- анальный секс.
Факторами риска является пожилой возраст, опущение мышц тазового дна. Анальная трещина после родов образуется при потугах, разрыве промежности.
Симптомы
Анальная трещина симптомы могут напоминать другие опасные болезни — рак прямой кишки, язвенный проктит, внутренний неполный язвенный свищ. Своевременное обращение к врачу позволит дифференцировать заболевания и назначить правильное лечение. Симптомы трещины прямой кишки немногочисленные, больных тревожат:
- сильные боли при опорожнении кишечника, вызванные спазмом волокон сфинктера;
- незначительные кровотечения в виде полоски крови на каловых массах;
- боязнь стула, связанная с появлением болезненных ощущений при дефекации.
Острая анальная трещина образуется при внезапном разрыве слизистой оболочки прямой кишки. Жгучая резкая боль усиливается в момент и после дефекации. Затем постепенно ослабевает. Хронические анальные трещины характеризуются волнообразным течением с периодами ремиссий и обострений.
Как выглядит дефект слизистой при осмотре? Это может быть микроскопическая едва заметная ранка или продольное щелевидная язва длиной около 2 см, глубиной 2-3 мм, шириной до 5 мм. Со временем ее края уплотняются. В нижней и верхней части появляются утолщения, фиброзные узелки. Из-за сильных болей волокна наружного сфинктера спазмируются, нарушается трофика (питание) тканей. Многочисленная микрофлора кишечника способствует развитию местного воспаления. В результате анальная трещина кровит, сроки заживления раны затягиваются.
Особенности заболевания у детей
Чаще всего анальная трещина у ребенка появляется вследствие запоров. У грудничков стул может задерживаться по следующим причинам:
- порок развития кишечника;
- однообразное питание при искусственном вскармливании;
- повышенное содержание в пище молочного белка (творога);
- недостаточное питание — нехватка грудного молока или прикорма;
- слишком жирное грудное молоко.
У ребят старшего возраста привычные запоры, трещина прямой кишки появляются при неправильном питании, низкой физической активности, систематическом сдерживании позывов к дефекации во время занятий. Задержка стула способствует растягиванию нижнего отдела толстого кишечника, снижается тонус его мускулатуры. Чем лечить запоры, чтобы не появилась трещина анального отверстия?
Малышам помогает массаж живота. В соответствии с возрастом нужно давать фруктово-овощные соки, пюре. Необходимо приучить детей постарше ходить в туалет в одно время. Регулярное опорожнение кишечника способствует выработке условного рефлекса.
Когда появляется трещина в заднем проходе у ребенка, нужно немедленно обратиться к педиатру, чтобы установить, а затем устранить причину болезни.
Сопутствие с геморроем
Неслучайно трещины ануса соседствуют с геморроем. Их появление зачастую связано с запорами. Несмотря на то, что это два разных заболевания, на начальном этапе болезней терапевтическая тактика практически одинакова. Что нужно предпринять для лечения геморроя и трещин заднего прохода в первую очередь:
- разнообразить питание;
- урегулировать режим труда и отдыха;
- больше двигаться, заниматься спортом, гимнастикой, меньше времени проводить сидя.
При лечении геморроя и трещин упор делается на питание. Чтобы стул наладился, иногда достаточно скорректировать рацион следующим образом. Включить в ежедневное меню до 40% растительной пищи. Овощи и фрукты обладают ощелачивающим действием, содержат много клетчатки, что важно для нормальной работы органов пищеварения.
Диета при анальной трещине идентична. Рекомендуются нежирные кисломолочные продукты. Они мягко слабят, содержат полезные для кишечника микроорганизмы. Усиливают перистальтику отруби, черный хлеб, растительные масла – хлопковое, подсолнечное, рыжиковое, льняное.
Вылеченный геморрой исчезнет навсегда, если прислушиваться к советам специалиста и упорядочить образ жизни. Если перечисленные меры не помогли, а трещина прямой кишки сталась, нужно обратиться к проктологу. Лечащий врач назначит лекарства от геморроя и трещин.
Сначала оба заболевания лечатся консервативно. От трещин в заднем проходе и геморроя используются мази, таблетки, свечи. Для разжижения стула перед дефекацией полезно сделать микроклизму (30 – 40 г) с маслами – облепиховым, вазелиновым, прополисным. Облепиха и прополис способствуют снятию воспалений, заживлению ранок. Хороший слабительный эффект оказывают такие лекарства от геморроя и трещин:
- таблетки, свечи «Релиф»;
- Дюфалак – пакетики, сироп;
- лекарство от геморроя Фитолакс — таблетки, пакетики, батончики;
- Лактофильтрум — таблетки;
- Фитомуцил — пакетики.
Препаратами от запора не следует пользоваться постоянно. Слабительное средство от геморроя и трещин эффективно только в начале заболевания, пока устраняются причины запора.
Консервативное лечение
Лечение трещины в заднем проходе первые полтора месяца от начала заболевания консервативное. Больным рекомендуется:
- послабляющая диета;
- в острой стадии, обострении – покой;
- гигиена ануса после дефекации;
- теплые сидячие ванны с ромашкой, марганцовкой;
- масляные микроклизмы.
Перечисленных мер бывает достаточно для нормального самочувствия больных. Как вылечить трещину в заднем проходе, если облегчение не наступило? Из медикаментов применяются антиспастические и обезболивающие свечи от анальных трещин:
- с папаверином – снимают спазмы кишечника;
- с прополисом – обезболивают и устраняют воспаление;
- Анестезин – местный анестетик;
- Анузол – содержит цинк, подсушивает ранки;
- Нео-Анузол – в состав входят обеззараживающие вещества: метиленовый синий, йод, резорцинол. Висмут обволакивает трещину;
- Проктокорт – противовоспалительное средство, содержит гидрокортизон.
Кроме свечей применяется мазь от анальных трещин анестезин, солкосерил, метилурациловая, синтомициновая. Спазмы сфинктера снимают:
- 0,2 – 0,5 % нитроглицериновая мазь, применяется 2 – 3 раза в день сроком 1 – 1,5 месяца;
- нифедипиновая мазь применяется 2- 4 раза в сутки, срок лечения 1 – 4 недели;
- введение малых доз ботакса, действие препарата сохраняется до 3 месяцев.
Постоянное применение мазей приводит к привыканию и снижает эффективность лечения. Дозировку препарата приходится увеличивать. Прежде чем воспользоваться мазями, посоветуйтесь с врачом.
Хирургическое лечение
Когда консервативное лечение трещины в заднем проходе не дает положительного результата, показано хирургическое вмешательство. В современной практике применяются следующие операции:
- иссечение в сочетании с боковой подкожной закрытой сфинктеротомией;
- иссечение трещины с задней сфинктеротомией;
- дозированная сфинктеротомия – частичное рассечение сфинктера приводит к временному парезу жома, достаточному для заживления раны;
- малоинвазивная операция по иссечению радиоволнами.
Ранее в лечении широко использовалась механическая дивульсия (растяжение) сфинктера. Насильственное растяжение ануса сопровождается разрывом части волокон сфинктера, нервных окончаний. Может повлиять на запирательную функцию сфинктера, привести к недержанию газов и кала в кишечнике.
Российские хирурги насильственную дивульсию практически не применяют. Вместо нее в практику внедрено дозированное растяжение сфинктера с использованием пневмобаллонов и конус-делататора. С их помощью спазмы ликвидируется за 7 минут. Трещина прямой кишки затягивается быстрее. Больной спустя неделю может приступить к работе.
При пневмодивульсии каждому больному подбирается отдельный баллон. После введения в анус он постепенно надувается до нужного размера. По окончанию операции сдувается, затем удаляется. Наиболее щадящим методом снятия спазмов сфинктера является конусодивульсия специальным конус-делататором. Процедура легко переносится больными. Окончательно трещина в заднем проходе у большинства пациентов заживает за 1,5 – 2 месяца.
Прогноз заболевания благоприятный. Вылечить трещины современными методами и средствами можно. Однако больным в будущем придется избегать запоров, больше двигаться, не поднимать тяжести, укреплять сфинктер простыми упражнениями.
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