Diagnosis
A torn anus is typically diagnosed on the basis of an inspection of the anus in combination with the information provided by the patient about symptoms, previous illnesses and stool habits. The tear is usually found at 6 o’clock in the so-called lithotomy position, i.e. lying on the back towards the coccyx. Lateral tears or tears occurring in groups, which are more likely to indicate other diseases, are very untypical.
On palpation of the tear, a painful ulcer or a coarse tissue strand can usually be detected. A proctoscopy can also be helpful, but due to the pain it is usually only possible under anaesthetic. When diagnosing a torn anus, the presence of haemorrhoids should always be considered. However, these can usually be excluded on the basis of the location of the mucous membrane defect. In fact, a torn anus is often wrongly diagnosed as haemorrhoids, so that unnecessarily extensive treatment is started.
Therapy
An untreated torn anus may take some time to heal. However, as they are in most cases very unpleasant for the affected person and there is also the risk of a chronification of the mucosal defect, a therapy is advisable in many cases. Here, a distinction must be made between an acute and an already chronic torn anus.
The first step in the treatment of an acute fissure is the regulation of bowel movement. The aim should be a soft, malleable consistency of the stool. A diet rich in fibre and a sufficient fluid intake are important aids in combating constipation.
In the case of prolonged diarrhoea, the cause should be addressed. Severe pain caused by the tearing of the mucous membrane can be treated after each bowel movement with a local anaesthetic ointment. Furthermore, good anal hygiene is important for rapid healing of the wound.
For this purpose, a washcloth soaked in lukewarm water and a little pH-neutral soap can be used after the bowel movement. A bidet, for example, is also ideal for anal cleaning. If these simple measures are followed, most freshly torn anus heals completely within six to eight weeks without any problems.
The chronic form of torn anus, however, requires more extensive measures. Fissures whose symptoms persist for more than two months are considered chronic. Here, too, stool regulation plays an important role, which is achieved by laxative medication in addition to food intake.
However, since anal cramps are a great strain during longer periods of illness and contribute to the maintenance of the disease, the tone of the sphincter muscle must also be regulated. This is achieved by using the active substances nitroglycerine, nifedipine or diltiazem from the group of calcium antagonists. These agents, which are often used to treat high blood pressure, have a vasodilating effect and thus help to relax the sphincter muscle.
They are applied three to four times a day for up to twelve weeks in the form of an ointment. Alternatively, patches containing active ingredients and more concentrated ointments are available, which have to be applied less frequently. About 80% of all patients are free of symptoms after six to eight weeks with the help of this treatment regimen.
If, despite good stool regulation and consistent application of the ointments and insufficient healing of the fissure is achieved, a surgical intervention represents the next step in the course of therapy. This involves an excision of the wound under anaesthetic, including any scarred tissue. The resulting smooth-edged wound is usually not sutured.
For this reason, complete wound healing takes another four to six weeks. Stretching or even severing of the anal sphincter muscle, as was done under anaesthesia until a few years ago, is generally considered outdated. If the symptoms caused by the torn anus persist for more than 2 months despite consistent application of the ointment and sufficient stool regulation, a chronic form of the torn anus is present.
In this case, the damaged mucous membrane is no longer able to heal on its own and instead begins to scar in a random manner. Skin proliferations with the formation of prominent skin folds, the so-called outpost folds, occur. The rough edges of the wound are usually palpable by the patient himself.
A conservative therapy promises no further healing here. In order to avoid further complications and to alleviate the symptoms, a surgical intervention is necessary. The so-called fissurectomy, which is the cutting out of a skin tear, is nowadays usually performed on an outpatient basis under short anaesthesia or, in the case of older patients, in some cases as part of a short inpatient admission.
During this procedure, the entire wound with the surrounding scar tissue is removed. However, the newly formed, smooth-edged wound is not sutured, so that the subsequent targeted wound healing takes another four to six weeks. The follow-up treatment is again carried out using the conservative methods described above.
Complications occur very rarely, so renewed or more serious interventions are usually not necessary. For the local treatment of a torn anus, a number of different ointments, gels, but also suppositories are available. In addition to active ingredients such as nifedipine or diltiazem, which have a vasodilating and thus relaxing effect on the anal sphincter muscle, suppositories are also available which have a local analgesic effect.
Their effect is based on commercially available local anaesthetics, above all the drug lidocaine. Their effect not only relieves pain but also relieves itching. Lidocaine has a very fast onset of action and a long duration of action.
As it causes hardly any allergic reactions and generally has very few side effects, lidocaine is the local anaesthetic of first choice for ruptured anuses. In addition to normal suppositories the active substance can also be applied in the form of anal tampons. These ensure a more targeted and even release of the active substance.
It usually takes several weeks before the therapy results in a torn anus and no symptoms. During these weeks the patient suffers from pain during everyday movements and even more so during bowel movements. Since conventional medical treatment attempts do not seem to bring any improvement at first, some patients resort to homeopathic remedies.
At this point, however, it should be mentioned that to date there have been no meaningful studies on the effects of homeopathic remedies. The theoretical foundations of homeopathy even contradict current medical, chemical and physical knowledge. At the same time, the homeopathic remedies on offer are not regulated by the current German Medicines Act, but are subject to their own, scientifically unjustifiable, regulations.
Nevertheless, there is a whole range of different homeopathic remedies for the treatment of a torn anus. Depending on the cause of the fissure, special preparations are recommended. As the list of these remedies and their recommended dosages is quite long, we would like to refer you to pages that are specifically dedicated to this topic. Caution is required in any case if the pain increases or spreads acutely. In this case, it is always advisable to seek medical advice.
