Anal fissure vs perineum tear treatment

By | July 1, 2017
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As its name suggests, anal fissure is a cut, tear or ulcer in the anorectal area. It is often caused by constipation and other inflammatory bowel diseases.  Aside from that, prolonged diarrhea, anal sex, poor bowel habits, HIV, childbirth and sexually transmitted diseases can cause it. Infants and older adults are at a risk of developing such disease.

Perineal tear, on the other hand, is an unintended laceration in the skin and soft tissues of the vaginal area of the woman which separates the vagina from the anus. It is often caused by vaginal childbirth. It can also be caused by sexual intercourse.  The tears are classified into four categories according to the gravity and extent of the tear. First-degree tears are limited to the fourchette and vaginal mucosa also known as the superficial perineal skin. Second-degree tears extend to the fascia and perineal muscles. On the other hand, third-degree tears include the fourchette, vaginal mucosa, muscles, perineal skin and anal sphincter. Lastly, fourth-degree tears  extend even to the rectal muscles.

Treatment

When comparing anal fissure vs perineum tear treatment, the most striking difference is that there are no medications to treat a perineum tear. A reconstructive surgery is the only way of restoring the perineum back to its original condition. While on the other hand, anal fissures can heal even without surgery.

The following are some of the medical treatments for anal fissures:

  1. Medications with hydrocortisone

Suppositories, foams, gels and creams with hydrocortisone will help in healing anal fissures. It will also relieve the pain.

  1. High blood pressure medication

Medications like diltiazem and nifedipine will help in relaxing the anal sphincter muscles.

  1. Botulinum toxin (botox) injections

Botox is usually used to remove wrinkles, crow’s feet and other skin imperfections. But it can also be used to treat anal fissures. The botox is injected directly to the anorectal area to promote healing and relieve the pain and itching.

  1. Nitroglycerin

Nitroglycerin is a vasodilator, which means that it opens up the blood vessels for better blood circulation. External application of nitroglycerin on the anal area promotes healing of the damaged tissues.

  1. Lateral Internal Sphincteroctomy (LIS)

This surgery is intended for people suffering with severe or chronic anal fissures. It involves the cutting of a portion of the anal sphincter muscles to promote healing and prevent future spasms.

Perineum tears heal over time. However, the cut or tear would still be there. As mentioned earlier in the difference between anal fissure vs. perineum tear treatment, a reconstructive surgery is needed to restore the perineum to its original form. A perineal body reconstruction, also known as perionplasty, is a surgery that repairs the weakened or broken muscles and skin of the perineal and vaginal area. The operation involves of the stitching of the perineal body and the tightening of the entrance to the vagina also called as introitus. The operation normally takes around 30 minutes and would only require general anesthesia or regional anesthesia. Optimal recovery from the surgery takes about four to six weeks. The stitches used will dissolve around six weeks.