TRIPLE APPROACH IN THE NON-OPERATIVE TREATMENT OF ANAL FISSURE: FIBER-RICH NUTRITION-HOT WATER SITZ BATH-ANAL MASSAGE

Yıl 2022, Cilt: 31 Sayı: 3, 362 - 368, 26.12.2022

Serap Pamak Bulut

https://doi.org/10.34108/eujhs.981523

Öz

Anal fissure constitutes an important part of proctological applications to surgery out patient clinics. Despite its prevalence, diagnosis and treatment remains a challenge in many respects. Today, there commendation of clinical guidelines is to prefer conservative treatments as the first choice in anal fissures. Hot water sitz bath, anal sphincter massage with finger and prevention of constipation can be counted among the basic principles. In this study, we sought to answer the question of whether the application of this triple application together with topical ointments increase ssuccess or not. The data of 134 anal fissure cases treated and followed up in the general surgery out patient clinic were analyzed retrospectively. The relationship between treatment compliance and response to treatment in cases treated conservatively with topical drug application, regulation of diet and bowel habits, hot water sitz bath and finger anal massage trio was not statistically significant (p= 0.08). Response to treatment was found to be significantly higher in patients who regularly applied anal massage (p= 0.038) and sitz bath (p= 0.001). In conclusion, it can be said that emphasizing the sitz bath and informing the patients about the relaxing of the anorectal sphincter are the keys to success in the treatment.

Anahtar Kelimeler

anal fissure, topical, conservative treatment, anal massage

ANAL FİSSÜRÜN AMELİYATSIZ TEDAVİSİNDE ÜÇLÜ YAKLAŞIM: POSALI BESLENME-SICAK SU OTURMA BANYOSU-ANAL MASAJ

Öz

Anal fissür genel cerrahi polikliniklerine proktolojik başvuruların önemli bir kesimini oluşturmaktadır. Yaygınlığına rağmen teşhis ve tedavi birçok bakımdan sorun olmaya devam etmektedir. Günümüzde klinik rehberlerin önerisi anal fissürlerde konservatif tedavilerin ilk seçenek olarak tercih edilmesidir. Bunların içinde sıcak su oturma banyosu, parmakla anal sfinkter masajı ve kabızlığın önlenmesi temel prensipler içinde sayılabilir. Bu çalışmada, bu üçlü uygulamanın topikal ilaçlarla birlikte uygulanmasının başarıyı arttırıp arttırmadığı sorusuna cevap aradık. Genel cerrahi polikliniğinde tedavi ve takipleri yapılan 134 anal fissür olgusunun verileri retrospektif olarak analiz edildi. Topikal ilaç uygulaması, diyet ile bağırsak alışkanlıklarının düzenlenmesi, sıcak su oturma banyosu ve parmakla anal masaj üçlüsü ile kombine edilerek konservatif tedavi edilen olguların tedaviye uyumları ve tedaviye cevapları arasındaki ilişki istatistiksel olarak anlamlı değildi (p= 0.08). Düzenli olarak anal masaj (p= 0.038) ve oturma banyosu (p= 0.001) uygulayan hastalarda tedaviye yanıt anlamlı olarak daha yüksek bulundu. Sonuç olarak oturma banyosuna ağırlık verilmesi ve hastaların anorektalsfinkterin gevşemesi konusunda bilgilendirilmesinin tedavide başarının anahtarı olduğu söylenebilir.

Anahtar Kelimeler

anal fissür, topikal, konservatif tedavi, masaj

Kaynakça

• Şişik A, Başak F, Hasbahçeci M, et al. Recovery from hemorrhoids and anal fissure without surgery. Turkish J Gastroenterol. 2020;31(4):289–94.
• Poskus T, Buzinskiene D, Drasutiene G, et al. Haemorrhoids and anal fissures during pregnancy and after childbirth: A prospective cohort study. BJOG An Int J Obstet Gynaecol. 2014;121(13):1666–71.
• Schouten WR, Briel JW, Auwerda JJA, et al. Anal fissure: New concepts in pathogenesis and treatment. In: Scandinavian Journal of Gastroenterology, 31:sup218, 78-81, DOI: 10.3109/00365529609094734W.
• Stewart DB, Gaertner W, Glasgow S, et al. Clinical Practice Guideline for the Management of Anal Fissures Dis Colon Rectum. 2017 Jan;60(1):7-14. doi: 10.1097/DCR.0000000000000735. PMID: 27926552.
• Qureshi W. How i Approach It: Anal Fissures. Am J Gastroenterol. 2020;115(3):315–6.
• Zaghiyan KN, Fleshner P. Anal fissure. Clin Colon Rectal Surg. 2011 Mar;24(1):22-30. doi: 10.1055/s-0031-1272820.
• Collins EE, Lund JN. A review of chronic anal fissure management. Tech Coloproctol. 2007;11(3):209–23.
• Alawady M, Emile SH, Abdelnaby M, et al. Posterolateral versus lateral internal anal sphincterotomy in the treatment of chronic anal fissure: a randomized controlled trial. Int J Colorectal Dis. 2018;33(10):1461–7.
• Brillantino A, Izzo D, Iacobellis F, et al. Safety and effectiveness of minimal sphincterotomy in the treatment of female patients with chronic anal fissure. Updates Surg. 2021 Oct;73(5):1829-1836. doi: 10.1007/s13304-020-00874-8.
• Lasheen AE, Morsy MM, Fiad AA. Segmental Internal Sphincterotomy-A New Technique for Treatment of Chronic Anal Fissure. J Gastrointest Surg. 2011;15(12):2271–4.
• Boland PA, Kelly ME, Donlon NE, et al. Management options for chronic anal fissure: a systematic review of randomised controlled trials. Int J Colorectal Dis. 2020;35(10):1807–15.
• Lund JN, Nyström PO, Coremans G, et al. An evidence-based treatment algorithm for anal fissure. Tech Coloproctol. 2006;10(3):177–80.
• Șurlin V, Scurtu S. Conservative Treatment for Anal Fissure – for How Long? – Review of the Literature and Personal Experience. Facta Univ Ser Med Biol. 2019;21(1):7.
• Gaj F, Biviano I, Candeloro L, et al. Anal self-massage in the treatment of acute anal fissure: A randomized prospective study. Ann Gastroenterol. 2017;30(4):438–41.
• Schouten WR, Briel JW, Auwerda JJA, et al. Ischaemic nature of anal fissure. Br J Surg. 1996 Jan;83(1):63-5. doi: 10.1002/bjs.1800830120.
• Trilling B, Pflieger H, Faucheron JL. Decreased blood flow to the posterior anal canal shown during Doppler-guided hemorrhoidal artery ligation explains anodermal ischemia in anal fissure. Tech Coloproctol. 2017;21(5):411–2.
• Lund JN, Scholefield JH. A randomised, prospective, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in treatment of anal fissure. Lancet 997 Jan 4;349(9044):11-4. doi: 10.1016/S0140-6736(96)06090-4.
• Grekova NM, Maleva EA, Lebedeva Y, et al. The effects of topical application of metronidazole for treatment of chronic anal fissure: A randomized, controlled pilot study. Indian J Gastroenterol. 2015;34(2):152–7.
• Garg P, Lakhtaria P, Gupta V. Oral Plus Local Antibiotics Significantly Reduce the Need for Operative Intervention in Chronic Anal Fissure: a Novel Finding. Indian J Surg. 2018;80(5):415–20.
• FitzDowse AJ, Behrenbruch CC, Hayes IP. Combined treatment approach to chronic anal fissure with associated anal fistula. ANZ J Surg. 2018;88(7–8):775–8.