2023-04-03T10:18:57
Fissure after Delivery Postpartum anal fissure is a common problem in mothers after labor. The disease affects many mothers both physically and mentally. Postpartum anal fissure is a painful tear in the lining of the anus that usually occurs after trying to pass hard stools. Postpartum anal fissure symptoms include: severe pain and burning sensation during and after defecation and bloody stools. Postpartum anal fissures are easy to mistake for hemorrhoids because both conditions can cause anal bleeding. The main cause of anal fissures after childbirth is due to sudden contractions during anal delivery, constipation. However, there is no clear cause behind this condition because in clinical practice many patients are not constipated. The cause of cracks or tears in the lining of the anus is mainly due to hard stools. Treatment of anal fissures after childbirth has the following methods: 1. Non-surgical treatment-This method can heal up to 90% of acute postpartum anal fissures. Prevent constipation or soften stool to help eliminate pathogens. Patients must drink a lot of water (more than 2 liters / day) and increase the fiber in the meal: such as vegetables, beans, fruits, ... Drinking a lot of water is important because water makes stools soft so it cannot cause diarrhea. damage the anus and also avoid recurrence. In addition, the doctor may also prescribe some stool softeners to reduce pain and bleeding. Soak the anus in warm water (40 degrees Celsius) for 10-20 minutes, 3-4 times a day, to help relax the sphincter, increase blood flow, relieve pain and make postpartum anal fissure patients more comfortable. The doctor can prescribe some topical ointments of the nitroglycerin group or calcium channel blocker to help relax the internal sphincter and increase perfusion of the fissure area, this therapy can help heal the disease with a rate of 65% - 90%. Another method is also applied is injecting Botox toxin into the inner sphincter, causing relaxation of the sphincter in about 2-3 months, chronic cracks can heal in 60-80% of cases, the cost of Botox injections is very high. and also recurrent. When the above lifestyle modifications and treatments still fail to heal, an acute postpartum anal fissure can turn chronic. At this time, it is necessary to identify other causes of postpartum anal fissure such as infection, anal examination under anesthesia or anesthesia, and internal sphincter tone measurement to determine hypertonia. Surgery is the last resort for the treatment of chronic postpartum anal fissures that have not responded to conservative treatment 2.Surgical treatment Medical treatment has advantages such as being able to repeat many times, combining many drug groups together to increase effectiveness, with few complications. Although surgery may be considered the gold standard, it is preferable to conservative medical treatment because of the risk of fecal incontinence (5-15%). The simple surgery is to cut a part of the sphincter in the anal canal (done under anaesthesia) to relieve pain, relax the muscles and heal the incision. Patients with postpartum anal fissures can be discharged from the hospital the next day, relieve pain after surgery for a few days, and completely heal after a few weeks. The success rate of surgery is up to 90%. Failure or recurrence may be due to insufficient sphincterotomy, in which case reoperation can be performed by resection of the other side.