Fisura Anal

El canal anal es un pequeño tubo que conecta el recto (la parte mas inferior del colon o intestino grueso) con el orificio del ano. Está rodeado de un aro de músculo que se llama esfínter anal. Una fisura anal (también llamada fisura en el ano) es un pequeño corte o abertura en el revestimiento del canal anal. Las fisuras son comunes, pero a menudo se confunden con otras enfermedades anales, tales como las hemorroides.

  1. Chronic anal fissure = fisura anal crónica
  2. Hypertrophied anal papilla = papila anal hipertrofiada
  3. Fissure with heaped up scarred edges = fisura con bordes indurados
  4. Sentinel skin tag = colgajo de piel



 

 

Causas de la fisura anal

Las fisuras son causadas generalmente por un traumatismo en el revestimiento interior del ano debido a un movimiento intestinal u otra dilatación del canal anal. Esto puede ser debido a una evacuación dura, seca o evacuaciones sueltas y frecuentes. Los pacientes con un músculo del esfínter anal apretado son más propensos a desarrollar fisuras anales. Las causas menos comunes de fisuras incluyen la enfermedad inflamatoria intestinal, infecciones anales, o tumores.

 

Síntomas

Las fisuras anales suelen causar un dolor agudo que se inicia con el paso de las heces. Este dolor puede durar varios minutos o unas pocas horas. Como resultado, muchos pacientes tratan de evitar movimientos intestinales para prevenir el dolor.

Otros síntomas incluyen:

  • Sangre roja brillante en el papel higiénico o en las heces después de una deposición
  • Un pequeño bulto o marca  en la piel cerca de la fisura anal (más común cuando crónica)
  • El tratamiento no quirúrgico
  • Su médico le explicará los beneficios y efectos secundarios de los tratamientos.

El tratamiento incluye:

  • Una dieta alta en fibra y suplementos de fibra (sin prescripción, 25-35 gramos de fibra / día) para que las heces sean blandas, formadas, y voluminosas.
  • Ablandadores fecales (sin prescripción) para que las heces sean más fáciles de pasar.
  • Beber más agua para ayudar a prevenir las heces duras y ayudar en la curación.
  • Baños calientes (baños de asiento) por 10 a 20 minutos, varias veces al día (sobre todo después de los movimientos intestinales para calmar la zona y ayudar a relajar los músculos del esfínter anal). Se cree que esto ayudará al proceso de la curación.
  • Las cremas anestésicas locales, como la lidocaína, que se pueden aplicar a la piel alrededor del ano para aliviar el dolor.
  • Los medicamentos como diltiazam, nifedipina, o el ungüento de nitroglicerina para relajar los músculos del esfínter anal que ayuda al proceso de la curación.

Analgésicos narcóticos se evitan debido a que pueden causar estreñimiento, que podría empeorar la situación.

 

Tratamiento Quirúrgico

Aunque la mayoría de las fisuras anales no requieren cirugía, las fisuras crónicas son más difíciles de tratar y la cirugía puede ser la mejor opción. El objetivo de la cirugía es ayudar a relajar el músculo del esfínter anal, reduciendo el dolor y los espasmos, lo que permite que cicatrice la fisura. Las opciones quirúrgicas incluyen la inyección de toxina botulínica (Botox) en el esfínter anal o división quirúrgica de la parte interna del esfínter anal (esfinterotomía lateral interna). El cirujano de colon y recto determinará  el mejor tratamiento y comentará al paciente los riesgos de la cirugía. Ambos tipos de cirugía se realizan normalmente como procedimientos ambulatorios en el mismo día.

 

Pronóstico Postoperatorio

La mayoría de los pacientes pueden volver al trabajo y a las actividades habituales  pocos días después de la cirugía. La curación completa después de los tratamientos médicos y quirúrgicos puede tardar de 6 a 10 semanas. Incluso cuando el dolor y el sangrado disminuyen, es importante mantener buenos hábitos de defecación y comer una dieta alta en fibra. La persistencia de heces duras o muy blandas pueden retrasar la curación.

  • Inyecciones de Botox® están asociadas con la curación de las fisuras anales crónicas en el 50% al 80% de los pacientes.
  • La esfinterotomía tiene éxito en más de 90% de los pacientes. Aunque es poco frecuente, este procedimiento puede afectar a la capacidad del paciente para controlar totalmente los movimientos del gas o las heces.

Las fisuras pueden reaparecer. Una fisura totalmente curada puede reaparecer después de una evacuación dura o trauma. Los problemas médicos, tales como la enfermedad inflamatoria intestinal (enfermedad de Crohn), infecciones o tumores anales pueden causar síntomas similares a las fisuras anales. Si una fisura no mejora o reaparece después de una mejoría inicial es importante ser evaluado de otras posibles enfermedades.

 

¿Pueden las fisuras anales causar cáncer de colon?

Las fisuras anales no causan ni aumentan el riesgo de cáncer de colon. Sin embargo, los síntomas de la misma pueden confundirse con los síntomas de otras enfermedades como cancer. Incluso cuando una fisura haya cicatrizado por completo, su cirujano de colon y recto puede solicitar otras pruebas. Entre ellas una colonoscopia para descartar otras causas de sangrado rectal.

 

¿Qué es un cirujano de colon y recto?

Cirujanos de colon y recto son expertos en el tratamiento quirúrgico y no quirúrgico de las enfermedades del colon, recto y ano. Han completado el entrenamiento quirúrgico avanzado en el tratamiento de estas enfermedades, así como la formación en cirugía general completa. Los cirujanos certificados por la junta de colon y recto completan residencias en cirugía general y cirugía de colon y recto, y deben pasar los exámenes intensivos llevados a cabo por el Colegio Americano de Cirujanos (ACS) y la Asociación Americana de Cirujanos de Colon y Recto (ASCRS).  Estos cirujanos poseen los conocimientos para el tratamiento de enfermedades tanto benignas como malignas del colon, recto y ano, y tienen capacidad para realizar exámenes de detección rutinaria y tratar quirúrgicamente estas enfermedades si fuere necesario. ,

AVISO LEGAL

La Asociación Americana de Cirujanos de Colon y Recto está dedicada a asegurar la atención al paciente de alta calidad, al avance de la ciencia, la prevención y el tratamiento de los trastornos y enfermedades del colon, recto y ano.  El propósito de estos folletos es proporcionar información sobre los procesos de enfermedades, y no la de indicar una forma específica de tratamiento. Están diseñados para el uso de  los médicos, trabajadores sanitarios y pacientes que deseen información sobre la gestión de las condiciones tratadas. Estos folletos no incluyen o excluyen otros métodos apropiados de atención médica de estas enfermedades. La última palabra sobre el tratamiento a seguir le corresponde al médico basándose en las circunstancias  de cada paciente.

 



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