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Uma fissura anal é um pequeno rasgo ou corte no revestimento do canal anal. Elas podem ocorrer em qualquer idade e têm distribuição igual por gênero. Entre 85% e 90% das fissuras ocorrem na linha média posterior (atrás) do ânus, com cerca de 10% a 15% ocorrendo na linha média anterior (frente). Fissuras localizadas em outro lugar (ao lado) devem levantar suspeita de outras doenças e precisarão ser examinadas mais detalhadamente.
Causa
As fissuras são geralmente causadas por traumas no ânus. A evacuação endurecida e seca é a principal responsável, mas fezes moles e diarreia também podem ser a causa. A lesão no tecido cria dor anal intensa, resultando em espasmos do esfíncter anal e um aumento subsequente na pressão do músculo do esfíncter anal. O aumento da pressão do músculo do esfíncter anal resulta em uma diminuição do fluxo sanguíneo para o local da lesão, prejudicando a cicatrização da ferida. As evacuações subsequentes resultam em mais dor, mais espasmo anal, diminuição do fluxo sanguíneo para a área e o ciclo se propaga. As estratégias de tratamento visam interromper esse ciclo para promover a cicatrização da fissura. As causas menos comuns de fissuras incluem doenças inflamatórias, sexo anal, certas infecções, sífilis, tuberculose, leucemia, HIV / AIDS ou tumores anais.
Sintoma
Muito comumente, as fissuras anais são diagnosticadas erroneamente como hemorróidas pelo paciente ou pelo médico devido a alguns sintomas semelhantes entre as duas. Os sintomas típicos de uma fissura anal incluem dor e sangramento com a passagem das fezes, e a dor pode persistir até por algumas horas. Entre as evacuações, os pacientes com fissuras anais costumam ficar relativamente assintomáticos. Muitos pacientes têm medo de evacuar e tentam adiar a próxima evacuação fazendo com que as fezes fiquem ainda mais endurecidas. Nos episódios crônicos os pacientes também se queixam de inchaço na borda anal e aumento do volume das peles ou plicomas.
Tratamento Não Cirúrgico
A base do tratamento é corrigir o agente causador. Mudanças de hábitos estão sempre associados ao tratamento de doenças orificiais. Deve-se aumentar a ingestão de fibras e até fazer uso dos suplementos, beber mais água e caso necessário utilizar laxantes osmóticos que mantenham as fezes macias até a cicatrização correta. Os antidiarreicos e repositores de flora podem ser necessários quando a causa é a diarréia. Banhos de assento por 10-20 minutos várias vezes ao dia (especialmente após as evacuações) são calmantes e promovem o relaxamento dos músculos anais, ajudando no processo de cicatrização.
Pomadas com a combinação de lidocaína para melhora da dor e medicamentos como diltiazem, nifedipina ou nitroglicerina que atuam no relaxamento do músculo do esfíncter anal com consequente aumento do fluxo sanguíneo, facilitam a cicatrização.
As fissuras podem reaparecer facilmente e é bastante comum que uma fissura totalmente curada reapareça após evacuação endurecida ou outra lesão. Mesmo quando a dor e o sangramento tiverem diminuído, é muito importante manter os bons hábitos intestinais e uma dieta rica em fibras como uma mudança sustentada no estilo de vida. Se o problema retornar sem uma causa óbvia, uma avaliação adicional pode ser necessária.
Tratamento Cirúrgico
Quanto as opções de intervenções, temos a injeção de toxina botulínica (Botox®) e a esfincterotomia lateral interna, porém precisa ser muito bem avaliado pelo seu cirurgião a indicação cirúrgica e os possíveis riscos individuais. O objetivo da cirurgia é ajudar a relaxar os músculos do esfíncter anal, o que reduz a dor e os espasmos, permitindo a cicatrização da fissura.
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filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″]https://grupoelasbrasilia.com.br/wp-content/uploads/2021/05/Sonaira-Bernardes-1.jpg[/fusion_imageframe][/fusion_builder_column_inner][fusion_builder_column_inner type=”2_3″ layout=”2_3″ align_self=”auto” content_layout=”column” align_content=”flex-start” valign_content=”flex-start” content_wrap=”wrap” spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” type_medium=”” type_small=”” order_medium=”0″ order_small=”0″ dimension_spacing_medium=”” dimension_spacing_small=”” dimension_spacing=”” 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filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”true” border_position=”all” element_content=”” first=”false”][fusion_title title_type=”text” rotation_effect=”bounceIn” display_time=”1200″ highlight_effect=”circle” loop_animation=”off” highlight_width=”9″ highlight_top_margin=”0″ before_text=”” rotation_text=”” highlight_text=”” after_text=”” title_link=”off” link_url=”” link_target=”_self” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” content_align_medium=”” content_align_small=”” content_align=”left” size=”2″ font_size=”30px” animated_font_size=”” fusion_font_family_title_font=”Poppins” fusion_font_variant_title_font=”700″ line_height=”” letter_spacing=”” text_shadow=”no” text_shadow_vertical=”” text_shadow_horizontal=”” text_shadow_blur=”0″ text_shadow_color=”” margin_top_medium=”” margin_right_medium=”” margin_bottom_medium=”” margin_left_medium=”” margin_top_small=”” margin_right_small=”” margin_bottom_small=”” margin_left_small=”” margin_top=”” margin_right=”” margin_bottom=”2px” margin_left=”” margin_top_mobile=”” margin_bottom_mobile=”” text_color=”#202020″ animated_text_color=”” highlight_color=”” style_type=”default” sep_color=”” link_color=”” link_hover_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]Dra. Sonaira Bernardes[/fusion_title][fusion_title title_type=”text” rotation_effect=”bounceIn” display_time=”1200″ highlight_effect=”circle” loop_animation=”off” highlight_width=”9″ highlight_top_margin=”0″ before_text=”” rotation_text=”” highlight_text=”” after_text=”” title_link=”off” link_url=”” link_target=”_self” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” content_align_medium=”” content_align_small=”” content_align=”left” size=”6″ font_size=”” animated_font_size=”” fusion_font_family_title_font=”Poppins” fusion_font_variant_title_font=”700″ line_height=”” letter_spacing=”” text_shadow=”no” text_shadow_vertical=”” text_shadow_horizontal=”” text_shadow_blur=”0″ text_shadow_color=”” margin_top_medium=”” margin_right_medium=”” margin_bottom_medium=”” margin_left_medium=”” margin_top_small=”” margin_right_small=”” margin_bottom_small=”” margin_left_small=”” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” margin_top_mobile=”” margin_bottom_mobile=”” text_color=”#202020″ animated_text_color=”” highlight_color=”” style_type=”default” sep_color=”” link_color=”” link_hover_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]Proctologista em Brasília, CRM-DF: 21376, RQE: 15426 e 17106[/fusion_title][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” content_alignment_medium=”” content_alignment_small=”” content_alignment=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” margin_top=”” margin_right=”” margin_bottom=”10px” margin_left=”” font_size=”” fusion_font_family_text_font=”” fusion_font_variant_text_font=”” line_height=”” letter_spacing=”” text_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]Proctologia | Colonoscopia[/fusion_text][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” content_alignment_medium=”” content_alignment_small=”” content_alignment=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” margin_top=”0px” margin_right=”” margin_bottom=”10px” margin_left=”” font_size=”15px” fusion_font_family_text_font=”Poppins” fusion_font_variant_text_font=”400italic” line_height=”” letter_spacing=”” text_color=”#7e858e” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]“Só será possível salvar o mundo quando conhecer-te a ti mesma. Por isso, prevenção é sobretudo um ato de amor que começa de dentro para fora e se estende ao outro.”[/fusion_text][fusion_button link=”https://grupoelasbrasilia.com.br/sonairabernardes/” text_transform=”” title=”” target=”_self” link_attributes=”” alignment_medium=”” alignment_small=”” alignment=”” modal=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” color=”default” button_gradient_top_color=”” button_gradient_bottom_color=”” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” accent_hover_color=”” type=”” bevel_color=”” border_width=”” border_radius=”” border_color=”” border_hover_color=”” size=”small” stretch=”default” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” icon=”fusion-prefix-fa-message-medical” icon_position=”left” icon_divider=”no” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]CONHEÇA A MÉDICA[/fusion_button][/fusion_builder_column_inner][/fusion_builder_row_inner][/fusion_builder_column][fusion_builder_column type=”1_6″ layout=”1_6″ align_self=”auto” content_layout=”column” align_content=”flex-start” valign_content=”flex-start” content_wrap=”wrap” spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” order_medium=”0″ order_small=”0″ hover_type=”none” border_color=”” border_style=”solid” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” filter_type=”regular” filter_hue=”0″ 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padding_top=”6%” admin_label=”Call to Action Agendamento” admin_toggled=”yes” background_image=”https://ml1ca8kph5lh.i.optimole.com/f8pwKbQ-zroGwOxF/w:auto/h:auto/q:auto/https://grupoelasbrasilia.com.br/wp-content/uploads/2021/05/cta-agende-sua-consulta.jpg” padding_bottom=”5%” padding_left=”0px” padding_right=”0px” background_color=”rgba(0,0,0,0.6)”][fusion_builder_row][fusion_builder_column type=”1_1″ layout=”1_2″ align_self=”center” content_layout=”column” align_content=”flex-start” content_wrap=”wrap” spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” order_medium=”0″ order_small=”0″ hover_type=”none” border_color=”” border_style=”solid” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”fade” animation_direction=”right” animation_speed=”1.0″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ padding_right=”” last=”true” border_position=”all” padding_right_small=”0px” first=”true”][fusion_title title_type=”text” rotation_effect=”bounceIn” display_time=”1200″ highlight_effect=”circle” loop_animation=”off” highlight_width=”9″ highlight_top_margin=”0″ before_text=”” rotation_text=”” highlight_text=”” 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