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

Abstract

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.

Keywords

• anal fissure
• topical
• conservative treatment
• anal massage

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

Abstract

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.

Keywords

• anal fissür
• topikal
• konservatif tedavi
• masaj

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