Analfissur – Afterriss

Eine Analfissur (Fissura ani) ist ein schmerzhafter Einriss der Afterschleimhaut und einem Teil der inneren Afterschließmuskulatur. Dieser befindet sich meist in Richtung Steißbein in relativer Nähe zum Afterrand. Jede Altersgruppe kann davon betroffen sein.

Ursache

Meist ist die Ursache zu harter Stuhl, der während der Entleerung durch die starke Überdehnung des Gewebes einen Riss verursacht.

Doch können auch eine explosionsartige Entleerung wie beim Durchfall oder entzündliche Darmerkrankungen (Morbus Crohn, Colitis ulcerosa etc.), Stoffwechselerkrankungen (z.B. Eisenmangel, Zuckererkrankung) oder verschiedene Medikamente für die Entstehung eine Analfissur verantwortlich sein.

Symptome

Meist spüren die Patienten starke Schmerzen während der Entleerung mit gleichzeitigem Auftreten von hellrotem Blut auf dem Toilettenpapier. Diese krampfartigen Schmerzen können teils noch länger nach der Entleerung anhalten.

Eine akute Analfissur heilt nach wenigen Tagen bis Wochen vollkommen ab. Die Wundheilung selbst kann sich jedoch durch Entzündungsprozesse verschiedener Ursachen erheblich Verzögern (z.B. unzureichende Analhygiene, unsachgemäße Anwendung von zum Teil schädigenden Substanzen und Salben).

Die chronische Verlaufsform zeichnet sich durch weiterhin bestehende Schmerzen während und nach der Stuhlentleerung aus. Dabei kommt es in nicht wenigen Fällen zur Ausbildung von Gewebeveränderungen (Marisken, Analfibrome), Analfisteln (Röhrengänge) und Abszessen.

Diagnose

Vor dem Austasten des Afters bringt der Arzt ein örtliches Betäubungsmittel (Lokalanästhetikum) auf, um die Untersuchung so schmerzfrei wie möglich zu gestalten. Die Untersuchung mit Hilfe des Proktoskops (Instrument zur Spiegelung des Enddarmbereichs) erfolgt beim ersten Mal nur bei entsprechender Schmerzfreiheit, um den Afterriss und etwaige Veränderungen besser beurteilen zu können, ansonsten zu einem späteren Zeitpunkt bzw. je nach Erfordernis unter örtlicher Betäubung.

Therapie

Bei der Behandlung des Afterrisses ist die Mitarbeit des Patienten ein wichtiger Beitrag, um eine schnellstmögliche Heilung herbeizuführen.

Die Betroffenen sollten auf eine ausreichende Trinkmenge und balaststoffreiche Ernährung achten, um die Stuhlkonsistenz geformt, aber immer noch weich genug zu halten. Bei einigen Patienten ist es wichtig, unter der Anwendung des sog. Analdehners eine Entspannung des stark verspannten Schließmuskels zu erreichen. Zusammen mit entsprechenden Salben und evtl. Zäpfchen sollte die Abheilung einer solchen Analfissur in aller Regel innerhalb von drei Monaten von statten gehen.

Wenn die Wundheilung nach Ausschöpfung aller konservativ nicht operativer Maßnahmen nicht absehbar ist, ist eine baldige operative Sanierung anzustreben, um weiteren Schaden (hier anale Inkontinenz) am Afterschließmuskel abzuwenden.

Wie bereits oben erwähnt, besteht durch eine anhaltende Entzündungsreaktion und fehlende Ausheilung die Gefahr einer Fistelbildung und folgend die eines Abszesses durch Einwandern entsprechender Bakterien.

Bei einem operativen Eingriff, der in der Regel mit einem kurzen Klinikaufenthalt verbunden ist, wird unter besonderer Vorsicht die Fistel „ausgeschält“. Dabei wird nur der wirklich von der Veränderung betroffene Teil des inneren Schließmuskels entfernt ohne dabei die Kontinenz zu beeinträchtigen. Doch sollte dies dem ausgebildeten Spezialisten vorbehalten bleiben (Coloproktologen).

Die anschließende ärztlich geführte Kontrolle zur richtigen Wundheilung ist genauso wichtig wie die Vorbereitung zur Operation und die Operation selbst.

Welche Behandlungsart für Sie in diesem Fall in Frage kommt, wird der Proktologe mit Ihnen im Detail besprechen, um eine rasche und nachhaltige Heilung zu erreichen.

Sie haben noch Fragen zu diesem Thema – dann wenden Sie sich vertrauensvoll an uns.

Ihr

Dr. Stephan Potzler

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