Specyfika leczenia szczelin odbytu u kobiet w ciąży i w okresie okołoporodowym

*Małgorzata Kołodziejczak¹, Agnieszka Kucharczyk¹, Aneta Obcowska²

Summary
Anal fissure is one of the most frequent proctologic disease. Post- labour fissure Is a special type of it. It is a separate disease with etiopathogenesis different than in those that occur in other periods of women's' and men's lives. Anteriorly placed fissures are ten times more common in women than in men, and mostly appear in post -labour period. After first labour about 9% of women suffer from fissure and the symptoms become visible right after or in the first 2 months after delivery.
A direct cause of the disease is perineum tissue ischemia caused by pushing during labour. Another risk factors are high birth weight of the baby, too long second period of labour and sphincter muscles insufficiency. Constipation appears to be main reason for fissure during pregnancy. What differs post- labour fissure from others is the sphincter tension. After delivery it is considerably reduced, while anal fissure not connected with labour is caused by increased tension of internal anal sphincter.
Post -labour fissure diagnosis is made on the basis of anamnesis and proctologic examination, which in this specific period should be gentle without any invasive procedures. Treatment ought to be conservative and applied carefully because of a possibility of drug filtering into mother's milk while breast-feeding. Surgery treatment is contraindicated mostly because of the decreased anal sphincter tension that, in combination with an operation, might cause fecal incontinence.

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