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Cranford Technique
I'm writing a paper right now on a unique treatment I do called
the Cranford Technique. This is a treatment sequence for fissures that
apparently no one else does – fissurectomy, anal dilation,
nitroglycerin – even though it addresses a syndrome that a
surprising number of patients have. A syndrome is any self-reinforcing
cycle that’s hard to break out of. The Cranford Technique
breaks the cycle and allows the fissure to
heal easily.
The reflex between fissures and stenosis
With a fissure you get spasms, as the sphincter muscle stays partly
contracted and tight all the time, trying to protect the
split rectal tissue. That causes a reflex that keeps the fissure
from healing.
But then what started as a spasm can become something else. Instead
of just a muscle reflex, it leads to actual
organic tissue changes where you have scar
tissue deposition. Now
if the reflex goes on for a period of time
then there's a change in the blood supply
because the muscle is in spasm, and the muscle
will develop what are called contractual
changes - the muscle
fibers and related tissue will shorten, scar
tissue is deposited, and you have stenosis. That’s
where the anal opening has become tightened
by the contractual changes
in the sphincter muscle.
It’s a real problem, especially because it causes straining
during bowel movements, which then causes or worsens everything else – hemorrhoids,
fissures, inflamed papillas, etc.
Anyway, in cases like these, I’m able to manually dilate
the sphincter to open it up, even when it's
locked down from scar tissue. This is done
under local anaesthesia.
How a Fissure Forms
A fissure is not going to be symptomatic
unless there is a reflex involved. Sometimes
a fissure splits open abruptly, but usually
it’s more gradual. The way it
happens is this : for all of us, every time
we have a bowel movement we have micro-trauma
and micro-fissures, technically, because
there’s some stretching of the anoderm. That’s
normal, and if the rectal tissue is normal,
it heals before the next act of defecation. But
if the tissue is weak for some reason or
already stretched, tiny fissures start to
organize into one bigger fissure and it doesn't
recover between one bowel movement and the
next. Then you have another bowel movement
and it tears a little more, then it sets
off the muscle, the muscle goes into spasm
and tightens, then you have to strain, and
you get this positive feedback cycle going. It
gets worse and worse, and there’s really
no upper limit to the pain.
What triggers a full-fledged fissure go
be formed could be a myriad of things. It
could be any combination of hard stools,
hemorrhoids, stenosis, a medication that
alters the stool, systemic disease – or
any combination. System diseases could
be TB, actinomycosis, Crohn's, ulcerative
colitis, AIDS, lymphomas, leukemias, and
others.
Treatment
The Cranford Technique consists of opening
up the fissure, trimming off the ulcerated
edges, modifying the sphincter muscle by
dilating it, then following up with topical
application of nitroglycerine. That
is it then heals from the inside out, which
is the only way it can heal. the only
way it will heal. It's like a fistula
-- I treat fissures like I do fistulas or
other infections, because technically a fissure
is an ulcerated, infected wound.
There really is no option to close or sew
the top layer that’s ulcerated. It
has to heal from the inside out. Like
a cut on your finger, tissue from below the
cut will naturally push up and replace the
skin that’s cut.
Recovery
The body’s healing ability is a remarkable
thing. You would think with a constant
waste stream going past a recently-trimmed
fissure, which is a wide open wound, there
would be no chance for it to heal. But
when the reflex with the muscle has been
broken, it does. The tissue of the
rectal mucosa or lining has a natural ability
to block out infection, grain in and heal.
Our Treatment Methods
Diathermy
When To Seek Help
Are You In Pain?
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