ANOKRYO®-Combi Set

Low temperature rod and dilatator as basic help for the treatment of the following symptoms:

• hemorrhoids (1st and 2nd degree)
• acute anal fissures
• perianal thrombosis
• bleeding
• pain relief
• inflammations
• itching
• accompanying constipation
• anal sphincter spasm
• anal complaints during pregnancy and lactation

With the combination of cold and stretching by ANOKRYO®, an effective therapy is available to alleviate patients’ discomfort quickly and without side effects and to promote the healing process. After storing the ANOKRYO® cold stick in its container (without lubricant) for approx. 1-2 hours in the freezer (minus 15-20° C), it reaches a temperature of -15° C. For use, it is covered with a waterproof cloth: For use, this is wetted with a water-soluble lubricant and then placed in the anal canal for 5-10 min. After the usual cleaning and disinfection, it is stored again in its container.

ANOKRYO® can be reused as often as desired.

The product contains no harmful ingredients, is odourless, hygienic and does not stain.

Side effects are not known.

The product contains no harmful ingredients, is odourless, hygienic and does not stain. Side effects are not known.

Dr. (syr) M.K.Koudaimi and Dr. F. Beersiek

The anal fissure

Conservative Treatment

Type of study: Application observation.

The use of a dilator (rod manufacturer: Med-Tec, Essen), which can be cooled down to -15° C, was tested.

Result: »For the treatment of outpatients with anal fissures, the described method is an enrichment of the conservative options due to its high effectiveness and economic efficiency«.

Anal fissure is a common disorder of uncertain aetiology. The lesion typically presents as a longitudinal tear of ovoid ulcer in the squamous epithelium of the anal canal, occurring most often dorsally at 6 o’clock in the lithotomy position. The anteriorly located fissure is rather the exception. Anterior fissures are the exception. Fissures are most frequently seen in young to middle-aged adults although some are occasionally seen in children.

The chief complaint is paincharacteristically occurring with or shortly after defecation. The pain may be extremely severe if stools are hard. Bleeding and pruritus are additional symptoms often present. The typical historyand the uniform presence of increased intra-anal pressure allow prompt diagnosis. Other painful anal conditions such as herpetic and syphilitic ulcer, perianal thrombosis, proctitis, and anal carcinoma must be excluded in the differential diagnosis.

The principle common to both conservative and surgical treatmentis the lowering of intra-anal pressure. Maximal sphincter dilatation and subcutaneous lateral sphincterotomy are well-recognized modes of treatment and have been very effective. Options diverge on the efficacy of more conservative dilatation methods. When dilatation is performed by the patient themselves, the method requires a high degree of compliance since the procedure may be rather painful at the beginning of treatment. Bearing this problem in mind we have considered a new approach to anal dilatation in combination with the anesthetizhing effect of low temperatures. A dilatator measuring 15mm in diameter was developed which can be cooled to -15° Celsius. The well known pain-effect of low temperatures generally allows the patient to easily insert the dilatator. The pain/sphincter spasm cycle can thus be interrupted. The fluid inside of the dilatator is unique in that low temperature duration in maximal and the rate of temperature equilibration therefore being gradual. The reactive hyperaemia occurring when tissue temperatures approach normal appears to facilitate fissure healing.

Materials and Methods

From December 1990 to July 1992, 37 patients with anal fissures were treated as outpatients at our hospital with the -Rod cooled to -15° C- Self-insertion of the rod was the sole mode of treatment. There were no other treatment adjuncts.

The 15oC rod was inserted in the lateral position and left in place for 5 minutes. Patients performed dilatation twice daily. To facilitate insertion, a water-soluble lubricant was applied. The Viscosity of the lubricant is not altered by the low temperatures. The patient group consisted of 20 males and 17 females. The average was 41.4 years and was relatively high. The distribution of fissure locations is shown in Fig. 1. Accordingly, 27 patients had posterior fissures, 9 anterior, 1 left lateral, and 2 patients had both an anterior and 1 posterior fissure. All 37 patients reported pain during defecation as symptoms. Pain duration ranged from minutes to hours. 15 patients reported a slight amount of bright red blood, 4 patients complained of intensive pruritus. The duration of symptoms ranged from two days to one year with 64 days being the average.

Results
All 37 patients were seen in our outpatient clinic during the treatment period and were examined upon completion of the treatment period. Treatment duration varied highly and ranged from 3 days to 32 days with 15, 3 days being the average. Pain subsided on the average after 4 days of treatment. Healing of the fissure was seen in 33 patients after an average treatment of 15, 3 days. Three fissures failed to heal and one patient was lost to follow-up. The three fissures failing to heal were treated subsequently by lateral sphincterotomy.

Discussion
Anal dilatation in combination with the anesthetizing effects of low temperatures is an effective means of treating the pain in anal fissures. The discomfort and complications associated with surgical treatment can be prevented by this mode of treatment. The anesthetizing effect of the rod cooled to -15° C allows patients to insert the dilatator themselves with minimal pain. This fact has accounted for the general acceptance of this method by patients. Patients with other painful anal conditions such as perianal thrombosis benefit from the dilatation with the low-temperature -Rod. Treatment of anal fissures on an outpatient basis by this efficacious and economic method has proven most valuable in conservative management.

Address:
Dr. med. (syr). M. Kamal Koudaimi, Evangelisches Krankenhaus Lutherhaus GmbH, Hellweg 100, 45276 Essen, Germany

Personal details:
Born on 11 December 1946 in Damascus, Syria, married, four children

Professional experience:
Studied in Damascus, followed by two years working in the dermatology department of the university hospital. Since 1974, specialist training in Germany. From 1975 to 1982, worked in surgery, including 1½ years in neurosurgery. Qualified as a specialist in surgery in 1983.