Anal fissure is a common anal canal disease that starts with a small fissure in the skin of the anal canal, sometimes to the subcutaneous tissue or to the superficial layer of the sphincter muscle, with a linear or prismatic fissure, and if the anus is opened, the fissured wound becomes round or oval. In general, there are four major theories of the etiology of anal fissures.
Anal fissure doctrine I
Anatomical defects theory: Anal fissures mostly occur in the posterior position of the anus, mainly because the superficial layer of the external sphincter muscle forms a “Y” shaped weak zone in the front and back of the anal canal, and the puborectal muscle strengthens both sides of the anal canal, so the posterior and anterior parts of the anus are not as strong as the sides, and the anal canal forms an angle with the posterior rectal wall after going down. When defecating, the pressure of dry stool on the weak area behind the anus is the greatest, and because of the poor blood flow and less elasticity in the midline after the anal canal, the back of the anus is easily injured and torn. This is the reason why the location of anal fissure fissures often occurs in the posterior area.
Anal fissure theory two
Infection theory: Special structures such as anal sinus, anal flap, anal papilla and anal gland at the upper dentate line of the anal canal are easily damaged by the downward movement of dry and hard fecal masses, causing local infection and inflammation, or leading to the obstruction of the anal gland and pus, and the formation of anal fissure after ulceration, and the formation of chronic ulcers due to local inflammatory stimulation, spasm of the sphincter, insufficient blood supply and long-standing wound failure.
Anal fissure theory three
Sphincter spasm theory: Due to pathological factors, the lower part of the external anal sphincter is fibrotic and loses its softness, forming an inelastic transverse gate at the lower end of the superficial “Y”-shaped weak zone of the external anal sphincter, which is prone to rupture and fissure when a dry and hard stool mass passes through the anal canal.
Anal fissure theory IV
Trauma theory-anal slit theory: Most scholars believe that when a dry hard fecal mass passes through the anal canal, it is easy to cause the anal canal to tear, especially for those with congenital anal dysplasia, which is more likely to be damaged.
There is an obvious causal relationship between anal fissures and local anatomy, and it can be said that the occurrence of anal fissures is the result of the interaction of multiple pathogenic factors. In patients with chronic constipation, the fecal mass is dry and hard, and the fissured skin of the anal canal is damaged during discharge due to excessive force during stooling, and the repeated injury causes the fissure to be deeper than the whole skin. The skin of the posterior middle of the anal canal is fixed and the end of the rectum is bent forward from the rear, so the pressure on the rear of the anus is greater, which leads to anal fissures.
Comprehensive treatment of anal fissure
Anal fissures mainly manifest as painful defecation, bleeding and constipation, except for acute attacks that require medical attention, most of them are based on home care, so how can we do a good job of self-care anal fissure symptoms? Experts have given us the following suggestions.
1, smooth stool.
Long-term constipation is the main cause of anal fissures, so it is vital to keep the bowels open for the prevention of the disease. Patients should develop the good habit of defecating every day, defecate regularly, increase outdoor activities appropriately, take laxatives such as liquid paraffin, fruit guide tablets, etc., if necessary, or use Chinese herbal medicines such as rhubarb and pan diarrhea leaves to make tea, which can loosen the stool to facilitate defecation, and take a hot water bath after defecation, which can improve local blood circulation, promote inflammation absorption, reduce pain, and relieve the patient’s tension to facilitate defecation.
2. Adjustment of psychology.
Strengthen the propaganda of anal fissure hygiene knowledge, explain to patients in detail the pathogenesis, regression and prognosis of the disease, so as to relieve patients’ nervousness and enhance their confidence in fighting against the disease, thus keeping their mood relaxed and calm.
3.Conditioning diet.
Reasonable dietary arrangements are conducive to ensuring smooth bowel movements. The diet should include more fresh fruits, vegetables and coarse fiber foods, less or avoid spicy and stimulating diets, and more water to ensure that the gastrointestinal tract has abundant digestive juice secretion, which is conducive to gastrointestinal peristalsis and prevents constipation.
4, pay attention to food therapy.
Regular consumption of coarse fiber food can stimulate gastrointestinal peristalsis, conducive to defecation. Some foods with blood laxative effect, such as cinnamon meat, dates, walnuts, flax, fungus, mulberry, pine nuts, etc. can often eat, can also be made into a medicinal diet diet, such as cinnamon meat porridge, flax cake, pine nuts fried corn, walnuts fried lean meat, etc., can laxative, promote the healing of fissures.
5. Pay attention to hygiene.
Keep the anal area hygienic, after the stool should be timely cleaning the anus, diligent bathing, diligent change of underwear, can effectively prevent infection, such as bleeding large amount, should go to the hospital, the amount of small should strengthen the observation, and pay attention to the consumption of blood nutrients and food to enhance the body resistance.
6.Adhere to the sitz bath.
Before and after the stool are 1: 5000 potassium permanganate warm water sitz bath, warm water for 43 ℃ -46 ℃, 2-3 times a day, 20-30 minutes each time. Sitz bath can relax the anal sphincter, reduce pain, improve local blood circulation, promote the absorption of inflammation, which is conducive to the healing of anal fissures.