Sinusitis is an acute and chronic inflammation occurring within the anal sinus (anal saphenous) and anal flap, often complicated by anal papillitis and anal papillomegaly. It is a common clinical condition that can lead to a variety of anal and intestinal diseases. Such as perianal abscess, anal fistula, anal fissure, proctitis, etc. Therefore, early treatment of anal sinusitis and anal papillitis is of great significance for the prevention of other perianal diseases.
Etiology and pathogenesis
Western medicine
Infection and injury: Because the opening of anal sinus is upward, it is easy to store feces and be scratched by dry and hard feces, which leads to poor drainage of anal sinus and bacterial multiplication and inflammation and edema of anal sinus.
The influence of sex hormone level: some research found that the level of sex hormones directly affects the proliferation and atrophy of the anal glands, and the influence of sex hormones androgens is the greatest. Men and young adults have higher levels of androgens, so they are prone to perianal infections; older people have lower levels of sex hormones, so sinusitis and perianal infections rarely occur.
Chinese medicine
Most of them are caused by the internal growth of dampness and heat due to poor diet, spicy food, alcoholic wine and thick taste, and the downward injection of turbid qi into the anus; or due to constipation and constipation of the intestines, local wounding and poisoning of the anal canal, resulting in stagnation of qi and blood and blockage of the meridians.
Clinical manifestations
The initial stage of anal sinusitis and anal papillitis is discomfort in the anal area, often with anal swelling and poor defecation; during the attack, there is a sense of anal dampness and itching, often accompanied by anal burning or tingling.
Diagnostic points
1.Self-perceived anal swelling, itching and pain at the onset.
2.Anal finger diagnosis of anal canal tightness, obvious pressure pain and hard nodules in the inflammation area, and swollen and obvious pressure pain anal papillae can be palpated in anal papillitis.
3.Anal saphenous fossa and anal papillae can be seen red and swollen under anoscopy, with purulent secretions and hemispherical or triangular or earthworm-shaped papillae, and larger papillae can prolapse out of the anus.
Differential diagnosis
Anal fissure: longitudinal fissures are seen in the anal canal, with long, intense, periodic pain.
Rectal polyps: rectal polyps are located in the rectal mucosal area on the dentate line, with red color and easy bleeding.
【Treatment measures
Conservative treatment
Chinese medicine
Internal treatment method
Damp-heat type
Symptoms: anal dampness, itching, painful swelling, constipation, red tongue, yellowish greasy coating, slippery pulse.
Treatment: Clearing heat and relieving dampness, resolving blood stasis and relieving pain.
Remedy: Gentian and liver diarrhea soup with reduction
Heat poisoning type
Symptoms: burning pain in the anus, irritable heat and thirst, constipation and urination, red tongue, yellow fur, and smooth pulse.
Treatment: Clearing heat and detoxification, relieving swelling and pain.
Treatment: Clearing heat and detoxifying the toxin, eliminating swelling and relieving pain.
Dampness and turbidity type
Symptoms: Dampness and itching of the anus, erosion, edema of the anal sinus or papillae, dullness, body fatigue, loose stools, cloudy urine, light color with white greasy coating, moist and smooth pulse.
Treatment: Strengthening the spleen and relieving dampness
Dioscorea allium percolating dampness soup with reduction
Deficiency fire type
Symptoms: Anal discomfort and vague pain, pale anal sinus, accompanied by hot flashes and night sweats, dry mouth, constipation, red tongue with little moss and fine pulse.
Treatment: Nourishing Yin and clearing heat
Treatment: Nourishing Yin and clearing heat.
External treatment
1, Chinese medicine fumigation sitz bath septoria 30g plantain 30g cypress 20g rhubarb 15g mannite 10g horsetail 10g water decoction to 2000ml county first fumigation and then sitz bath 10 to 20 minutes, twice a day.
2.Application method: Huanglian cream or anal cream or Ma Yinglong hemorrhoid cream applied to the anus.
3.Plugging method: available anal Thai plugs or hemorrhoid plugs or Ma Yinglong hemorrhoid plugs, etc. Na anus.
4, enema method: rhubarb 15g mannitol 15g Huanglian 15g horsetail 15g Diyu 15g water decoction to 100ml in two enemas.
Western medicine
1, antibiotics: preferred metronidazole, the second choice of Qingda, haloperidol, etc.. Oral or transanal administration.
2, anal suppositories: anti-inflammatory pain suppositories or chlorhexidine suppositories nano-anal.
Surgical treatment
1.Excision and drainage
Indications: Simple anal sinusitis that cannot be cured for a long time.
Operation method: the patient takes the side lying position or truncated position, routine disinfection, local anesthesia, reveal the lesion anal sinus, probe into, cut the anal sinus along the probe, trim the wound so that the drainage is unobstructed, check that there is no active bleeding, compress the trauma of the operation area with yellow lily oil sand strips or comfrey oil sand strips, sit in the herbal bath every day after the operation, change the medicine until it is cured.
2.Excision
Indications: Applicable to those with invisible fistula or pus, or those with enlarged anal papilla.
Operation method: The patient is placed in the left lateral position, disinfected routinely, local anesthesia, and the anal sinus and papillae in the area are exposed. The anal sinus is separated to the root of the papilla by clamping and ligation and then excised. The wound medication and postoperative treatment were as above.
Home care]
1.Keep the stool unobstructed, do not squat for a long time and aggravate the symptoms of local swelling.
2, the use of traditional Chinese medicine three herbal lotion (septoria, verbena, plantain each 30g cypress, double flowers, yuanhu each 15g park nit, alum each 10g) fumigation sitz bath twice a day or 1U5000 potassium permanganate fumigation bath.
Prevention and rehabilitation】
1, active physical exercise, enhance physical fitness, improve resistance to disease, do not sit for a long time, dozens of times a day to do anal lifting action.
2, keep the bowels open, actively treat diarrhea and other inflammatory diseases of the intestinal tract.
3.Eat spicy, seafood, fish and shrimp and other stimulating foods carefully.
4, keep the perianal area locally clean, insist on warm water bath after stool and before bed.