Anal fissure is a small ulcer on the whole layer of the skin of the anal canal below the dentate line, which is oriented parallel to the longitudinal axis of the anal canal, about 0.5 to 25 px long, shuttle-shaped or oval-shaped, and difficult to heal. Qu Mouwen, Department of Anorectal Medicine, Guang’anmen Hospital, Chinese Academy of Traditional Chinese Medicine How to treat anal fissure? I believe this is a topic of concern to everyone. Here are some methods on how to treat anal fissures. The principles are to soften the stool, keep it open, stop the pain, release the sphincter spasm, interrupt the vicious cycle, and promote the healing of the trauma. Specific measures are as follows: (a) Keep the stool unobstructed Oral laxatives or paraffin oil to soften and lubricate the stool, increase fibrous food and change the stool habit to gradually correct the occurrence of constipation. (B) local sitz bath Before and after defecation, use 1:5000 warm potassium permanganate coating solution to sit in the bath to maintain local cleanliness. (iii) Anal canal dilation For acute or chronic anal fissure and not complicated by papillary hypertrophy and anterior sentinel hemorrhoids. After local anesthesia, the patient is placed in the lateral position, and the anal canal is dilated with two index fingers, and then two middle fingers are gradually inserted to maintain the dilatation for 5 min. After dilatation of the anal canal, the spasm of the anal sphincter can be removed, so the pain can be relieved immediately after the operation. After dilatation, the anal fissure wound is enlarged and opened, drainage is unobstructed, and the superficial wound can heal quickly. However, this method can be complicated by bleeding, perianal abscess, hemorrhoid prolapse and short time fecal incontinence, and the high recurrence rate is its shortcoming. For chronic anal fissures that do not heal over time and for which non-surgical treatment is ineffective, the following surgical treatments can be used 1.Anal fissure excision: that is, excision of the anal fissure and its surrounding triangular skin, under local anesthesia or lumbar anesthesia to perform a shuttle or fan-shaped incision to remove all of the anterior sentinel hemorrhoids, hypertrophic anal papillae, anal fissure, and if necessary, vertical severance of part of the internal sphincter. The advantage of this method is that all lesions are removed, the wound surface is wide, the drainage is smooth, and it is easy for granulation tissue to grow from the base, but the disadvantage is that it leaves a large wound surface and the wound healing is slow. 2, internal sphincter cut: the internal sphincter has the characteristics of the digestive tract irregular ring muscle, easy to spasm and contraction, which is the main cause of anal fissure pain, so the internal sphincter can be cut to cure anal fissure. Generally, partial internal sphincterotomy rarely causes fecal incontinence. There are 3 methods as follows. (1) Posterior internal sphincterotomy: The lower edge of the internal sphincter is cut directly through the fissure, and sometimes the lower part of the external sphincter is also cut to facilitate drainage. If there are inflamed anal sinuses, hypertrophic papillae or external hemorrhoids, they can be removed at the same time. The wound is open and heals on its own. However, if the wound is slow to heal and occasionally has a “locked hole” deformity, which affects poor anal function, this procedure is not recommended. (2) Lateral open internal sphincterotomy: A 50px isolated incision is made in the lateral skin of the anal margin, the incision is extended to the intersphincter sulcus, the internal sphincter is revealed and separated upward to the dentate line, the two broken ends are ligated to stop bleeding, and the skin is closed with silk sutures. Advantages of this method: the operation is performed under direct vision, the muscle is completely cut, hemostasis is complete, and the tissue can be taken for biopsy. (3) Lateral subcutaneous internal sphincterotomy: stabbing between the internal and external sphincters and cutting off the internal sphincter from the outside to the inside to avoid penetrating the skin of the anal canal. Advantages of the method: avoids open wounds and reduces pain. The wound heals quickly. Disadvantages: the cut of the muscle is not complete and sometimes bleeding is easy. Therefore the procedure is only suitable for experienced surgeons. The above is the introduction to the treatment of anal fissure disease, I hope the above can help you.