Anal fissure is a condition in which the entire skin of the anal canal splits and forms an infected ulcer. It is characterized by periodic pain and is more common in young adults and more common in women than men. It occurs in the anterior and posterior median position of the anus, especially in the posterior position. It is also common in female patients in the anterior median position. In Chinese medicine, it is called “cracked hemorrhoid” and “hooked intestine hemorrhoid”.
[Etiology]
Western medicine believes that the formation of anal fissures is related to the following factors.
1. infection: infection of the anal fossa spreads subcutaneously to the anal canal to form an abscess, which breaks down to form an ulcerated wound.
2. trauma: various anal traumas, dry and hard stools, rough anal examinations and tears in the perineal area during childbirth of pregnant women can damage the skin of the anal canal and form anal fissures after infection
3, anatomical factors: weak muscles at the front and back of the anus, easy to cause lacerations when forceful defecation, and rectum and anal canal into an angle, the rear of the anal canal is under greater pressure during defecation, more likely to be damaged by pressure to form anal fissure.
According to Chinese medicine, blood heat, intestinal dryness and yin deficiency can lead to constipation and defecation, which can cause anal skin fissures and secondary infection and gradually form chronic ulcers.
[Clinical manifestations]
The typical symptoms of anal fissure are pain, blood in the stool and constipation.
Pain: The pain of anal fissure is a typical periodic pain. When defecating, the anal canal expands and stimulates the ulcer surface, causing burning or cutting pain, which lasts for a few minutes and is reduced, called the pain interval, and after defecation, severe pain occurs due to continuous spasm of the sphincter, which can last for several hours until the sphincter is fatigued and relaxed, and the pain is gradually relieved. When the disease is serious, the pain is intense, restless, and can radiate to the pelvis and lower limbs.
2.Blood in stool: bleeding during stool, not much, bright red, or blood on stool paper, or attached to the surface of stool, or sometimes dripping blood.
3. Constipation: Most patients with anal fissure have habitual constipation, which is aggravated by fear of pain during stool and reluctance to defecate, thus forming a vicious circle.
[Diagnostic points]
Anal fissures have typical clinical symptoms and are not difficult to diagnose. The clinical divisions are early anal fissures and old anal fissures.
1. Early anal fissure: there is only a small poke-shaped ulcer on the skin of the anal canal, with a shallow trauma, a flat base, bright red color, easy bleeding, neat and elastic edges, and mild pain.
2, old anal fissure: early anal fissure without proper treatment can develop into old anal fissure, fissure repeated infection, injury, deeper trauma, uneven base, grayish white, generally not bleeding, thickened and hardened edges, local superficial veins and lymphatic reflux obstruction, causing edema and connective tissue hyperplasia, forming connective tissue external hemorrhoids, called “sentinel hemorrhoids “The fissure is a fissure of the upper end of the anal papilla. The anal papilla at the upper end of the fissure undergoes hyperplasia and fibrous changes due to repeated inflammatory stimulation, forming a hypertrophic anal papilla. The fissure ulcer surface, sentinel hemorrhoids, and hypertrophic anal papillae are called the “anal fissure triad”.
Patients with anal fissures should not undergo anal fingering and microscopy to avoid severe pain, and those who do need to be examined should be anesthetized with local infiltration.
[Differential diagnosis]
1. Tuberculosis: Tuberculous anal fissures are characterized by caseous necrosis on the ulcer surface, uneven base, gray color, submerged edges, oval shape, and purulent odorous secretions. The pus can be cultured for Mycobacterium tuberculosis, the pain is not severe, and the fissure can occur in any part of the perianal area.
2, ulcerative colitis: ulcerative colitis can often be complicated by anal fissures, which are characterized by shallow anal fissures, mostly found on both sides of the anus, accompanied by pus and blood stools, diarrhea, abdominal pain and other symptoms.
3, clonorchiasis: clonorchiasis has a higher chance of occurrence of anal fissure, which is characterized by deep fissures, submerged edges, sometimes the submerged edges of two fissures communicate with each other, the skin above forms a skin bridge, the skin around the fissure is blue, can occur in any part of the perianal area, the pain is light. The skin around the fissure is bruised and can occur in any part of the perianal area, and the pain is mild.
[Treatment]
Treatment of anal fissures is aimed at relieving pain and promoting ulcer healing. Early anal fissures are usually treated conservatively, while old fissures should be treated surgically.
Internal treatment.
1. Blood-heat and intestinal dryness: the symptoms are constipation and hard stool, pain in the anus during stool, bright-colored blood in the stool, dripping down, or paper stained with blood, which may be accompanied by distress, bitterness in the mouth, dryness in the throat, not daring to eat, red tongue, yellow dryness in the moss, and number of pulse.
2. Blood deficiency and intestinal dryness: pain and bleeding in the stool, dry stool, dry skin, distress and insomnia, afternoon hot flashes, red tongue with little moss and fine pulse. The treatment is to cool the blood and nourish the blood, moisten the intestines and open the bowels.
External treatment: External use of comfrey oil sand strips, raw muscle yuhong cream or Ma Yinglong hemorrhoid cream, or use anal tai suppository or taining suppository to nail the anus.
Surgical treatment: The purpose is to remove the ulcerative fissure of the anal canal together with “sentinel hemorrhoids”, hypertrophic anal papillae and inflammation involving the anal sinus, and to cut open part of the internal anal sphincter and the lower part of the external sphincter.
1.Anal dilatation method: suitable for early anal fissure, without superfluous external hemorrhoids, anal papillae hypertrophy and other comorbidities.
2.Cutting therapy: for old anal fissures with superfluous external hemorrhoids, anal papillary hypertrophy, etc.
3.Longitudinal incision and transverse suture method: for old anal fissure with anal canal stenosis.
Post-operative treatment: eat liquid diet or soft food for two days and control stool for 1-2 days. After defecation, fumigate with 1:5000 potassium permanganate solution or Chinese herbal medicine Sancho lotion, and incorporate anal plugs or taining plugs and comfrey oil sand strips into the anus for medication change.
[Home care]
1. Develop good habits of regular bowel movements, and for those who have anal fissures, keep the stools clear and free of hard knots, and eat more fresh vegetables and coarse fiber foods. If necessary, take laxatives, such as hemp and intestinal pills, etc.
2. Use 1:5,000 potassium permanganate solution or Chinese herbal soup to sit in the bath after the stool to release the spasm of the sphincter muscle, improve local circulation and reduce pain. You can also use Huanglian cream or comfrey oil sand strips or Ma Yinglong hemorrhoid cream or anal plugs, hemorrhoid plugs nano-anal.
3, when the pain is severe, you can take oral painkillers or take Shi Tai suppositories to the anus.
[Prevention and rehabilitation]
1, keep the stool smooth, avoid constipation or diarrhea, regulate diet, drink more water, less smoking, less alcohol, less spicy food is an effective way to prevent anal fissure.
2, appropriate physical activity.