The symptoms of anal fissures are painful without words and many sufferers will feel them. Below you will find commonly used and effective treatment methods.
(i) Drug treatment
Stage I anal fissure can usually be controlled or cured by taking medication.
1.Softening stool
Increase dietary fiber food, develop a good habit of defecating on time, keep the stool open, interrupt the vicious cycle, relieve pain and release the sphincter spasm. Constipation can be added with laxative drugs, taking probiotics.
2.Application of drugs
Commonly used are anesthesia, promote fissure healing and relieve sphincter spasm three types.
(1) anesthesia lidocaine gel, etc.
(2) promote fissure healing class hemorrhoid cream, recombinant human epidermal growth factor, etc.
(3) Relief of sphincter spasm class At present, there are mainly two kinds of drugs.
(1) diltiazem ointment
Calcium channel blocker, if not commercially available can be homemade, using 30mg of diltiazem tablets crushed and mixed with 15g of petroleum jelly. Diltiazem, as a calcium channel blocker, can act as a vasodilator and release smooth muscle spasm by inhibiting the transport of extracellular calcium ions into the cells. It can also relieve internal sphincter spasm, lower anal canal pressure, improve blood circulation, and heal anal fissures.
②Nitroglycerin ointment
It can also be made by crushing 0.5mg of nitroglycerin tablet and mixing it with 2.5g of petroleum jelly. Nitroglycerin has the effect of relaxing smooth muscle and dilating blood vessels by inhibiting neurotransmitters. The drug has adverse effects such as headache, which should be discontinued if more pronounced. It is reported that the cure rate of these two drugs can reach 50% to 90%.
(II) simple treatment
1.Anal dilation
Anal dilation is mainly applied to stage I and II anal fissures. The anus can be dilated with fingers or instruments (you can use the commonly used flapper anoscope in the anorectal department). This method is easy to operate and is effective in relieving severe anal pain, but it can recur and can be complicated by adverse reactions such as anal hematoma, bleeding, and anal incontinence within a short period of time. The operation should be gentle, never rough, and more lubricating ointment should be placed. Under the condition that the patient can bear, proceed gradually.
2.Injection of botulinum toxin
Applicable to all stages of anal fissure. Botulinum toxin type A is an extremely strong neurotoxin, and after local injection into the internal anal sphincter, it can block the release of acetylcholine from the presynaptic membrane of the neuromuscular junction, resulting in chemical denervation and local muscle paralysis, thus reducing muscle tension and improving local blood supply to heal anal fissures. Botulinum toxin type A is a safe and effective biological agent, and most of the toxin is rapidly combined with the muscle after a small amount of local injection.
(iii) Surgical treatment
Anal fissure excision and anal canal release is the most safe and reliable clinical surgical method. It is suitable for stage II and III anal fissures. The purpose of surgery is to remove the anal fissure and its appendages and to treat the anal canal for decompression.
Prognosis
After treatment with drugs or surgery, most of them will be cured, and only a very small number of patients will have recurrent attacks.