Anal fissures are prismatic fissures or ulcers formed by rupture of the skin of the anal canal below the dentate line. It is a common anal canal disease that occurs in young adults, but also in children and less frequently in the elderly. According to the statistics of Europe and the United States, women get this disease more than men, and some data show that men are more common than women in China, but according to the author’s clinical observation, more women than men visit the clinic, and I hope that colleagues will provide the latest information on the specific epidemiology of this disease. Anal fissures often occur in the posterior and anterior middle of the anus, with the posterior part of the anus being the most common and the sides less common. At first, there is only a small fissure on the skin of the anal canal, sometimes it can be cracked to the subcutaneous tissue or to the superficial layer of the sphincter, the fissure is linear or prismatic, if the anus is opened, the fissure wound becomes round or oval. Meng Yong, Department of Anorectal Medicine, Jinan City Hospital of Traditional Chinese Medicine Patients with long-term constipation, because of the dry and hard stool, when the stool is too hard, the skin of the anal canal is fractured when it is discharged, and repeated injuries make the fracture deep to the whole skin. The skin of the posterior middle of the anal canal is more fixed and the end of the rectum is bent forward from the rear, so the pressure on the rear of the anus is greater and is a common site for anal fissures. Rough examination can also cause anal fissures. The skin at the lower end of the fissure is edematous due to inflammation, superficial venous and lymphatic reflux obstruction, forming a connective tissue external hemorrhoid, called “anterior sentinel hemorrhoid”. The upper end of the anal fissure becomes a hypertrophic papilla due to inflammation and fibrosis.
The clinical symptoms of anal fissure are pain and bleeding. The pain is very characteristic, i.e., sudden cut-like pain during defecation (due to feces cutting through the skin of the anal canal), followed by brief relief, and then prolonged anal pain (due to spasm of the anal sphincter after stimulation). It is common for patients to fear defecation due to pain, and a vicious cycle of “fear of pain —- tolerate stool —- dry stool —- more pain” occurs. The bleeding caused by anal fissures also varies depending on the extent of the torn blood vessels, and it is common to see cases of anemia due to long-term or massive bleeding from anal fissures. If an anal fissure is not treated in time, it can lead to ulceration of the anal canal (fissure fibrosis, also known as old anal fissure), hypertrophy of the anal papilla (polyp-like tumor), sentinel hemorrhoids (skin hyperplasia) and three other conditions, which can also develop into anal sinusitis (chronic inflammation of the anus) and anal fistula (purulent inflammation of the anus). The first three are called the “five features of anal fissure”. There is also the possibility of becoming anal canal cancer due to long-term chronic inflammatory irritation. Typical symptoms are pain, constipation, and bleeding. The pain is relieved briefly after the feces is expelled, but after a few minutes, the sphincter muscle spasms reflexively, causing intense pain for a longer period of time, which can be relieved by painkillers in some cases. Therefore, patients with anal fissures are afraid of defecation, making constipation even worse and forming a vicious circle. A small amount of bleeding may occur on the surface of the feces or drip blood after the fissure. The newly occurred anal fissure has neat, soft edges, shallow ulcer base, no scar tissue, red color and easy bleeding. Chronic anal fissures are deep and hard, grayish-white, and do not bleed easily. The bottom of the fissure is a “sentinel hemorrhoid”.
The life conditioning of anal fissure patients.
The main problem with anal fissures is the dryness of the stool and the difficulty in defecating. The first thing to do is to lift the mental worries. Some people are afraid of anal pain during defecation to postpone defecation time, which is counterproductive, because the longer the time, the more dry the stool, but increase the pain of defecation. You should get into the habit of having a regular bowel movement, once a day, so that the stool will not be dry and the pain can be reduced. At the same time, drugs and food can be used to soften the stool and reduce the expansion of the anus, which can also reduce the pain during defecation. When taking laxatives, it is important to pay attention to the proper dosage. Too much medicine, too thin stools and too many bowel movements per day will increase the stimulation of the anus. At the same time, excessive reliance on drugs to help defecate, laxatives a stop stool more constipated, easy to form stubborn constipation, making anal fissures more and more serious. Therefore, the prevention of constipation should not rely on laxatives, but mainly on diet, such as bananas, pears, apples, peaches, melons and other fruits, celery, bamboo shoots, wild rice, vegetables, etc. Balanced nutrition, eating more food rich in dietary fiber can make the stool soft and easy to discharge, so as to reduce the stimulation of the anal fissure wound and promote healing. The actual fact is that you should not eat or eat less of stimulating foods such as wine, tobacco, chili, squash, ginger and garlic.
The long time pain after the fissure is mainly caused by the spasm of the internal sphincter, the physical effect of hot water bath can make the spasm relieve the pain, this is a proven method, the anal part soaked in hot water, both to relieve pain and wash the anal dirt, such as the conditions of the drug fumigation bath effect is even better.
Third, many lesbian anal fissures occur mostly after childbirth, because of the increase in the body of the uterus during pregnancy, rectal pressure, anal blood circulation is affected, the postpartum pelvic void, intestinal cavity expansion, fecal collection; at the same time, the postpartum diet fine, lack of dietary fiber, so that dry stool; and because of postpartum bed, intestinal peristalsis slow, several days without stool, resulting in constipation. When defecating, the dry and hard stools tear the anus and cause anal fissures. Therefore, during pregnancy and especially during the postpartum period, special attention should be paid to softening the stool and protecting the anus.