1.What is anal fissure?
As the name implies, anal fissure is a full-length fissure of the skin of the anal canal and the formation of a poke-shaped ulcer due to repeated infection. The fissures tend to occur in the anterior and posterior positions of the anal canal. In men, it is more common in the posterior position, and in women, it is more common in the anterior position, with a higher prevalence in women than in men. The disease is more common in young adults and the physically strong, and the age of the disease is about 20-40 years old, while children and the elderly rarely suffer from the disease. Once suffering from this disease, often recurring anal pain, blood in the stool, stool difficulties, etc., is a more stubborn and frequent common disease, thus affecting normal health and work.
2.What are the symptoms of anal fissure?
The typical clinical manifestations of anal fissure patients are pain, constipation and blood in the stool.
1.Pain: Anal fissure can cause periodic pain due to fecal discharge, which is the main symptom of anal fissure. When defecating, the fecal mass stimulates the nerve endings of the ulcer surface and immediately feels burning pain in the anus, but the pain is relieved a few minutes after defecation, which is called the intermittent pain period. Later, due to the spasm of the internal sphincter, severe pain is produced again, and this period can last for half to several hours, making the patient restless and difficult to bear, until the sphincter is fatigued, the muscle relaxes and the pain is relieved. However, the pain occurs again when the patient has another bowel movement. The above clinical term is anal fissure pain cycle. The pain may also radiate to the perineum, buttocks, inner thighs or sacrococcygeal region.
2. Constipation: Reluctance to defecate due to anal pain can lead to constipation over time, which can lead to dry and hard stools, and constipation can aggravate anal fissures, forming a vicious cycle.
3. Blood in the stool: A small amount of fresh blood is often seen on the surface of the stool or on the stool paper when defecating, or drops of fresh blood. Hemorrhage is rare.
4.Other: itching, discharge, diarrhea, etc.
If the stool passes through the anal opening, you will feel a burning or cutting pain, accompanied by bright red blood on the surface of the stool or blood dripping from the anus, and the pain is slightly relieved after defecation, followed by a continuous unbearable pain for several hours or even a day. If you have these symptoms, then you may have an anal fissure.
3.What is anal fissure triad?
You can often hear anal fissure triad mentioned by anorectal specialists in daily medical activities. It generally refers to anal papilloma or anal papillitis, sentinel hemorrhoids, old anal fissures or subcutaneous fistulas caused by prolonged anal fissures, which should belong to stage III anal fissures. Therefore, anal fissure triad is a stage III anal fissure.
4.How to diagnose and treat anal fissure?
(1) Chinese medicine diagnosis and treatment.
Anal fissure is divided into three types: blood-heat and intestinal dryness type: the symptoms include one line of stool for two or three days, dry and hard, pain in the anus during stool, blood dripping from the stool or blood stained by hand paper, red color of the fissure, abdominal distension, yellow urine, red tongue, and string pulse; Yin and blood deficiency type: dry stool, one line for several days, painful blood dripping from the stool, deep red fissure, dry mouth and throat, irritability of the heart, red tongue, little or no moss, and fine pulse; Qi stagnation and blood stasis type: anal Stabbing pain is obvious, especially after defecation, the anus is tight, the fissure is purple and dark, the tongue is purple and dull, and the pulse is stringent or astringent.
For the blood-heat and intestinal dryness type, the main treatment is to moisten the bowels and open the stool, and the hospital’s homemade oral medicine is Ma Ren Wan.
(2) External treatment with Chinese medicine
(1) Drug fumigation treatment: Decoct the drug into water, or use boiling water to flush directly, fumigate first and then wash, then take a sitz bath for about 15 minutes after each bowel movement, once a day. It can be used for conservative treatment of anal fissure and postoperative medicine. It has the effect of reducing swelling and relieving pain. Commonly used drugs include Scutellaria granules, fumigating enema solution, fumigating combination, etc., all of which are self-prepared by hospitals.
②Therapeutic topical medicine is applied directly to the affected area or evenly coated on small gauze strips and covered with small gauze strips on the wound surface. It has the function of stopping pain and bleeding, creating muscle and closing the mouth, reducing swelling and promoting wound healing. Commonly used drugs include silver ash cream (powder), Jiuhua cream (powder), crispy bile hemorrhoid cream, etc.
(3) Surgical treatment
①Finger method of anal dilation is suitable for stage I-II uncomplicated anal fissure. Local anesthesia, left side lying position. Procedure: Apply petroleum jelly or paraffin oil to the index and middle fingers of both hands. During the operation, note that anesthesia must be adequate and violence should not be used. Gradual force should be used to avoid tearing of the mucosa or skin.
② Hanging wire surgery is suitable for anal fissure with submerged fistula. Procedure: After satisfactory anesthesia, routine disinfection, make a small radial incision of about 1.5 cm in the skin of the external anal margin of the fissure, remove the sentinel hemorrhoid and the hypertrophic anal papilla at the same time, insert a ball probe through the lower part of the external sphincter skin and the internal sphincter with the small incision, under the guidance of the index finger of the left hand in the anus, search for the posterior anal sinus, insert the probe from the upper end of the fissure at the anal sinus, hang the rubber band, withdraw the needle and lead to the external anal area. The inner and outer ends of the rubber band were clamped together, clamped, and the silk ligated under the clamp.
(iii) Internal sphincterotomy. Because the sphincter under the fissure has been stimulated for a long time and has become fibrotic, bleeding and pain are less than those of the non-fibrotic sphincter after picking off, so the sphincter is picked off in situ. Xiong Zhiyan et al. used anal fissure incision and in situ sphincterotomy (the perianal skin was incised with the fissure as the center, and the tip did not exceed the tooth line. The skin at the bottom of the incision was lifted with tissue forceps, the subcutaneous tissue was sharply separated upward, and the fissure, connective tissue external hemorrhoid and hypertrophic anal papilla were excised together, and the exposed lower part of the external sphincter and the lower edge of the internal sphincter were picked up and cut off about 1 cm. In the comparison of the two groups, the postoperative pain was mainly grade I in the patients who underwent incision and in situ sphincterotomy on the first to third day, and the pain was significantly less than that in the control group.
Lateral internal sphincterotomy is suitable for simple anal fissure with anal sphincter spasm and anal stenosis. A curved incision of about 2 cm is made on either side of the anal margin at a distance of 1-1.5 cm from the anal canal. A hemostatic forceps is extended from the incision to the intersphincteric sulcus, the internal and external sphincters are separated upward, the lower edge of the internal sphincter is clamped and separated upward to the dentate line, and then the internal sphincter is picked out from the incision and cut under direct vision. The lateral incision was closed with a mattress suture, and the stitches were removed in 3-7 days, and the sutures were not allowed to sit in the bath before removal. Posterior median internal sphincterotomy is used for posterior median stage III anal fissure. A longitudinal incision of about 1.5 cm is made from the dentate line to the anal verge to separate the tissues between the internal and external sphincters. The anal fissure incision is made along both sides of the fissure from the tooth line down to about 1.0 cm outside the fissured hemorrhoid, deep to the bottom of the ulcer, and the scar tissue at the edge of the fissure is removed along with the sentinel hemorrhoid, subcutaneous fistula, hypertrophic anal papilla and infected anal sinus.
5.Does painful stool necessarily mean anal fissure?
Not necessarily. In addition to anal fissures, severe anal pain can also be seen in some of the following diseases.
(1) Perianal abscess is a common disease, which is commonly known as “abscess”. A lump can be found next to the anus, which is painful to touch and sometimes accompanied by fever. The pain is more intense and increases with activity. If the location is shallow, it can break down on its own and pus can flow out.
(2) Internal hemorrhoids are commonly found in patients with mixed hemorrhoids, due to dry stool, long squatting time, cold, anxiety and other reasons, resulting in inflammation and edema of the mixed hemorrhoids and prolapse of the internal hemorrhoids.
(3) Severe pain in the late stage of anorectal cancer. Treatment: medication for pain relief, no other methods.
Therefore, if you have a painful anal disease, you must go to a specialist anal hospital to ask a doctor to check and judge to determine which disease it is.
6.How is anal fissure staged?
Anal fissure staging is often dichotomous, trichotomous or quintuple.
(1) Dichotomous method
①Acute and chronic classification method
Acute anal fissure: refers to a fresh fissure of the skin of the anal canal without papillary hypertrophy and sentinel hemorrhoids.
Chronic anal fissure: refers to old fissures of the anal canal, which form ulcers after repeated infections, combined with hard nodules at the trauma edge, papillary hypertrophy and sentinel hemorrhoids.
②Early and late classification method
Early anal fissure: the fissure is fresh, chronic ulcers have not yet formed, and the pain is mild.
old anal fissures: the fissures are already pyknotic ulcers, along with sentinel hemorrhoids, anal sinusitis or anal papillary hypertrophy, and periodic pain.
(2) Five-point method
Mostly adopted by foreign scholars.
①Stenosis type: the internal sphincter is in spasm, the anal canal is tense and narrow, with typical periodic pain, and this type accounts for more than 70% of anal fissures.
②Prolapse type: Anal fissure caused by prolapsed and inflamed internal and external hemorrhoids. The pain is mild, and there is no obvious narrowing of the anal canal.
③Mixed type: Anal fissures caused by a mixture of stenosis and prolapse type.
④Vulnerable type: superficial ulcers caused by eczema and dermatitis of the anal canal skin.
⑤Syndromic: syndromic anal fissures such as Crohn’s disease, ulcerative colitis, anal canal tuberculosis, syphilis, etc. Fissures with delayed healing of postoperative trauma of the anal canal also belong to this.
(3) Three-part method
The three-division method is the commonly used clinical division method, which is simple and practical, and clear and easy to follow.
Stage I anal fissure: also called primary anal fissure, i.e. fresh anal fissure or early anal fissure. The skin of the anal canal is superficially damaged, and the tissue around the wound is basically normal.
Stage II anal fissure: also known as simple anal fissure. The anal canal has formed ulcerative fissures, but there are no comorbidities, no anal papillary hypertrophy, sentinel hemorrhoids and subcutaneous fistulae, etc.
Stage III anal fissure: This refers to old anal fissures and generally refers to anal fissure triad, but also includes references such as quadruple or quintuple fissures. The manifestation is that the fissure is old ulcer, combined with anal papillary hypertrophy and sentinel hemorrhoids, or accompanied by subcutaneous fistula and anal saphenous inflammation, etc.
7.How does anal fissure occur?
Modern medicine believes that the formation of anal fissure is mainly caused by mechanical stimulation and inflammatory changes of anal skin and blood vessels.
Anatomy: The external anal sphincter is divided into two parts from the caudal bone forward to the back of the anal canal, along the two sides of the anal canal forward around the anal canal, to the front of the anal canal these two parts are joined, leaving a gap in the front and back of the anal canal. Lack of blood supply and less elasticity in the posterior median line of the anal canal are both causes of anal fissure.
②Injury: dry stool can make the anal skin tear, frequent fecal excretion during diarrhea makes the anal canal sensitive and tight, normal consistency of stool can also cause injury, chronic inflammation of the anal canal, proliferation of fibrous tissue, formation of anal comb sclerosis, preventing sphincter relaxation, making the anal canal vulnerable to injury rupture. Rectal foreign bodies, improper anal dilation methods, anal surgery, childbirth, congenital anal stenosis, proctocolitis, and tuberculosis can also lead to anal fissures.
③Infection: acute and chronic anal sinusitis, anal papillitis, internal hemorrhoids and polyps are the main causes of infection. The pathogenic bacteria of the infection enter the anal gland through the glandular opening and generate abscesses in the subcutaneous tissue of the anal canal, which break down and form ulcers. Small superficial thrombosis due to infection can also lead to anal fissure.
The etiology of chronic anal fissure: it is not clear. It is generally believed that it is related to the following aspects. First, most of the anal fissures are in the lower edge of the posterior anal canal sphincter in the shape of a shuttle, with only a few edges overlapping with the lower part of the internal sphincter. Secondly, the reflex muscle pain spasm caused by pain makes the blood supply locally insufficient, delaying the healing of anal fissure and becoming chronic anal fissure. Third, there are embryonic remnants of epithelial tissue deep in the anal canal, and the rupture of the anal canal skin exposes the epithelial cells within the submucosa to the bottom of the fissure, and due to the foreign body stimulation of epithelial fragments on the fissure and repeated infection, chronic anal fissure is easily formed.
8.Why is anal fissure painful?
The main reason for severe pain is due to the stimulation of nerve endings in the fissure during fecal discharge, which immediately causes burning and knife-like pain in the anus, thus causing the internal anal sphincter to contract spasmodically, resulting in persistent pain. Then, as time passes, the sphincter gradually becomes fatigued and relaxes, and the pain then decreases and gradually disappears. This is known as a cycle of pain in anal fissure pain symptoms.
In addition, not only can feces cause severe pain in anal fissures, but coughing, sneezing, and urination can cause this pain cycle.
9.How does anal fissure differ from anal fissure?
Anal fissure is a disease most easily confused with anal fissure. Anal fissure occurs as a superficial cracking of the skin at the anal glands and anal canal. This manifestation occurs in anal skin diseases, such as eczema, dermatitis and anal pruritus. Although there is pain during defecation, there is no persistent spasmodic pain, there may be blood on the hand paper, and local skin lesions such as papules, keratosis and hyperplasia are often seen. In contrast, anal fissures are mostly 1 or 2 fissures, occurring at the anal canal, with persistent severe pain, often reaching deep into the muscular layer.
In terms of treatment, anal fissures are mostly caused by skin diseases, so external medication is the main treatment, while anal fissures are mainly treated by surgery.
10.Why do more women than men suffer from anal fissures, and what should women pay attention to in their lives?
In our daily life, we find that the number of young women suffering from anal fissures is much higher than that of men. This is due to the anatomical characteristics of the perineum of the anus in women. The vagina is in front of the female anus, and the muscles nearby are weak. In addition, women have special physiological reasons, such as excessive force during menstruation, pregnancy, especially during childbirth, or menstrual blood loss, which can cause constipation.
Based on the above reasons, the following aspects should be noted for the prevention of anal fissure: ① Menstrual period: pay attention to menstrual hygiene, keep the perineum dry and avoid inflammation of the anal area; in addition, menstrual period, such as excessive blood loss, can cause a decrease in intestinal fluids, dry stool discharge difficulties, the anal canal tears when Nou earn, so you can give appropriate drugs to supplement Qi and blood as well as laxative drugs to keep the stool smooth. ② Pregnancy and childbirth: When women are pregnant, due to increased abdominal pressure, venous reflux is obstructed, coupled with high nutrient requirements during pregnancy, constipation and other conditions can increase the tearing strength of the tissues around the anus during defecation. When giving birth, pay attention to protecting the perineum and anal tissues, so as not to tear the anal canal tissue due to excessive force, anal fissures occur.
11.What is the “fear of defecation” and how to carry out psychological care?
In patients with anal fissures, the presence of fissured ulcer surface can cause the fissures to be bruised or damaged by the passage of feces through the anal canal during defecation. Therefore, patients with anal fissures generally experience severe pain during defecation. Because of the severe pain during defecation, many patients are often afraid of defecation, a phenomenon known as “fear of stool. What is the effect of “fear of stool” on anal fissures and how should this be treated? Fear of defecation” causes patients to intentionally prolong the time of defecation and reduce the number of bowel movements, which results in the stool staying longer in the intestine and the water being completely absorbed, so the stool becomes drier and drier. Once you have a bowel movement, the pain becomes more intense, and the fissure becomes more and more severe and deeper. This results in a vicious cycle of pain caused by anal fissures → fear of pain and not defecating → the drier the stool → the deeper the fissure → the more painful it is.
If you have a “fear of stool”, first of all, you should eliminate the mental worries. Because you should know that the more you are afraid of defecation and do not defecate, the more severe the pain will be. Therefore, you must not have this fear of psychology, to develop a good habit of daily bowel movements. Some patients take some laxatives orally for a long time in order to soften the stool and reduce the irritation of the fissure when passing through the anal canal, thus also reducing the degree of pain. The long-term use of such drugs can lead to gastrointestinal dysfunction and a series of gastrointestinal diseases; in addition, long-term diarrhea can also lead to anal canal narrowing and the formation of laxative-dependent stubborn constipation. The development of stubborn constipation is not only not beneficial to anal fissure, but also aggravates the condition of anal fissure, making it persistent and affecting normal work and study.
12.What does tuberculous anal fissure look like and how should it be prevented and treated?
Tuberculous anal fissure is characterized by caseous necrosis that can be seen on the ulcerated surface of the fissure, uneven bottom, gray color, submerged skin margin, and oval shape; and purulent smelly secretions, and pus culture can be cultured for Mycobacterium tuberculosis. Tuberculous fissures are not as painful as general anal fissures and the fissures can occur anywhere in the anal canal.
In addition to the above features, tuberculous fissures may also show tuberculosis on X-ray and have positive sputum culture. The treatment should be timely, accurate and systematic along with anti-TB treatment along with Chinese and Western medicine for fissures. Only in this way can the real source of tuberculous anal fissures be eliminated, the symptoms and the root cause be treated together, and early recovery be achieved.
Patients with tuberculous anal fissure should also strengthen their nutrition while undergoing treatment by taking in some nutrient-rich substances such as high protein, high calories and high fat. Avoid smoking, alcohol, spicy and other stimulating products, pay attention to rest, do not overwork.
13.What should I do if I have an anal fissure?
Anal fissures can generally be cured if timely treatment is given in the early stage. Otherwise, the anal canal ulcers become bigger and deeper, and even the fissures reach deep into the anal sphincter, and the fibrous tissue at the edge of the ulcers becomes hard and cannot heal for a long time; in serious cases, not only does the anus hurt when defecating, but coughing and sneezing can also cause painful attacks. Due to long-term local inflammation and infection, anal fissures are often accompanied by pathological changes such as anal sinusitis, anal papillomegaly, subcutaneous fistula, and fissured hemorrhoids.
If a patient has an anal fissure, he or she should go to a local hospital for examination and treatment in a timely manner. In addition, you should eat more vegetables, fruits and foods with more fiber to keep your bowels open. Take a daily sitz bath with 1:5000 potassium permanganate solution after a bowel movement. After the sitz bath, you can use Ma Yinglong hemorrhoid cream, Jiuhua cream and other drugs for external rubbing, and at the same time oral anti-inflammatory, pain-relieving drugs, timely treatment of anal sinusitis and other inflammatory lesions around the anorectum, control the infection, not to spread the inflammation.
14.Why must anal fissure patients clean their anus after defecation?
When patients with anal fissures defecate, the anal sphincter is prone to spasm due to the stimulation of the fecal mass, prompting the fecal mass to embed in the wound, thus stimulating the peripheral nerves in the anal area and causing severe pain. Therefore, it is important to wash the anal area after defecation to keep it clean and hygienic. Anal cleaning can be done with.
①Compound scutellaria granules 12g dissolved in 2000ml of water and sit in a bath after each stool.
②1:5000 potassium permanganate solution.
③Warm water.
④Warm water with light salt. Use the above drugs to clean the residual feces in the fissure after stool. This can reduce pain and help the wound healing, which is one of the important measures to prevent and treat anal fissure.
15.What are the conservative treatments for anal fissure?
Patients with anal fissures should pay attention to keeping their stools open and avoiding dry stools and constipation, which is an important part of conservative treatment. If this is done, damage to the anal canal from fecal masses can be avoided or reduced, and even superficial fissures will heal on their own as a result. Patients who usually have dry stools or constipation can take some heat-clearing and laxative drugs, such as Spleen Yogurt Pill, Sophora Yogurt Pill or paraffin oil every night before going to bed, or boil mung beans or soybeans into water for internal use to keep the stools soft and moist. Then, patients who have formed anal fissures need to commonly use anti-inflammatory and pain-relieving, antiseptic and muscle-generating drugs to close the mouth, such as using Yuhong cream, raw muscle white jade cream, Jiuhua cream, Ma Yinglong hemorrhoid cream, etc. Externally, acupuncture therapy is also available to treat anal fissures. At present, long-acting anesthetics are also used clinically to do local closure, which also has a more satisfactory effect on anal fissure patients in terms of pain relief.
16.How to take care of the periodic pain of anal fissure?
Pain is one of the main symptoms of anal fissure, and this pain has a distinctive feature: pain at the beginning of defecation, a short interval of pain relief after defecation, followed by more intense and continuous pain, which can last for several hours to a day, or even until the next defecation, forming the so-called “anal fissure pain cycle”. From a medical point of view, the pain during defecation in anal fissure is usually due to traumatic pain, and the continuous pain after defecation is due to spasm of the internal sphincter until the sphincter is fatigued and the pain is relieved.
So, what should patients with anal fissures pay attention to if they have periodic pain? What should be taken care of? Here are some simple ways to relieve the severe pain of anal fissures.
①Drugs: Patients who suffer from anal fissure and have severe pain with knife-like stabbing pain during stool, can take pain medication half an hour before stool. Generally, after taking pain medication, it takes some time for the medication to take effect. Therefore, mastering the correct time to take the medicine is the key to relieving anal fissure pain.
② Sitting bath: After a bowel movement, anal fissure patients can take a sitz bath with warm water. Hot water can promote blood circulation and relieve sphincter spasm. As mentioned earlier, the severe pain after a bowel movement is caused by spasm of the sphincter muscle, so sitting in a bath with warm water is also effective in relieving the severe pain of anal fissure.
③Tui-na massage: When patients with anal fissure are in severe pain, they can be rubbed by their family members near the long strong point in front of the tip of the tailbone. By rubbing the point, the muscle spasm can be relieved and the sensation of tissue ischemic pain caused by spasm can be slowed down; at the same time, using gentle techniques such as rubbing and massage to push in the painful local area can strengthen the inhibition process of their nerves, reduce local pathological stimulation and make the local pain sensation less.
④Qigong: If there is severe pain in anal fissure, you can practice relaxation gong, which is helpful to relieve pain. Specific methods: generally take the supine position, can also take the sitting position, whether lying or sitting, the body needs to be properly placed, so that the whole body in a natural relaxation position. When lying down, the head can be slightly higher than the pillow, and at the back of the shoulders into a light slope, the two arms are naturally placed on both sides of the body, the two legs are naturally straight (Figure 1); sitting position, stretching the waist and chest, sinking shoulders and elbows, the two hands and forearms are naturally placed lightly on the thighs, the head is flat (Figure 2). The eyes are lightly closed, the mouth is naturally closed, and the tongue licks the palate. After the posture is adjusted, meditate on the words “pine” and “quiet” with the natural breathing, inhale the word “quiet” and exhale the word “pine”. According to the order of head, neck, shoulders, arms, hands, chest, abdomen, waist, hips, legs, feet, one by one with the silent recitation of the word “loose” and relax. Repeat several times, when the whole body has been relaxed, and then think about the blood vessels, nerves, internal organs, anus, according to the method of relaxation. The patient can be induced to relax with the induction words record with music, and relax with the induction words, more likely to succeed. Relaxation is practiced for about 20 to 30 minutes each time.
⑤ Regular bowel movements: Patients with anal fissures are often afraid to defecate because of the intense pain during the bowel movement, which makes the stool even drier. Therefore, anal fissure patients should develop the habit of insisting on regular bowel movements every day. If the stool is dry and difficult to discharge, you can take honey, sesame oil and other laxative foods orally every day. Keeping the bowels open is one of the most fundamental ways to relieve the pain of anal fissure.
17.What should anal fissure patients pay attention to after surgery?
After surgery, anal fissure patients should pay attention to the following aspects.
① Diet: After surgery patients, diet is based on light, easily digestible food, avoid spicy, tobacco, alcohol and other stimulating food. Generally, 2 to 3 days after surgery, it is appropriate to enter semi-fluid food such as flour, lotus root powder, vegetable soup, etc. About 1 week, Chai fish soup can be taken appropriately to facilitate wound healing.
② Stool: control no bowel movement within 48 hours after surgery. For the first stool, defecation can be done after enema in the hospital. In this way, the stimulation of the wound by stool can be reduced and the occurrence of postoperative complications such as bleeding, edema and pain can be reduced. If the stool is difficult to pass, once in several days, you can take some laxative drugs under the guidance of the doctor.
③ Removal of stitches: Patients with anal fissures who have used lateral sutures are usually removed in 5 to 7 postoperative days. Before removing the sutures, do not take a sitz bath to avoid bacteria penetrating deeper into the tissues along the sutures, causing infection and forming perianal abscesses that do not heal over time.
④Medication change: Post-operative patients, after daily stools and sitz baths, should undergo local medication change treatment in a specialized hospital. If the medical conditions are poor in the region, patients should also be under the guidance of doctors, at home by family members or myself daily local change of medicine, in order to play a role in eliminating corruption and muscle, to promote early wound healing.
18.What are the contraindications for patients after anal fissure surgery?
As the saying goes, “three parts of medicine and seven parts of nourishment”. It can be seen that how to choose food and how to reasonably arrange meals plays a very important role in the whole process of disease treatment. On the other hand, the avoidance of food is also very close to the occurrence, development and return of the disease, only know its appropriate but do not know the taboo is not comprehensive, must grasp the diet of the two aspects of the appropriate, taboo, flexible adaptations. So, what are the dietary taboos after anal fissure surgery? First of all, you should avoid tobacco, alcohol, strong tea and other foods, as well as ginger, garlic, chili, pepper and other irritating foods; in addition, there is a “taboo”, which is usually called avoid “hairy things”. For example: fish, yellow fish, carp, crucian carp, ark, clams, crabs, shrimp; vegetables, leeks, mushrooms, celery, fennel, etc., these foods are mostly sweet and warm, dry, after eating to help heat and fire, will aggravate the post-operative anal fissure symptoms.
19, anal fissure patients should be how to adjust care?
The first and foremost problem of anal fissure care is to keep the bowels open and avoid dry stools. The stool should be passed once a day. Many patients with anal fissures have a fear of defecation due to painful fissures during defecation, so that the stool stays longer in the intestine, water is absorbed again and the stool becomes drier, resulting in a vicious cycle of pain → fear of stool → dry stool. In addition, some patients believe that the thinner the stool, the better, the more frequent the daily bowel movements, the pain and damage of the fissure will be aggravated by the stimulation of defecation. Therefore, it is better to have 1 stool per day, not dry and not thin. Some patients have dry stools, discharge difficulties, they buy some laxative drugs orally, if the guide, rhubarb, senna, etc., after taking these laxatives diarrhea, can cause the intestinal fluid more reduced, it will produce the side effect of constipation, so it will form a stubborn constipation, so that the anal fissure more and more serious. So the prevention and control of constipation should never rely on laxatives, if you have to take drugs, with some laxative drugs, such as spleen about pill. This will increase the intestinal fluids and push the feces out.
Patients suffering from anal fissures can take a fumigation bath with boiling water after the stool to keep the fissure wound clean, which is an important measure to prevent and treat anal fissures. The fumigation should be done by immersing the anus into the water in order to wash away the anal dirt and allow the drug to enter the anal canal and play its proper role.
In addition, the treatment of anal fissures should be early and timely. If the fissure is fresh, most of them can heal within 1 to 2 weeks after taking Chinese herbal medicine internally and using fumigation and dressing externally. Old fissures, on the other hand, require surgery to cure. Surgical methods include fissure excision, finger dilation, and internal sphincterotomy. Generally, the surgery can gradually heal after 10-15 days, and there are no after-effects.
20.What should patients with anal fissure pay attention to in terms of diet?
Patients with anal fissures should first keep their bowels open and their stools soft in texture. Therefore, if you suffer from anal fissure, you should pay attention to the diet not to eat irritating food, such as wine, chili, ginger, garlic, onion, etc., because these irritating foods can aggravate the stimulation of the fissure, making it more and more serious; in addition, you should avoid eating warm and dry food, such as dog meat, mutton, beef, etc.. The warm and dry food enters the body and is not easy to digest, which can aggravate the condition of anal fissure. The patient with anal fissure should also avoid certain diets during the taking of drugs, such as taking detoxifying drugs, avoiding fish, shrimp, mutton, parsley, leeks, etc.; taking qi and blood tonic drugs, avoiding radish, peaches, plums, etc., otherwise it will affect the efficacy of the drug and will not achieve the desired purpose.
21.What should elderly people with anal fissures pay attention to in their lives?
Constipation has become one of the most common diseases of the elderly because of the decline of various functions of the body. Due to long-term constipation, anal fissures often occur as a result. So, if the elderly suffer from anal fissures, should pay attention to how to regulate the stool, in order to facilitate the recovery of anal fissures?
(1) Exercise: Life lies in exercise. Constipation in old age is often caused by the weakening of the diaphragm, abdominal muscles, and anal raphe muscle tone and contraction after old age, resulting in lower defecation power. Therefore, the elderly should actively participate in exercise, such as taijiquan, Mulan fan, Mulan sword and other relaxed physical exercise, to strengthen their own body function, in order to accelerate the intestinal peristalsis, improve the symptoms of constipation.
(2) diet: elderly teeth fall, more can not chew fiber-rich vegetables and fruits. Therefore, it will favor some non-fiber food, the result is bound to eat less and lack of fiber and the amount of food to the intestinal tract stimulation is weakened, thus forming constipation. Therefore, elderly people suffering from anal fissures should eat more fiber-containing foods and not eat too fine. In this way, it is conducive to improving constipation and accelerating the healing of anal fissures.
(3) Drugs: many elderly people suffer from dry stool, discharge difficulties, they will take laxatives for a long time, once stopped, but aggravate the constipation. So it becomes more dependent on laxatives, and as a result, the stress of the intestinal wall is getting lower and lower. If you don’t take laxatives or enemas, the stool stays in the rectum and can even form embedded fecal stones, which can press on the anus and produce a heavy pressure, stimulate the rectum and produce increased secretion, and from time to time, mucus flows from the anus, forming the so-called “pseudo-diarrhea”. Therefore, if the elderly suffer from anal fissures and constipation, you should take some laxative drugs, but not long-term laxatives such as rhubarb, fruit guide tablets. Otherwise, it will only aggravate the constipation and affect the early recovery of the disease.
22, how to practice anal transfer abdominal work to treat anal fissure?
The first step: turn the abdomen around 100 times each. Method: Stand naturally with both feet shoulder-width apart. Lower limbs slightly curved, both hands crossed waist, head and lower limbs do not move, mouth and eyes slightly closed, tongue licking the palate, with both hands from the left to the right to turn the abdomen a total of 100 times, then from the right to the left to turn the abdomen 100 times. Turn the abdomen with breathing, breathing should be slow and even long. Each exhale or inhale need to complete 5 times to turn the abdomen, the intention to focus on the Dantian, to exclude distracting thoughts.
The second step: qigong anal lifting, sinking anal movement. Standing and breathing requirements as above, the two hands naturally down. With the inhalation slowly anal lift, ideas from the anus up to the hundred, and then with the exhalation slowly sink the anus, ideas from the hundred will descend to the anus. An exhale and an inhale for a time, do 15 minutes each morning and evening.
This gong can effectively improve the local blood flow in the anus and thus has a certain effect on the relief of anal fissure symptoms. Therefore, before doing this gong, patients should condition their spirit, be persistent and concentrate their thoughts in order to get twice the result with half the effort and achieve the expected effect.
23.What is the effect of surgery for anal fissure?
When we evaluate the effect of various types of surgery, we mostly use HSU and Mackeigen (1984) 1743 cases of long-term chronic anal fissure various surgical treatments for comparison.
①A total of 334 cases of anal fissure resection and superficial internal sphincterotomy with partial or complete wound closure, 26.5 minutes of surgery, 2.8 injections, 4.6 days of hospitalization, 16.6% of urinary retention, 6.1% of abscesses, anal fistulas, incontinence, poor wound healing and strictures, and 13.1% of recurrences.
②Anal fissure resection and hemorrhoidectomy 874 cases, 41.7 minutes of surgery, 4.6 injections, 5.6 days of hospitalization, 31% urinary retention, 7% bleeding, abscess, anal fistula, incontinence, poor wound healing and stenosis, and 4.9% recurrence.
(iii) 89 cases of lateral sphincterotomy with 11.1 minutes of operation time, 1.6 injections of anesthetics due to pain, 2.5 days of hospitalization, 7.9% urinary retention, 1.1% wound complications abscess, and 5% recurrence.
④Multiple internal sphincterotomies were performed in 199 cases, with 15.5 minutes of surgery, 1.7 injections of anesthetic, 2.6 days of hospitalization, 8.1% urinary retention, 1.5% wound bleeding, and 5% recurrence.
⑤ V-Y plication was performed in 247 cases with 45.6 minutes of surgery, 3.3 injections, 5.2 days of hospitalization, 27.1% urinary retention, 2.4% abscess, bleeding, subcutaneous necrosis, poor wound healing and stricture, and 7.2% recurrence.
The above comparison shows the choice, advantages and disadvantages of the surgical procedure. However, the surgical procedure is not chosen exactly according to the above figures, but according to the needs of your condition.
24.How should anal fissure be prevented? What should I pay attention to in my life?
1.It is to keep the stool smooth and soft. If you have a fecal matter that stays in the colon and rectum for a long time, the water is reabsorbed and it is easy to be dry and constipated. 1 several times a day, the pain and damage will be aggravated by the stimulation of defecation, so you should defecate once a day, and the feces should not be dry or thin. The majority of patients with anal fissures have habitual constipation, and often take laxatives such as fruit guide and rhubarb to make their stools thinner, which have the side effect of causing constipation after diarrhea, resulting in more and more anal fissures. The actual fact is that you can’t get a lot of money from the company, but you can get a lot of money from the company. Stimulating foods such as alcohol, tobacco, chili, squash, ginger, garlic, etc. should be avoided or eaten sparingly. Drink a glass of cool boiled water every morning on an empty stomach before bedtime to take traditional Chinese medicine maren pills, honey, etc. to promote bowel movements.
2, should develop the habit of regular morning defecation, because the upright reflex and gastrocolic reflex after waking up in the morning, can promote defecation.
3.Participate in a variety of physical activities in the morning, such as exercise, running, taijiquan, qigong, etc., can prevent constipation and anal fissure.
4, timely treatment of various diseases that cause anal fissures, such as ulcerative colitis and other diseases, to prevent anal fissures.
5, women should pay attention to hygiene during menstruation, do not participate in heavy physical labor. During pregnancy, you should eat more fruits and vegetables to prevent constipation. Pay attention to protecting the perineum when giving birth, do not tear the perineum and anus.
25.What should I do if I have an anal fissure in infants and children?
Anal fissure attacks are painful and can affect the child’s health and life, when these measures can be taken.
Keep the bowels open and train your child to develop the good habit of having bowel movements on time every day. Not being picky about food, not being partial to food, drinking a certain amount of water and eating a certain amount of fresh vegetables every day can help keep the stool open. Once constipation occurs, you can eat some bananas, if necessary, you can also let the child take some Chinese medicine such as maren zhi spleen nine, so that the stool becomes softer and easier to discharge.
For children with anal fissures, parents should let them wash with a 1:5000 solution of potassium permanganate in warm water or Chinese herbal medicine such as compound scutellaria granule solution after each stool, so that the ulcers will be easily healed. Some anal fissure ointment can also be applied if necessary.
If the anal fissure is long, you can cauterize the ulcer with 20% silver nitrate and then wash away the excess silver nitrate with a cotton swab dipped in saline, once a day, which also works quickly.
26.How to choose topical drugs for anal fissure patients?
The topical drugs: Chinese and Western drugs, such as Chinese medicine, such as four yellow cream, Huanglian cream, Yulu cream, Jinhuang Ruyi cream with anti-inflammatory, anal pain, hemostatic, remove corruption and muscle, directly put on the anal fissure, can promote ulcer healing and treatment of anal fissure; Western medicine, such as antibiotic ointment, such as tetracycline, gentamycin, etc., can control and prevent the role of infection; external application of chymotrypsin can promote the healing of anal fissure wound; ulcer bleeding In the case of bleeding ulcers, thrombin and Yunnan Baiyao can be applied to the anal fissure; for obvious pain, benzocaine or dacronin ointment or dicaine ointment can be applied, which has good pain relief function.
Suppositories: such as anti-inflammatory pain suppositories, chlorhexidine hemorrhoid suppositories, Ma Yinglong hemorrhoid suppositories, etc., stuffed into the anus after the stool, can play an anti-inflammatory and pain relief effect.
27.How to treat anal fissure early?
Early prevention and treatment of anal fissures should be advocated, and early onset anal fissures can be cured by conservative treatment.
1, to keep the stool smooth: dry stool, can take oral laxative laxative drugs, such as if the guide tablets, hemp pill, paraffin oil, castor oil, senna leaf water, rhubarb, etc..
2, sitz bath, keep the anal part clean: fumigate sitz bath with warm water after stool or fumigate with our homemade Chinese medicine compound scutellaria granules in water to keep the anal fissure wound clean, which is an important measure to prevent and treat anal fissure. This is an important measure to prevent and treat anal fissures. When fumigating, the anus should be immersed in the liquid in order to wash away the anal dirt, so that the drug can enter the anal canal and play the role of anti-inflammation, pain relief and promote the healing of fissures.
3.External drugs: anal local Huanglian cream, Jiuhua cream and other external application.
4, enema using Chinese and Western drugs for retention enema. For example, 0.5% procaine solution enema is often used to relax the anal sphincter, which is beneficial to the healing of the wound.
Most fresh anal fissures can be healed within 1 to 2 weeks after treatment with herbs and other drugs. With the above treatment, symptoms can usually be improved or even be seizure-free for many years. For chronic and recurrent anal fissures, surgical treatment by manipulation or TCM is recommended. Manual treatment, i.e. anal dilation, can heal old anal fissures. TCM surgery is divided into ligation, hanging, and lateral incision, which are chosen by the doctor according to the condition. Old anal fissures often require the administration of surgery to cure them. Therefore, if there is no significant improvement, a specialist should be consulted or surgery should be performed.