Treatment routine of anal fissure
Anal fissure is an inflammatory disease in which the entire skin of the anal canal splits and ulcers form. Anal fissures are often a single fissure, with the vast majority occurring in the posterior median line of the anal canal, followed by the anterior median line (more common in women), and very rarely laterally. Anal fissures are a common anal canal disorder, second only to hemorrhoids in the incidence of anal disorders, and a common cause of severe pain at the anal canal in young people. It is characterized by periodic anal pain, bleeding and constipation.
I. Diagnosis and diagnostic basis
1.Symptoms
Pain: The pain is directly related to defecation and can be radiated to the sacrococcygeal area, especially when the stool is dry, and in typical cases, the pain is light during defecation and heavy after defecation, first light and then heavy, with intermittent intervals, showing a special pain cycle. The pain is highlighted by the fact that the pain that occurs a few moments after defecation is much more intense than when defecating, and there is often a small rest before the onset of severe pain, which is called the pain interval.
Bleeding: Bleeding is sporadic and usually not much, but it may appear as blood on hand paper or blood dripping from the stool, with bright red color.
Itching: due to secretions from anal fissure ulcers or stimulation by secretions produced by anal sinusitis and anal papillitis, which are complicated by anal fissure.
Constipation is one of the causes of anal fissures, which in turn can cause constipation and severe pain in the anus during defecation.
Patients often have a fear of stool, so artificially control defecation, resulting in the stool in the rectum for too long, too much water absorption and more dry, defecation more difficult, thus forming a vicious circle.
2. Physical signs
The examination of anal fissure should be based on visual diagnosis, the patient should be in a suitable position, the inspector with both thumbs will gently separate the anal edge skin to both sides. A poke-shaped ulcer can be seen in the skin of the anal canal migration area, and if the ulcer surface is lightly touched with a probe, it can cause obvious pain. In old anal fissures, the ulcer surface is gray with a deep base and thickened edges, and a fissured hemorrhoid can be formed at the lower end of the ulcer.
3.Stage of anal fissure
There are various stages of anal fissure, but the following are more practical in clinical practice.
Early anal fissure: there is a shuttle-shaped ulcer in the epithelium of the anal canal, with shallow trauma, neat and elastic edges, fresh base, no obvious scar, and easy healing.
Old anal fissure: due to frequent contraction of the sphincter, the ulcer surface is infected and the wound surface is poorly drained, resulting in hardening and thickening of the ulcer margin, inflammation, congestion, edema, fibrosis, obstruction of venous and lymphatic flow, causing edema and connective tissue hyperplasia. It is often combined with pathological changes such as anal papillomegaly, superfluous external hemorrhoids (sentinel hemorrhoids) and subcutaneous fistula.
Differential diagnosis
1.Anal canal epithelial carcinoma: the ulcer is uneven, irregular in shape, with hard raised edges, surrounded by inflammatory infiltration, with persistent pain and special odor, if the tumor invades the sphincter, anal relaxation or incontinence can be seen.
2.Anal skin fissures: can occur in any part of the anal canal, its fissures are superficial, only seen under the skin, often seen in several fissures at the same time, light pain, little bleeding, no ulcers, fissured hemorrhoids, anal papillary hypertrophy and other complications, itching symptoms are obvious.
3, Crohn’s disease anal canal ulcers: ulcers can occur in any part of the anus, which is characterized by irregular ulcer shape, deep bottom, subterranean edges, often coexisting with anal fistula. Also accompanied by a series of features of Crohn’s disease such as anemia, abdominal pain, diarrhea, intermittent low-grade fever and weight loss.
III. Treatment
General treatment.
1, dietary regimen: reasonable diet, more fiber-containing foods, such as vegetables and fruits, avoid eating spicy fried products and excessive alcohol consumption.
2, living hygiene: regular life, living sometimes. The anal area should be kept clean, after the stool and before bedtime warm water bath, cleaning the anus, in order to reduce the stimulation of the anus.
3. Treatment of other diseases: those suffering from anal cryptitis, anal eczema and dermatitis should be treated in time to avoid inducing anal fissures. Actively treat the epithelial damage of the anal canal caused by various reasons to prevent its secondary infection and ulcer formation.
Western medicine treatment
1. Treatment principles: Treatment of anal fissure includes non-surgical treatment and surgical treatment. Except for old anal fissures that do not heal for a long time, non-surgical treatment can be used in general.
2. Specific measures and drugs: The treatment principle is to eliminate the symptoms of anal fissure and promote the healing of fissures.
Treatment routine of anal fissure
Anal fissure is an inflammatory disease in which the whole layer of skin of the anal canal is cracked and an ulcer is formed. Anal fissures are often a single fissure, with the vast majority occurring in the posterior median line of the anal canal, followed by the anterior median line (more common in women), and very rarely laterally. Anal fissures are a common anal canal disorder, second only to hemorrhoids in the incidence of anal disorders, and a common cause of severe pain at the anal canal in young people. It is characterized by periodic pain in the anus, bleeding, and constipation.
I. Diagnosis
Diagnosis based on
1.Symptoms
Pain: The pain is directly related to defecation and can be radiated to the sacrococcygeal region, especially when the stool is dry, and in typical cases, the pain is light during defecation and heavy after defecation, first light and then heavy, with intermittent intervals, showing a special pain cycle. The pain is highlighted by the fact that the pain that occurs a few moments after defecation is much more intense than when defecating, and there is often a small rest before the onset of severe pain, which is called the pain interval.
Bleeding: Bleeding is sporadic, usually not much, but it may appear as blood on hand paper or blood dripping from the stool, with bright red color.
Itching: due to secretions from anal fissure ulcers or stimulation by secretions produced by anal sinusitis and anal papillitis, which are complicated by anal fissure.
Constipation is one of the causes of anal fissures, which in turn can cause constipation and severe pain in the anus during defecation.
Patients often have a fear of stool, so artificially control defecation, resulting in the stool in the rectum for too long, too much water absorption and more dry, defecation more difficult, thus forming a vicious circle.
2. Physical signs
The examination of anal fissure should be based on visual diagnosis, the patient should be in a suitable position, the inspector with both thumbs will gently separate the anal edge skin to both sides. A poke-shaped ulcer can be seen in the skin of the anal canal migration area, and if the ulcer surface is lightly touched with a probe, it can cause obvious pain. In old anal fissures, the ulcer surface is gray with a deep base and thickened edges, and a fissured hemorrhoid can be formed at the lower end of the ulcer.
3.Stage of anal fissure
There are various stages of anal fissure, but the following are more practical in clinical practice.
Early anal fissure: there is a shuttle-shaped ulcer in the epithelium of the anal canal, with shallow trauma, neat and elastic edges, fresh base, no obvious scar, and easy healing.
Old anal fissure: due to frequent contraction of the sphincter, the ulcer surface is infected and the wound surface is poorly drained, resulting in hardening and thickening of the ulcer margin, inflammation, congestion, edema, fibrosis, obstruction of venous and lymphatic flow, causing edema and connective tissue hyperplasia. It is often combined with pathological changes such as anal papillomegaly, superfluous external hemorrhoids (sentinel hemorrhoids) and subcutaneous fistula.
Differential diagnosis
1.Anal canal epithelial carcinoma
The ulcer is uneven, irregular in shape, with hard and raised edges, surrounded by inflammatory infiltration, with persistent pain and special odor, and if the tumor invades the sphincter, anal relaxation or incontinence can be seen.
2.Anal skin fissure
It can occur in any part of the anal canal, its fissures are superficial and only seen under the skin, often several fissures exist at the same time, with light pain, little bleeding, no ulcers, fissured hemorrhoids, anal papillary hypertrophy and other complications, with obvious itching symptoms.
3, Crohn’s disease anal canal ulcers
Ulcers can occur in any part of the anus and are characterized by irregular ulcer shape, deep bottom and submerged edges, often coexisting with anal fistula. Also accompanied by a series of features of Crohn’s disease such as anemia, abdominal pain, diarrhea, intermittent low-grade fever and weight loss.
III. Treatment
General treatment
1. Dietary regimen: eat a reasonable diet, eat more fiber-containing foods such as vegetables and fruits, and avoid spicy and fried products and excessive alcohol consumption.
2.Healthy living
Live a regular life and live at regular intervals. You should keep your anus clean. You can take a warm water bath and cleanse your anus after defecation and before going to bed to reduce the stimulation of the anus.
3.Treat other diseases
Those who suffer from anal cryptitis, anal eczema and dermatitis should be treated in time to avoid inducing anal fissure. Actively treat the epithelial damage of the anal canal caused by various reasons to prevent its secondary infection and ulcer formation.
Western medicine treatment
1.Treatment principles
The treatment of anal fissure includes non-surgical treatment and surgical treatment. Except for old anal fissures that do not heal for a long time, non-surgical treatment is generally available. The principles of treatment are: to eliminate the symptoms of anal fissure and to promote the healing of fissures.
2.Specific measures and drugs
Conventional treatment
Wash the affected area with physiological saline or 1:5000 potassium permanganate solution or sitz bath once or twice a day for 15 to 30 minutes each time.
Vaseline oil gauze or gentamycin eye ointment, Botrytis oil ointment change, 2 times a day.
Symptomatic treatment
Pain: relief of pain, oral Tramadol extended-release tablets lOOmg twice daily, depot 2 tablets 3 times daily, or sublingual nitroglycerin 10mg each time if necessary. morphine should not be used as it can cause constipation and affect the healing of anal fissure.
Bleeding: take vitamin C 200mg orally 3 times a day, vitamin l