Keywords】Anal fissures left untreated for a long time can also lead to ulcers and repeated inflammation, causing pain that is difficult to heal. Long-term blood in the stool will lead to blood pooling under the skin, forming a bulging hematoma, forming thrombosed external hemorrhoids; fissure wound fibrous tissue proliferation will form scars, causing anal stenosis; wound infection and inflammation, often leading to anal papillomegaly or even perianal abscess, which then leads to anal fistula. These add to the difficulty of thorough treatment. Therefore, it is best to treat anal fissures in a timely manner and not to delay. Anal fissure is a common disease, ranking second in the incidence of anorectal diseases, after hemorrhoids. Because the symptoms are similar to those of hemorrhoids, it is not easy for the general public to distinguish between them. The difference between anal fissures and hemorrhoids is that: a. Hemorrhoids generally bleed more than anal fissures. Although external hemorrhoids can be painful during acute attacks, they do not have a clear pattern of pain like anal fissures. The acute fissure is the early stage of the fissure and is less severe; the chronic fissure is deeper and repeatedly does not heal, and scar tissue forms around the fissure, or is accompanied by external hemorrhoids, enlarged anal papillae and anal fistulas. Why does anal fissure form? The internal sphincter of the anus is stimulated by acid and intestinal dirt and spasms occur, resulting in local ischemia of the anal canal; at the same time, the anal canal does not stretch normally during defecation, resulting in obstruction to the discharge of stool. In young people, the sensitivity of the internal sphincter is higher, and the incidence of fissure is higher because of irregular diet and life and constipation. In children, the anal sphincter is not yet mature, and the diet is low in vegetables and coarse fiber, so the stool is coarse and hard, which also makes it more frequent. In women, the perineal sphincter is weaker, especially during menstruation and pregnancy, which causes pelvic congestion and poor reflux, and also during childbirth, which causes the anal canal to tear easily due to ischemia. How to prevent anal fissure? First of all, to correct constipation; secondly, the diet is mainly light and vegetarian, to prevent the bad stimulation of the anus by irritating stool; finally, to keep the anus clean and hygienic to prevent infection. If you get anal fissure, you should treat it in time, otherwise, acute can turn into chronic, and it can be cured by medicine, but it must be treated by surgery. If chronic is not treated, it can lead to constipation, cramps, and fissures that affect and aggravate each other, and even lead to gastrointestinal disorders and anorectal neurosis. Long-term untreated fissures can lead to ulcers and recurrent inflammation, causing pain that is difficult to heal. Long-term blood in the stool will lead to blood pooling under the skin, forming a bulging hematoma, forming thrombosed external hemorrhoids; fissure wound fibrous tissue proliferation will form scars, resulting in anal stenosis; wound infection and inflammation, often leading to anal papillomegaly or even perianal abscess, and then fistula. These add to the difficulty of thorough treatment. Therefore, it is best to treat anal fissures in a timely manner and not to delay. The treatment of anal fissures: can be divided into Chinese and Western medicine combined treatment, Chinese medicine will be divided into three types of anal fissures, according to the different types of evidence to treat. 1. Blood-heat and intestinal dryness: two or three days of stool, dry and hard, blood dripping from the stool or blood-stained paper, anal pain, abdominal distension, yellow urine, red fissure, reddish tongue, yellow dry coating, and stringy pulse. Treatment: Clearing heat and dipping fire, increasing fluid and relaxing stool. Recommended formula: Cool Blood and Dihuang Tang. 2.Yin deficiency and fluid deficiency: dry stool for several days and one line, painful drops of blood in the stool, dry mouth and throat, irritability of the five hearts, deep red fissure, red tongue, little or no moss, thin pulse. Treatment: Cool the blood and nourish it, increase fluid and relax the stool. Recommended remedy: Run intestinal pills. 3. Qi stagnation and blood stasis: stabbing pain in the anus, especially after defecation, tightening of the anus, purple and dark fissure, purple and dark tongue, string or astringent pulse. Treatment: Promote the circulation of Qi and Blood, moisten the bowels and open the bowels. Recommended formula: Liu Mo Tang. Treatment of anal fissure is based on oral Chinese medicine, external Chinese medicine and anal dilation and surgery. Non-surgical treatment includes anal dilation to release the spasm of sphincter muscle and relieve the pain, oral administration of apricot drainage honey and mare’s intestinal pills to soften the stool, and Chinese herbal fumigation and sitz bath to stop the vicious cycle and promote the healing of the trauma while relieving the accompanying complications. For long-standing anal fissures that do not heal and for which non-surgical treatment is ineffective, surgical treatment can be used, and our hospital mainly adopts the following procedures (1) partial lateral internal sphincterotomy: it is currently the most commonly chosen procedure, which can effectively reduce the complications and recurrence rate of surgery. The specific operation method: the patient takes a lithotomy position, after sacral anesthesia or local anesthesia, a shuttle-shaped incision is made at 5 or 7 points about 1.5 cm from the posterior anal margin, the index finger reaches into the anus and touches the intersphincteric groove, holds a curved forceps to enter from the incision, enters along the subcutaneous to the intersphincteric groove of the anal canal subcutaneously, under the guidance of the index finger, picks up and cuts off part of the internal sphincter, the finger diagnoses the anal relaxation, the intersphincteric groove above the visible fissure The fissure is then partially excised to expose the fresh wound, and pressure dressing is applied after surgery. (2) Posterior internal sphincter partial excision: directly cut the lower edge of the internal sphincter with the anal fissure, sometimes also cut the lower part of the internal sphincter, if there is inflammation anal fistula, hypertrophic anal papilla can be removed at the same time, the incision is open, healing is slow, occasionally lock hole deformity. Specific operation method: The patient is placed in a lithotomy position, and after sacral or local anesthesia, the skin is routinely disinfected and incised in the shape of “△” on both sides of the anal fissure, with the low end starting 1.5 cm outside the anal verge and the top ending 0.3 cm above the dentate line, and the bottom width 0.5 cm. Lift the skin of the bottom incision with tissue forceps and sharply separate the subcutaneous hard fibrotic tissue external hemorrhoids (sentinel hemorrhoids) and hypertrophic anal papillae upward, and remove them together. (3) Anal fissure hanging wire surgery: Applicable to anal fissure with subterranean fistula. To avoid postoperative pain, local injection can be given to incorporate painkillers, which is suitable for outpatient treatment. Specific operation method: After successful anesthesia, take a truncated position: sterilize and lay a sterile empty towel, first finger diagnosis, then gently expand the anus to accommodate three transverse fingers, make a radial incision in the skin of the external anal margin of the fissure, about 1.5 cm long, insert a ball probe through the lower part of the external sphincter skin and internal sphincter from the small incision, under the guidance of the left index finger in the anus, look for the posterior anal sinus, the left index finger against the probe head gently from the upper end of the fissure anal sinus The skin of the anal margin is cut, the pectineum is excised, and the submerged skin on both sides of the fissure, sentinel hemorrhoids, hypertrophic anal papilla and subcutaneous fistula are removed. The wound is then shaped like a “△”. A silk loop with a rubber band was hung on the spherical probe and then withdrawn, and the lead was led to the outside of the anus, the inner and outer ends of the rubber band were pulled tight, clamped, and the thick silk ligated under the clamp. After the operation, we gave oral in-hospital preparation of postoperative drink (Gong Ying, Di Ding, Ze Xie, Poria and other 10 herbs) to clear heat and detoxify the toxins, reduce swelling and disperse knots, and facilitate urination. Anti-inflammatory drink (11 herbs including Phellodendron, Scutellaria, Radix et Rhizoma, Pollen) clears heat, dampness, diuresis and detoxification. The effect is remarkable. At present, I have been using the most advanced p.m.m. technology and a new generation of digital display rectal testing equipment. It is the most advanced p.m.m technology and the new generation of digital display rectal testing equipment. Regardless of the severity of the disease. HCPT non-surgical minimally invasive technology is characterized by computer monitoring, automatic alarm at the end of treatment, short treatment time, less trauma, no pain, no carbonization, no crust, no odor, good vascular closure, no bleeding, safe and reliable, no infection, no sequelae and complications, in addition, no hospitalization, with the treatment, does not affect normal life and work. The second step: many anal fissure patients think that even if the symptoms of anal fissure are relieved, they are cured of anal fissure, in fact, this understanding is wrong. The “source” of anal fissures – constipation – should not be forgotten. If constipation is not removed, it will aggravate and trigger new anal fissures again, so it is best to eliminate constipation along with the treatment of anal fissures. For the treatment of constipation, Jinan Anal Hospital uses colon hydrotherapy to cleanse the entire intestine with sterilized and filtered 38-degree constant temperature sterile pure water. By removing the intestinal stool and toxins, cultivating the growth of beneficial bacteria to improve the intestinal environment, restore the normal peristaltic function of the intestine, enhance their own immune function, and completely eliminate constipation. If there are other diseases that cause anal fissures, it is timely examination and active treatment of the original disease.