I. Drug treatment
Stage I anal fissure can usually be controlled or cured by 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 spasm of sphincter. 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 blockers, if not commercially available can be homemade, using 30mg of diltiazem tablets crushed and mixed with 15g of petroleum jelly. Diltiazem, a calcium channel blocker, can act as a vasodilator and release smooth muscle spasm by inhibiting the transport of extracellular calcium ions into the cell, and was mainly used orally for the treatment of angina pectoris and hypertension. 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%.
Second, simple treatment
1.Anal dilation
Anal dilation is mainly applied to stage I and II anal fissures.
Dilate the anus with fingers or instruments (you can use the flapper anoscope commonly used in the anorectal department). This method is easy to operate and effective in relieving severe anal pain, but it can recur and can be complicated by anal hematoma, bleeding, short time anal incontinence and other adverse reactions. 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.
Third, surgical treatment
Anal fissure excision and anal canal release surgery 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
The majority of patients will be cured after medication or surgery, and only a very small number of patients will have recurrent attacks.
Prevention
It is important to maintain a relaxed and happy state of mind. Treatment and prevention of constipation is the most important way to prevent recurrence of anal fissures. Pay attention to anal cleanliness and hygiene, develop the hygiene habit of cleaning the anus in time after defecation, and treat perianal inflammatory diseases such as anal sinusitis, anal papillitis, perianal eczema and perianal skin disease in time. Doing so can effectively prevent the occurrence and recurrence of anal fissures.