I. Definition and characteristics
A full longitudinal fracture of the skin of the anal canal with the formation of an infected ulcer is called anal fissure. The disease is most common in young and middle-aged women. The site of anal fissure is usually in the anterior and posterior median position of the anus, especially in the posterior position, and fissures located in the anterior median line are mostly seen in women. The main clinical features are periodic anal pain, bleeding and constipation. In Chinese medicine, this disease is called “hooked hemorrhoids” and “fissured hemorrhoids”, etc.
Diagnosis
(a) Symptoms
Pain Periodic pain is the main symptom of anal fissure. Pain during defecation lasts for several minutes, followed by severe pain due to continuous spasmodic contraction of the sphincter, until the pain is gradually relieved after the sphincter is fatigued and relaxed, and this process is the anal fissure pain cycle.
2. Bleeding Bleeding during stool, small amount, bright red.
Constipation Most patients have habitual constipation, which is aggravated by the fear of pain during stool, forming a vicious circle.
(B) Physical examination
Longitudinal fissures or longitudinal pike ulcers of the anal canal can be seen at the time of consultation, mostly located at 6 and 12 o’clock of the truncus position. Complications such as superfluous external hemorrhoids and enlarged anal papillae can be seen in old anal fissures.
(III), classification
1.Early anal fissure has a short onset and only a small ulcer is seen on the skin of the anal canal, with a shallow, bright red wound and neat, elastic edges.
2.Old anal fissure Early anal fissure is not properly treated and continues to be infected.
III. Treatment
Early anal fissures can be treated conservatively, while old anal fissures mostly need to be treated surgically. During the treatment, attention should be paid to prevent constipation and release the spasm of sphincter to interrupt the vicious cycle and promote the healing of anal fissure.
(I) Discriminatory treatment
1. Internal treatment
Blood-heat and intestinal dryness: two or three days of one line of stool, dry and hard, pain in the anus during stool, blood dripping from the stool or blood staining the hand paper, red color of the fissure, abdominal distension, yellow urine. The tongue is red and the pulse is stringy. Treatment is to clear heat and moisten the bowels, the formula cool blood Dihuang Tang combined with spleen about Ma Ren Wan.
Yin deficiency and fluid deficiency: dry stool, one line for several days, painful dripping blood at the time of stool, deep red fissure. Dry mouth, dry throat, irritable heat in the five hearts. Red tongue, little or no coating, fine pulse. The treatment is to nourish Yin, clear heat and moisten the bowels, the prescription is to moisten the bowels.
Qi stagnation and blood stasis: Stabbing pain in the anus 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. The treatment is to regulate Qi and activate Blood, moisten the bowels and open the bowels. The formula is Liu Mo Tang with safflower, peach kernel and red peony.
2.External treatment
①Early anal fissure Available raw muscle yu red ointment dipped in raw muscle san, apply to the fissure. Take a sitz bath with potassium permanganate solution or bitter ginseng soup or pepper salt water every day after defecation.
② old anal fissure Available seven three dan or orange hemorrhoid san and other corrosive drugs applied to the fissure, two, after the decay off, change to use the raw muscle san to close the mouth. Can choose closed therapy, in the long strong point or fissure base injection of long-lasting pain relief solution.
(II), other therapies
For old anal fissures and early anal fissures for which non-surgical treatment is ineffective, surgical treatment can be considered and different surgical methods can be selected according to different situations.
1.Anal expansion method
Indications Applicable to early anal fissure without comorbidities such as connective tissue external hemorrhoids and anal papillomegaly.
2.Cutting therapy
Indications Applicable to old anal fissures with connective tissue hemorrhoids, papillary hypertrophy, etc.
3.Anal fissure lateral excision
Indications Applicable to old anal fissure not accompanied by connective tissue external hemorrhoids, subcutaneous fistula, etc.
Prevention and regulation
1.Cultivate good bowel habits and treat constipation in time.
2. The diet should contain more vegetables and fruits to prevent dry stools and avoid abrasion of the anus by coarse and hard stools.
3, pay attention to anal cleanliness, avoid infection. After the occurrence of anal fissure, early treatment is advisable to prevent the secondary development of other anal diseases.