Anal Fissure

　　Anal fistula is mostly caused by general suppurative infection, and a few are caused by specific infection. Such as tuberculosis, Crohn's disease. Ulcerative colitis is less common, and secondary infection caused by rectal and anal trauma can also form fistula. Rectal and anal malignant tumors can also溃破成瘘管，but they are rare and have obvious differences from general suppurative anal fistula.

　　Common causes of anal fistula:

　　First, sex hormone factors, excessive secretion of androgens may be related to the high incidence of anal fistula in males. According to statistics, a large number of neonates have anal fistula (more in males), children are very rare, young and middle-aged males are the most, and the elderly are rare. The main reason is that the maternal androgen and adrenal androgen in neonates are strong, and the body's own sex hormones begin to be active during puberty. Subsequently, some sebaceous glands, especially the anal glands, begin to develop and proliferate, which is more obvious in males than in females. As the level of androgens in the elderly decreases, the anal glands atrophy, and the chance of anal gland infection decreases.

　　Second, special infections, such as tuberculosis bacilli and actinomycetes infections in rectal cancer, and infections of multiple rectal polyps can lead to anal fistula.

　　Third, poor venous return of the anal veins, frequent local congestion, malnutrition of the tissue, and poor healing. Abscesses formed by infections such as tuberculosis bacilli and actinomycetes, and Crohn's disease that is difficult to heal can form special anal fistula.

　　Fourth, diseases of adjacent organs, such as sacral tuberculosis, osteomyelitis, and infection of pre-sacral cysts after incision and drainage or rupture, can form anal fistula.

　　Fifth, there is a certain amount of pressure in the rectum, which can constantly and continuously allow rectal infectious substances such as feces and gas to enter the fistula through the internal orifice, stimulate the cavity wall, and then be discharged from the external orifice after secondary infection, which is also a cause of fistula formation.

　　Sixth, overeating of rich and sweet foods, strong wine, overexertion, and excessive sexual activity can also cause anal fistula.

　　An untreated anal fistula can cause anal itching, lead to anal incontinence, and in a few patients, there is a risk of cancer. Let's follow the expert to see what the dangers of not treating an anal fistula are.

　　1. Infection and pus discharge

　　After the anal fistula is infected and inflamed, the anal pain is severe. After rupture, the pus pollutes the underwear, and the pus stimulates the local skin, causing severe anal itching. Over time, it can cause the body to become weak and thin, spiritless, the ability to resist diseases to decline, and the attacks to become more frequent, forming a cause and effect.

　　2. Increase in fistula and fistula tube

　　Repeated recurrence of anal fistula can cause pus to penetrate the wall of the tube and spread along the anal sphincter space to form multiple and complex anal fistulas. Not only does it make treatment difficult, but it also affects the physiological function of the anus.

　　3. Risk of canceration

　　The multifocality of anal fistula can form rectovaginal fistula, rectourethral fistula, and rectovesical fistula, threatening surrounding organs. Moreover, old anal fistulas that have not been treated or misdiagnosed for many years have the possibility of canceration.

　　4. Anal incontinence

　　Allowing the anal fistula to develop can cause serious damage to the anal sphincter, even possibly causing complications such as anal incontinence.

　　In addition, long-term chronic inflammation stimulation can stimulate abnormal cell proliferation, leading to malignant lesions. Moreover, long-term bacterial infection can also lead to canceration. Therefore, patients with anal fistula must go to regular hospitals for examination and treatment in time and should not blindly diagnose and treat themselves.

　　Anal fistula is a common anal disease. It is very painful to have this disease, so mastering the correct symptoms of anal fistula is of great importance for treatment. Here, I introduce the typical symptoms of anal fistula.

　　1. Discharge of pus

　　This is the main symptom. The amount of pus is related to the length and amount of the fistula tube. New fistulas discharge more pus. The secretion stimulates the skin and causes itching and discomfort. When the external opening is blocked or pseudo-healed, the pus in the fistula tube accumulates, locally swells and hurts, even causes fever. Later, the sealed fistula opening breaks, and the symptoms begin to disappear.

　　The main symptom is the discharge of a small amount of purulent, bloody, and mucous secretions from the external opening of the anal fistula. Larger high anal fistulas, because the fistula tube is located outside the sphincter, not controlled by the sphincter, often have feces and gas discharge.

　　2. Pain

　　When the fistula tube is unobstructed and without inflammation, there is usually no pain, only local swelling and discomfort, which is exacerbated when walking. When the fistula tube becomes infected or the pus discharge is not smooth and becomes swollen and inflamed, pain may occur. Internally, there is often a feeling of heat and discomfort in the lower rectum and anal area, and pain during defecation.

　　3. Itching

　　Due to the continuous stimulation of pus on the perianal skin, there is often itching, perianal dampness and discomfort, skin discoloration, and epidermal shedding. The proliferation and thickening of fibrous tissue, sometimes forming eczema.

　　4. Impaired defecation

　　If the complex anal fistula does not heal for a long time, it can cause large fibrotic scars or ring-like tendons around the anal rectum, affecting the relaxation and closure of the anus, making it difficult to defecate and feeling incomplete defecation.

　　5. General symptoms

　　During the acute inflammatory period and the recurrence of complex anal fistula, varying degrees of fever, or accompanied by emaciation, anemia, and physical weakness, may occur as long-term chronic consumption symptoms.

　　These symptoms such as anal fistula discharge are common in anal fistula. Some anal diseases like anal abscess also have the manifestation of abscess. Everyone should be good at differential diagnosis, check and diagnose in time, and receive treatment as soon as possible.

　　肛瘘是很多人的难言之隐，带来的不仅仅是病痛，还有生活上的不便。那么如何预防肛瘘呢?肛瘘患者的自我调养尤为重要，它不仅能改善局部不良环境的刺激，同时也为治疗及预后提供了良好的基础。

　　1、建立正常的膳食习惯。因肛瘘的发生与湿热有关，对于油腻饮食，可以内生湿热，所以不宜多吃。应多吃清淡含丰富维生素的食物，如绿豆、萝卜、冬瓜等新鲜蔬菜、水果。对经久不愈的肛瘘多为虚证，饮食上多吃含蛋白质类食品，如瘦肉、牛肉、蘑菇等。

　　2、及时治疗肛窦炎、肛乳头炎以免发生肛管直肠周围脓肿及肛瘘。

　　3、肛门灼热不适、肛门下坠者要及时查清原因，及时治疗。

　　4、防治便秘和腹泻对预防肛管直肠周围脓肿有重要意义，因为大便干结容易擦伤肛窦，再加上细菌侵入而感染。腹泻者多半有直肠炎和肛窦炎的存在，可使炎症进一步发展。

　　5、不积极治疗可能会引起肛管直肠周围脓肿的全身性疾病，如溃疡性结肠炎、克隆氏病等。

　　6、每日排便后坐浴保持肛门清洁，对预防感染有积极作用。

　　另外，当肛瘘感染化脓时，可借用消毒的针头挑破外口，清除脓液，也是一种很好的护理措施，既可缓解胀痛，又能预防脓液向其它部位蔓延。局部可常用清热解毒的中草药，煎汤外洗。

　　肛瘘是一种反复发作的，困扰很多患者的疾病。得了肛瘘怎么办?治疗肛瘘首先是要进行准确的肛瘘诊断。肛瘘的诊断并不困难，但要正确地寻找到瘘管的走向、瘘管的内口却是不太容易的。因此，掌握肛瘘的正确的检查方法非常重要。

　　1、望诊

　　可见外口常在肛门周围皮肤上或臀部形成一突起或凹陷。周围皮肤因脓液刺激，常有脱皮发红，有时有肉芽组织由外口内突出。周围皮肤红紫色，多为结核性瘘管。

　　2、触诊

　　低位肛瘘之瘘管，在皮下可以摸到绳状硬条，由外口行向肛门，用指按压，有脓液由外口流出。

　　3、直肠指检

　　常在肛管后侧、齿线附近可摸到中心凹陷的小硬结，有轻微压痛，即是原发内口。

　　4、全身检查

　　肛瘘虽然表现为局部病变，但也与全身情况或某些疾病相联系，绝不能忽视全身检查。活动性肺结核患者发生肛瘘，往往为结核性肛瘘，且术后创口愈合较慢;骶髂骨结核患者发生的肛瘘，有可能是骨结核所引起的;非特异性溃疡性结肠炎，有时也因并发肛门脓肿，破溃后形成肛瘘等。对复杂性肛瘘更应注意全身检查，必要时作细菌培养和抗生素敏感试验，并注意血沉、血象变化。

　　Anal fistula is a troublesome disease for patients. Many patients have been troubled by this disease for a long time, which is a serious threat to our health. We all hope to be cured completely. At the same time, we should also pay attention to dietary rules during the treatment process. Let's take a look at the points to note in diet together.

　　Points to note in diet:

　　1. Anal fistula patients should pay attention to dietary health, try not to use grilled foods, and also reduce the intake of fried foods, which are easy to exacerbate the symptoms of anal fistula patients.

　　2. In daily life, develop good living habits, pay attention to dietary health, eat more light and nutritious foods, and eat less spicy and刺激性 foods, and fried and fried foods to prevent the exacerbation of anal fistula symptoms.

　　3. When anal fistula patients supplement nutrition, they must also pay attention not to eat warm-nourishing foods, and can use nourishing foods for nutritional supplementation.

　　What foods are good for anal fistula patients?

　　1. Chronic anal fistula is mostly due to deficiency, and the diet should include foods rich in protein and other nutrients, such as lean meat, beef, mushrooms, jujube, sesame, etc.

　　2. Foods for the prevention and treatment of deficiency include black fungus, yam, coriander, chive, eggplant, coix seed, water chestnut, lotus root, fennel, lychee, chicken, lamb, and fig.

　　3. The occurrence of anal fistula is closely related to dampness and heat, so foods that produce dampness and heat should be limited, and the habit of smoking, drinking, and tea should be戒除. Eat more light and rich in vitamins, such as winter melon, luffa, mung bean, radish, etc.

　　What should anal fistula patients not eat?

　　1. Avoid foods that cause heat and inflammation, such as fish, shrimp, crab, and fried and grilled foods; eat more light and easy-to-digest foods, as well as fresh fruits and vegetables.

　　2. What should anal fistula patients not eat? Experts say that anal fistula patients should avoid eating all kinds of spicy and刺激性 foods, such as alcohol, scallions, garlic, chili, etc.

　　3. For patients with chronic complex anal fistula and tuberculous anal fistula, it is recommended to eat easily digestible and nutritious foods after surgery, especially foods rich in protein, such as chicken, duck, beef, eggs, milk, soy milk, etc.

　　Common food therapy:

　　(1) Stir-fried 1 eel, 100 grams of lean pork, and 25 grams of Astragalus, add salt, sugar, and a moderate amount of yellow wine, eat after removing Astragalus. Suitable for patients with deficiency-type anal fistula.

　　(2) 100 grams of rice and 100 grams of millet, wash and put into a pot with an appropriate amount of water, bring to a boil, wait until the congee is half-cooked, add 500 grams of soy milk and stir well, then cook until done. Suitable for patients with deficiency, suitable for the elderly and children.

　　(3) Marigold 6 grams, sugar 6 grams, green tea leaves 3 grams, pour boiling water into a cup, let it sit for a moment, with a light fragrance and elegance, can clear heat and detoxify, promote blood circulation, relieve dampness and arthritis, and alleviate the pain and swelling of anal fistula.

　　Anal fistula can bring harm to one's health and life, and also put patients in an embarrassing situation. This is also one of the reasons why many patients with anal fistula are eager to cure it. Seeing that many people are asking about the current methods to根治 anal fistula, the editor consulted an expert with this question, and the following is the expert's answer.

　　(1) Acute Infection Attack Phase

　　Apply antimicrobial agents, local physical therapy, hot water sitz bath, and incise and drain if an abscess forms.

　　(2) Fistulotomy

　　Applicable to low-level simple anal fistula, the external fistula between the internal and external anal sphincters. Incising the fistula only damages part of the internal anal sphincter, the subcutaneous part and superficial part of the external anal sphincter, and will not cause incontinence after surgery. Generally under saddle anesthesia, use a probe inserted from the external orifice to pass through the internal orifice of the fistula along the direction of the probe, incise the fistula, and scrape clean the gangrenous granulation tissue. To ensure that the fistula grows outward from the bottom, cut a little of the skin on both sides of the incision, forming a 'V'-shaped wound with a small bottom and large mouth. At the same time, pay attention to whether there are branch ducts and they should also be incised.

　　(3) Ligation Therapy

　　Applicable to high-level simple anal fistula, where the internal orifice is above the anal and rectal ring plane. Surgical transection can cause anal incontinence. Use fistula ligation to make the muscle to be ligated and the surrounding tissue produce adhesion first. Due to local ischemia and necrosis after ligation, it will naturally break after 10 to 14 days, at which time there is no contraction incontinence, the fistula opens into a wound, and gradually heals. Method: insert the probe from the external orifice through the fistula to the internal orifice, and guide a sterile thick silk thread or rubber band to pull it out from the internal orifice to the external orifice, and then tie the thread tightly. Pay attention to the following when ligation:

　　① Find the exact location of the internal orifice and do not create a false channel to avoid surgical failure.

　　② Before tightening the silk thread or rubber band, cut the skin and subcutaneous part of the anal sphincter muscle to reduce postoperative pain and shorten the date for the thread to fall off.

　　③ The ligation should be appropriately tightened, as it is not easy to break if it is too loose. Take a hot water sitz bath after the operation, and tighten it again after 3 to 5 days, generally completely broken after 2 weeks.

　　(4) Fistulectomy

　　Applicable to low-level simple anal fistula. Different from incision, it involves separating and removing the fistula and surrounding tissue until the healthy tissue wound is small on the inside and large on the outside. Generally, it is not sutured, and after the operation, take a sitz bath, change the dressings, until it heals. When treating anal fistula, pay attention to high or complex fistula in surgery, protect the anal and rectal ring, and avoid incontinence after surgery.

　　What methods can be used to cure anal fistula permanently? Everyone is probably very well aware that the first choice for treating anal fistula is still surgery. In addition, please pay more attention to your diet and personal habits, which have a decisive role in whether the anal fistula can be successfully cured.