Anal fissure

　　Anal fissure is a gastrointestinal disease second only to hemorrhoids. Due to the similarity of anal fissure symptoms to hemorrhoids, it is not easy for most people to distinguish between them. The majority of chronic anal fissure patients are young people and children around 20 years old, and it is rare in the elderly, with more females than males. Modern medicine believes that the formation of anal fissure is mainly caused by mechanical stimulation and inflammatory changes of the anal skin and blood vessels.

　　1, Infection

　　Acute and chronic anal sinusitis, papillary inflammation, internal hemorrhoids, and polyps are the main causes of infection. The pathogenic bacteria of infection enter the anal glands through the gland orifices, form abscesses in the subcutaneous tissue of the anal canal, and then溃破 to form ulcers. Small superficial thrombosis can also cause anal fissure due to infection.

　　2, Injury

　　Dry and hard stool can tear the anal skin, frequent defecation during diarrhea makes the anal canal sensitive and tight, and normal consistency stool can also cause damage. Chronic inflammation of the anal canal, fibrous tissue proliferation, and the formation of anal hair hard nodules hinder the relaxation of the anal sphincter, making the anal canal prone to injury and rupture. Rectal foreign bodies, improper dilatation methods, anal surgery, childbirth, congenital anal stenosis, proctocolitis, tuberculosis, and other conditions can also lead to anal fissure.

　　3, Anatomy

　　The external anal sphincter extends from the coccyx to the posterior aspect of the anal canal, divides into two parts, runs along the two sides of the anal canal, surrounds the anal canal to the front, and joins at the front of the anal canal, leaving a gap at the front and back of the anal canal. The majority of the levator ani muscle is attached to the two sides of the anal canal, and the front and back are less, and the posterior and anterior parts of the anal canal are not as strong as the two sides, which are easy to be injured. The anal canal downward and backward forms an anal-rectal angle, and the posterior part of the anal canal is under greater fecal pressure. The blood supply to the median line of the posterior part of the anal canal is insufficient, and its elasticity is small, which are all reasons for the formation of anal fissure.

　　If anal fissure is not cured for a long time, it forms a chronic anal fissure. When the body's immunity decreases or other triggering factors appear, it will recur or worsen acutely, causing great suffering to the patient. Anal fissure not only causes great pain to the patient but also can cause other complications, as follows:

　　1, Fusiform ulcer:Anal canal skin laceration, after infection, forms an ulcer.

　　2, Latent fistula:At the base of the anal sinus, there are often fistulas that communicate with the ulcer, which is due to the infection and suppuration of the anal sinus, forming small abscesses that溃破.

　　3, Papillary inflammation:The upper end of the ulcer is connected to the anal verge, the inflammation spreads, often causing anal sinusitis and papillitis, and finally forming papillary hypertrophy.

　　4, Fissure hemorrhoid:The skin at the lower end of the fissure is changed due to inflammation, superficial veins and lymphatic回流 are blocked, causing edema, tissue proliferation, and forming a connective tissue hemorrhoid, also known as sentinel hemorrhoid.

　　Anal fissure refers to the crack or ulcer formed by the breakage of the transition epithelium of the anal canal below the anal verge, which is the second most common anal disease after hemorrhoids. Anal fissure often brings a lot of inconvenience to people's lives. Below, the editor will introduce several common symptoms of anal fissure.

　　1. Constipation

　　This is often due to the patient's fear of the severe pain during defecation, intentionally delaying the time and frequency of defecation, causing the stool to stay in the rectum for a longer period of time, with all the water being absorbed, making the stool dry and hard. When defecating at this time, it will worsen the wound trauma, deepen the fissure, and increase the pain. Repeating this cycle will form a vicious cycle.

　　2. Pain

　　Pain is the symptom of early anal fissure, mainly manifested as severe pain, persistent severe pain that can worsen, and can automatically relieve after several hours. This pain symptom appears during defecation, and other symptoms include squatting, sitting, and walking.

　　3. Bleeding

　　During defecation, damage to the wound can lead to bleeding from the fissure. Generally, the bleeding is not much, and there may be blood stains on the stool, or fresh blood drops after defecation, or blood on the toilet paper.

　　4. Anal itching

　　Due to the secretion from the ulcerated surface of the fissure or subcutaneous fistula, or the secretion from the anal glands, it can stimulate the skin around the anus, causing anal eczema and anal itching. The patient may feel that the anus is always moist and uncomfortable, and the skin may have superficial fissures or skin damage.

　　5. General symptoms

　　Severe pain can increase the patient's mental burden and affect rest, leading to neurasthenia. Some patients may intentionally reduce their food intake due to fear of defecation, which can lead to mild anemia and malnutrition over time. Women may experience irregular menstruation and pain in the lower back and sacrum. During the infection period of anal fissure, there may be fever, swelling, pain, and purulent discharge.

　　Tip:The occurrence of anal fissure is caused by many reasons. To properly prevent anal fissure, one should pay attention to their dietary habits and living hygiene. Once anal fissure occurs, timely medical treatment should be sought.

　　Anal fissure severely affects the patient's defecation habits and is prone to recurrence. So, how should we prevent it in daily life?

　　1. Smooth defecation

　　Chronic constipation is the most important cause of anal fissure, so maintaining smooth bowel movements is crucial for preventing the disease. Patients should develop the habit of defecating every day, defecating at regular times, appropriately increasing outdoor activities, and taking mild laxatives if necessary, such as liquid paraffin, rhubarb tablets, etc. They can also choose traditional Chinese medicine such as rhubarb and senna leaves to make tea for drinking, which can make the stool soft and facilitate defecation. Taking a warm water sitz bath after defecation can improve local blood circulation, promote the absorption of inflammation, alleviate pain, and relieve the patient's tension to facilitate defecation.

　　2. Adjust psychology

　　Strengthen the education of hygiene knowledge about anal fissure, and explain in detail the pathogenesis, progression, and post-recovery of the disease to the patients to alleviate their tension and enhance their confidence in fighting the disease, thus maintaining a comfortable and peaceful mood.

　　3. Adjust diet

　　Reasonably arrange your diet to ensure smooth bowel movements. The diet should include more fresh fruits, vegetables, and coarse fiber foods, and less or avoid spicy and stimulating foods. Drinking more water can ensure that the gastrointestinal tract has abundant digestive fluid secretion, which is beneficial for peristalsis and prevents constipation.

　　4. Pay attention to hygiene

　　Maintain hygiene around the anus, wash the anus promptly after defecation, take a bath regularly, and change underwear frequently to effectively prevent infection. If there is a large amount of bleeding, you should go to the hospital for treatment. For those with less bleeding, you should strengthen observation and pay attention to eating nutritious foods and supplements to enhance the body's resistance.

　　5. Persistence in sitting bath

　　Use potassium permanganate bath at a ratio of 1:5000 in warm water before and after defecation, with water temperature of 43℃-46℃, twice or three times a day, for 20-30 minutes each time. Bathing can relax the anal sphincter muscle, relieve pain, improve local blood circulation, promote the absorption of inflammation, and is conducive to the healing of anal fissure. Chinese medicine can also be used in combination with bathing.

　　6. Appropriate exercise

　　Participate in sports activities appropriately, such as doing exercises, running, practicing Tai Chi, etc., which can prevent the occurrence of constipation.

　　Many patients with anal fissure will have the situation of not wanting to defecate or being afraid of defecation. Anal fissure makes patients feel restless, and anal fissure often causes long-term pain. Early treatment may be the best choice for anal fissure patients. And the examination of anal fissure plays a very important role in the final healing of anal fissure. So, what are the examinations for anal fissure?

　　1. Inspection

　　In acute anal fissure, secretion can be seen in the anal region, and the lower end of the fissure can be seen by spreading the buttocks. If the lower end of the fissure is gently touched with a probe, it can cause pain. Chronic anal fissures are often accompanied by external hemorrhoids.

　　2. Palpation

　　Clinical anal perianal palpation and endoscopy are not suitable for the diagnosis of anal fissure. Because these examinations can cause severe pain in patients, local anesthesia can be used for dilated anal examination.

　　3. Scope examination

　　Ovoid ulcers or small fissures can be seen, the edges of acute anal fissures are regular, and the bottom is light red. The edges of chronic anal fissures are irregular, the bottom is deep grayish white, and some severe anal fissures may even show anal sphincter fibers.

　　4. Histopathological examination

　　For chronic ulcers located in the lateral position, consider whether there are rare lesions such as tuberculosis, cancer, Crohn's disease, and ulcerative colitis, and perform histopathological examination for differential diagnosis.

　　Patients with anal fissure should eat easily digestible, absorbable, light, and non-spicy foods. Regular consumption of coarse fiber foods can stimulate gastrointestinal motility and is conducive to defecation. Foods with blood and bowel nourishing effects, such as longan meat, jujube, walnut, sesame, black fungus, mulberry, pine nuts, etc., can be eaten regularly, and can also be made into medicated food therapy recipes for consumption, such as longan meat congee, sesame seed cake, pine nut stir-fried corn, walnut stir-fried lean meat, etc., which can moisten the intestines and promote defecation, and promote the healing of the fissure.

　　In addition, drinking plenty of water can ensure abundant secretion of digestive juices in the gastrointestinal tract, which is conducive to gastrointestinal motility and prevents constipation. Hard defecation is likely to cause anal fissure. In fact, one of the most important factors in the formation of anal fissure is our dietary habits. Eating and drinking excessively is definitely not good for the body! Therefore, it is very important to pay attention to dietary habits to prevent anal fissure!

　　The symptoms of anal fissure include anal bleeding, pain, constipation, etc. There are many methods to treat anal fissure. The following summarizes the specific therapies for everyone:

　　1. Internal treatment

　　1. Common drugs

　　5% magnesium sulfate 5-20ml, phenolphthalein 1-2 tablets, furosemide tablets 2 tablets, liquid paraffin oil 10-20ml, take one of the above before going to bed.

　　2. Scheduled Physiological Defecation

　　The appropriate time for defecation in line with physiological requirements is in the morning after getting up or after meals. Defecating in the morning or after meals can avoid increasing abdominal pressure and defecate smoothly. It is necessary to develop good defecation habits.

　　2. External Treatment

　　1. Sitting Bath

　　Use warm water sitting bath before defecation to relax the anal sphincter muscle, reduce the stimulation of stool on the anal fissure ulcer, and use warm water sitting bath after defecation to clean the stool residue inside the anal fissure ulcer, reduce foreign body stimulation, and alleviate anal pain and spasm.

　　2. Medication Application

　　For patients with fresh anal fissures, Mayinglong Hemorrhoid Cream, erythromycin ointment can be applied externally, and analgesic suppositories, chlorhexidine hemorrhoid suppositories can be inserted into the anus, which have the effects of anti-inflammatory and analgesic.

　　3. External Wash

　　1:5000 potassium permanganate solution can be used for sitting bath after defecation to achieve anti-inflammatory and analgesic effects.

　　4. Local External Application for Analgesia

　　5% lidocaine ointment or 2% dicaine ointment can be used to apply externally on the anal fissure. It can alleviate local anal pain and relieve sphincter spasm.

　　3. Blockade Therapy

　　Use 0.25% bupivacaine 5ml for fan-shaped injection at the patient's Changqiang acupoint, once every other day, 5 days as a course, or use methylene blue, dicaine injection (methylene blue 0.25g, dicaine 0.2g, distilled water added to 100ml) for local blockade, 5-10ml each time, 1-2 times a week.

　　4. Surgical Treatment

　　1. V-Y Anal Canal Plasty

　　Patients with anal fissure complicated with anal canal skin defect and obvious stricture are suitable for this operation. In a strict sense, this operation belongs to anal plastic surgery. That is, make a Y-shaped incision, excise the anal fissure and anal sinus, incise the superficial sphincter muscle, and then make an inverted V-shaped skin flap, so that the bottom of the skin flap is outside the anal canal, pull the skin flap into the anal canal, and suture it with the rectal mucosa.

　　2. Perianal Skin Fissure

　　Acute perianal skin fissures should be treated for the cause. Chronic perianal skin fissures should excise the diseased skin, suture or open the wound.

　　3. Other

　　If anal fissure is complicated with grade I or II internal hemorrhoids, perform the lateral sphincterotomy first and simultaneously excise the same point internal hemorrhoids and ligate them. If not at the same point, it should be incised after surgery and then inject the internal hemorrhoids.

　　When internal hemorrhoids are large, it is advisable to perform hemorrhoidectomy first and then perform the lateral sphincterotomy of anal fissure.