1 What is anal fissure?
Anal fissure is abbreviated as anal fissure, which refers to the rupture or full-thickness of the skin of the anal canal that occurs below the dentinal line of the rectum, with radial longitudinal ulcers (also described as fusiform or elliptical) with chronic infection and periodic pain Disease. In anorectal disease, the incidence of anal fissure is second only to hemorrhoids.
2 What is the cause of anal fissure?
Generally speaking, there are two main reasons for the formation of anal fissure, one is long-term or recurrent constipation, and the other is local infection. The two are complementary. Long-term or repeated occurrence of constipation is the most direct cause of the formation of anal fissures. Due to frequent constipation, the skin of the anal canal is repeatedly torn, and the crack is infected and becomes an ulcer. The stimulation of chronic inflammation prevents the ulcer from healing and forms an inflammatory crack. Local infection is the main cause of anal fissure. There are many kinds of bacteria in the anus itself. When the anal canal is damaged due to constipation, fecal irritation, bacterial infection, superficial skin necrosis and other factors are used in conjunction with the anal canal injury. The ulcer is formed and the ulcer edge is inflammatory hyperplasia. The inflammation infiltrates around, affecting the surrounding tissues, especially the internal anal sphincter, causing it to spasm and produce periodic pain, which eventually becomes anal fissure.
Some scholars believe that congenital anal dysplasia is also one of the reasons for anal fissure. There is some truth to this.
3 Why does anal fissure occur in the posterior median or anterior median?
In most patients with anal fissure, the anal canal split occurs in the mid-post anus. We have done statistics. The latter accounted for 67.5% of the fractures, the former accounted for 6%, and the anal fissures both before and after accounted for 26.5%. Anal cracks occur in the anteroposterior median of the anus because the anteroposterior median of the anal canal is anatomically weak. That is, when the external sphincter of the anus wraps around the anal canal from both sides, it attaches to the tip of the tailbone backwards, and stops at the pubic symphysis forward, so that there is little muscle support in the front and back of the anal canal, especially the back, where there is a triangular shape. gap. Therefore, it is not difficult for us to understand that when constipation is forced to defecate, when the anal canal reaches its limit, it is easy to be torn in weak places. This is the reason why anal fissures tend to occur in the anteroposterior median of the anus.
4 Are women prone to anal fissure? Is small anus prone to anal fissure?
These two statements have some truth. Some scholars have done statistics, and 65% of the patients with anal fissure are women. There are three reasons for this: First, from an anatomical point of view, the anterior anal sphincter of women is weaker than that of men and is easy to tear. Secondly, the female genitals are easily affected by inflammation, causing the tissue to become brittle; the sphincter spasm and tear the skin of the anal canal. Third, women have high abdominal pressure during pregnancy, and local blood circulation in the anus is poor due to high abdominal pressure. After the anal canal is torn, it is not easy to heal and eventually become anal fissure. Therefore, it is necessary for women to pay attention to menstrual hygiene and smooth stool. As for the theory that the anal fissure is due to the anal small one, some experts have proposed that people with congenital anus narrow when discussing the pathogenesis of anal fissure. When the stool is dry and hard, the skin of the anal canal is more susceptible to damage during defecation and becomes anal fissure. We also found in this aspect in the clinical examination that people with relatively small anus are indeed more likely to suffer from anal fissure than ordinary people.
5 What are the clinical manifestations of anal fissure?
The clinical symptoms of anal fissure are very simple. They are the three major symptoms of anal pain, blood in the stool, and constipation (or dry stool), sometimes only severe anal pain. On closer inspection, the anal pain caused by anal fissure is very characteristic, which can be distinguished from other anal diseases. In the early stage of anal fissure, only anal pain occurs during defecation. After defecation, the lip and Yue beats gradually decrease until disappear. As the disease progresses, periodic pain occurs, that is, tear-like pain during defecation. The pain is gradually relieved for about 10 minutes, which is called the pain intermittent period. The duration of this intermittent period varies. Later, due to the reflex spasm and contraction of the internal anal sphincter, more severe and continuous pain appeared. This pain can last for several hours to ten hours. Finally, the internal sphincter fatigue and relax, and the pain can be relieved. When he had a bowel movement again, the patient had the above-mentioned pain again. This kind of periodic anal pain is a painful characteristic of anal fissure, which is not available in other anal diseases. Regarding blood in the stool, anal fissure has very little blood in the stool, with only a few drops of blood or a little blood when wiping with tissue. Constipation is one of the causes of anal fissure. Due to anal pain, the patient does not dare to defecate hard. As a result, the stool is drier and the anus becomes more painful during defecation, which becomes a "vicious circle". These are the three major clinical symptoms of anal fissure, apart from this, there are few other symptoms.
6 Is anal chapped and anal fissure the same thing?
Anal fissure is a secondary disease after long-term non-healing of anal eczema, perianal skin diseases and other skin-like changes in the perianal skin. It is not an anal fissure. The clinical features of anal chapped anus are mild anal pain, accompanied by perianal itching, with little or no bleeding; the appearance of the anus shows rough perianal skin, with multiple cracks distributed radially around the anus, and the cracks are shallow and painless to touch. Obvious scratches are also common around the anus. These characteristics of anal chapped anus are obviously different from the severe pain of anal fissure. They are two completely different diseases. Clinically, according to the degree of anal pain, the tension of the anal sphincter, and the color and morphology of the perianal skin, anal chapped and anal fissure are easily distinguished.
7 Who are susceptible to anal fissure?
The incidence of anal fissure does have a certain pattern to follow: from the perspective of age, it is rare in the elderly and children, and more common in young adults, especially between 20 and 40 years old. It is reported that 80% of the patients with anal fissure are young and middle-aged. From the perspective of gender, the incidence of women is higher than that of men. Our statistical results show that the ratio of male to female is 1:1.9; from the perspective of marriage smoking status, the incidence of married people is higher than that of unmarried people; from the perspective of occupation, students The incidence is relatively high. The reason for this is that we believe that the young and middle-aged people are the most stressful and exhausting period of work, family burden and mental pressure. Life is often irregular and easy to get angry, so the incidence of anal fissure is high. The female anal sphincter is weaker than that of males, and it is more likely to be injured during childbirth after marriage, so the incidence is also high. Due to the stress of study, poor diet and nutrition, low water intake, dry intestines and easy constipation, students also have frequent anal fissures.
8 How to classify anal fissure?
There are many classification methods for anal fissures, which are not uniform, as follows.
(1) Two-stage classification: acute (stage) anal fissure and chronic (stage) anal fissure.
(2) Three-stage classification: first-stage anal fissure (simple anal fissure), second-stage anal fissure (for ulcer formation period), and third-stage anal fissure (with 3-5 characteristics).
(3) Four classifications: divided into four types of anal fissures: simple, ulcerative, obsolete, and secondary.
(4) Five-type classification: divided into five types of anal fissures: stenosis, prolapse, mixed, fragile, and symptomatic.
(5) Type II classification: In 1975, at the first national anorectal academic conference in China, according to clinical practicality, anal fissures were divided into two types, simple anal fissures and old anal fissures, as follows.
Simple anal fissure is also called early anal fissure. It is characterized by short course of disease, fresh cracks, no chronic ulcers, no sentinel hemorrhoids, and mild pain.
Old anal fissures are characterized by the formation of anal canal ulcers, accompanied by sentinel hemorrhoids, hypertrophic anal papillae, combo belt hyperplasia, and periodic anal pain.
At present, the classification of simple anal fissure and old anal fissure has been widely accepted by anorectal physicians and has guided clinical work.
9 What are the methods to treat anal fissure?
There are many ways to treat anal fissures, which can be roughly divided into seven treatment methods: oral administration, external washing, external application, injection, anal expansion, sealing, and surgery.
Oral administration is mostly based on the traditional Chinese medicine prescriptions for clearing heat, expelling wind, cooling blood and relieving pain. There are also western medicines that are used for analgesia, anti-inflammatory, and laxative to treat anal fissure. Take a sitz bath. The topical method is to apply ointment to the crack to exert the local anti-inflammatory and analgesic effects. At present, Chinese medicine ointments are mainly used in China, such as Rongchang Kangtai ointment and Mayinglong ointment. The injection method is to use some drugs to make spot injections at the base of the anal fissure, such as Danshen injection, 10% sodium citrate and lidocaine. The anal expansion method is a treatment method in which the doctor expands the patient's anus with his fingers under local anesthesia, cuts off the sphincter band, and relieves the internal sphincter spasm. The sealing method is a treatment method in which compound methylene blue preparations are used for sealing injection in the local anal cleft. There are more than 30 methods for surgical treatment of anal fissures. At present, the most commonly used clinical surgical methods are lateral anal fissure resection and internal sphincterotomy.
10 What are the advantages and disadvantages of the various methods for treating anal fissure?
In the oral method, taking traditional Chinese medicine has no side effects, but the effect is slow and easy to relapse; taking anti-inflammatory and analgesic western medicine can quickly relieve the pain, but the effect is not lasting. It only temporarily relieves the patient's pain, and then defecate, the pain remains the same.
In the external washing method, the effect of external washing with traditional Chinese medicine is immediate. If combined with external application of ointment, some simple anal fissures can be cured. The disadvantage is that the decoction is time-consuming and inconvenient to use.
The method of external application of ointment to treat anal fissure is convenient and painless, but the curative effect is limited and not solid. It is often used in conjunction with the external washing method, that is, first wash the sitz bath, and then apply the ointment.
The above three methods are also called symptomatic treatment, so they do not solve the fundamental problem. The injection method and the sealing method can effectively relieve the spasm of the internal anal sphincter and relieve pain. The effect can be maintained for several months or longer. The disadvantage is that the recurrence rate is high (about 50% of patients will relapse) and most patients always have an anus. Discomfort. The pain can be relieved after the anal expansion method is implemented. The disadvantage is that it is easy to relapse and many patients have sensory fecal incontinence within a short time after the anus expansion, and can also be complicated by hematoma and bleeding, causing panic and loss of confidence in the patient. These three treatment methods are different from surgical methods and conservative treatments. They are between surgical methods and conservative methods. They have certain technical requirements in operation. Their common advantage is that they have better short-term effects (compared with drugs). It is better to take a sitz bath outside. The patient suffers little pain. The common shortcoming is that the long-term effect is not satisfactory, and there is always a feeling of regret. In addition, the recurrence rate is relatively high.
Surgical treatment is mainly aimed at old anal fissures. The advantage is that the anal fissure is completely cured without recurrence. The disadvantage is that the pain is greater than other treatments and the recovery period is relatively long, about 20 days.
11 What are the traditional Chinese medicine prescriptions for oral and external washing for the treatment of anal fissure?
Chinese medicine believes that the cause of anal fissure is the dryness of the colon or the dryness of the intestine due to wind-heat and poisonous fire. There are three main types of clinical syndrome differentiation.
(1) Wind-heat and intestinal dryness syndrome: It is characterized by constipation, a couple of days, pain in the anus and anus, bright red cracks, red tongue, dry tongue, and dry pulse strings.
(2) Damp-heat accumulation syndrome: dry stool or uncomfortable stool, severe pain in the anus, red tongue, yellow greasy coating, solid or weak pulse.
(3) Blood deficiency and intestinal dryness syndrome: It is characterized by easy congestion, continuous pain in the anus, low bleeding, pale color, fatigue, pale tongue, thin white dry coating, thin and weak pulse.
The syndromes of dryness of the intestines and accumulation of damp-heat are empirical heat syndromes, and the syndromes of intestinal dryness due to blood deficiency are mixed syndromes of deficiency and excess. For those with a short course of disease and mild illness, bezoar detoxification can be taken orally 3 times a day, 3 tablets each time, after meals) and Maren Runchang Pill (1 time a day, 1 pill each time) to relieve fire , Poisoning fire to defecate will relieve the pain. For patients with severe anal pain and constipation, Fangfengdiyu Decoction can be used as the basic prescription for treatment.
The composition of Fangfeng Diyu Decoction: 20 grams of Fangfeng, 10 grams of Diyu, 15 grams each of red peony root, tree peony bark, and comfrey, 10 grams of rhubarb.
For the syndrome of wind-heat and intestinal dryness, the prescription does not need to be added or subtracted; for the syndrome of damp-heat accumulation, add 15 grams each of Citrus aurantium, Magnolia officinalis, and Atractylodes, to prevent wind; for the syndrome of blood deficiency and intestinal dryness, heating rehmannia, 10 grams of angelica, red peony, Moutan bark and comfrey are reduced to 10 grams, and rhubarb is reduced to 6 grams.
Taking a sitz bath outside of the decoction of traditional Chinese medicine to treat anal pain caused by anal fissure has an immediate effect. The medicine is mainly to clear away heat and detoxify and promote blood circulation to remove blood stasis, such as Sanleng, Zedoary, Yuanhu, safflower, Coptis, and Rhubarb each 30 grams, decoct in water for 20 minutes, first fumigate and then take a bath.
The treatment of anal fissure with traditional Chinese medicine only has a temporary effect. If you want to completely cure the anal fissure, you must rely on surgical treatment.
12 What are the commonly used western medicines for the treatment of anal fissure?
In view of the characteristics of anal fissure with anal pain and blood in the stool as the main symptoms, conservative treatment with western medicine is only symptomatic treatment. Commonly used oral western medicines are analgesic and anti-inflammatory, analgesics such as pain-relieving tablets and ibuprofen tablets, and anti-inflammatory drugs include cephalosporins and floxacin. When the anus is severely painful, 50-100 mg of meperidine can be injected intramuscularly to relieve the pain. There are various antibacterial and anti-inflammatory ointments for topical western medicine, including eye ointments, which can be applied to the anal cracks. Potassium permanganate can also be mixed into a 1:5000 solution for sitting in a bath, which also has analgesic effect.
The conservative treatment effect of western medicine is general. It can be used in combination with Chinese and western medicine, and the effect is better. In addition, pethidine is addictive and should not be used frequently. Remember.
13 Is the anal fissure surgery sutured?
Almost all patients with anal fissure will ask this question. According to the way of thinking we are used to, even if it is split, it is logical to stitch it together. In fact, this is a misunderstanding of the patient. We have already discussed that because the dry feces cracked the skin of the anal canal, the crack became inflamed, repeated unhealed, and formed ulcers. The ulcers could reach the muscle layer and the inflammation could stimulate the internal anal sphincter and cause the internal anal sphincter. Spasms, there will be persistent pain in the anus, and the crack will not heal. In other words, the non-healing of anal fissure and anal pain are caused by spasm of the internal anal sphincter. Therefore, anal fissure surgery is to cut off the annular internal anal sphincter, relieve its spasm, and make the crack heal naturally, instead of sewing the crack as people imagine.
14 Will cutting off the internal sphincter during anal fissure surgery cause anal incontinence?
Cutting off the internal anal sphincter during anal fissure surgery will not cause anal incontinence, because the muscles that control the opening and closing of the anus are not only the internal sphincter, but the external anal sphincter is divided into three layers: subcutaneous, superficial and deep, and puborectal There are many groups of muscles, including the puborectalis and deep external anal sphincter. The anal sphincter is a smooth muscle that is not controlled by human consciousness. Cut it off. The anus will not be incontinent. Other muscles can also coordinate and control the anus opening and closing to maintain normal bowel function. So don't worry about anal fissure surgery Incontinence can occur in the anus.
15 Are there any side effects from anal fissure surgery?
What side effects will appear after anal fissure surgery, and the degree of it varies from person to person. In theory, although the sphincter will not cause anal incontinence, the strength of retraction of the anus will be weakened. After the incision scar is formed, the anus is not closed as tightly as before the operation, and problems such as air leakage and a small amount of intestinal fluid leakage will occur. However, in clinical practice, we have found that patients with sensitive physique, scar physique, and always doubtful attitude have obvious side effects after anal fissure surgery. People with scars are caused by excessive scars and lax anus closure. Those with sensitive constitutions and doubters have strong psychological hints at work. However, patients do not have to worry too much. As time goes by and the body is repaired, the scars will gradually soften. With more anal exercises, the side effects will disappear about three months after the operation, and those with sensitive constitutions may take longer.
In short, after anal plough operation, there will be temporary air leakage, fluid leakage and other problems, but the side effects have a process from heavy to light to gradually disappear. The length of this process varies from one to six months. , The reason is mainly related to the patient's physical type.
16 Is anal fissure surgery painful?
Every patient will ask this question. It should be said that due to anesthetics during anal fissure surgery, the patient will feel but no pain and no pain; after the operation, the anesthetic effect will gradually decrease, and there will be pain, but the degree of pain is much less than before the operation, because Before the operation, the internal anal sphincter spasm is severe pain. During the operation, the internal sphincter is cut off and the severe pain is gone. What is left is the pain at the surgical mouth, which the body can tolerate, and the patient feels that the pain has been significantly reduced. Many patients after surgery tell us, "As long as you are not afraid, it is not too painful." So we can tell everyone that there will be pain after anal fissure surgery, but the degree of pain is determined by the patient's psychological and physical fitness.
17 What to do if pregnant women suffer from anal fissure?
Anal fissure is characterized by severe pain in the anus, and the effect of the operation is immediate, but the infection rate of anal fissure surgery is higher than that of hemorrhoids, so antibiotics must be used after the operation to prevent infection. Drugs used by pregnant women may have adverse effects on the fetus. Therefore, we suggest that pregnant women who have anal fissure should not undergo surgery, but should be treated conservatively, and surgery will be performed after delivery, depending on the situation. The conservative treatment of pregnant women with anal fissure is mainly Chinese medicine sitz bath. Chinese medicine sitz bath will not have any effect on the pregnant woman and fetus. After the sitz bath, a small amount of Chinese medicine or western medicine ointment with anti-inflammatory and antibacterial effects can be applied to the anal crack, but it is prohibited Preparations containing musk (because musk has the effect of falling fetus, it is important to keep the stool smooth. If conservative treatment still does not relieve anal pain, anal expansion can be used, but the action should be light.
Prescription for pregnant women with anal fissure sitz bath: 20 grams each of Fangfeng, Sanyu, red peony root, Coptis and Asarum, 10 grams each of Frankincense, Myrrh, and Alum. Take 1500ml of cold water, heat and fry for about 1000ml (or fry for 15 minutes), pour the medicinal solution into another basin, fumigate first, and then take a bath for about 20 minutes. 1-2 times a day.
18 How to treat tuberculosis patients after getting anal fissure?
As mentioned in the first chapter, the wounds of tuberculosis patients undergoing hemorrhoid fissure and other anorectal surgery are generally very difficult to heal. In addition, anal fissure surgery is different from hemorrhoid surgery. Hemorrhoid surgery has a shallow wound and does not involve deep muscle layers and is not easy to be infected. The surgical incision is deep, involving the internal anal sphincter, and the risk of infection is higher than that of hemorrhoids. Therefore, patients with tuberculosis who have anal fissure should be treated conservatively and surgery is prohibited. For patients with anal fissure combined with tuberculosis, the method of using Chinese medicine to bathe and applying hemorrhoid ointment can also receive good therapeutic effects. If it is a more serious anal fissure, which is more painful and conservative treatment fails to alleviate the condition, anal expansion surgery can be used to treat it, which is simple and inexpensive.
The operation method of anal expansion is: the patient takes the stone cutting position, routine disinfection of the anus, local anesthesia, after applying paraffin oil to the index finger and middle finger of both hands, slowly extend the left and right index fingers back to back into the anus and open the anal canal to both sides. The middle fingers also extend into the anus. The direction of force is downwards and outwards to enlarge the ulcer of anal fissure, the fibrous tissue is torn apart, and the fingers feel loose in the anus, and there is no harm if there is a little bleeding. Then apply anti-inflammatory ointment to the crack and place oil gauze to drain. OK. It is best to apply anti-inflammatory cream every day for the next 1-2 weeks.
19 How to treat diabetic patients suffering from anal fissure?
Diabetics have slow healing of surgical incisions and are prone to infection, but surgery is not impossible. Therefore, how to treat diabetic patients with anal fissure depends on the severity of the disease. Anal fissures with mild symptoms can be treated conservatively, that is, a traditional Chinese medicine bath and external application of ointment. Severe anal fissures can be treated surgically while controlling blood sugar. Disinfection before surgery should be strict, and every time dressing change after surgery should be strictly disinfected and adequate antibiotics should be given intravenously for 5-7 days. In the diet, eat according to the requirements of diabetes, and eat more pumpkin, celery, cucumber and soy products, milk and other foods suitable for diabetic patients. If 9 mouths heal slowly, 4 units of insulin can be instilled into the incision during daily dressing change, which can accelerate wound healing without any side effects. If there are signs of wound infection, a small amount of honey can be used to apply externally to the wound. Not only will the effect be good, the blood sugar will not increase.
According to our experience, the wounds of diabetic anal fissure patients can be healed as scheduled by using Chinese medicine preparations, such as Rongchang Kangtai ointment or Jingwanhong ointment.
20 How to treat anal fissure in children?
Anal fissures in children are mostly due to dry and hard stools, which crack the skin of the anal canal during defecation, and then become contaminated by feces, causing infections and eventually forming chronic ulcers. In principle, conservative treatment is given to children with anal fissure.Children's anal fissures should be treated conservatively when the skin of the anal canal is split but not infected. For example, oral laxative fire-prevention Sanhuang tablets have no side effects on children and can be taken) to make the stool smooth to relieve pain during defecation, and apply externally to the crack to reduce inflammation The cream can be cured in a few days. If anal canal ulcers are formed and the child suffers from severe pain, in addition to taking the nephew defecation agent, use Chinese medicine to fumigate and wash the sitz bath to relax the spasm sphincter to relieve anal pain. After the sitz bath, use Antai ointment, Wanhong ointment etc. Topical application, antibacterial and anti-inflammatory, promotes the healing of ulcers (rips), and most children can be cured after a week. For those who still do not heal after the above-mentioned treatments, other methods (such as anal expansion, surgery, etc.) can be considered.
21 Apart from conservative treatment, what about other treatments for anal fissure?
Anal fissures in children should be treated conservatively in principle, but for those who do not heal for a long time, anal canal dilation, injection, surgery and other methods can be selected according to the child's condition. Anal canal dilatation is simple and effective, and it should be performed under sacral anesthesia. Anal fissure injection has the advantages of less pain, less damaged tissue, and faster recovery, and the effect is better than that of anal expansion. Surgery is an anal fissure resection. For children, if other treatments are not effective after use, anal fissure resection is finally used. Regardless of the above method, you should go to a regular hospital for treatment. After the operation, you should keep your stool unobstructed, and use Chinese medicine to fumigate and wash the sitz bath.
Children's skin is delicate and tender, so the traditional Chinese medicine for sitz bath should be light-smelling heat-clearing medicine and blood-activating medicine. Recommended prescription: 20 grams of honeysuckle, 10 grams of forsythia, 10 grams of male worm, 15 grams each of red peony, safflower, 8 grams each of Frankincense and Myrrh. Take one dose a day, decoction and warm bath 2 times. This prescription can also be used for children with simple anal fissure who do not undergo surgery or conservative treatment.
22 Can anal fissure self-heal?
Fresh anal fissures with a short course of disease are generally very shallow, not deep into the muscle layer, and no chronic ulcers are formed. This kind of anal fissures only need to make the stool smooth, and some drugs such as Rongchang Kangtai ointment and Mayinglong ointment are used for treatment. The crack can heal, but it can recur when it encounters constipation, diarrhea and other triggers. As for the anal fissure, whether it is mild or severe, it will not heal itself without treatment. For recurring anal fissures, we also call them old anal fissures. Drug treatment basically has no obvious effect. Only surgery can be completely cured. In other words, surgery is currently the only way to cure old anal fissures.
23 What are the complications after anal fissure surgery? How to deal with these complications?
If it is a simple anal fissure, there will be no other complications except bleeding after the operation. If it is an old anal fissure, due to the long course of the disease and repeated attacks, sentinel hemorrhoids, anal papillary hypertrophy and even subcutaneous fistula have been complicated before the operation. These accompanying lesions should be removed during the operation, so that its trauma The area is much larger than that of anal fissure surgery alone, so some post-operative complications may occur. The common complications after old anal fissure surgery include bleeding, tissue edema, infection, and anal pain after defecation. For postoperative bleeding, if it is bleeding, pressure can be used to stop the bleeding. If it is pulsatile bleeding, the bleeding point should be ligated. Patients with postoperative infections should be debrided in time and given adequate antibiotics intravenously. For complications such as tissue edema and anal pain after defecation, a bath with Chinese medicine is very effective. Patients with tissue edema should be treated with heat-clearing and damp-drying, blood-activating and stasis-removing drugs, and those with post-defecation anal pain should be treated with blood-activating and pain-relieving, detoxifying drugs. The treatment effect of the above conditions is very good.
24 What are the causes of complications after anal fissure surgery?
Some complications after anal fissure surgery are not normal, so the reasons for these complications should be clarified. The causes of complications after anal fissure surgery are very complicated, and different complications have different causes: pulsatile bleeding is caused by cutting off small arteries during the operation, and the reason is clear. The edema of the wound margin tissue is mainly caused by the patient's higher sensitivity to the wound. After the tissue is damaged, the inflammatory reaction is intense, and the tissue exudates and edema is obvious. Anal fissure surgery is characterized by severe anal pain during defecation. After the operation, defecation should be basically painless or mild anal pain. However, some patients still have obvious anal pain when defecation after the operation, which is mainly related to the patient's physical fitness , Pain tolerance is related to the degree of nerve sensitivity, so people with poor physical fitness, weak pain tolerance, and usually more sensitive people still feel anal pain when defecation after anal fissure surgery, but the degree is still lighter than before the operation. As for the infection after anal fissure, there are three main reasons: On the one hand, the doctor's surgical incision is too small, which causes poor drainage and local hypoxia, which is conducive to the growth and reproduction of some anaerobic bacteria, leading to purulent infection. On the other hand, the patient defeces too frequently, 2-3 times a day, or always defeces soon after changing the dressing, and fails to change the dressing in time after defecating, causing the wound to be contaminated for a long time, resulting in infection. Another reason is the failure to press the gauze into the incision when changing the dressing, resulting in false healing and infection (formation of a subcutaneous fistula).
25 How to prevent complications after anal fissure?
Starting from the following aspects can well prevent complications after anal fissure surgery.
(1) Fully disinfect before operation, the incision during operation should not be too small, and the drainage should be smooth.
(2) Check the bleeding carefully and ligate the bleeding point.
(3) Warn patients not to reduce their diets and eat more high-fiber diets. Only enough food residues in the large intestine can cause intestinal reflex peristalsis, and stool can be unblocked. Otherwise, it can only backfire, dry stool and cause painful defecation.
(4) It is best to change the dressing after defecation every day, and press the gauze into the incision to make the granulation tissue grow upward from the base. Avoid false healing.
(5) Give enough antibiotics intravenously for about 5 days after the operation. It is best to add 0.4-0.5 grams of metronidazole injection every day to prevent anaerobic infection.
(6) Patients with conditions should take a Chinese medicine for promoting blood circulation and pain relief for about 15 minutes after defecation, and then put 1 hemorrhoid suppository into the anus.
26 Is it easy to be infected after anal fissure?
As we all know, there are many and complex bacteria in the anus, so patients generally think that it may be easy to get infection after anal fissure surgery. In fact, this is a misunderstanding. Theoretically, the anal canal tissue has a special immune function to intestinal bacteria, so although the incision of anal fissure surgery is relatively deep, it is generally not infected. However, specific problems need to be analyzed in detail. The methods of anal fissure surgery are different, and the probability of infection is also different. For example, if the anal fissure is cut and sutured, the patient is less painful and the treatment course is short, but the requirements for sterile conditions are high, otherwise it is easy to be infected and clinically infected. It is also those who suture wounds. For anal fissure resection, the incision is left open without sutures. The patient suffers relatively great pain, but the requirements for aseptic conditions are not high, and infections are rare. In short, those who do not suture the mouth during anal fissure surgery will not be infected as long as they follow the doctor's advice and insist on changing the dressing.
27 What are the benefits of dressing change after anal fissure surgery?
Since the anal fissure operation needs to cut off the internal anal sphincter, the incision is deep below the sphincter layer, and there are many kinds of bacteria and other bacteria in the anus, and the incision is easily contaminated, so it is necessary to change the dressing after the operation. The method of dressing change is controlled by the doctor, usually once a day, after waking up in the morning to defecate. There are three benefits of dressing change: First, the perianal and incision must be strictly disinfected before each dressing change to prevent infection. The second point is that the doctor will insert the drainage strip into the incision and the entire wound when changing the dressing to prevent contamination and infection in the incision and the entire wound. The third point is that the doctor observes the tissue growth of the incision and wound when changing the dressing daily, and monitors the development and prognosis of the disease. Some patients no longer feel uncomfortable after changing the medicine several times, and think that they are cured and stop changing the medicine. This is wrong. Generally, after anal fissure surgery, it takes 15-20 days or even longer for the wound to open and change the dressing, so it is necessary to insist on dressing change.
28 Will the anal fissure recur after surgery?
Suffering from anal fissure, the internal anal sphincter is cut off by surgery to relieve its spasm, thereby curing the anal fissure. After the internal anal sphincter is severed, the possibility of anal fissure recurrence is almost impossible. Of course, nothing is absolute. As we said earlier, there are two main reasons for the formation of anal fissures, even esthesia and chronic inflammation of the anus. If the anal fissure is cured by surgery, you don’t pay attention to the cleanliness of the anus, and you don’t pay attention to keeping the stool smooth, but the stool is still often dry, and you can’t force it down, and the anus may still be stretched and torn again. Need to pay attention. This also reminds us that after anal fissure surgery, we still need to maintain good diet and hygiene habits. As long as we pay attention to it in daily life, there will be no recurrence after anal fissure surgery.
29 What should I pay attention to after anal fissure surgery is cured?
There are many aspects that need attention after anal fissure surgery is cured, such as diet, rest, mood, work and rest, etc., but there are three main ones. The first one is the most important, that is to keep the stool smooth. The second is very important, that is to clean the anal door after defecation (water temperature is equal to or lower than body temperature). The third article must persist, that is, do more exercises of levator and rectum. Grasp these three points and pay attention to other aspects. In short, after recovery, neither need to be cautious everywhere nor care about anything.
30 Can anal fissure be prevented?
Anal fissures can be prevented. After all, not everyone suffers from anal fissures. The incidence of anal fissures in the population is only a few percent. As long as we develop a good living habit, we can prevent the occurrence of anal fissures. The specific measures for prevention are. In terms of diet, do not eat or eat less fried spicy foods, because they are easy to cause gastrointestinal dampness and heat and poisonous fire internal attack and cause dry stool; eat more vegetables, fruits, apples, peaches, apricots, bananas, watermelons Wait, wait for foods rich in cellulose and vitamins, because they can soften stools and promote bowel movements. In terms of work, avoid depression and anger, or excessive tension and fatigue, because bad emotions and fatigue can cause depression or dryness, and depression and dryness will inevitably turn fire. You must be regular in your daily life. Don't change your lifestyle easily. It is best to develop a good habit of waking up in the morning to defecate, and wash the anus with water at about 30°C after going to bed. Pregnant women should regulate their life and exercise under the guidance of obstetricians and gynecologists, and strengthen health care during pregnancy. In short, constipation is the direct cause of anal fissure. Preventing constipation basically prevents anal fissure.