2020年11月13日星期五

hemorrhoids and anal fissures,How to treat anal fissure

    Many patients with anal fissure have a common entanglement, that is, do not know what method to choose to cure anal fissure? Clinically, we advocate the use of different treatment methods according to different disease stages.

    Generally, anal fissures are usually divided into stages: ①Initiation stage: Superficial damage to the skin of the anal canal, and the tissue around the wound is basically normal, manifested by mild pain and bleeding in the anus during defecation, and anal spasm is not obvious. ② Chronic stage: there is a history of recurrent attacks, prolonged unhealed, severe pain and bleeding with defecation, obvious cramps in the anus, and skin tags (also called sentinel hemorrhoids) in the anal fissure due to repeated inflammatory stimulation and sometimes purulent Secretions. ③Complication stage: due to the appearance of anal fissure skin tags, the drainage of the anal fissure is not smooth, and once infected, a secondary abscess will appear, which will eventually form a secondary anal fistula. At the same time, due to repeated inflammation and stimulation of the anus, the internal anal fissure There will also be growths called anal papilloma at the other end. Therefore, the fistula of anal fissure, sentinel hemorrhoids, and anal papilloma are often referred to as the "triad of anal fissure" in medicine.

    According to years of experience, the initial stage of anal fissure can be cured by dietary adjustment and drug treatment.

    In terms of diet, once anal pain and bleeding occur, you should fast for spicy food, drink alcohol, eat more vegetables, fruits, and drink honey water to ensure smooth stools. If constipation will aggravate anal fissures and hinder the healing of anal fissures. From the perspective of medication, the main advocates are external use of Chinese medicine for bathing, ointment and laxative medication. Commonly used medicines for Chinese medicine sitz bath are: Sophora flavescens, Phellodendron aurantium, Citrus aurantium, Yuanhu, Di Ding, Sichuan pepper, Chuanxiong, Houttuynia cordata, etc. Its function is to clear away heat and detoxify, promote blood circulation and reduce swelling, and relieve anal sphincter through fumigation and washing. Spasticity and prevent wound infection. If medication is inconvenient, you can also use a spoonful of fine salt and a spoonful of hot water to boil the pepper for a sitz bath. The specific method is: boil the medicine or pepper salt water and wait for the temperature to be 40~50° for a sitz bath, 1 per day ~ 2 times, each time taking a bath for 10 minutes. The topical ointments mainly include Mayinglong musk ointment, Jiuhua hemorrhoid ointment, Taining cream, erythromycin ointment, etc., which play a role in promoting wound healing. There are many types of laxatives, which can be applied under the detailed guidance of doctors.

    For chronic anal fissures, especially when the "triad" of anal fissures occur, medication may be helpful to relieve symptoms, but it cannot achieve a fundamental cure. At this time, surgical treatment is necessary. One of the fundamental purposes of the operation is to remove the anal fissure to form a new wound, and the other is to remove the high anal pressure factor of the anal fissure, so as to ensure the blood supply of the anal canal and make the wound heal. The traditional domestically recognized surgical methods basically use anal fissure resection and internal sphincterotomy. The internal sphincterotomy is divided into open and closed sphincter. The main purpose is to cut the lower third of the internal sphincter. , Make it no longer spasm, and achieve normal anal blood supply and wound healing. The advantage of this operation is that part of the internal sphincter is cut off, which has a high probability of success. The disadvantage is that the postoperative pain is greater and the recovery time is prolonged. Based on the pathogenesis of anal fissure, I believe that the reason why anal fissure does not heal is mainly because the long-term spasm of the anal sphincter leads to fibrous hyperplasia of the inner sphincter. Due to the hyperplasia, the spasm of the sphincter is aggravated, the anal pressure increases, and the anal canal blood supply is higher. It is not good. Therefore, based on the removal of the original ulcers and growths, the surgery can be cured only by removing the spasm and fibrosis of the sphincter, and relaxing the anus. There is no need to cut off the internal sphincter and cause excessive damage and slow healing. It is clinically verified that the recovery is fast, safe, reliable, and effective.

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