2020年11月17日星期二

hemorrhoids in children,Treatment of anal fissure in children

    A parent came to the clinic because of the child's blood in the stool. After examination, it was anal fissure. The following is a brief description of the disease.

    Definition and classification of anal fissure:

    Anal fissure is the surface split of the narrowest anal canal tissue from the dentate line to the anal margin at the exit of the digestive tract, forming small ulcers, the direction is parallel to the longitudinal axis of the anal canal, fusiform or elliptical, about 0.5-1.0cm , Often cause severe perianal pain. The most common site of anal fissure is the front and back center of the anus, and the center is more in the past. Anal fissures can be divided into acute and chronic. Chronic anal fissures have a long course and recurring episodes. The anal flap and anal papilla at the upper end of the fissure are edema, causing the anal papilla to become hypertrophy, and the skin at the lower end is pouched down and protruding outside the anus, forming a "sentinel" Hemorrhoids, anal fissure, sentinel hemorrhoids, and anal papillary hypertrophy often exist at the same time, which is called anal fissure triad.

    Cause:

    1. Dry and hard stools or constipation

    Anal fissure is firstly caused by impact or friction from external forces. If the stool is too thick and hard, the anal adaptability is poor at this time, which will cause the anal canal to split. Some studies have found that not only constipation, but also diarrhea can also cause anal fissure, which can account for 4% to 7% of anal fissure inducement.

    2. Internal sphincter spasm

    Inflammatory stimulation of the intestines, anal canal or anal sinus, acidic stool stimulation, sphincter exposure, anger and tension and other abnormal emotions can cause high tension of the internal anal sphincter, which can cause a significant increase in the resting pressure of the anal canal, and the stretchability of the anus at this time Not enough, when hard feces pass through, cracks will occur.

    3. Anatomical defects

    The external anal sphincter forms two triangular fissures before and after the anal canal, which lacks sufficient support for the anal canal, but it can crack when feces impact. At the same time, the anal arteries are distributed from both sides to the middle, and cross the anus front and back. As a result, two weak areas are formed before and after the anus, resulting in poor blood supply in this area. The anal canal and the rectum continue at a 90-degree angle. The posterior wall of the anal canal bears the greatest pressure during defecation, so anal fissures are most likely to occur at the posterior midline.

    Clinical manifestations:

    1. Pain: Pain-relief-peak-relief-pain again. Stool stimulates the nerve endings on the ulcer surface during defecation, causing severe burning or knife-like pain after defecation, which can radiate to the buttocks, perineum, sacrum or inner thigh, which is called pain during defecation. The pain relieved a few minutes after going to the toilet, this period is called the pain intermittent period. Later, due to internal sphincter spasm, severe pain occurs, which lasts for several minutes or several hours. At this time, the patient will be restless and unbearable. After the sphincter is fatigued, the muscles relax and the pain gradually relieves. After defecation again, the pain occurs again.

    2. Bleeding in stool is mainly caused by dripping blood during defecation or rubbing blood on paper after defecation. The blood is bright red. The amount of bleeding is related to the depth and size of the crack, but it will not spurt like hemorrhoids and rarely hemorrhage. Anal fissure blood in the stool will also periodically recur.

    3. Constipation Many patients with anal fissure themselves have constipation. After suffering from anal fissure, some patients are afraid of defecation because of anal pain. Over time, the stool will become harder and harder, and constipation can aggravate the anal fissure.

    treatment

    1. Correct bowel abnormalities

    Constipation is one of the main symptoms of anal fissure, and it is also the main reason for the formation of anal fissure. It can be used to increase dietary fiber food, probiotics, lactulose and other methods to soften the stool and keep it smooth. Constipation can be added with laxatives and probiotics. can

    2. Clean the anus, take a bath

    Sit in hot water 3 times a day, 5 minutes each time. If you have recent painful bowel movements or fresh anal fissures, take a bath with 1:5000 potassium permanganate warm water to keep the area clean.

    3. Local medication

    (1) Analgesics. Anesthetics (such as lidocaine gel) and non-steroidal anti-inflammatory drugs (such as diclofenac cream, ibuprofen cream, etc.) can relieve pain symptoms.

    (2) Promoting crack healing, hemorrhoid cream, recombinant human epidermal growth factor, etc.

    4 Prevent the vicious circle of anal fissure:

    I have had fresh bleeding or painful bowel movements. I used Kaiserol once a day for a week, or injected 10ml of medical paraffin oil into the anus every day for a week.

    5. Surgical treatment

    It is suitable for chronic anal fissures with triad of anal fissures or non-surgical treatment. Commonly used surgical methods include anal fissure resection and lateral internal sphincterotomy.

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