Anorectal fistula is a granulomatous tube connecting the anal canal or rectum to the perianal skin. It mainly invades the anal canal and rarely involves the rectum, so it is often called anal fistula. The inner mouth is mostly located near the dentate line and the outer mouth is located in the perianal skin. Place. The entire wall of the fistula is composed of thickened fibrous tissue, with a layer of granulation tissue inside, which does not heal for a long time. The incidence is second only to hemorrhoids, and is more common in young men. It may be related to the strong secretion of sebaceous glands, one of the male sex hormone target organs. Anal fistula is not self-healing advice or to go to a professional hospital for examination and treatment in time is the key
Anal fistula refers to the granulomatous duct around the anus, which consists of three parts: the inner mouth, the fistula, and the outer mouth. The internal orifice is often located in the lower rectum or anal canal, mostly one; the external orifice is on the perianal skin, which can be one or more, which is unhealed or intermittently recurrent. It is one of the common rectal and anal canal diseases, any age It can be affected, and it is more common in young men. The incidence is second only to hemorrhoids, and is more common in young men. It may be related to the strong secretion of sebaceous glands, one of the male sex hormone target organs.
Most anal fistulas are formed by rupture of anorectal abscess or after incision and drainage. The abscess gradually shrinks, but the contents of the intestine continue to enter the abscess cavity. In the process of healing and shrinking, a tortuous cavity is often formed, which is not easy to heal due to poor drainage. After a long time, there are many scar tissues around the cavity, forming a chronic infectious duct . Walking near the internal and external sphincter, the skin of the external mouth grows faster, often with false healing, causing repeated attacks. Most of the infections of the pipeline are purulent infections, and a few are tuberculosis.
1. Abscesses around the anorectum are often ruptured or cut outside the anus, and pus flows out from the outside mouth, but the primary infection is mostly in the anal sinus. The anal sinus is the gateway to secondary infections, repeated infections, forming a fistula.
2. The fistula usually passes between the anal sphincter. Because the sphincter constantly contracts and relaxes, it compresses the fistula and affects the elimination of pus. It is prone to pus infection and difficult to heal.
3. There is a certain amount of pressure in the rectum, and rectal infections such as feces and gas can often enter the fistula from the internal opening, irritating the cavity wall, and being discharged from the external opening after secondary infection, which is also the cause of the fistula.
4. After the anorectal abscess is ruptured, the pus is discharged, the abscess cavity is gradually reduced, and the external ulcer and incision are also reduced. The cavity wall forms a hard duct wall with connective tissue hyperplasia, so it cannot be closed naturally.
5. The fistula is curved, or there are sinuses or branches, the drainage is not smooth, the pus is retained, and repeated infections make the fistula difficult to heal.
6. Poor anal venous return, frequent local congestion, and malnutrition of tissues, affecting healing.
7. Abscesses caused by tuberculosis, actinomycetes and other infections, Crohn's disease, etc. are difficult to heal on their own and form specific anal fistulas.
Anal fistula-the cause of anal fistula recurrence
1. Improper handling of anal glands: According to recent studies, anal gland infection is an important cause of anal fistula. Therefore, it is necessary to remove the internal mouth, as well as the anal glands and ducts with inflammation near the internal mouth.
2. The position of the inner mouth is difficult to find: Sometimes the inner mouth cannot be accurately found, or the primary infection is still left in the inner mouth.
3. Anal sinusitis: The complicated anal sinusitis is not treated in time, causing anal sinusitis to develop into anal fistula again.
4. Newly formed anal fistula: Most patients have perianal abscess due to anal gland infection, which leads to a new anal fistula, which is mistaken as a recurrence. It is not difficult to distinguish in clinical practice.
5. Complicated internal orifice: When there are two or more internal orifices in the fistula, the search for the internal orifice is incomplete, leading to recurrence.
1. Infected discharge
One of the main symptoms of anal fistula is the discharge of pus or even fecal water after infection. It not only pollutes underwear, but also irritates the skin around the anus, causing obvious symptoms of anal itching, which makes the patient miserable, and also produces peculiar smell, which causes the patient There is a lot of embarrassment in public.
2. Increased fistula
If an anal fistula is not treated in time, it will recur, and the number of fistulas will continue to increase, and even fistulas will form in the anal sphincter space, which will evolve into a complex and intractable anal fistula. It will affect the normal physiological function of the patient's anus.
3. Anal incontinence
If anal fistula is left untreated for a long time and allowed to develop, it will cause serious and irreversible damage to the anal sphincter, causing patients to have varying degrees of anal incontinence, which will bring patients a lifetime of pain.
Anal fistula has primary internal orifice, fistula, branch tube and secondary external orifice. The internal mouth is the entrance to the source of infection, mostly in and near the anal sinus, on both sides of the posterior midline, but it can also be in the lower rectum or any part of the anal canal. Fistulas are straight and curved, and a few have branches. The outer mouth is the place where the abscess ruptures or the incision and drainage is located. It is mostly located in the skin around the anal canal. Because pathogenic bacteria continue to enter the duct through the inner mouth, and the duct tortuously walks around the inner and outer sphincter, the wall of the duct is composed of fibrous tissue and there are Granulation tissue, so it will not heal for a long time.
Generally, simple anal fistulas have only one internal port and one external port. This type of anal fistula is the most common clinically. If the outer mouth is temporarily closed and the local drainage is not smooth, infection will gradually occur and an abscess will form again. The closed outer mouth can be pierced or another outer mouth can be formed elsewhere. Such repeated attacks may expand the scope of the disease or sometimes cause several external openings that communicate with the internal openings. This anal fistula is called a complex anal fistula, that is, there are one internal opening and multiple external openings. However, some people believe that complex anal fistulas should not be divided into the number of external openings, but refer to those whose main fistula involves the anorectal ring or above. Although this type of anal fistula has only one external port and one internal port, the treatment is more complicated, so it is called complex anal fistula. On the contrary, sometimes anal fistula has multiple external openings, but the treatment is not complicated.
Types of anal fistula
1. According to the location, depth, height and number of fistulas and fistulas, the classifications are:
1. External fistulas and internal fistulas: external fistulas have at least two fistulas, one on the skin around the anus, most of which is 2 to 3 cm away from the anus, called the external opening, and the other in the intestinal cavity, mostly at the tooth line The inside of the anal sinus is called the internal orifice. A few internal orifices are above the middental line and on the wall of the rectum. The internal opening of the internal fistula is the same as the external fistula, there is no wound, and 90% of the clinical findings are external fistulas.
2. Low fistula and high fistula: The fistula is located below the plane of the anorectal ring as a low fistula, and above this plane is a high fistula . The latter is related to the choice of treatment.
3. Simple anal fistula and complex anal fistula: the former has only one fistula, the latter can have multiple fistulas and fistulas.
Anatomical classification of anal fistula
2. From the perspective of clinical treatment, the relationship between anal fistula and sphincter is more important, which can be divided into:
1. Intersphincteric type-the most common type, the inner mouth is located on the tooth line, the fistula runs between the inner and outer sphincter, and the outer mouth is on the skin around the anus;
2. Transsphincter type-the fistula penetrates the skin around the anus through the space between the external sphincter and the ischial anal canal;
3. Suprasphincter type—uncommon. The fistula penetrates the levator ani muscle as above and penetrates into the skin around the anus;
4. Outer type of sphincter-rare, the inner mouth is on the dentinal wall of the rectum, the outer mouth is on the skin of the perianal distance, the fistula is outside the inner and outer sphincter, and goes down through the levator anus.
Anal fistula-symptoms and signs
Anal fistula is often a perianal abscess that ruptures spontaneously or the wound does not heal after incision and draining to form an external fistula.
1. Clinical manifestations: A small amount of pus repeatedly flows out from the outer opening of the fistula, which contaminates underwear; sometimes the pus irritates the perianal skin and causes itching. If the outer mouth is temporarily closed and pus accumulates, there will be swelling, pain, redness and swelling in the local area. The closed outer mouth can be pierced again, or another new outer mouth can be formed nearby. Such repeated attacks can form multiple outer mouths. Communicate with each other. If the fistula drains smoothly, there will be no local pain, only slight swelling and discomfort, and patients often don't mind.
2. Inspection: The outer mouth is a papillary protrusion or a bulge of granulation tissue, with a small amount of pus flowing out under pressure. Low anal fistulas often have only one outer mouth. If the location of the fistula is shallow, a hard cord can be felt under the skin. The outer mouth leads to the anal canal. The location of high anal fistula is often deep and it is not easy to touch the fistula, but there are often multiple external openings. Due to the stimulation of secretions, the perianal skin often thickens and redness. If there are external openings on the left and right sides of the anal canal, it should be considered as a "shoe-shaped" anal fistula. This is a special penetrating sphincter anal fistula, and also a high curved anal fistula. The fistula surrounds the anal canal and passes from one side of the ischiorectal fossa to the opposite side, forming a semi-circular shape like a shoe iron, hence the name. There is an inner orifice near the dentate line, and the number of outer orifices can be multiple, scattered on the left and right sides of the anus, and there are many branch tubes spreading around. Shoe-shaped anal fistula is divided into two types: front-shoe-shaped and back-shoe-shaped. The latter is more common, because the back tissue of the anal canal is looser than the front, and the infection is easy to spread.
Anal fistula-common symptoms
What are the common symptoms of anal fistula disease? Apart from prolapsed masses and lumps, what other common symptoms are there? 
(1) The tumor prolapsed. A swelling prolapsed outside the anus after going to the toilet. It is common in internal hemorrhoids, papilloma, rectal polyps, rectal prolapse and so on. It should be noted that the tumor that protrudes from the anus should be sent back in time, otherwise it may cause the tumor to be incarcerated, difficult to repay, and cause pain and necrosis.
(2) Lumps. The neoplasms or protrusions around the anus are common thrombotic external hemorrhoids, connective tissue external hemorrhoids, condyloma acuminatum, and anal squamous cell carcinoma.
(3) Swelling. The swelling mentioned here mainly refers to perianal abscess and thrombotic external hemorrhoids. The swelling of perianal abscess is characterized by swelling, pain and throbbing, and often patients cannot straighten their waist. The swelling of thrombotic external hemorrhoids is limited to only one point. Does not affect body position. Incarcerated internal hemorrhoids. The anal margin is edema due to obstruction of blood return and lymph flow, swelling like a blooming crystal "violet", with dentate lines visible in the middle, and red hemorrhoid mucosa on or above it. In severe cases, it can be intensified to form a plug.
(4) Secretions flow out of the anus. It can not only overflow from the fistula, but also from the anus, such as internal hemorrhoids, rectal prolapse caused by anal muscle relaxation, or overflow from the perianal skin, such as anal eczema. Clinical pus out of hemorrhoids and fistula. It is more common in anal fistula, abscess ulceration, inflammation of anal fissure, and proctitis.
(5) Perianal itching. Itching and discomfort are mostly caused by irritation of the anus and surrounding skin. It is common in anorectal inflammatory lesions, skin diseases and enterobiasis. Severe itching, moist skin around the anus, and anal eczema for papules; unbearable itching, thick and rough skin, lightening or darkening of the skin is anal pruritus; if it is more itchy at night. Sometimes small white worms are seen around the anus, which is anal enterobiasis.
(6) Changes in bowel habits. Healthy people have normal bowel habits, and changes in bowel habits are common in hemorrhoids, anal fistulas, anal fissures, and anorectal tumors.
(7) Stool becomes thinner. Stool thinning is common in certain congenital diseases (such as congenital anorectal stenosis, anorectal lesions) or anorectal cancer. In addition, surgical injuries such as hemorrhoids, anal fistulas, and trauma can make stool thinner.
(8) Abnormal stool. Any abnormalities in stool quality, volume, daily bowel movements, and bowel sensation are all abnormal stools. Many people usually think. Diarrhea and constipation are abnormal stools, in fact, this is only one aspect.
In addition, if the stool contains mucus, bleeding, abdominal pain or bloating, as well as anal pain and itching, the occurrence, development, and relief are all related to defecation, and even cause and effect each other. Therefore, the above abnormalities can also be attributed in a broad sense. Abnormal stool.
(9) Diarrhea. Patients often have more stools, thin or watery stool, and pus and blood in the stool. More common in dysentery and enteritis.
(10) Constipation. Constipation is the most common symptom in patients with hemorrhoids, and it is a symptom that can occur in many diseases. Constipation refers to a decrease in the number of bowel movements, less than 2 to 3 times in 7 days, feces staying in the intestines for too long, too much water absorption, too dry and hard feces, which makes it difficult to discharge, which brings adverse effects on people's physical and mental health. It is not only the cause of hemorrhoid fistula and anorectal disease. It can also cause and aggravate many systemic diseases.
Anal fistula-the distribution of fistulas
There is a certain regularity in the distribution of the external and internal openings of anal fistula. Goodsall (1900) once proposed: draw a horizontal line in the middle of the anus. If the external opening of the anal fistula is in front of this line, the fistula often runs straight toward the anal canal, and the internal opening is located The corresponding position of the external opening; if the external opening is behind the horizontal line, the fistula is often curved, and the internal opening is mostly located in the middle of the anal canal. This is generally called Goodsall’s law. Most anal fistulas conform to the above rules, but there are exceptions. For example, the front high-shoe-shaped anal fistula may be curved, and the posterior low perianal abscess may be straight. Clinically, it has been observed that the straightness and curvature of anal fistula are not only related to the front and back of the anal canal, but also to the high and low positions of the anal fistula, and the distance between the external mouth and the anal margin. Cirocco (1992) once conducted a retrospective analysis of a group of anal fistula cases to test the accuracy of Goodsall's law in predicting anal fistula progression. He believed that this law was quite accurate in predicting the progression of anal fistula in the posterior external opening, especially for female patients, with 97% of internal openings. It is located in the posterior median anal crypt, but the prediction of the anal fistula of the anterior external mouth is not accurate. Only 49% of the radial fistulas conform to this rule, because Goodsall did not realize that 9% of the anterior anal fistula originated in the anterior median anal crypt.
Anal fistula-development process
Wuxi Kangtai experts pointed out that the formation of anal fistula is inseparable from the development of perianal abscess. The formation of anal fistula generally goes through four stages:
The first stage: infection and inflammation of anal crypts and anal flaps. At first, it is limited to local inflammation. If it is not treated in time, the inflammation can spread around the anus.
The second stage: Inflammation starts from the local anal recesses and anal flaps, and gradually spreads to form perirectal inflammation. If the inflammation cannot be controlled, it may invade into the tissue gaps with low disease resistance.
The third stage: due to the decreased disease resistance of the tissues around the anorectal space, it becomes a place for germs to invade, spread, accumulate and multiply, causing the tissues here to be prone to infection and inflammation, which is invincible, and the formation of anorectal abscesses. If the anorectal abscess can be treated properly in the early stage, the abscess can often dissipate and heal without leaving sequelae; if the early treatment is delayed or improperly handled, the tissue necrotic pus can spread along the local space, making the condition aggravated and complicated.
The fourth stage: The perianal abscess ruptures spontaneously or after treatment with incision, drainage and dressing, although the abscess cavity gradually shrinks, but the ulcer does not close for a long time. At this time, the cavity wall has formed a hard duct wall with connective tissue hyperplasia. The remaining space is the fistula. The pus often flows out of the fistula, with repeated infections and recurring attacks. It cannot heal itself for a long time and becomes a fistula.
1. Medical history The patient often has a history of perianal abscess or incision and drainage, and the wound has not healed for a long time.
2. Clinical manifestations: Repeatedly flowing out a small amount of pus through the fistula, perianal pus swelling and pain, perianal skin itching; pus outflow from the fistula when touched, hard cords can be palpable under the skin.
3. Auxiliary examination: The probe can be inserted into the pipe through the external port; the methylene blue can be injected through the external port, and the gauze in the anal canal is stained blue; fistula angiography can show the image of the pipe.
Anal fistula-auxiliary examination
1. Digital rectal examination: There is mild tenderness on the inside and outside of the mouth, and a few can be palpable to induration.
2. Methylene blue dyeing method: stuff white wet gauze into the anal canal and the lower end of the rectum, and inject 1-2ml of methylene blue into the fistula through the external mouth, and then take out the gauze from the anal canal. According to whether there is methylene blue staining on the gauze and Stain the site to determine the existence of the fistula and the location of the internal mouth.
3. Probe inspection Use a probe to insert the pipe through the outer port to determine the location of the fistula and the inner port. This method is generally performed under anesthesia during the operation. If the operation is improper or unfamiliar with this method, it may cause false passages.
4. Fistula angiography 30%-40% lipiodol is injected from the external mouth. X-ray film can be used to observe the distribution of fistula. It is mostly used for the diagnosis of high complex anal fistula and shoe-shaped anal fistula (Figure 6). Yang (1993) examined 17 cases of clinically suspected anorectal abscess or fistula, 6 cases of clinically suspected abscess, anal canal ultrasound AUS examination also showed abscess; another 82% (9/11) AUS found fistula, and clinical Routine inspection failed to find.
5. Anal canal ultrasound is sometimes valuable for the diagnosis of intersphincteric fistula, but it cannot diagnose external sphincteric fistula and transsphincteric fistula.
6. MRI Lunniss reported 35 cases of the results of this method, and the coincidence rates with the surgical results were: primary anal fistula (85.7%), secondary fistula and abscess (91.4%), hoof fistula (64.3%), fistula 80% of the inner mouth. Therefore, it is believed that the diagnosis of anal fistula position during MRI examination has extremely high accuracy. Correct use of MRI clinically can not only increase the success rate of surgery, but also monitor whether the complex anal fistula is completely healed.
Anal fistula-differential diagnosis
1. Perianal hidradenitis: This is the perianal skin disease that is most easily misdiagnosed as anal fistula, because its main feature is the formation of perianal abscess and residual sinus. There are often bulges and pus in the sinus, and there are multiple external openings, so it is easy to be misdiagnosed as multiple anal fistulas or complex anal fistulas. The main point of differentiation is that the lesions of perianal hidradenitis suppurativa are in the skin and subcutaneous tissues. The lesions are extensive and may have numerous sinus openings, which are nodular or diffuse, but the sinuses are shallow and do not communicate with the rectum. After incision of the sinuses There is no pus, fistula, and no internal mouth. Wiltz reported 43 cases of perianal hidradenitis suppurativa, 35 cases were first diagnosed as anal fistula, Tibetan hair cyst, sinus and anal abscess, and had a history of more than 6 years before diagnosis.
2. Pelvic osteomyelitis: Pelvic osteomyelitis caused by pelvic purulent or tuberculosis lesions often occurs in the perineum sinus, which is very similar to the external opening of anal fistula. However, the former does not have an internal mouth, and X-ray shows that the pelvis is diseased.
3. Anterior sacral fistula: The abscess between the sacrum and the rectum is punctured near the coccyx. The fistula is located in the sacral cavity. The external opening is often located on both sides of the tip of the coccyx. The probe can penetrate 8-10cm, and the fistula is parallel to the rectum.
4. Sacrococcygeal bone tuberculosis: slow onset, no acute inflammatory changes such as redness, swelling, heat, pain, thin pus after ulceration, large outer mouth, irregular edges, and unhealed for a long time. X-ray film showed bone damage and tuberculosis foci in the sacrum.
5. Sacrococcygeal teratoma: anterior coccygeal fistula or internal rectal fistula can be formed after rupture. Large teratomas can protrude from the sacrum and are easy to diagnose; small asymptomatic tumors can be palpated behind the rectum and smooth, lobed masses. X-ray film showed a mass between the sacrum and the rectum, with irregular scattered calcification shadows, bone or teeth.
6. Advanced anorectal cancer: Anal fistula can form after ulceration, characterized by hard masses, pus and blood in secretions, and foul smell. Pathological sections can be diagnosed.
Anal fistula-treatment options
Schematic diagram of anal fistula thread therapy
Once an anal fistula is formed, there is generally no possibility of self-healing, and surgical treatment is the only cure. However, in recent years, some people have used artificial materials to fill fistulas to treat anal fistulas. They believe that the effect is better and does not require surgical treatment. The principle of surgery is to cut or remove the fistula, making it an open wound and achieving the goal of gradual healing. The treatment should emphasize understanding the position of the internal mouth and the relationship with the deep part of the external sphincter to avoid damage to the sphincter and cause anal incontinence. There are several commonly used surgical methods .
1. Fistula incision: It is suitable for simple low-position anal fistula. The probe is used to check the entire fistula during the operation, and all the fistula is cut through the probe, and the granulation tissue in the fistula is scraped to make the wound surface V-shaped. Fill the wound with oil gauze, and wash the wound with 1:5000 PP powder or hot water every day after 2 to 3 days. During the whole treatment process, care should be taken to ensure that the granulation tissue of the incision surface grows from the base to the superficial surface, and finally heals completely. Therefore, it is very important to observe the wound surface and change the dressing frequently. The topical application of Shengji ointment or growth hormone preparation for 2 to 3 days after the operation can accelerate the healing of the wound.
2. Thread-hanging therapy is suitable for high simple or complex anal fistula. This method can avoid postoperative anal incontinence caused by sphincter incision, rupture and contraction at one time. It is widely used in clinical practice, easy to operate, and can be implemented in outpatient clinics. The disadvantage is that the postoperative recurrence rate is relatively high, which is mainly related to the incomplete exploration of the branch and internal mouth by the surgeon. High complex anal fistula can be changed into a simple anal fistula after repeated threading. Operation method: Under anesthesia, insert a probe from the outer port, pass the fistula through the inner port, tie a rubber band to the probe at the inner port, and then pull the rubber band from the inner port through the fistula to the outer port. Cut the skin between the inner and outer mouth and tighten the rubber band to ligate. The thread can be tightened again 3 to 5 days after surgery. Generally, the rubber band falls off within 2 weeks after surgery, leaving the open surface to heal gradually. If the rubber band does not fall off after 2 weeks, scissors can be used to cut the tissue bound by the rubber band.
3. Anal fistula resection is generally suitable for low simple anal fistulas, but in recent years, many scholars have applied this method to high anal fistulas and complex anal fistulas. The method is to remove all the fistulas at one time, and the wound surface is healthy and normal tissue, and it is small inside and large outside. The superficial wound can be sutured in full thickness, and the stitches will be removed after 5 days, and the wound can be healed at first stage. The deeper wound should be opened. When the high anal fistula is resected, the deep part of the external sphincter should be separated, and those who need to be cut should pay attention to suture the reconstruction.
Common dietary recipes for patients with anal fistula
The occurrence of anal fistula is closely related to dampness and heat, so greasy food that generates dampness and heat should be tempered, and at the same time, we should quit smoking, alcohol and tea addiction. Eat more light and vitamin-rich foods, such as wax gourd, loofah, mung bean, radish, etc.
Prolonged anal fistulas are mostly of the fictitious type. Foods such as lean meat, beef, mushrooms, jujube and sesame should be eaten in the diet. In addition, foods for prevention and treatment of deficiency syndrome include fungus, yam, coriander, leeks, eggplant, ginseng, water chestnut, lotus root, fennel, lychee, chicken, mutton, figs, etc.
Common diet therapy:
1. 1 piece of rice field eel, 100 grams of lean pork, 25 grams of astragalus, stir-fry, add salt, sugar, and rice wine, and eat after removing the astragalus. It is suitable for patients with virtual anal fistula.
2. 100g each of rice and millet, wash, put in a pot, add appropriate amount of water to boil, wait until the porridge is cooked to half-cooked, add 500g of soy milk, stir well and cook, ready for consumption. It is suitable for patients with futility, both young and old.
3. 6 grams of chrysanthemum, 6 grams of white sugar, and 3 grams of green tea leaves, put in a teacup and brew with boiling water. It is slightly stuffy for a while, with a light fragrance and elegant, which can clear away heat and detoxify, promote blood circulation, remove dampness, and relieve anal fistula swelling and pain.
Anal fistula-TCM treatment of anal fistula
Indications of TCM treatment of anal fistula:
It can be said that drug therapy looks dull in the face of anal fistula, and only surgery can show its skills. However, some anal fistulas do not necessarily require surgery, and some patients are not suitable for surgery. Therefore, the traditional Chinese medicine treatment of anal fistula has its limitations. There are four scopes: first, patients with internal hemorrhoids and external hemorrhoids; second, elderly and weak people who are not suitable for surgery; third, the middle and late stages of internal and external hemorrhoids and other serious diseases. People who suffer from (such as liver disease, kidney disease, abdominal tumors, etc.); the fourth is anal fissure, anorectal abscess, fistula inflammation, and all anal infections.
What are the traditional Chinese medicine treatment methods for anal fistula?
The treatment of anal fistula in Chinese medicine is mainly based on internal treatment, which can be summarized into the three principles of elimination, care, and compensation, which can be used flexibly according to the severity of the disease. The specific decomposition is as follows.
This is to use dissipating drugs to dissipate the initial perianal carbuncle and inflammatory external hemorrhoids, and avoid the pain of pus and incision. This method is suitable for perianal carbuncle, inflammatory external hemorrhoids, thrombotic external hemorrhoids and anal fissures without purulent. The specific usage depends on the nature of the disease. If there is evil expression, it is better to remove the surface; if the inside is solid, it is better to pass the inside; if the heat toxin accumulates, it should clear away heat and detoxify; Those with blood stasis should promote blood circulation and remove blood stasis.
This is the use of medicines that nourish qi and blood to help the righteous qi and the leakage of poison to prevent the poison from invading. This method is suitable for the mid-stage of perianal abscess, weak righteousness, excessive toxins, inability to pass the toxin, perianal carbuncle flat and collapsed, loose roots and feet, and insufficiency and decay. If the poisonous qi is strong but the righteous qi is not decayed, pus-permeable drugs can be used to promote the early release of sepsis, reduce pain and swelling, so as to prevent the sepsis from running around and causing future problems.
Three: make up
This is to use tonic drugs to restore righteousness, help regenerate the affected area, and make sores and fistulas heal as soon as possible. This method is suitable for the elderly with physical weakness, weak qi and blood, late ulcers, or after anorectal disease, heat toxins have gone, and the lesions have been removed, and those who are mentally weak, weak in vitality, pus and water, and difficult to collect sores, and Patients with blood in the stool and prolapse. Those with weak qi and blood should replenish qi and blood; those with weak spleen and stomach should manage the spleen and stomach; and those with insufficient liver and kidney should replenish liver and kidney. But when the poisonous evil is not exhausted, do not use the tonic method as early as possible to avoid the evil's internal connotation, which will cause trouble over time.
Anal fistula-preventive measures
1. Prevention and treatment of constipation and diarrhea are of great significance to the prevention of perianal abscess and anal fistula.
2. Treat anal cryptitis and anal papillitis in time to avoid the development of perianal abscess and anal fistula.
3. Actively treat systemic diseases that can cause perianal abscess, such as Crohn's disease, ulcerative colitis, and intestinal tuberculosis.
4. If the anus is burning and uncomfortable, and there is a feeling of falling, it is necessary to promptly diagnose and treat.
5. Establish a normal life content (a balanced diet), develop good bowel habits, take a bath after defecation every day, and keep the anus clean, which has a positive effect on preventing infection.
Diet after anal fistula operation
Cocoa milk: half a catty of milk, 6 grams of cocoa powder, 10 grams of brown sugar, put the cocoa powder and brown sugar into the cup, flush the boiled milk into the cup, and then eat. Can be taken for a long time.
Mung bean glutinous rice porridge: 50 grams of mung beans, 100 grams of glutinous rice, add appropriate amount of water and heat to cook the porridge, then eat.
Eel medicated diet: 2 eels, eviscerated, cooked with 2 cups of wine, 1 bowl of water, and eaten with salt and vinegar.
Egg melon seed soup: 2 eggs, shelled, 30 grams of melon seeds, add 2 bowls of water, and serve with sugar.
Spinach mixed with bean sprouts: 100 grams of spinach, 100 grams of vermicelli, 50 grams of bean sprouts, 10 grams of leeks, cold dressing is enough.
Anal fistula-how to determine the internal mouth of a complex anal fistula
(1) Surgical examination, how to determine the internal orifice of complicated anal fistula? First, cut open the fistula and look for the internal opening along the fistula, which is generally easy to find.
(2) Dyeing inspection. Put dry gauze into the rectum. If it is stained, it proves that there is an internal mouth.
(3) Probe examination, how to determine the internal orifice of complicated anal fistula? Fingers can be inserted into the anus first, and a silver round-tip probe is used to gently probe into the intestinal cavity from the outer mouth along the pipe. Complete anal fistula. The fingers in the intestinal cavity can touch the probe near the tooth line to determine the inner mouth , Do not blindly use force when exploring, avoid false roads and spread the infection.
(4) Anal endoscopy, all the dentition lines can be seen under direct vision. The internal mouth is often inflamed and inflamed with anal fistula with secretions. For suspicious anal crypts, a silver round tip probe can be used. 
Anal fistula-cancerous anal fistula
1. Causes of cancer
1 Long-term chronic inflammation stimulation. The long-term existence of inflammation causes purulent secretions and feces to be discharged from the fistula, which stimulates the abnormal proliferation of tissue cells and leads to malignant lesions.
2 Bacterial infection. Bacteria exist in the fistula for a long time, especially the infection of Pseudomonas aeruginosa or Mycobacterium tuberculosis, which can linger and cause cancer.
Drug stimulation. Long-term and large-scale use of various topical drugs often stimulate the local area and cause cancer.
2. The problem of cancer
It can be explained clearly in three sentences
1. Anal fistula is not directly related to cancer. Anal fistula is not a pre-cancer lesion; 2. Chronic anal fistula does have cancerous cases due to long-term inflammatory stimulation or scar tissue mutation; 3. Chronic anal fistula cancerous cases are very rare, and anal fistula cancerous The probability is very low.
Anal fistula, when hemorrhoids, hides great harm
Both anal fistulas and hemorrhoids occur in the anus, and both have symptoms of pain and bleeding, so it is easy to treat anal fistulas as hemorrhoids. One of the main symptoms of hemorrhoids is prolapse of internal hemorrhoids. The internal hemorrhoids protruding outside the anus are clamped by the sphincter, venous return is blocked, and the arterial blood is still infused to increase the volume of the hemorrhoids, until the arterial blood vessels are compressed, thrombosis occurs, the hemorrhoids become hard and painful, and it is difficult to send them back Inside. Anal fistula is also a common anal disease. It can also be called hemorrhoids, which is the sequelae of ulceration and incision of abscesses around the anal canal and rectum.