2020年12月21日星期一

hemorrhoids and anal fissures,A new concept of the etiology of anal fissure-impaction theory

    Through historical research, hypothetical reasoning, clinical verification, and comparison with other theories, a new concept of the cause of anal fissure-impaction theory is proposed. The so-called impaction theory refers to the impaction of objects in the anorectum (various primary lesions), which hinder defecation. During defecation, the anal canal expands beyond the limit, and the skin of the anal canal is cracked to form an anal fissure. Hypothetical reasoning: A block is inserted in the anorectum, which hinders the discharge of stool. To discharge stool, one must work hard. The external force causes the caliber of the anal canal to be enlarged, the skin of the anal canal is torn, and anal fissure is formed. If the internal hemorrhoids, rectal tumors, hypertrophic anal papillae, and secret fecal masses are considered as impacted masses in the rectum, it will also cause anal fissures. Contrast (compared with traditional theory):

    ⑴ Anatomy theory of anal fissure: The anatomical structure of anal fissure is a congenital condition that anal fissure is prone to occur in special parts of the anus, but it is not a direct factor leading to the formation of anal fissure, that is, there is no fundamental reason for anal fissure formation without impact factors.

    ⑵ Theory of trauma: impaction factor is the direct factor of trauma, and trauma is the result of impaction factor hindering defecation.

    ⑶ Infection theory of anal fissure: infection can be secondary to the formation of anal fissure, which is a condition for the anal fissure to become chronic, or it can occur before the formation of anal fissure, which is a condition for hemorrhoids to aggravate or to transform.

    ⑷ Theory of internal sphincter spasm: chronic inflammation stimulates internal sphincter spasm, anal canal stenosis and other factors that are pathological changes during the development and change of anal fissures, not the cause of anal fissures. Clinical verification: In clinical research, based on the "impactation theory" and the principle of "using generalization" as the treatment principle, thoroughly treat internal hemorrhoids, hypertrophic anal papilla, rectal tumor, constipation and other primary diseases in anal fissure cases The lesions are all cured. In summary, the use of "impactation theory" to summarize the pathological factors of anal fissures, explain the occurrence of anal fissures, and guide the treatment of anal fissures are better than other theories. Use "impactation theory" to study the anal fissures The formation has high academic and clinical value.

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