hemorrhoids and anal fissures,Anal sinusitis—the first source of infection for various anorectal diseases

    I. Overview

    Anal cryptitis is an acute and chronic inflammatory disease of anal sinus and anal flap, also known as anal sinusitis. Due to chronic stimulation of inflammation, anal papillitis and anal papillary hypertrophy are often complicated. Its clinical features are discomfort, dampness, pain, and discharge in the anus. Because the symptoms are mild and they are inside the anal canal, they are easily ignored by patients and doctors. Anal cryptitis is the main infection that causes anorectal diseases. According to statistics, about 85% of anal carbuncle, anal leak, anal fissure, anal papilloma, etc. are caused by anal sinus infection. Therefore, early diagnosis and treatment of this disease Have a positive meaning.

    2. Pathogenesis

    1. Hot and damp betting is mostly due to irregular diet, over-eating mellow wine and thick taste, spicy and burning; or harassment of insects, damp and heat endogenous, betting on the anus; or due to dry intestines, constipation, damage and poisoning.

    2. Internal heat due to yin deficiency caused by burning body fluid and loss of yin and fluid due to the evil poison of stagnation of heat.

    Western medicine believes that the cause of anal cryptitis is that the anal sinus is prone to inflammation due to the anal anatomy. The structure of the anal sinus is cup-shaped, with the opening facing upward, which not only has poor drainage, but also tends to accumulate fecal residue, which hinders the secretion of anal glands. It is easy for bacteria to multiply, and bacteria invade into the anal gland from its bottom, causing inflammation of the anal sinus, and then other anorectal diseases.

    Three, diagnosis

    (1) Clinical manifestations

    The disease can occur at any age, mainly young adults, and more women than men.

    1. Anal discomfort The patient has no obvious symptoms in the initial stage, but often has a feeling of incomplete defecation, a feeling of foreign body in the anus and a feeling of falling. In severe cases, there is a sense of tenesmus.

    2. Pain There may be tingling, and the anal sinus is compressed by stool during defecation, and the anal pain may be aggravated, usually not very severe, and disappear within a few minutes. If the sphincter muscle is stimulated by inflammation and contracture, the pain will be aggravated, and there may be short-term paroxysmal tingling, or the pain may last for several hours. In severe cases, it may spread to the hip and back of the thigh.

    3. Dampness and secretions Increased secretions due to inflammation of the anal sinus and anal flap; inflammatory edema of surrounding tissues, resulting in anal incomplete exudation. Make the anus moist and itchy. Acute phase is often accompanied by constipation, stool often contains a little mucus, this mucus flows out before the stool, sometimes mixed with bloodshot eyes. If the nipple is enlarged and prolapsed from the anus, it can aggravate the moist itching of the anus.

    4. Digital rectal examination can find a sensation of tightness in the anus and burning sensation in the anus. The inflammation of the anal sinus has obvious tenderness, induration or depression, and the swollen and tender anal nipple can be felt.

    (2) Other auxiliary examinations

    1. Anoscopy The inflamed anal sinus and anal flap are hyperemia, edema, anal papilla enlargement, purulent secretion or red granulation swelling at the crypt opening.

    2. Probe inspection When using the probe to explore the anal sinus, it can penetrate into the deeper part of the anal sinus and discharge pus.

    Four, treatment

    In the early stage, it is necessary to clear away damp heat, purify fire and detoxify, and add antibiotics when necessary. If the disease recurs and forms a local abscess, surgery should be used to cure it.

    (1) Internal governance law

    1. Damp-heat betting syndrome: anal bulging discomfort, or burning and stinging may occur, aggravated during stool, fecal sticky freezing, may be accompanied by tenesmus, anal damp itching, with dry mouth, constipation; red tongue, yellow and greasy coating , Pulse slip number or string number. Treatment method: clearing away heat and dampness, promoting blood circulation and relieving pain. Recipe: Modified Pain Rushen Decoction. Then dry and increase the yellow, hemp kernel, peach kernel and so on.

    2. Yin deficiency and internal heat Syndrome: anal discomfort, faint pain, aggravation during stool, anal mucus overflow; night sweats, dry mouth, constipation; red tongue, yellow or little coating, thin pulse. Treatment: nourishing yin and clearing away heat, cooling blood and relieving pain. Recipe: Addition and subtraction of Liangxue Dihuang Decoction.

    (2) External governance law

    1. Fumigation and washing Use Sophorae Sophorae Decoction, Qudu Decoction, Nepeta Recipe and other decoctions, smoke first and then wash, twice a day.

    2. Suppository various hemorrhoids suppositories such as Indomethacin suppository (indomethacin), Zhichuangning suppository (metazolidone), Puji hemorrhoid suppository, Taining suppository (carrageenan), Mayinglong hemorrhoid suppository, Kangtai Suppository, etc., stuffed into the anus after taking a bath every day, 2 times a day, or use red oil ointment, Jiuhua ointment, comfrey ointment (composite ointment made from comfrey, dragon blood, angelica dahurica, angelica, etc.), anus Ointment, Taining Cream (Carrageenan), Mayinglong Musk Hemorrhoid Ointment, Dragon Ball Ointment, Moist Burn Ointment, etc., apply 1 to 2 times a day into the anus.

    (3) Surgical therapy

    Patients with pus in the anal sinus, or with nipple hypertrophy or invisible fistula, should be treated surgically.

    1. Incision and drainage method is suitable for simple anal cryptitis and purulent; or there is a recessive fistula.

    2. Resection method is suitable for anal cryptitis accompanied by anal papilla hypertrophy.

    (4) Other therapies

    1. Antibiotics Anal cryptitis is generally caused by E. coli infection, but also proteus and tuberculosis. According to different types of infected bacteria, corresponding drugs can be given, and drug sensitivity test can be done if necessary.

    2. Chinese medicine retention enema is based on the effective prescriptions selected by clinicians in long-term clinical practice, and the clinical application is added or subtracted according to the symptoms, such as Jiawei Huanglian Jiedu Decoction, self-made Kushen Diyu Huaijiao Decoction, self-made red ice Enema such as soup treats anal sinusitis with satisfactory results. The retention enema of traditional Chinese medicine can avoid the decrease of drug efficacy caused by gastrointestinal malabsorption and the adverse reaction of the drug to gastrointestinal stimulation. It is more rapid than oral to gastrointestinal absorption, so that the drug can reach the disease site and achieve the purpose of recovery.

    3. Acupuncture treatment of anal sinusitis by acupuncture at Changqiang, Pangyaoshu (1 cun next to the Yaoshu point, one on each side), Cilian, Chengshan, and Dachangshu acupuncture for anal sinusitis, first acupuncture at Changqiang acupoint and needle tip Penetrate 1.5-2 inches parallel to the sacrococcyx, and there must be numbness radiating to the rectum. After Pangyaoshu acupuncture gets qi, insert a 2cm moxa stick into the needle handle to warm moxibustion for 1-2 strong. After acupuncture on the other Shu points, get qi acupuncture once 5 minutes, and keep the needle for 40 minutes. After the needle is lifted, puncture and cupping on Ciliao and Pangyaoshu points, leaving the cup for 10 minutes. The treatment is performed every other day, and 10 times is a course of treatment.

    Tuina therapy can also be used to treat anal sinusitis. The patient takes a lateral position, and liquid paraffin is used as a lubricant. The left and right thumbs alternately perform circular movements of the anus. The technique is from light to heavy, followed by gently pushing into the anus. The degree of manipulation is based on the patient's comfort or tolerance. 30min each time, 5d is a course of treatment, generally 1-3 courses of treatment.

    4. Physiotherapy is treated with Kangte CW-Ⅱ microwave treatment instrument (Shenzhen McMan Medical Instrument Co., Ltd.): insert the microwave probe coated with paraffin oil into the anus about 6-7cm, the power is 25W, 30min/time, 1 Times/d, 1 week is a course of treatment. The physiotherapy head should be fixed in an appropriate position, and the dosage should be adjusted to make the patient feel warm and comfortable, and there should be no burning sensation.

    The 2GZ-straight intelligent anorectal therapy machine (produced by Hefei Microcomputer) can also be used for treatment, 40min/time, once/d, set temperature 44℃, after treatment, self-made Jiuhua ointment is incorporated into the anus. 1 time/d, 10 times is a course of treatment.

    Five, prevention and care

    Proper treatment of this disease at the initial stage can be cured. If the early treatment is not timely or improperly treated, and the inflammation is not controlled, diseases such as anal carbuncle, anal leak, anal fissure, and anal papilloma may occur.

    Prevention and care:

    1. Keep bowel movements unobstructed and anus clean.

    2. Treat constipation, diarrhea and other diseases in time.

    3. If the anus has hemorrhoids, anal fissure, or anal leakage, it should be treated in time.



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