2020年12月3日星期四

hemorrhoids and anal fissures,Anal Fissure

    Anal fissure is a rupture of the skin of the anal canal below the dentate line to form a prismatic crack or ulcer. Anal fissure is a common anal canal disease, which occurs in young adults and children

    It can also happen, with fewer elderly people. According to European and American statistics, women suffer from this disease more than men. According to clinical observations in China, men are more common than women. Anal fissure often occurs

    Born in the posterior and anterior center of the anus, most of them are in the back of the anus, and less on both sides. At first there was only a small crack in the skin of the anal canal, sometimes cracked to the skin

    Lower tissue or up to the superficial sphincter. The slit is linear or prismatic. If the anus is opened, the wound surface of the slit becomes round or oval. Early and timely

    Treatment can be cured.

    Traditional Chinese medicine believes that anal fissures are caused by constipation, too much effort to defecate and cause skin cracks in the anus. Repeated infections with toxic toxins cause local anal qi and blood.

    It is caused by poor operation and loss of nutrition in the wound. Therefore, Chinese medicine advocates that stools should be kept unobstructed at ordinary times, and for anal fissures, it can be used to clear heat and moisturize the intestines and external use to clear heat

    Drugs for detoxification, muscle growth and mouth closure. Anal fissure is an independent disease, which is different from ulcers in other parts of the body. It has a special pro

    Bed manifestations, that is, severe pain, predominantly in the posterior midline, low healing rate, lack of granulation tissue, lack of skin growth, anal high pressure, often accompanied by anal

    Nipple hypertrophy and sentinel hemorrhoids. The classification of anal fissure    One, the two-stage classification of anal fissure:

    Early anal fissure (acute stage): the fissure is fresh, no chronic ulcer is formed, and the pain is mild;

    Old anal fissure (chronic stage): Chronic ulcers have formed in the fissure, and there are also anal papillary hypertrophy, skin tags, etc., and severe pain.

    2. Three-stage classification of anal fissure:

    Stage I anal fissure: The skin of the anal canal has a superficial longitudinal fissure, with neat and tender wound edges. The tenderness is obvious and the wound is full of elasticity.

    Stage II anal fissure: There is a history of repeated attacks. The wound edge has irregular thickening and poor elasticity. Purple-red or purulent discharge at the base of the ulcer, surrounding mucosa

    Congestion is obvious.

    Stage III anal fissure: The ulcer has hard edges, purulent secretions at the base, hypertrophy of the anal papilla near the anal sinus at the upper end, and fissure hemorrhoids at the lower end of the wound.

    Or there may be a subcutaneous fistula. symptom

    Diagram of anal fissure

    When the patient defecates, the nerve endings in the anal fissure are stimulated, causing burning or knife-like pain in the anal canal, and the painful stimulation makes the internal anal sphincter retract

    The contraction causes persistent pain. As time goes by, the anal sphincter relaxes, the pain decreases and gradually disappears, so that defecation reappears immediately

    The formation of repetitive pain, this phenomenon is called anal fissure periodic pain. Clinically, it is common for patients to be afraid of pain and defecation, and appear "fear of pain-endure the bowel -"

    ---Dry stools-more painful" vicious circle phenomenon.

    The typical symptoms are pain, constipation, and bleeding. When defecation, dry and hard feces directly squeeze the ulcer surface and prop up the cracks, causing severe pain and feces defecation

    The pain is relieved briefly after going out. After a few minutes, the sphincter reflex spasm causes intense pain for a long time. Some analgesics are needed.

    ease. Therefore, patients with anal fissure fear defecation, which makes constipation worse and forms a vicious circle. There may be a small amount of bleeding on the surface of the feces or stool

    After dripping blood. During the examination, use the thumbs of both hands to gently separate the anal orifice, and the ulcer can be seen. The edge of the newly occurred anal fissure is neat and soft, and the ulcer has a shallow bottom and no scar

    Scar tissue, red color, easy to bleed. Chronic anal fissures are deep and hard, off-white, and not easy to bleed. Below the breach is a "sentinel hemorrhoid". Anal finger and anoscopy

    It will cause severe pain in the patient and should not be performed.

    Symptoms of anal fissure caused by syphilis

    Anal fissure caused by syphilis is initially itchy and tingling in the anus, and ulcers can be formed after scratching and removing the scab. The crack is generally not painful, and there is often a small amount of

    The secretions stick to the ulcer surface. A secondary infection or ulcer involving the sphincter is painful.

    Ulcers often occur on both sides of the anus, are fusiform, with raised edges, red in color, pale white in the bottom, and often accompanied by swollen inguinal lymph nodes. Kang's reaction

    Was positive.

    Cause

    "Yi Zong Jin Jian · Essentials of Surgical Heart Techniques" says: "The anus is surrounded, the folds are ruptured, and those with stools will become dry."

    Intestinal dryness, or constipation due to yin deficiency and body fluid deficiency, forced defecation, laceration of the anal skin, and subsequent infections, gradually forming a chronic, fusiform

    ulcer. But there are also infections caused by anal stenosis, anal eczema, hemorrhoid injury and other infections.

    1. Anatomical factors: the superficial part of the external anal sphincter, starting from the tailbone, forward to the back of the anus. The front and back of the anus are not as firm as both sides, easy

    Injured. Therefore, the back of the anus is more compressed by feces, and because of the insufficient blood circulation at the back of the anal canal, the elasticity is poor, and the anal glands are more distributed.

    These are the factors that cause anal fissure.

    2. Trauma theory: Dry and hard stool or foreign body can easily cause damage to the skin of the anal canal, which is the main cause of anal fissure.

    3. Infection theory: It is mainly infection of the anal crypt in the back of the anus. The inflammation spreads to the lower part of the anal canal, causing the subcutaneous abscess to rupture and form anal fissure.

    4. The theory of internal sphincter spasm: The anal sphincter is in a state of spasm due to injury or inflammation of the anal canal, resulting in increased anal canal tension

    Strong, easily damaged into anal fissure.

    5. Anal narrow elementary school said: The skin of the anal canal is slow in development, resulting in a narrow anal canal, which is easily damaged into anal fissure.

    Causes of high female anal fissures in summer

    Diagram of anal fissure

    One: Women are more picky eaters than men, the summer is hot, the diet is not much, bowel movements are irregular, and most have a history of constipation.

    Two: Some unmarried women are also more likely to suffer from anal fissures, especially during menstrual periods, which are more likely to get worse. It may be that menstrual periods are not well rested and pay attention to menstrual periods

    Hygiene. In summer, bacteria multiply rapidly, and poor hygiene during menstruation can cause local inflammation in the anus, leading to anal fissure.

    Three: Young and middle-aged women encounter childbearing barriers, their activities after pregnancy are correspondingly reduced, bowel movements are weakened, constipation is extremely easy to produce, and dry and hard stools are easy to scratch

    The skin of the anal canal causes local infections.

    Four: Often due to excessive exertion during childbirth, it is easy to tear the anal canal and perineum, causing pain and bleeding, and anal fissure.

    Chinese medicine believes that the cause of anal fissure

    ① Feel the wind and fire dryness and heat evil: dry fire builds up in the stomach and intestines, burns body fluids, feces are hard and dry, difficult to discharge, and the anus is damaged by the force

    Cracks, cracks that deepen repeatedly due to constipation, do not heal for a long time, leading to anal fissures.

    ②Heat and dampness accumulate in the anus: Exotic damp-heat evil, internal accumulation of alcohol, wine, fat and sweet, so that damp-heat accumulates in the stomach and intestines, betting on the anus to produce carbuncle, and the carbuncle will not heal

    Anal fissure.

    ③Intestinal dryness with blood deficiency: the elderly, postpartum patients and patients with anemia have dry intestines due to blood deficiency and constipation, and anal fissure is most likely to occur.

    These three types of people are prone to chronic anal fissures

    1. The sensitivity of the internal sphincter in young people is relatively high, and there are more irregularities in diet and life, so the incidence is high.

    2. Children's anal sphincter is not yet mature. There are few vegetables and crude fiber foods in the diet, and the stools are thicker and more frequent.

    3. Women's perineal sphincter is weak, pelvic congestion during menstruation, poor reflux, and force during childbirth, resulting in ischemia and easy tearing of the anal canal

    crack.

    Five major causes of anal fissure recurrence

    ①Improper handling of the internal ostium of anal fissure: The internal ostium was not accurately found, or the primary infection, that is, the internal ostium was not completely removed.

    ②Improper treatment of anal glands: Anal gland infection is an important cause of anal fistula. Therefore, the internal mouth should be removed, and there is inflammation near the internal mouth.

    Anal glands and anal gland ducts.

    ③The fistula branch and its cavity are not completely removed: that is, if the necrotic tissue is not scraped or the branch is removed during the operation, it can lead to recurrence.

    ④The internal orifice is complicated: when there are two or more internal orifices in the fistula, the search for the internal orifice is incomplete, leading to recurrence.

    ⑤ Newly formed anal fistula: Most patients have a perianal abscess due to anal gland infection, resulting in a new anal fistula, which is mistaken for recurrence.

    It is not difficult to distinguish in clinical practice.

    Reasons for women's easy anal fissure after childbirth

    ① Long-term bed rest after childbirth, little activity, slow bowel movement, and abdominal wall expansion during pregnancy, postpartum abdominal wall relaxation and weakness,

    If the pressure is lowered, the intestinal contents will easily stagnate in the intestinal cavity and be difficult to discharge.

    ② Inadequate diet after childbirth, excessive intake of fine foods, no or very little foods rich in fiber such as vegetables and fruits, some people still

    Drink less water.

    Squatting in the toilet and reading the newspaper are prone to anal fissure

    Anal fissure mostly occurs in middle-aged people, but it can also occur in the elderly and children. Generally speaking, most patients with anal fissure are accompanied by constipation.

    Anal fissure caused by forced defecation.

    Constipation factors: Among the pathogenic factors of anal fissure, constipation is the biggest curse. Long-term retention in the rectum can not only induce rectal cancer, but also

    The accumulation of feces also affects blood circulation. The patient's effort to remove the dry fecal mass will inevitably put a lot of pressure on the anus, resulting in cracks, swelling, etc.

    List pathological changes.

    Squatting to read the newspaper: When going to the toilet, a large number of people like to squat to read and read the newspaper, which will cause prolonged squatting and defecation time, which is easy to cause

    Blood stasis in the anus and rectum can induce disease. Smoking while going to the toilet can buffer the brain's defecation reflex, which can easily cause constipation. Excessive force during defecation, one

    Regardless of whether the bowel movement is strong or not, some people try blindly and vigorously, which can only increase the unnecessary burden and localization of the rectal anus and pelvic floor muscles.

    Blood stasis leads to the occurrence and development of anal fissures.

    pathology

    The pathological changes of anal fissure can be divided into four stages: 1. Initial stage: the anal fissure caused by the above factors, the initial skin damage of the anal canal

    Wounds, or superficial ulcers, and the surrounding tissues are basically normal.

    2. Ulcer formation stage: bad granulation hyperplasia in the wound. At the bottom of the wound, there are circular fibers, and the skin at the edge of the wound is hyperplasia.

    3. Chronic ulcer stage: old wound ulcer, internal sphincter can be seen under planing.

    4. Chronic ulcers combined with other pathological changes: on the basis of chronic ulcers, there are submerged anal fistulas, etc., chronic anal fissures often combined with the following pathological changes

    change.

    ① Anal papillitis: The upper end of the ulcer is connected to the tooth line, and the inflammation spreads, often causing anal sinusitis, and finally forming anal papilla hypertrophy.

    ② Anal sinusitis: Anal sinus infection spreads, small abscesses are formed under the skin of the anal canal, and ulcers are formed. Anal fissure first, then anal sinusitis.

    ③ Fusiform ulcer: anal canal skin laceration, after infection, the formation of ulcers.

    ④ Anal comb induration: that is, the chute is thickened and hardened, forming a comb-like induration, which is exposed to the base of the ulcer and hinders the relaxation of the sphincter, affecting

    Healing of ulcers.

    ⑤ Latent fistula: A fistula at the base of the anal sinus is often connected to an ulcer, which is caused by the formation of a small abscess and rupture due to infection of the anal sinus.

    ⑥ Split hemorrhoids: The skin at the lower part of the split is changed due to inflammation, and the superficial vein and lymphatic drainage are blocked, causing edema and tissue hyperplasia. Connective group

    Textured external hemorrhoids, also known as sentinel hemorrhoids.

    The requirements of underwear for patients with anal fissure

    Anal fissure is a rupture of the skin of the anal canal below the tooth line to form a prismatic crack or ulcer. Is a common anal canal disease, anal fissure often occurs behind and before the anus

    In the middle, it is mostly in the back of the anus and less on the sides. At first there is only a small crack in the skin of the anal canal, sometimes it can crack into the subcutaneous tissue or until the sphincter

    In the superficial muscle layer, the slit is linear or prismatic. If the anus is opened, the wound surface of the slit becomes round

    There are many reasons for the formation of anal fissure, such as: anatomical factors, trauma factors, infection factors, internal sphincter spasm factors, anal narrow factors

    Therefore, the principle of treatment for anal fissures is to prevent the dryness of stool first, so as not to scratch the skin of the anal canal again, and promote inflammation.

    The absorption prevents infection, and secondly promotes wound healing to achieve the purpose of treating anal fissures.

    Then the prevention should be to develop the habit of regular bowel movements every day, and eat more vegetables to keep the stool smooth, prevent constipation, and avoid smoking and drinking.

    Exciting food, eat more fresh fruits, vegetables and crude fiber foods. Keep the anus clean, wash the anus in time after going to the toilet, take a bath frequently, and change frequently

    Underwear can effectively prevent infection. In addition, the choice of underpants for patients with anal fissure is also more important, because underpants should not be too tight for patients with hemorrhoids.

    Yes, on the one hand, tight underwear affects the local blood circulation around the anus and delays the healing of the wound. On the other hand, it increases the growth of bacteria and aggravates the disease.

    Therefore, experts recommend that you use some loose, comfortable, and therapeutic functional underwear, such as: hemorrhoid belt, hemorrhoid underwear, etc.

    Very good and convenient treatment of anal fissure

    According to the theory of meridian of traditional Chinese medicine, the Hemorrhoid Eliminating Belt uses high-tech neodymium-iron-boron biomagnetic field to act on the acupoints of Guanyuan, Qihai, perineum, and Changqiang of the human body.

    Make the bio-magnetic field continuously release bio-energy, act on the relevant acupoints of the body, open up blood circulation in the hemorrhoids, eliminate stagnation of qi and blood, and open up blocked meridians

    , Eliminate inflammation and swelling and pain, promote siltation, coagulation or semi-coagulated blood dilution in the lesion, and restore normal circulation of blood in the veins of hemorrhoids.

    So as to promote the absorption of anal fissure inflammation and wound healing, at the same time, it can also regulate gastrointestinal function, reduce constipation and diarrhea, and the anti-hemorrhoid belt can also be adjusted to the second

    Pulse, lift the qi in the depression, consolidate the body, accelerate the absorption of inflammatory exudates, and accelerate the discharge of pain-causing chemicals, so as to achieve both symptoms and root causes

    purpose. Classification  The classification of this disease has not been unified at home and abroad. The clinically commonly used two-stage classification and three-stage classification.

    (1) The second-stage classification:

    ①Early anal fissure (acute stage): the fissure is fresh, no chronic ulcer is formed, and the pain is mild;

    ②Old anal fissure (chronic stage): Chronic ulcers have formed in the fissure, and there are also anal papilla hypertrophy, skin tags, etc., and severe pain.

    (2) Category 3:

    ① Stage I anal fissure: The skin of the anal canal has a superficial longitudinal fissure, and the wound edge is neat and tender. The tenderness is obvious and the wound is full of elasticity.

    ② Stage II anal fissure: there is a history of repeated attacks. The wound edge has irregular thickening and poor elasticity. The base of the ulcer is purplish red or has purulent discharge, and the surrounding is sticky

    The membrane hyperemia is obvious.

    ③Stage Ⅲ anal fissure: the edge of the ulcer is hard, the base is purplish red with purulent secretions, the upper end is close to the anal sinus, the anal papilla is hypertrophy, and there is a fissure hemorrhoid at the lower end of the wound edge

    , Or the formation of subcutaneous fistula. Complications     If the treatment is not timely, the crack will be repeatedly inflamed and infected, and it will develop under the skin of the anal margin and form a skin

    Lower abscess and fistula.

    Anal fissure is a common anal canal disease. Due to its long-term repeated infection, it has an impact on people’s lives and a series of complications

    disease:

    1. The ulcer first started as a longitudinal slit in the skin of the anal canal, which was linear or prismatic, with soft and neat edges, and a shallow and elastic bottom. Repeated infections made the slit unhealed for a long time.

    Close together, the edges are thickened, the base is hard, and it gradually becomes a deeper chronic ulcer. Mild stimulation can cause severe pain.

    2. Sentinel hemorrhoids The skin under the cleft is irritated by inflammation, which obstructs the return of lymph and venules, causing edema and fibrosis to form a size

    Varying skin tags, called sentinel hemorrhoids, are also connective tissue external hemorrhoids.

    3. Anal sinusitis and anal nipple hypertrophy are the result of repeated stimulation of inflammation at the upper end of the cleft. The nipple hypertrophy can protrude out of the anus with defecation.

    4. Anal marginal abscess and anal fistula The inflammation of the cleft extends to the subcutaneous, coupled with sphincter spasm, so that the ulcer drainage is not smooth, and the secretions sneak into the skin of the anal margin

    , The formation of an abscess, the pus ruptures to the breach, forming a subcutaneous fistula.

    5. Thickening of the combo The combo area is the narrowest area of ​​the anal canal, and is a prone area for anal comb induration and narrow anal canal. The thickened tissue under the combo zone is called

    Inflammatory stimulation of the anal fissure can cause it to thicken and lose its elasticity, and hinder the healing of the anal fissure. Therefore, the thickened combo strip should be used when treating anal fissures.

    Cut off.

    Patients with anal fissure should not do anal finger examination

    Anorectal examination has a good effect in the diagnosis of many anorectal diseases, and it is easy to operate, so it is a common examination method for anorectal doctors

    One of the methods. But nothing is omnipotent, and anal fingers are no exception. For example, anal fingers cannot be used for anal fissure inspection.

    The typical symptoms of anal fissure are pain, constipation, and bleeding. Dry and hard stools directly squeeze the ulcer surface and prop up the crack during defecation, causing severe pain.

    The pain is relieved briefly after the stool is discharged. After a few minutes, the sphincter reflex spasm causes intense pain for a long time, and some require pain relief.

    The prescription can be relieved. Therefore, patients with anal fissure fear defecation, which makes constipation worse and forms a vicious circle.

    Home self-examination of anal fissure

    The clinical manifestations of anal fissure mainly include symptoms such as pain, bleeding, constipation, and anal itching.

    If you have these symptoms, go to the hospital for treatment. ①Whether it is painful: its main manifestations are severe pain and continuous drama

    The pain can continue to worsen, and it can be relieved automatically after a few hours. ②Bleeding: When defecating, the wound is injured, which can cause bleeding from the crack.

    diagnosis

    The symptoms of anal fissure have clear characteristics. As long as the history of the disease and the characteristics of pain and bleeding are detailed, the diagnosis is not difficult. But at the time of diagnosis,

    for

    In order to improve the accuracy of diagnosis and prevent mistakes, the differential diagnosis should be strictly based on the aspects of questioning, palpation, inspection and biopsy

    Inspection: Excretion can be seen in the anus of acute anal fissure, and the lower end of the anal fissure can be seen when the buttocks are pulled. If the lower end of the fissure is lightly touched with a probe, it can cause pain

    ; Chronic anal fissures often have connective tissue external hemorrhoids.

    Digital examination: Clinical perianal digital examination and microscopy are not suitable for the diagnosis of anal fissure, because these examinations can cause severe pain in the patient. Adoptable Bureau

    Anal examination with anesthesia.

    Speculum examination: oval ulcers can be seen, or small cracks can be seen. Acute anal fissures have neat edges and light red bottom; chronic anal fissures

    The edges are irregular, the bottom is dark gray and white, and sphincter fibers can be seen in some severe anal fissures.

    Differential diagnosis: It must be differentiated from tuberculous ulcer, syphilis ulcer, chancroid and epithelial cancer. Among them, ulcerative colitis and granuloma

    Anal fissure complicated by colitis is easy to identify.

    Identification method

    Anal fissures can have one or several fissures, but most anal fissures occur on the midline, directly before or after, that is, at 6 o'clock and 12 o'clock in the stone cutting position.

    Due to the dryness of feces, the skin of the anal canal is scratched when passing through the anus. Generally, it cannot be called anal fissure. Because the stool is dry and hard, when it passes through the anal canal,

    A wound made by a torn tube is called an anal fissure. The depth of the damage varies. A shallow anal fissure can only lacerate the skin of the anal canal, and a deep anal fissure can damage the skin

    Tissue to muscle tissue, and even damage to muscle tissue.

    The difference between hemorrhoids and anal fissure

    Most of the anal fissures are accompanied by sentinel hemorrhoids, especially those who have been neglected for a long time. After the development of old anal fissures, they are often accompanied by external hemorrhoids,

    Internal hemorrhoids, at this time, the signs of the two outside the anus are basically the same. Therefore, understand the difference between anal fissure and hemorrhoids, and raise awareness of anorectal abnormalities to treat

    Treatment is of great benefit.

    Similarities between the two:

    1. Both show symptoms during defecation;

    2. Both have symptoms of blood in the stool;

    3. Both are accompanied by symptoms of pain after defecation.

    The difference between the two:

    1. The symptoms are different in the early stage. Hemorrhoids usually have early blood in the stool and no pain; anal fissures usually have early pain and occasional blood in the stool;

    2. Different symptoms occur. In the later stage of hemorrhoids, the hemorrhoids will protrude out of the anus, which can be touched by hand and feel intuitive; in the later stage of anal fissure, the anus is still pain

    Pain is dominant, and the pain deepens like a knife cut.

    3. Local examination of the anus can also be used for identification.

    How to distinguish anal fissure from anal fissure

    Anal fissure is a disease that is easily confused with anal fissures. The anal fissure occurs in the superficial cracking of the skin at the anal gland and anal canal. The crack can occur in the anal canal

    Any part of the skin is mostly superficial, confined to the subcutaneous layer, and does not involve the muscle layer, and there are several cracks at the same time, which can be seen without retraction of the anus. and

    Anal fissures have more than 1 to 2 fissures, which occur in the anal canal, with persistent severe pain, often reaching the muscle layer. In terms of treatment, anal chapped is treated with external medicine

    Mainly, anal fissure is mainly treated by surgery.

    Anal fissure must be differentiated from the following diseases

    1. Anal skin chapped: mostly caused by anal pruritus, anal eczema, etc. The crack is superficial and short, not in the anal canal, and the pain is mild

    Less blood, heavier itching, no complications such as ulcers, split hemorrhoids and anal papilla hypertrophy.

    2. Anal tuberculosis: Irregular shape of ulcers, surging edge, mild pain, no split hemorrhoids, tuberculosis nodules and cheese can be seen during pathological examination

    Like necrotic lesions.

    3. Anal skin cancer: Irregular shape of ulcer, uneven surface, raised edge, hard quality, strange smell and persistent pain, pathological

    The section shows cancer cells.

    Cure

    Fresh anal fissure

    Healing can be achieved by non-surgical treatment, such as a local hot bath, and potassium permanganate solution after the toilet, can promote the relaxation of the anal sphincter; ulcers

    surface

    How to treat anal fissure best?

    Apply anti-inflammatory analgesic ointment (including dicaine, berberine, metronidazole, etc.) to promote ulcer healing; oral laxatives to make stool soft and smooth;

    Those with severe pain can use procaine to partially seal or retain the enema to relax the sphincter.

    Old anal fissure

    After the above treatment is ineffective, surgical resection, including ulcers and skin tags (sentinel hemorrhoids) can be removed together, and part of the external sphincter can be cut off

    Fiber can reduce postoperative sphincter spasm and facilitate healing. Wounds should not be sutured. Postoperative defecation should be kept smooth. Hot water baths and wound dressings can be kept straight.

    To complete healing. In recent years, liquid nitrogen cryopreservation of anal fissures has achieved satisfactory results, with little postoperative pain, no bleeding from the wound, and no anal loss.

    Prohibition and other advantages.

    There are roughly the following methods for surgical treatment:

    1. Resection: It is suitable for stage III or chronic anal fissure, with good postoperative effect and very little recurrence.

    2. Rear internal sphincterotomy: The main purpose is to eliminate internal sphincter spasm.

    3. Lateral internal sphincterotomy: The main purpose is to reduce and prevent anal dysfunction.

    4. Anal canal dilation: mainly used for the loss and contraction of anal canal elasticity, sphincter dysfunction, and organic stenosis caused by various reasons

    5. V-Y anal canal plasty: suitable for skin defects of the anal canal and obviously narrow anal fissures.

    6. Treatment of skin cracks around the anus: surgery should be selected according to the cause of the disease.

    7. Anal fissure with stage Ⅰ or small stage Ⅰ hemorrhoids: a lateral internal sphincterotomy should be done first, and injections for the treatment of internal hemorrhoids after the anal fissure is cured.

    Other therapies: such as laser, electrocautery treatment, etc.

    Postoperative care

    After anal disease surgery, sometimes the pain is heavier. Therefore, the following aspects must be taken to reduce the pain.

    1) The surgical operation should minimize the tissue damage: that is, the sphincter should be minimized during the operation, and the clamp and excessive shear should be reduced.

    And friction wounds, only in this way can the nerve and muscle damage be reduced, the edema is reduced, and the anal pain after the operation is reduced;

    2) The anal sphincter should be relaxed as much as possible during the operation: an anesthetic technique should be used during the operation to fully relax the anal sphincter,

    For those with muscle contracture and hypertrophy, it should be fully released, and if necessary, cutting can also reduce anal pain;

    3) Make an incision during the operation: the incision during the operation should be long and wide enough, the wound surface should be flat, and the edges should be neat to allow sufficient drainage and wound surface

    Reduced irritation, thereby reducing anal pain;

    4) Control infection and rational use of analgesics: The surgical incision is good, and the incidence of infection and edema is low. However, appropriate antibiotics should be taken after the operation.

    Vitamins to prevent infection. At the same time, proper administration of analgesics can also relieve the patient's anal pain;

    5) Less activity, more sleep: Take appropriate sedatives, reduce activity, reduce the chance of friction from anal wounds, and also make anal pain after surgery

    Ease.

    Principles of treatment of anal fissure

    (1) Maintain smooth stools and prevent constipation: Eat more vegetables and fruits, increase drinking water, and correct constipation. Laxatives or paraffin oil can be taken orally,

    Make the stool soft and smooth to facilitate defecation.

    (2) Partial sitz bath: sitz bath with hot water or potassium permanganate warm water, temperature 40℃~50℃ (2~3 times a day, 20~30 minutes each time. Sit with warm water

    Bathing can relax the anal sphincter, improve local blood circulation, promote the absorption of inflammation, relieve pain, and clean the local area to facilitate wound healing. Sitz bath

    Afterwards, anti-inflammatory and analgesic drugs can be applied externally to relieve symptoms.

    (3) Sealing therapy: For severe pain, use 1% to 2% procaine injection into the base of the anal fissure and the anal sphincter on both sides to relieve the sphincter

    About muscle spasm to relieve pain.

    (4) Anal canal dilatation: It is suitable for patients with acute or chronic anal fissure without complicated nipple hypertrophy and sentinel hemorrhoids. Use your fingers under local anesthesia or sacral anesthesia

    The expansion of the anal canal can relieve the spasm of the anal canal sphincter and achieve the purpose of pain relief.

    (5) Surgical treatment: Surgical treatment can be used for chronic anal fissures that do not heal for a long time and are ineffective in non-surgical treatment. Anal fissure and surrounding lesions

    All the tissues are removed to make it a fresh wound and heal again.

    (6) HCPT surgery: HCPT minimally invasive and painless surgery incorporates high and new technology. The biggest feature of the HCPT minimally invasive and painless surgery system is surgery

    The patient has no bleeding and little pain.

    HCPT minimally invasive surgery, incorporating high-tech, combined with clinical experience, the first generation of American HCPT electrocoagulation suitable for anorectal diseases developed

    The electrosurgical instrument is composed of an inspection system, a treatment system, a computerized case management system, a fiber colonoscope, and a digital camera system. With power-on self-test

    , Fault alarm function. The most important feature of the treatment system is that patients undergoing surgery have no bleeding and little pain. Avoid sequelae and complications, prevent recurrence

    Treatment of anal fissure by magnetic therapy

    "Yi Zong Jin Jian · Essentials of Surgical Heart Techniques" says: "The anus surrounds, the folds are broken, and those who have stools will become dry."

    Intestinal dryness, or constipation due to yin deficiency and body fluid deficiency, forced defecation, laceration of the anal skin, and subsequent infections, gradually forming a chronic, fusiform

    ulcer. But there are also infections caused by anal stenosis, anal eczema, hemorrhoid injury and other infections.

    Magnetic therapy is a method of treating certain diseases by applying artificial magnetic fields (external magnetic fields) to the meridians, acupoints and lesions of the human body.

    A simple and effective scientific method, including oral and topical magnetic drugs.

    The effect of magnetic therapy on anal fissures; anal fissures are caused by constipation and too much effort to defecate and cause skin cracks in the anus, and repeated infections with toxic toxins.

    The blood flow in the anal canal is not smooth and the wound loses nutrition. According to the theory of meridian acupoints in traditional Chinese medicine, the use of magnets to make hemorrhoid-eliminating belts and bio-magnetic fields

    It is used for the acupuncture points of Guanyuan, Qihai, Perineum, Changqiang, etc. of the human body, so that the bio-magnetic field continuously releases bio-energy, which acts on the relevant acupoints of the body to open up

    Local blood circulation around the anus, eliminate stagnation of qi and blood, open up blocked meridians, eliminate inflammation and swelling and pain, and promote stagnation, coagulation or semi-coagulation of the lesion

    The blood dilution can restore the normal circulation of local blood, nourish the wound, and also regulate gastrointestinal function and reduce constipation and diarrhea. Effective

    Treat anal fissures.

    Six treatments for anal fissure

    1. Internal governance

    ① Heat knot in the intestines, to relieve heat and laxative, nourish yin and cool blood for treatment, the representative prescription is Liangxue Dihuang Occasion Maren Pill;

    ②For those who bet on heat and dampness, to clear away heat and relieve dampness, add or subtract pain-relieving Rushen Decoction;

    ③In the case of yin deficiency and intestinal dryness, the treatment is to nourish yin, promote fluid, and moisturize the intestines to relax bowel movements, and add or subtract Zengye Decoction;

    ④For those with blood deficiency and intestinal dryness, to nourish blood and nourish yin, moisten the intestines to relax bowel movements, and often add or subtract Runchang pills.

    2. External governance

    ①Sit bath: Sit bath with warm water before defecation to relax the anal sphincter and reduce the impact of feces on the anal fissure; after defecation, take a bath to wash fecal residues

    , Reduce foreign body stimulation, relieve sphincter spasm and anal pain.

    ②Externally applied drugs: The anti-inflammatory and pain-relieving ointment is prepared with Chinese and Western medicines and directly applied to the cracks to relieve pain and relieve sphincter spasm.

    Analgesic suppositories are available.

    3. Sealing therapy is suitable for early simple anal fissures, using methylene blue and procaine injection as a long-acting anesthetic, and local injections for anal fissures

    , The medicine is injected into the base of the anal fissure and surrounding tissues, and the fingers are gently massaged.

    4. Anal expansion therapy requires that under local anesthesia, a finger tears the tightly packed comb band to relax the spasm sphincter and improve the blood in the anus.

    Circulation to achieve the purpose of curing anal fissure.

    5. Massage therapy Massage specific Tianshu acupoints, which can promote bowel movements, relieve constipation and relieve symptoms. It is suitable for various stages of anal fissure

    Treatment has a certain effect.

    6. Minimally invasive treatment, HCPT minimally invasive and painless treatment is to enter the anus through the rectal fiberscope, and directly perform the microscopic treatment on the inner mouth through the monitor.

    Injury electrocoagulation to make the internal mouth of the anal fistula dry and close, and then wash away the pus in the fistula, so that the bacteria and feces in the stool will be

    Without getting into the surrounding tissues, infection and pain will not form, and the anal fistula will be healed.

    Surgical steps of anal fissure resection

    1. Position: Stone cutting position.

    2. Exploring the crypts: After anesthetizing, disinfecting, and wearing gloves, use the index finger to spread the anus gently with disinfected liquid paraffin or soap. Use an anoscope or hide

    Hook exploration, if anal fissure and crypts are found to communicate or there is a mucosal edge underneath, it should be incised and drained.

    3. Incision: Make a prismatic or fan-shaped incision around the ulcer surface of the anal fissure from the tooth line to 2cm outside the anal orifice, reaching the basal layer of the ulcer.

    4. Resection of the anal fissure: Use small blood vessel clamps to clamp the edge of the ulcer along the incision and separate it sharply to the base of the ulcer. All anal fissures and lesions are removed.

    Pits, hypertrophic anal nipples and skin tags. The advantage of this method is that the lesion is completely removed, the wound is wide, and the drainage is smooth, which facilitates the growth of granulation tissue from the base.

    5. Cut off the external sphincter subcutaneous group: The anal fissure often leads to long-term sphincter muscle fibrosis, of which the external anal sphincter subcutaneous group is the first

    Injured, it becomes hard and loses elasticity, hindering the drainage of the breach. A horizontal cord can be palpated in the middle of the wound, which can be cut off at the proximal tooth line.

    6. Bandaging the wound: After compression or ligation to stop bleeding, the wound is opened and covered with Vaseline gauze.

    Treatment of Anal Fissure Based on Syndrome Differentiation

    (1) Dry and fire stool: often because of the pain of dry stool, they dare not eat normally, accompanied by upset, bitter mouth, dry throat, yellowish tongue coating, pulse count.

    Symptom: Dry fire stagnation, in the intestines. Treatment: It is appropriate to clear away heat and relieve fire, moisten the intestines and laxative. Recipe: Gardenia Golden Flower Pill, or add or subtract using this recipe. outer

    Fumigate and wash with Qudu Decoction, and apply Shengjiyuhong ointment to the wound.

    (2) Damp-heat accumulation: abdominal pain and discomfort during defecation, uncomfortable defecation, swelling of the anus, mucus and blood from time to time, or pus and blood, yellow thick and greasy fur. certificate

    Genus: Betting on hot and humid, accumulated in the anus. Treatment method: clearing damp heat, moistening the intestines and laxative. Prescription: Huanglian Decoction plus or minus taken orally. Apply Sihuang ointment externally to the anal fissure.

    (3) Blood deficiency and dry intestines: pain in the anus, bleeding during stool, constipation, dry skin, dry mouth and tongue, upset and insomnia, hot flashes in the afternoon, red tongue

    Less moss, fine pulse. Symptom: blood deficiency and intestine dryness, resulting in the formation of fire. Treatment method: cooling blood and nourishing blood, moistening dryness and laxative. Prescription: Maren Runchang Pills, or use Jichuan

    Just fry.

    Prescriptions for treating anal fissures in Chinese medicine

    1. 20 grams of houttuynia cordata, honeysuckle, wild chrysanthemum, and oldenlandia diffusa, 30 grams of Bletilla striata, 5 grams of borneol, 15 grams of Sophora japonica or Sophora japonicus.

    2. Salvia, Astragalus, Angelica dahurica, Radix Scutellariae, Phellodendron, Atractylodes, Angelica, Chuanxiong, Yuanhu each 20g, Sanyu, Sophora japonica each 15g, Borneol 5g

    , Milk does not have 10 grams each.

    3. Red peony root, cork, scutellaria, dandelion, basilica, violet, honeysuckle, 30 grams each, 10 grams each of alum and gall.

    4. 20 grams each for milkweed, agrimony, Yuanhu, red peony root, sophora flavescens, and parsnip, 10 grams each for alum and gall.

    The above-mentioned medicine is cleaned, put in a pot, add an appropriate amount of water, soak for 5-10 minutes, decoct the juice, put it in a bathtub, mix with borneol or alum

    Evenly, sit in the bath when warm, 2-3 times a day, 10-30 minutes each time, for 1-2 weeks. Prevention    Early prevention and treatment of anal fissures should be promoted. Somebody's life

    Not suffering from anal fissures, his experience is to maintain soft stools, have regular bowel movements, and do not have the bad habit of squatting for a long time. This is the basis for preventing anal fissure

    Method. The initial anal fissure in the early stage can be cured by conservative treatment. For example, use crude fiber diet or intestinal moisturizing drugs to regulate and soften stools, and cooperate with external

    Medications such as 2% raw skin nitrate or hemorrhoids bath liquid hot bath, Huanglian ointment, Jiuhua ointment and other external application, if you also ask a specialist to help drain the medicine strip, you will recover

    It's faster and usually cures within a week.

    For chronic recurrent anal fissures, it is advisable to perform manual or traditional Chinese surgical treatment. Manipulative treatment means expanding the anus, which can heal old anal fissures. Chinese medicine

    Surgery is divided into ligation, thread hanging, lateral incision, etc. The doctor chooses according to the condition, which can cure the "five features of anal fissure."

    Prevention of old anal fissures

    Old anal fissure is a common anal canal and anal disease. The symptoms are revealed as anal canal ulcers, which are not easy to heal, and the anus during and after defecation

    The pain is severe.

    1. Appropriate participation in sports activities, such as doing exercises, running, Tai Chi, etc., can prevent the occurrence of constipation.

    2. Treat anal sinusitis in time to prevent the formation of ulcers and subcutaneous fistulas after infection, and wash and bathe with warm water after defecation to keep the anal fissure wound clean.

    It has anti-inflammatory and pain relief effects and promotes wound healing.

    3. Prevent concurrent anal fissure. Treat Crohn's disease, ulcerative colorectitis, anal tuberculosis and other intestinal diseases in time to prevent concurrent anal fissure.

    4. Prevent iatrogenic anal canal damage from causing anal fissures. During anal examination, the operation should be gentle and appropriate. Do not perform the rectal finger roughly and forcefully.

    Medical diagnosis and insertion of a speculum to prevent anal fissure caused by iatrogenic anal canal damage.

    Prevention and health care of anal fissure in children

    Prevention and health care of anal fissure in children

    1. Develop good habits for children to defecate on time.

    It is necessary to choose when the parents and children are not busy, let the children defecate, and do it patiently and on time every day, so as to develop the habit of defecation on time.

    2. Let the children have an appropriate amount of activity.

    Allow the child to have a proper amount of activity. In the late newborn period, the child can be prone on an empty stomach, and the baby can be allowed to roll and crawl on the bed when the baby is slightly older

    This is not only good for preventing constipation, but also good for the healthy development of children.

    3. Carry out scientific feeding.

    Children's diet should be combined with their physiological characteristics to meet growth needs and protect the body's health. Therefore, there must be a reasonable dietary structure. Pediatric solid

    Of course, you must take in enough protein, but you must also take in an appropriate proportion of carbohydrates, which has a greater effect on preventing constipation in children.

    Careful care and prevention of baby's anal fissure

    The clinical manifestations of anal fissure are severe pain in the anus during and after defecation, so the baby is irritable and crying. In the fastest growing period

    Of infants suffering from anal fissure, as long as parents take timely measures, it can be cured quickly.

    1. Breastfeeding. Breast milk mainly contains lactalbumin, which is easy to digest and absorb, so babies who eat breast milk have soft stools.

    2. Cultivate children's regular bowel habits. Parents should cultivate good habits for their children to defecate regularly every day, and at the same time let their children take a certain amount of

    The amount of water and fresh vegetables containing cellulose can help keep children's stools smooth.

    3. Keep the local area clean and sanitary. The child has an anal fissure. Parents should wipe it clean with soft toilet paper every time the child has a bowel movement.

    Then, under the guidance of a doctor, use a certain concentration of potassium permanganate warm water solution to sit in a bath for 10-20 minutes, which can achieve local disinfection and accelerate the healing of the crack.

    fruit.

    4. Local cauterization treatment. For children with recurrent anal fissures for a long time, parents can use silver nitrate under the guidance of a doctor to burn locally,

    Then wipe off the excess silver nitrate with a cotton swab moistened with saline. Once a day, the anal fissure will heal quickly.

    Family treatment of early anal fissure in children

    Apply egg butter on top. Boil 10 eggs, remove the shells and egg whites, put the egg yolks in the pot, and continue to fry over medium heat. After about 15 minutes, egg yolk charcoal

    Turn to black. Continue to fry for 5 minutes, dark brown thick egg butter will appear. Remove the residue and leave the oil, clean the anus after defecation every day, and use a cotton swab to clean the egg butter

    Apply to the anal cleft. Use twice a day for 10 days. External treatment can be combined with oral administration of Huaiju Decoction: 10 grams of Huai Mi, 10 grams of chrysanthemum, and water

    500ml brew. Add proper amount of Sophora japonica nectar when drinking, several times a day, and drink frequently when tea.

    Use strong tea or coffee-containing beverages. Because the tannic acid in tea can astringent stools, while coffee is diuretic and accelerates water loss.

    Self-care of anal fissure

    Unobstructed stool: Keeping stool unobstructed is essential for the prevention of the disease. Patients should develop a daily bowel habit, defecate regularly, and increase appropriately

    Add outdoor activities and take laxatives when necessary.

    Adjust psychology: Strengthen the education of hygiene knowledge of anal fissure, explain to patients the pathogenesis, outcome and recovery of the disease in detail, so as to relieve the patient

    Nervous mood enhances the confidence in fighting the disease, so as to maintain a comfortable and peaceful mood.

    Conditioning diet: reasonable arrangement of meals is conducive to ensuring smooth stools, and more fresh fruits should be eaten in meals

    , Vegetables and crude fiber foods.

    Pay attention to diet: often eating crude fiber food can stimulate gastrointestinal peristalsis and help defecation.

    Pay attention to hygiene: Keep the anal area clean, wash the anus in time after going to the toilet, take a bath frequently, and change the underwear frequently to effectively prevent infection.

    Adhere to the sitz bath: Use 1:5000 potassium permanganate warm water to sitz bath before and after defecation, warm water at 43℃~46℃, 2~3 times a day, 20~30 each time

    minute.

    Preventive measures for postoperative sequelae of anal fissure

    1. The diet should be light, eat less spicy, fried, fried, spirits and other indigestible and irritating foods, and eat more fruits, vegetables and fiber foods

    Drink plenty of water, especially bananas and honey-like laxative foods.

    2. Do not stand and sit for a long time, increase exercise appropriately, especially the levator anus exercise.

    3. Stool regularly every day, and the time of each bowel movement should not be too long, about 5 minutes is appropriate.

    4. Sit bath and fumigation before and after defecation to keep the anus clean.

    5. Drink a cup of warm salt water or cool boiled water every morning when you get up to promote bowel movements.

    6. If you have dry stools, you can take appropriate intestinal and laxative drugs. Long-term use will not only aggravate constipation but also form drugs.

    物dependence.

    Preventing anal fissure starts with preventing constipation

    To prevent the occurrence of anal fissures, hemorrhoid patients should start with constipation and develop the habit of waking up to have a bowel movement every morning. If you don’t want to wake up in the morning,

    Massage the abdomen for 15 minutes after breakfast to produce bowel movements and defecate in time. It is advisable to wash the anus with warm water after defecation to maintain perianal hygiene, which is beneficial

    Protection of skin and mucous membranes to avoid cracking and itching.

    Five health care methods for female anal fissure

    ①Keep the stool unobstructed and develop the habit of defecation regularly every day. When you find that the stool is dry and clumpy, you should not try to blame it, but use warm salt water enema

    Or Kaisailu is injected into the anus to moisturize the bowel.

    ② Treat the anal crypt inflammation in time to prevent the formation of ulcers and subcutaneous fistulas after infection.

    ③ When using an anal speculum for examination, avoid rough operation and damage the anal canal when using the speculum.

    ④ Treat various diseases that cause anal fissure in time, such as ulcerative colitis, to prevent anal fissure from occurring.

    ⑤If women want to prevent anal fissure, they must drink less alcohol, not eat spicy food, and the diet should not be too fine, and should match coarse and fine grains

    , Vegetables and other fiber-rich foods are consumed as much as possible to keep stool normal.

    Three precautions for preventing anal fissure recurrence

    1. Prevent constipation. Develop the habit of defecation at regular intervals every day. When you find that your stools are dry and clumpy, don't try to blame it.

    2. Prevent infection. Patients with other diseases such as anal cryptitis must treat the anal crypt inflammation in time to prevent the formation of ulcers after infection

    And subcutaneous fistula.

    3. Treat in time. Treat various diseases that cause anal fissure in time, such as ulcerative colitis, to prevent anal fissure from occurring

    Nursing

    Patients with anal fissures often have a special sense of fear for defecation, because they are afraid of bleeding from the defecation, and deliberately endure it, resulting in dry stools and forming a vicious circle.

    Therefore, when nursing at home, be patient and persuade them to develop the habit of defecation regularly every day, and eat more vegetables to keep the stool smooth.

    People with constipation can give laxatives, such as 20-40 ml of paraffin oil, once a night. However, cathartic agents are prohibited.

    Hot water sitz bath can improve local blood circulation and keep local clean. The method is to put 40℃ warm water or potassium permanganate in a deep basin.

    Liquid, let the patient sit in the basin for about 15-20 minutes. You can also try block therapy, or smear the ulcer surface with silver nitrate, and then wash it off with isotonic saline.

    Apply anti-inflammatory analgesic ointment or suppository.

    Precautions

    Anal fissure is one of the more painful anal diseases and can be accompanied by a lot of anal discomfort. Therefore, the following items should be noted:

    (1) Maintain unblocked stools. After the formation of dry and hard feces, do not try to discharge them. You can choose to pull warm salt water enema, or paraffin oil enema, or use the plug

    The dew is injected into the anus to smooth and defecate.

    (2) Treat anal cryptitis on time to prevent infection from forming ulcers and subcutaneous fistulas.

    (3) During anal examinations, such as digital anal examinations, anoscopy or other equipment, avoid using rough force to prevent anal fissure from damaging the anal canal.

    (4) Treat various diseases that cause anal fissure in time, such as ulcerative colitis, to prevent anal fissure from occurring.

    (5) Drink less alcohol, don't eat spicy foods, eat too finely, match coarse and fine grains, and consume as much fiber-rich foods as vegetables and so on.

    , Can keep the stool normal.

    The main problem in the maintenance of anal fissure patients is dry stool and difficulty in defecation.

    In nursing, we must first relieve mental concerns. Some people are afraid of anal pain during defecation and postpone defecation time. This is counterproductive.

    The longer the time, the drier stools will increase the pain of defecation.

    Should develop the habit of regular bowel movements, bowel movements once a day, stool will not dry, pain can be reduced. At the same time, drugs and food can be used to soften the

    Stool, reduce the expansion of defecation to the anus, and also reduce the pain during defecation.

    Pay attention to the appropriate amount when taking laxatives. When the amount is too large, the stool will be too thin, and defecation several times a day will increase the stimulation of the anus. At the same time, can't

    Relying on drugs to help defecation, because drugs have certain side effects, the stool will become more secret when the laxative is stopped, and it is easy to form intractable constipation and make the anus

    The crack is getting heavier.

    Family nursing rules for patients with anal fissure

    Pay attention to diet: often eating crude fiber food can stimulate gastrointestinal peristalsis and help defecation. Some foods with the effect of nourishing blood and moisturizing the intestines such as longan

    , Jujube, walnut, flax, fungus, mulberry, pine nut, etc. can be eaten regularly, and can also be made into medicated dietary treatments, such as longan porridge, flax cake,

    Stir-fried corn with pine nuts and lean meat with walnuts can moisten the intestines and promote the healing of cracks.

    Anal fissures are mainly manifested as painful defecation, bleeding, and constipation. Except for acute attacks requiring medical attention, most of them are mainly home care. Pay attention to the following

    Aspects.

    Adjust psychology: Strengthen the education of anal fissure hygiene knowledge, explain to patients the pathogenesis, outcome and recovery of the disease in detail, so as to alleviate the patient’s

    Nervous mood enhances the confidence in fighting the disease, thereby maintaining a comfortable and peaceful mood.

    Unobstructed stool: Keeping stool unobstructed is very important to the prevention of the disease. Patients should develop a daily bowel habit, defecation regularly, and when necessary

    Taking laxatives, such as liquid paraffin, fruit guide tablets, etc., can also choose Chinese medicine rhubarb, panxie leaves and other tea to drink, which can make the stool soft and facilitate defecation.

    After taking a bath with hot water, it can improve local blood circulation, promote inflammation absorption, relieve pain, relieve the patient's nervousness, and facilitate defecation.

    Adjust your diet: Arrange your diet reasonably to ensure smooth stools. Eat more fresh fruits, vegetables and crude fiber food in your diet, and eat less

    Or avoid eating spicy and stimulating diet, drinking more water can ensure the gastrointestinal tract has a rich secretion of digestive juice, which is conducive to gastrointestinal peristalsis and prevents constipation.

    Pay attention to hygiene: keep the anus clean, wash the anus in time after defecation, take a bath frequently, and change underwear frequently, which can effectively prevent infection, such as

    If the blood volume is large, you should go to the hospital for treatment. If the volume is small, you should strengthen the observation, and pay attention to the consumption of blood-enriching nutrients and food to enhance the body's resistance.

    Adhere to the sitz bath: Use 1:5000 potassium permanganate warm water to sitz bath before and after defecation, warm water at 43℃-46℃, 2-3 times a day, 20-30 minutes each time

    , Sit bath can relax the mylar sphincter, relieve pain, improve local blood circulation, promote the absorption of inflammation, and help the healing of anal fissures.

    "Crack" after anal fissure should be raised

    The prevention and treatment of constipation cannot rely on laxatives. It is necessary to formulate a reasonable diet and a diversified diet, omnivorous whole grains, fruits and vegetables, especially

    Eat more foods rich in fiber and vitamins.

    Anal fissure patients should develop the habit of defecation at regular intervals in the morning, because the erect reflex and gastro-colon reflex after getting up in the morning can promote defecation. In addition

    , In the morning, participate in a variety of sports activities such as doing exercises, running, doing Tai Chi, practicing Qigong, etc., which can prevent constipation and prevent anal fissure.

    After going to the toilet, use warm water to wash the seat bath or use the detoxification soup or the pain relief soup to keep the anal fissure wound clean. This is an important measure to prevent anal fissure

    . When fumigating and washing, the anus must be immersed in the liquid medicine to wash away the anal dirt and allow the medicine to enter the anal canal to reduce inflammation, relieve pain and promote the healing of the crack

    effect.

    Patients with anal fissure should eat more fruits and vegetables rich in cellulose and vitamins to prevent and treat constipation. Apples, peaches, apricots, pears, bananas, melons

    Other fruits, such as celery, spinach, leeks, alfalfa, day lily, rice white, bamboo shoots and other vegetables, are rich in cellulose and vitamins.

    Food can make the stool soft and easy to discharge, reduce the stimulation of dry and hard feces to the anal fissure wound, and promote the healing of the wound.

    Nursing care of patients with anal fissure during and after operation

    1) Try to relax the anal sphincter during the operation: use anesthesia technique during the operation,

    Fully relax the anal sphincter. For those with internal anal sphincter contracture and hypertrophy, it must be fully released. If necessary, cutting off can also reduce anal pain.

    2) The incision should be made during the operation: the incision should be long and wide enough during the operation, the wound surface should be flat, and the edges should be neat to allow sufficient drainage and wound surface

    The irritation is reduced and the pain in the anus is reduced.

    3) Control infection and rational use of analgesics: The surgical incision is good, and the incidence of infection and edema is low. However, appropriate antibiotics should be taken after the operation.

    Vitamins to prevent infection. At the same time, proper administration of analgesics can also reduce the patient's anal pain.

    4) Less activity and more sleep: Take appropriate sedatives to reduce activity, reduce the chance of friction from anal wounds, and also cause postoperative anal pain

    Ease.

    5) The surgical operation should minimize the tissue damage: that is, the sphincter should be minimized during the operation, and the clamp and excessive shear should be reduced.

    Only in this way can the nerve and muscle damage be reduced, the edema is reduced, and the anal pain after the operation is reduced.

    Prevention of complications after anal fissure

    1. The doctor’s experience is very important, so you should choose someone with rich experience. Before the operation, the lesion should be fully disinfected and no incision should be made during the operation.

    Too small, so the drainage will naturally flow.

    2. Incision and drainage are on the one hand. In case of hemorrhagic disease, of course, we must cast a net widely and fill up more fish, carefully check the bleeding and look for

    And ligate bleeding points.

    3. After the operation, many people dare not eat, thinking that it will reduce bowel movements and irritate the wound, but this is a big mistake.

    4. Post-operative maintenance is the top priority, especially when changing dressings.

    5. Antibiotics after surgery are also very important. After surgery, sufficient antibiotics should be injected intravenously for about 5 days, not too little.

    Less naturally does not work, of course, this naturally has to be slightly increased or decreased according to the doctor's advice.

    6. Sit bath after defecation is also one of the important tasks of maintenance. Of course, not all patients can achieve it, but it must be possible

    Strictly enforced.

    Nursing measures for pregnant women with postpartum anal fissure

    First of all, you must pay attention to participate in some activities as much as possible during pregnancy, (unless there are contraindications to activities) generally do not rest in bed all day. At the doctor during pregnancy

    Proper activities under the guidance, and more importantly, a proper diet. In addition to eating chicken, meat, fish, eggs and other foods, you should also eat some vegetables and water appropriately.

    Fruits and whole grains, beans and their products, and sweet potatoes can also be eaten appropriately. Drink plenty of water and soup to keep the body hydrated. Of course, Sim

    Spicy food should not be eaten.

    If you have constipation, you can take some laxatives appropriately. If you guide 1-2 tablets per night, or use a little scent leaf soaked in water as tea, you can also use Kaisailu

    Anal plug is a laxative. If anal fissure has occurred, seek medical treatment in time.

    Hazard

    1. Lead to anal sinusitis: the spread of anal sinus infection, the formation of small abscesses under the skin of the anal canal, ulcers and ulcers. Sometimes anal fissure first, then anal sinus

    inflammation.

    2. Lead to anal papillitis: The upper end of the ulcer is connected to the tooth line, and the inflammation spreads, often causing anal sinusitis and papillitis, and finally forming nipple hypertrophy.

    3. Lead to split hemorrhoids: the skin under the split is changed due to inflammation, the superficial veins and lymphatic drainage are blocked, causing edema, tissue hyperplasia, and formation of connectives

    External hemorrhoids, also known as sentinel hemorrhoids.

    4. Fusiform ulcer: anal canal skin laceration, after infection, the formation of ulcers.

    5. Anal comb induration: that is, the combi membrane thickens and hardens to form a comb-like induration, which is exposed to the base of the ulcer, hindering the relaxation of the sphincter and affecting the ulcer

    The healing of the ulcer.

    6. Latent fistula: The base of the anal sinus is often connected with a fistula and ulcer. This is caused by the formation of a small abscess and rupture due to infection of the anal sinus.

    Non-surgical treatment of anal fissure

    Early fresh anal fissures are usually cured by non-surgical conservative treatment, such as keeping the stool soft and applying anti-inflammatory analgesic ointment locally.

    The specific methods are:

    1. Internal therapy The general principles of TCM treatment based on syndrome differentiation are:

    ①The heat is in the intestine. Treating diarrhea and nourishing yin and cooling blood, the representative prescription is Liangxue Dihuang occasion Maren Pill

    ②For those who bet on damp heat, to clear away heat and relieve dampness, add or subtract pain-relieving Rushen Decoction;

    ③In the case of yin deficiency and intestinal dryness, the treatment is to nourish yin, promote fluid, and moisturize the intestines to lax a bowel movement.

    ④For those with blood deficiency and intestinal dryness, to nourish blood and nourish yin, moisten the intestines and laxatives, often add or subtract Runchang pills.

    2. External treatment method The anal local medication treatment, the methods are as follows:

    ① Sit bath: Sit bath with warm water before defecation to relax the anal sphincter and reduce the impact of feces on the anal fissure. Sit bath after defecation can wash fecal residues and reduce

    Less foreign body stimulation, relieve sphincter spasm and anal pain. You can choose to use Chinese herbal medicine as a fumigation and washing sitz bath or a 1:5000 potassium permanganate solution for sitz bath.

    ②Externally applied drugs: Anti-inflammatory and pain-relieving ointment is prepared with Chinese and Western medicines, and directly applied to the cracks, which can relieve pain and relieve sphincter spasm.

    Analgesic suppositories are available. Generally speaking, use Shengji San and Jiuhua ointment for fresh anal fissures; use Hongsheng Dan to decompose old anal fissures, and then use Shengji ointment or Baiji ointment for treatment.

    Treatment. Gu Baoqing prepared by the Fourth Military Medical University has anti-inflammatory and analgesic properties and can treat acute and chronic anal fissures.

    3. Sealing therapy is suitable for early simple anal fissures, using methylene blue and procaine injection as a long-acting anesthetic, and local injections for anal fissures

    , The medicine is injected into the base of the anal fissure and surrounding tissues, and the fingers are gently massaged.

    4. Anal expansion therapy As early as 1829, Recamier reported that anal expansion was used to treat anal fissures, requiring the fingers to tear the tightly packed combs under local anesthesia.

    Band, relax the spasm sphincter, improve the blood circulation in the anus, and achieve the purpose of curing anal fissure.

    5. Massage therapy Massage specific Tianshu acupoints, which can promote bowel movements, relieve constipation and relieve symptoms. It is suitable for various stages of anal fissure

    Treatment has a certain effect.

    Lose weight carefully reduce anal fissures

    Recently, many girls suffer from hemorrhoids and anal fissures. After questioning, it turns out that they are all caused by weight loss. "Due to deliberately reducing the intake of staple foods,

    There is no way to form a ‘fee meaning’, perhaps only two or three times a week, so that it’s easier to break the tissues near the anus during defecation. "According to Hangzhou Kangtai Hospital

    According to the doctor, “adolescent girls have endocrine disorders, which are prone to constipation. In addition, the lack of water in the large intestine and deliberate weight loss have multiple reasons.

    Plus, problems such as anal fissures followed one after another. "

    Ordinary people may not know much about the formation of stool. Stool is mainly formed by food residues after digestion. If you deliberately lose weight without eating staple foods, the food

    Without fiber and carbohydrates, stool cannot be formed, and the indigestible garbage that is usually eaten cannot be produced because of the inability to form stool.

    The stools are deposited when they want to go to the toilet, which causes the stools near the anus to unite and dry into unremovable stools, which will not be eliminated when accumulated to a certain extent.

    Method to exclude the anus and cause anal fissure.

    Precautions for patients with anal fissure

    (1) Maintain unblocked stools. After the formation of dry and hard stools, do not try to discharge them. You can choose to pull warm salt water enema, or paraffin oil enema, or use a plug

    The dew is injected into the anus to smooth and defecate.

    (2) Treat anal cryptitis on time to prevent infection from forming ulcers and subcutaneous fistulas.

    (3) During anal examinations, such as digital anal examinations, anoscopy or other equipment, avoid using rough force to prevent anal fissure from damaging the anal canal.

    (4) Treat various diseases that cause anal fissure in time, such as ulcerative colitis, to prevent anal fissure from occurring.

    (5) Drink less alcohol, don't eat spicy foods, eat too finely, match coarse and fine grains, and consume as much fiber-rich foods as vegetables and so on.

    , Can keep the stool normal.

    Diseases easily caused by anal fissure infection

    1. Ulcer—it is a longitudinal slit in the skin of the anal canal at first, which is linear or prismatic, with soft and neat edges, shallow and elastic bottom, repeated infections make the slit long

    It does not heal, with thickened edges and hard base, which gradually becomes a deeper chronic ulcer. Mild stimulation can cause severe pain.

    2. Sentinel hemorrhoids-due to inflammation and stimulation of the skin under the cleft, the return of lymph and venules is blocked, causing edema and fibrosis to form a size

    Varying skin tags, called sentinel hemorrhoids, are also connective tissue external hemorrhoids.

    3. Anal sinusitis and anal nipple hypertrophy-it is the result of repeated stimulation of inflammation at the upper end of the crack. The nipple hypertrophy can be prolapsed with defecation.

    Outside.

    4. Anal marginal abscess and anal fistula-the inflammation of the fissure expands to the subcutaneous, coupled with the sphincter spasm, makes the ulcers not drain smoothly, and the secretions sneak into the anal margin

    Subcutaneously, an abscess is formed, and the pus ruptures to the cleft, forming a subcutaneous fistula.

    5. Thickening of the combo——The combo area is the narrowest area of ​​the anal canal, and is a prone area for comb induration and narrowing of the anal canal. Thickened tissues under the combo area

    It is called comb band. The inflammatory stimulus of anal fissure can make it thicken, lose its elasticity, and hinder the healing of anal fissure. Therefore, when treating anal fissure, the thickened combs

    The film tape is cut off.

    Drink and eat

    Dietary taboos for anal fissure

    1. Anal fissure diet should not eat spicy, greasy, raw, cold and hot foods.

    2. It is not suitable to eat fragrant fried food, such as fried food and roasted seeds.

    3. It is not suitable to eat warm tonic products, but to eat nourishing products, such as walnuts, lotus seeds, jujube, etc.

    4. Anal fissure diet should eat foods that are rich in cellulose and have a moisturizing effect, such as shepherd's purse and white fungus.

    5. Eat foods that are easy to digest and soft in texture.

    6. It is advisable to eat cool foods, such as vegetables and fruits.

    Differentiation of anal fissure and Crohn's disease

    Crohn’s disease is a disease that occurs around the anus, such as anal abscess, anal fistula, anal fissure, anal ulcer, and skin tag.

    The probability is the highest, nearly 50%. Fresh anal fissures can be seen neatly, with different depths, mostly one or two, with blood or even dripping

    . Chronic patients usually have ulcers with a small amount of secretions, gray-white cracks, hyperplastic tissue, and tough texture. In this period of anal fissure, anal fissure triad can be seen,

    Nipple hypertrophy, anal fissure, sentinel hemorrhoids.

    Six points of anal fissure care

    Unobstructed stool: Long-term constipation is the main cause of anal fissure. Therefore, maintaining unobstructed stool is very important for the prevention of the disease.

    Should develop the habit of daily defecation, regular defecation, increase outdoor activities appropriately, and take laxatives, such as liquid paraffin, fruit guide tablets, etc., if necessary.

    Adjust psychology: Strengthen the education of anal fissure hygiene knowledge, explain to patients the pathogenesis, outcome and recovery of the disease in detail, so as to alleviate the patient’s

    Nervous mood enhances the confidence in fighting the disease, thereby maintaining a comfortable and peaceful mood.

    Adjust your diet: Arrange your diet reasonably to ensure smooth stools. Eat more fresh fruits, vegetables and crude fiber food in your diet, and eat less

    Or avoid eating spicy and stimulating diet, drinking more water can ensure the gastrointestinal tract has a rich secretion of digestive juice, which is conducive to gastrointestinal peristalsis and prevents constipation.

    Pay attention to diet: often eating crude fiber food can stimulate gastrointestinal peristalsis and help defecation. Some foods with the effect of nourishing blood and moisturizing the intestines such as longan

    , Jujube, walnut, flax, fungus, mulberry, pine nut, etc. can be eaten regularly, and can also be made into medicated dietary treatments, such as longan porridge, flax cake,

    Stir-fried corn with pine nuts and lean meat with walnuts can moisten the intestines and promote the healing of cracks.

    Pay attention to hygiene: keep the anus clean, wash the anus in time after defecation, take a bath frequently, and change underwear frequently, which can effectively prevent infection, such as

    If the blood volume is large, you should go to the hospital for treatment. If the volume is small, you should strengthen the observation, and pay attention to the consumption of blood-enriching nutrients and food to enhance the body's resistance.

    Adhere to the sitz bath: Use 1:5000 potassium permanganate warm water for sitz bath before and after defecation, warm water at 43 ℃~46℃, 2~3 times a day, 20~30 each time

    Minutes, the sitz bath can relax the hilar sphincter, relieve pain, improve local blood circulation, promote the absorption of inflammation, and help the healing of anal fissures.

    Precautions for home care of anal fissure    1. Develop a good habit of regular bowel movements. Those who have anal fissure should keep their stools unobstructed, and eat more

    Fresh vegetables and crude fiber foods. Take laxatives if necessary, and wait if you can.

    2. Use 1:5000 potassium permanganate solution or hot water to take a bath after going to the toilet to relieve sphincter spasm, reduce pain and improve local circulation. Can also be applied externally

    Anti-inflammatory analgesic ointment or suppository.

    3. Analgesic tablets can be taken orally when the pain is severe.

    4. When the anal fissure does not heal for a long time, or the pain is unbearable, you can go to the hospital to use 10 ml of 0.5% procaine solution for a closed injection in the anal base.

    The analgesic effect is better. Anal fissure resection can also be performed under local anesthesia.

    5. Prevention and treatment of constipation is an important measure to prevent anal fissure. Adjusting diet, drinking more water, smoking less, drinking less alcohol, and eating less spicy food is to prevent constipation.

    Effective way.

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preparation h hemorrhoids,The chrysanthemum is wounded all over the floor, and the person with hemorrhoids has blood in the stool.

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