Anal fissure is a split between the dentate line and the surface of the anal canal tissue at the anal margin, forming small ulcers, the direction is parallel to the longitudinal axis of the anal canal, fusiform or elliptical, about 0.5 to 1.0 cm long, often causing severe perianal pain. The most common part of anal fissure is the front and back center of the anus, and the center will be more in the future. Anal fissure is divided into acute and chronic.
Pain is the main symptom of anal fissure. Compared with hemorrhoids, the pain of anal fissures is usually more severe, longer lasting, and typically periodic. Stool stimulates the nerve endings on the ulcer surface during defecation, causing burning or knife-like pain, which is called pain during defecation. Pain is relieved a few minutes after defecation, which is a painful intermittent period. Later, due to internal sphincter spasm, severe pain occurred, which lasted for several minutes or several hours, until the sphincter relaxed and the pain gradually eased. Until the next bowel movement, the pain recurs
Blood in stool
Patients with anal fissure may also have symptoms of blood in the stool, but compared with hemorrhoids, the amount of bleeding in anal fissure is less, usually with blood in the toilet paper, blood in the stool or dripping, and seldom massive bleeding. Anal fissure blood in the stool will also periodically recur.
Constipation is not only the cause of anal fissure, but also the clinical manifestation of anal fissure. Stool is thick and hard, it is easy to damage the skin of the anal canal during defecation and cause anal fissure, and the pain of anal fissure makes the patient unwilling to defecate. The feces stay in the rectum for longer time, absorb more water, and become harder and harder to discharge. , But also aggravated the symptoms of constipation.
The secretions from the ulcer surface or the subcutaneous fistula irritate the skin of the anal margin, causing symptoms of moist and itching.
(1) Look at "sentinel hemorrhoids" Patients with anal fissure generally grow epidermis on the front and back sides of the anal margin. This is called "sentinel hemorrhoids" in clinical practice and is one of the important signs of anal fissure.
2) Look at the crack at the front and back center of the anus, you need to gently pull the anus to see. See if the crack is fresh and deep. Sometimes you will see white inside the breach, which means it is deeper and has split to the fascia tissue on the surface of the internal sphincter.
(1) Touch the tension of the anal canal. Put more lubricating oil on the finger cot, gently put it into the anal canal, feel the tension of the anal canal, and judge the severity of anal fissure. Excessive tension in the anal canal should be treated even if there is no crack.
2) Touch the scar tissue and fistula. The severity of scar tissue indicates the course and prognosis of anal fissure. Subcutaneous fistula with anal fissure also requires digital examination to judge.
(3) Touch the anal nipple. Patients with anal fissure should not use an anal mirror. You can use your fingers to check whether there is anal nipple hypertrophy.
According to the medical history, typical clinical symptoms and findings during examination, it is not difficult to diagnose. If the edge of the anal fissure is soft and tidy, the bottom is shallow, there is no scar, the color is pale red, and it is easy to bleed, indicating an acute anal fissure. If there is a scar around the cleft, the bottom is not neat, it is gray and white, it is not easy to bleed, and there is an "anal fissure triad" (sentinel hemorrhoids, anal papilla hypertrophy, old anal fissure), indicating chronic anal fissure.
●Internal hemorrhoids are mostly painless, with intermittent blood after the stool, blood dripping during stool or blood on the stool, and hemorrhoids can protrude outside the anus in severe cases.
●External hemorrhoids usually manifest as skin tags on the anal mouth, anal discomfort, dampness and uncleanness, sometimes accompanied by itching.
●Mixed hemorrhoids can have symptoms of internal and external hemorrhoids at the same time.
Early rectal cancer may have no obvious symptoms. As the disease progresses, patients may experience dull pain in the lower abdomen, often accompanied by changes in stool characteristics and habits, mucus pus and blood in the stool, and tenesmus. Low-level rectal cancer can be touched by digital examination. Electronic colonoscopy can usually confirm the diagnosis.
Anal fistula usually manifests as a drainage hole in the skin at any part of the anal margin. Exploring the skin holes will reveal a channel extending from the perianal skin to the anorectum. The drainage of the fistula may be purulent, and inadequate drainage will be accompanied by abscesses, causing discomfort, erythema and sclerosis. There is no such fistula in anal fissures.
Perianal abscess is mainly local symptoms such as perianal pain, and severe cases may be accompanied by systemic symptoms such as fever. For superficial perianal abscesses, physical examination can reveal tender perianal redness and swelling, which may be accompanied by fluctuating sensation, and pus can be drawn out by puncture. Deep perianal abscesses can be found on digital examinations and other perianal examinations. The diagnosis can be confirmed by puncture and extraction of pus. If necessary, it can be diagnosed by computer tomography (CT), magnetic resonance imaging (MRI) or ultrasound.