2021年1月22日星期五

hemorrhoids and anal fissures,Features and treatment of anal fissure

    Anal fissure is a laceration that occurs in the entire layer of the skin of the anal canal. Mostly caused by dry stool. The site of occurrence is more common in the posterior or anterior position of the anus. Men, women and children can suffer from this disease. The clinical symptoms of anal fissure are pain and bleeding. The pain is very characteristic, that is, sudden knife-like pain during defecation (due to the skin of the anal canal being cut by the stool), and then relieved for a short time, followed by prolonged anal pain (due to spasm caused by stimulation of the anal sphincter ). It is common in clinical patients to have periodic, tear-like pain in a vicious circle due to fear of pain and defecation. Bleeding caused by anal fissures is also more or less due to the degree of tearing of blood vessels. It is common for cases of anemia due to prolonged or massive bleeding from anal fissures.

    If anal fissure is not treated in time in the early stage, there will be anal canal ulcers, anal papillary hypertrophy, sentinel hemorrhoids and other three symptoms. If it continues to develop, anal sinusitis (chronic inflammation of the anus) and anal fistula may occur, which are collectively called the first three. Five characteristics of anal fissure".

    Early prevention and treatment of anal fissures should be promoted. Some people do not suffer from anal fissure in their lifetime. Their 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 fundamental way to prevent anal fissure. The initial anal fissure in the early stage can be cured by conservative treatment. For example, using crude fiber diet or intestinal moisturizing drugs to adjust and soften the stool, with external medications such as 2% raw skin nitrate or hemorrhoid lotion for bathing, and external application of hemorrhoid ointment, usually cure within a week.

    For chronic recurrent anal fissures, it is advisable to perform manual or traditional Chinese surgical treatment. Manipulative treatment is to expand the anus, which can heal old anal fissures. Surgery in Chinese medicine is divided into ligation, thread hanging, and side cutting.

    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 and analgesic ointment locally. The specific methods of combining traditional Chinese and Western medicine are:

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

    ① The heat is in the intestine. Treating diarrhea, nourishing shade and cooling blood, and the representative prescription is Cooling Blood Dihuang Occasion Maren Pills;

    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 with Zengye Decoction;

    ④For those with blood deficiency and intestinal dryness, to nourish blood and nourish yin, moisten the intestines and relax bowel movements.

    2. External treatment method The anal topical medication treatment is 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; post-defecation bath can wash away fecal residue, reduce foreign body stimulation, and relieve sphincter spasm and anal pain. Chinese herbal medicine can be used as a fumigation bath or a 1:5000 potassium permanganate solution.

    ②Externally applied drugs: Anti-inflammatory and pain-relieving ointment is prepared with Chinese and Western medicines and applied directly to the crack to relieve pain and relieve sphincter spasm. Analgesic suppositories can also be used. Generally speaking, fresh anal fissures are treated with Shengji San and Jiuhua ointment; old anal fissures are treated with Hongsheng Dan to rot, and then Shengji ointment or Baiji ointment is used for treatment.

    3. Sealing therapy is suitable for early simple anal fissures. Methylene blue and procaine injection is used as a long-acting anesthetic. Local injections are made for the anal fissure. 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. It required that under local anesthesia, the fingers should tear the tightly bundled sphincter to relax the spasmodic sphincter and improve local blood circulation in the anus. Patient topical medication

    5. Surgical treatment (1) Anal fissure resection: centered on the anal fissure, from the inside to the tooth line and outside to the outside of the anal margin about 2cm, the anal fissure and its pathological tissues are removed together, and the combo belt is cut at the same time. Under the lower edge of the inner sphincter, pierce with curved hemostatic forceps, along the outer side of the muscular layer, pass through the upper end of the inner sphincter, pull the inner sphincter out of the anus, cut it off, and cut the subcutaneous layer of the outer sphincter with a knife at the lower end Part of it is to make the foundation and margin of the wound flat and open to ensure smooth drainage. Keep the wound open and change the dressing daily. (2). Longitudinal section and transverse suture: It is suitable for patients with stage Ⅱ and Ⅲ anal fissure and anal stenosis.

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