Anal fissure

Introduction The anal fissure is a small ulcer formed after the laceration of the anal canal skin layer below the dentate line. Its direction is parallel to the longitudinal axis of the anal canal. It is about 0.5-1.0 cm long. It is fusiform or elliptical and often causes severe pain and is difficult to heal. The anal canal surface laceration can not be regarded as anal fissure due to rapid self-healing, and often asymptomatic. Anal fissure is a common anal canal disorder and a common cause of severe pain in the anal canal in young and middle-aged people. Anal fissure is most common in middle-aged people, but it can also occur in the elderly and children. The average male is slightly more than female, but there are also reports of more women than men. Anal fissure often occurs in the back of the anus, in the middle of the front, mostly in the back of the anus, and less on both sides. From the beginning, there is only a small gap in the skin of the anal canal, sometimes it can be split into the subcutaneous tissue or until the shallow layer of the sphincter. The slit is linear or prismatic. If the anus is opened, the wound surface of the breach is round or elliptical.

Cause

The occurrence of this disease is mainly related to the following factors:

1. Anatomical factors: the shallow part of the external anal sphincter, from the tailbone, forward to the back of the anus. Divided into two bundles, along the sides of the anal canal, to the front of the anus, and combined with each other. Therefore, there is a gap between the anus and the front. And most of the levator ani muscles are attached to both sides of the anal canal, less before and after. It can be seen that the front and rear of the anus are not as strong as the sides, and are easily damaged. And an angle of nearly 90 degrees is formed with the rectum downwards and backwards. Therefore, the back of the anus is heavier by the feces, and because of the lack of blood circulation in the posterior part of the anal canal, the elasticity is poor, and the distribution of the anal glands is more. These are all factors that cause anal fissure.

2. Trauma theory: dry feces or foreign bodies can easily cause damage to the anal canal skin, which is the main cause of anal fissure.

3. Infection theory: mainly anal crypt infection in the back of the anus, inflammation spread to the lower part of the anal canal, causing the subcutaneous abscess to collapse into an anal fissure.

4. Internal sphincter spasm: due to anal canal injury or inflammatory irritation, the anal sphincter is in a paralyzed state, resulting in increased anal canal tension, easy to damage into anal fissure.

5. Anal narrow primary school said: anal canal skin is slow in development, the formation of anal canal is small, easy to damage into an anal fissure.

Chinese medicine believes that the cause of anal fissure:

More by blood and heat, intestinal dryness, constipation, defecation is too hard, the anal skin rupture, repeated and onset. "The medicinal Jin Jian Surgical Heart Law" said: "The anus is surrounded, the creases are broken, and the knot is broken, and the fire is dry." I want to explain the constipation caused by hot colonic dryness or loss of Yin and Jin. Defecation force, causing anal skin laceration, followed by secondary infection, gradually forming a chronic, fusiform ulcer. However, there are also infections due to infections such as anal canal stenosis, anal eczema, and acne damage.

Chinese medicine believes that the occurrence of anal fissure is caused by dry fire, damp heat, anal and blood deficiency.

1 Feel the heat of the wind and heat: the dry fire is in the stomach and intestines, burns the body fluid, the stool is hard and dry, it is difficult to discharge, and the strong anus damages the anus, causing the crack, the crack is repeatedly deepened due to constipation, and does not heal for a long time, leading to anal fissure.

2 damp heat accumulates in the anus: the external sense of dampness and heat evil, the internal product alcoholic fat, so that the damp heat accumulates the gastrointestinal tract, the anus is born, and the anal fissure is not cured.

3 blood deficiency intestinal dryness: the elderly, postpartum and anemia patients, blood deficiency, dryness and constipation, the most prone to anal fissure.

an examination

The symptoms of anal fissure have clear characteristics. As long as the course of medical history is detailed, as well as the characteristics of pain and bleeding, the diagnosis is not difficult. However, in the diagnosis, in order to improve the accuracy of diagnosis and prevent mistakes, it should be strictly diagnosed according to several aspects such as consultation, palpation, visual diagnosis and biopsy.

Visual examination: acute anal fissure visible secretions in the anus, retracting the buttocks can be seen at the lower end of the anal fissure, such as using the probe to touch the lower end of the rupture, can cause pain; chronic anal fissure often has connective tissue external hemorrhoids.

Finger diagnosis: due to sphincter spasm anus tightening, such as excessive force, often cause severe pain, sometimes under local anesthesia. The crack touched in the anus, the edge of the acute one is soft, the bottom is shallow, elastic, and sensitive to touch; the chronic side has a hard protrusion, deep bottom, and no elasticity.

Speculum examination: visible oval ulcers, or see small cracks. The edge of the acute anal fissure is neat and the bottom is light red; the edge of the cleft of the chronic anal fissure is not neat, the bottom is dark grayish white, and some people with severe anal fissure can also see sphincter fibers.

Differential diagnosis

1. Anal skin abrasions:

Anal fissures need to be bruised with the anal skin.

2. Intestinal inflammatory diseases:

Some intestinal inflammatory diseases may be associated with ulcers around the anus, and should be identified when diagnosed.

1 anal tuberculosis ulcer; 2 Crohn's disease anal canal ulcer; 3 syphilis ulcer; 4 ulcerative colitis and anal fissure of the cupping network.

The symptoms of anal fissure have clear characteristics. As long as the course of medical history is detailed, as well as the characteristics of pain and bleeding, the diagnosis is not difficult. However, in the diagnosis, in order to improve the accuracy of diagnosis and prevent mistakes, it should be strictly diagnosed according to several aspects such as consultation, palpation, visual diagnosis and biopsy.

Differential diagnosis: It must be differentiated from tuberculous ulcers, syphilis ulcers, soft chancre and epithelial cancer. Among them, ulcerative colitis and granulomatous colitis are easily identified by anal fissure.

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