肛裂

定义

An 肛裂 is a cut or tear in the lining of the anus. The anus is the opening through which stool leaves the body.

肛裂

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原因

The exact cause is not known. In most people, it happens as a result of trauma to the anal lining. Trauma can be caused by:

• A large, dry, or hard stool (poop)
• 频繁的 腹泻
• Tightened anal sphincter, a group of muscles that open and close the anus
• 分娩
• Receiving anal intercourse
• Sexual abuse in children

风险因素

肛裂s are most common in middle-aged adults. 但是他们可以 发生在任何年龄. Things that may raise the risk of this problem are:

• 便秘
• 腹泻
• Pregnancy with vaginal delivery
• Receiving anal intercourse
• Sexual abuse in children
• 结肠镜检查
• Diets low in fiber, high in processed meat and white bread

症状

症状 are severe burning or tearing 疼痛 during and after 排便(便便). A person may also pass bright red blood or mucous.

诊断

The doctor will ask about symptoms and past health. 一个物理 检查就完成了. It will focus on the anus. The doctor will likely be able to see an 肛裂. This is enough to make the diagnosis.

If the diagnosis is not clear, these tests may be done:

• Digital rectal exam—to feel for any lumps or abnormalities
• Anoscopy—to look at the anal canal with a scope
• 核磁共振成像扫描 or CT扫描

治疗

The goal of treatment is to promote healing. 选项有:

• Self care, such as warm sitz baths and increasing fiber and fluids
• 药物，如:
  • Stool softeners or laxatives
  • 前ical anesthetic to ease 疼痛
  • 前ical steroid cream to ease swelling
  • 前ical nitrates and calcium channel blockers to increase blood flow and ease 疼痛
  • Injected botulinum toxin to relax tightened muscles

People who are not helped by these methods may need surgery. 选项有:

• 横向的内部 括约肌切开术 ——一个 tiny incision in the sphincter muscle fibers to prevent spasms that result in straining during a bowel movement
• Fissurectomy—Removing the fissure
• Anal advancement flap—Covering the fissure with tissue from another part of the body
• Anal dilation—Widening and stretching the anal canal (rare)

预防

The risk of this problem may be lowered by:

• Eating a high fiber diet
• Drinking plenty of fluids

参考文献

• 肛裂. American Society of 结肠 and Rectal Surgeons 网站. 可以在: http://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure.
• 肛裂. EBSCO DynaMed网站. 可以在: http://www.力学.com/condition/anal-fissure.
• Boland PA, Kelly ME, et al. Management options for chronic 肛裂: a systematic review of randomised controlled trials. 结直肠疾病. 2020;35(10):1807-1815.