1, related information of anal fistula
1. What are the symptoms of anal fistula?
(1) expansion
When the painful fistula is unobstructed without inflammation, there is generally no pain, only a slight swelling of the anus, which can be aggravated when walking. If the external orifice is closed, pus accumulates in the fistula, or feces enter the fistula, the pain will increase or increase during defecation, while the blind fistula often feels burning discomfort in the lower rectum and anus, and the pain will increase during defecation.
(2) discharging pus
Purulent discharge is the main symptom of anal fistula. Generally speaking, the newly generated fistula discharges more pus, and the pus is sticky, yellow and smelly; For a long time, the fistula discharges pus less, or sometimes no, as thin as water; If the amount of pus increases, it means that a new fistula has been created.
(3) Constipation
Sclerosis or scars are caused by repeated stimulation of fistula wall and fistula, which makes fibrous tissue proliferate and forms tough connective tissue on fistula wall and fistula. Often manifested as discoloration of the skin around the fistula, exfoliation of the epidermis, depression and deformation, touching the cord-like induration leading to the anus.
(4) Systemic symptoms
Most of them have no systemic symptoms. When anal fistula invades a large area or has many branches, repeated inflammation and infection will lead to emaciation, anemia, constipation, difficulty defecation and other systemic symptoms.
(5) Itching
Anal skin is stimulated by secretions such as pus, which constantly stimulates perianal skin and often feels itchy skin. Perianal dampness and discomfort, skin discoloration, epidermis shedding, fibrous tissue hyperplasia and thickening, and sometimes eczema.
2. Factors inducing the onset of anal fistula
Perianal abscess: It is mainly due to dirty feeling and feces staying in anal recess, causing anal adenitis and perianal abscess, which is the main cause of anal fistula.
Anorectal injury: trauma, slippery foreign body from digestive tract, metal, anal surface and anoscope damage the anorectum, and bacteria can invade the wound and cause perianal abscess.
Fistula often passes between anal sphincter, because sphincter often contracts and relaxes constantly, and clings to fistula. Affect the discharge of pus. It is easy to accumulate pus and infection, and it is difficult to heal.
After the rupture of perianal abscess, pus is discharged, the abscess cavity is gradually reduced, and the external rupture opening and wound are also reduced, and the cavity wall forms a hard pipe wall for connective tissue proliferation, which cannot be closed naturally.
Poor anal venous return, local congestion and tissue malnutrition affect healing.
Abscess caused by tuberculosis, actinomycetes and other infections, Crohn's disease and other diseases are difficult to heal themselves, forming a special anal fistula.
3. Can anal fistula be cured?
The internal orifice of anal fistula is mostly located near the dentate line, and the external orifice is mostly located in the perianal skin. Anal fistula is difficult to be cured once and never recurs. The treatment process is very long, mainly due to irregular diet. So far, the more effective way to treat anal fistula is surgery.
Anal fistula can still be cured. Patients with anal fistula can be classified into simple anal fistula, complex anal fistula and horseshoe anal fistula according to their etiology, pathological changes or pathological changes. For patients with anal fistula, once the disease is found or diagnosed, most of them can't heal themselves and need medication or surgery. The principle of surgical treatment is to cut or cut off anal fistula, which can be cured by general surgery.
2. Precautions before anal fistula operation
1, establish normal eating habits, because the occurrence of anal fistula is related to damp heat. For greasy diet, it can be endogenous damp heat and should not be eaten more. You should eat more light foods rich in vitamins, such as fresh vegetables and fruits such as mung beans, radishes and wax gourd.
2, develop good defecation habits, prevent dry stool, damage the skin of anal canal, and cause infection. Taking a bath after defecation every day to keep the anus clean has a positive effect on preventing infection. Keep the anus clean, get into the habit of washing the part or anus after defecation every morning and evening, and keep the anus clean.
3, the secretion of anal fistula for a long time, underwear should be changed frequently, washed frequently, and sunned more. You can also use anal belt to protect the anus, so as not to pollute the underwear too much. The anal belt should also be changed frequently, and pus and secretions should not be accumulated in the affected area.
4. When the anus damp is unwell, it is extremely important to pay attention to the cleanliness of anus. Always wash the anus with warm water, at least once a night. Generally, it can be washed with warm salt water or alum.
5. When the anal fistula is inflamed and suppurated, if the external orifice is blocked, a sterilized needle can be used to puncture the external orifice to discharge pus, which can not only relieve the pain, but also prevent the pus from spreading to other parts.
3. Postoperative sequelae of anal fistula
1. the anus damp or leaking a small amount of loose stool: because the anus is not tightly closed due to excessive surgical scar, patients often belong to scar constitution. As time goes on, scars can gradually soften and sequelae can disappear. It's just that this time is long and short, which varies from person to person. For example, diabetics will take longer.
2, anorectal stenosis: due to the complex fistula, resulting in a large area of scar contracture. How to manage it depends on the specific situation.
3. anal incontinence: It is rare to have complete anal incontinence after anal fistula surgery in clinic, and repair surgery is needed; Common diseases are incomplete anal incontinence and anal sensory incontinence, which can only be treated by old-fashioned methods and strengthening anal function exercise.
4. Treatment of infantile anal fistula
1. Non-surgical therapy:
The lesion range is less than 2×2cm, the abscess site is red and swollen, or the fistula course is short (less than 6 months). Traditional Chinese medicine has the functions of clearing away heat, reducing swelling and detoxicating, and at the same time, the medicine juice is washed locally, and gold ointment is used externally.
2. Incision and drainage:
When the pus matures, the pus is discharged from the radial incision at the highest or obviously undulating part of the abscess, and then the drainage strip is placed for several days.
Studies have shown that the recovery rate of children after non-surgical treatment and simple incision and drainage is 65%.
3. Surgical treatment:
One-time incision: used for low simple anal fistula or perianal abscess with obvious internal opening.
Incision and thread-drawing method: the course of disease is long (more than 6 months), the infection is difficult to control after non-surgical treatment, and it recurs after incision and drainage.
Thread-hanging method: used for complex anal fistula and large perianal abscess.
On the premise that infantile anal fistula's (perianal abscess) has self-healing, initial local shower and external application of traditional Chinese medicine can promote inflammation to dissipate, and simple incision and drainage can be performed after suppuration.
Infants' immature tissues are treated with radical surgery prematurely, which increases the damage to perianal tissues, leading to local defects and deformities of anus, and even complications such as overflow and fecal incontinence. The operation scope of simple incision and drainage is small, only the abscess cavity needs to be cut to discharge pus, and the infected anal gland does not need to be removed, which reduces the occurrence of sequelae.