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Anal Fissures (肛裂)

A fissure is basically a tear in the anal tissue. The most common symptoms associated with anal fissures are:

1. Cyclical pain (周期性疼痛): First, there’s the pain during defecation, after which there is this pain for a few minutes, then this pain that may last a few hours (internal sphincter spasm).
2. Bleeding (出血): very minute bleeding of fresh blood. Can be seen on the tissue you wipe with, in the feces itself, or dripping from the anus.
3. Constipation (便秘): Habitual constipation (习惯性便秘) is most seen here.

This tear in the anal tissue produces a vertical ulcer, usually at 12 or 6 o’clock. 12 o’clocks are the most commonly occuring; 6 o’clocks are seen more in ladies.

They usually cure on their own.

Spasms related to Anal Fissures

1. Spasm of internal sphincter muscles (内括约肌痉挛): This is the muscle just under the ulcer opening of the fissure, and it react spasmically to passing objects.
2. Spasm of levator ani (肛提肌): This rectal pain that happens in episodes is caused by spasm of the levator ani muscle (肛提肌). They call it levator syndrome, ischiococcygeal syndrome, proctalgia fugax and coccydynia. What happens is a spasm in the rectal area which grows in intensity, then slowly subsides. When it happens varies from person to person. This is much less commonly related to anal fissures, but should be taken into consideration.

Differential Diagnosis (鉴别):

1. Crohn’s Disease (克罗恩病)
2. Ulcerative Coliitis (溃疡性结肠炎)

Complications (并发症):

1. External Hemorrhoid (外痔)
2. Enlarged Papillae (乳头肥大)
3. and some more…

Treatment:

1. Prevent constipation
2. Prevent that internal sphinter muscle from going into spasms – this is the cause of a vicious cycle. We can consider the different ways to help relax the internal sphincter (内括约肌). One way is to use either fingers or a machine to stretch the anal canal slowly.
3. If there are already growths, e.g. enlarge papillae (乳头肥大) or formation of fibrous tissue (结缔组织性外痔), then we have to get rid of them surgically.

How can Chinese Medicine be Used?

1. Prevent constipation: Use formulas like 润肠汤 to ensure gastrointestinal clearance.
2. Reduce bleeding: A formula like 凉血地黄汤 will do.
3. Astringent method to take away the pain: Using external washes like 苦参汤 or even sichuan peppers (花椒) can help.

The aim in the end is not to let an ordinary fissue develop into something chronic that could cause complications.

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