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If you eat too spicy food, you will experience anal pain when going to the toilet, and sometimes a burning sensation. If in addition to anal pain, you also have constipation and blood in your stool, you need to consider anal fissure, which is an inflammation of the intestine and is most common in middle-aged people. This article introduces the relevant clinical manifestations of anal fissure. If you want to know more, you can take a look.

Anal fissures are small ulcers in the full thickness of the skin of the anal canal below the dentate line. Anal fissures often occur in the posterior and middle part of the anal canal. If there are anal fissures on the sides of the anal canal, or if there are multiple fissures, it should be considered that they may be early manifestations of intestinal inflammatory diseases. It often occurs in middle-aged people between 30 and 40 years old, but can also occur in the elderly and children.

Clinical manifestations

Typical clinical manifestations of patients with anal fissure include pain, constipation and blood in the stool.

Pain: Anal fissures can cause periodic pain due to defecation, which is the main symptom of anal fissures. When defecating, the feces stimulate the nerve endings on the ulcer surface, and you will immediately feel a burning pain in the anus, but the pain will ease a few minutes after defecation. This period is called the pain interval. Later, due to the spasm of the internal sphincter, severe pain will occur again. This period can last from half an hour to several hours, making the patient restless and very difficult to bear. Until the sphincter fatigues, the muscles relax and the pain is relieved. But the pain occurred again when I defecated again. The above is clinically called anal fissure pain cycle. The pain may also radiate to the perineum, buttocks, inner thighs, or sacrum.

Constipation: This is both the cause and consequence of anal fissure. After anal fissure, the patient is unwilling to defecate due to anal pain, which will cause constipation over time and the stool will become drier and harder. Constipation can aggravate the anal fissure, forming a vicious circle and making it difficult to heal the anal fissure.

Blood in stool: During defecation, a small amount of fresh blood is often seen on the surface of the stool or on toilet paper, or drops of blood. Major bleeding is rare.

Others: such as anal itching, discharge, diarrhea, etc. Anal itching is caused by the secretions of anal fissure ulcers or the stimulation of secretions produced by concurrent anal cryptitis, anal papillitis, etc.

Signs: 355 cases of anal fissure were reported abroad with the following different signs: anal canal spasm 78%, sentinel piles 68%, hypertrophic papillae 25%, anal fistula 6%, intersphincteric abscess 4%, hemorrhoids 38%, and anal canal stenosis 2%.

Diagnostic tests

Testing

1. Rectal examination and endoscopic examination: For anal fissures that are difficult to diagnose, rectal examination and anoscopy may be performed as appropriate. The operation should be performed gently to avoid causing severe pain to the patient. 2. Histopathological examination: For chronic ulcers located on the side, we should consider whether there are rare lesions such as tuberculosis, cancer, Crohn's disease and ulcerative colitis. Biopsy of the tissue can be used for differential diagnosis.

The diagnosis and differential diagnosis usually includes a history of constipation. When asking about the bowel movement history and whether there is a history of pain during defecation, there are often typical intervals and cycles of pain after defecation. If local examination reveals the "triad" of anal fissure in the posterior midline of the anal canal, the diagnosis is clear. However, in the early stages of anal fissure, it is necessary to differentiate it from anal skin lesions. Once anal fissure has been confirmed, rectal digital examination and anoscopy are generally not recommended to avoid causing severe pain.

Differential Diagnosis

1. Anal skin abrasion: Anal fissure needs to be differentiated from anal skin abrasion in the early stage.

2. Intestinal inflammatory diseases: Some intestinal inflammatory diseases may be accompanied by ulcers around the anus, and care should be taken to differentiate them during diagnosis.

① Anal tuberculosis ulcer;

② Anal ulcer caused by Crohn's disease;

③ Syphilitic ulcer;

④ Anal fissure complicated by ulcerative colitis.