Make a diagnosis first. Many people come to the hospital to say yes. The doctor needs to see if it is anal fissure when checking. Look at the difference between self-examination and hemorrhoids and anal fissure. Can be cured after non-surgical treatment, such as local hot water hip bath, and then use potassium permanganate solution hip bath. The emphasis is on prevention. If the above treatment fails, the anal fissure can be surgically removed. It is a small ulcer formed by tearing the skin layer of anal canal below the dentate line. Its direction is parallel to the longitudinal axis of anal canal and its length is about 0.5 ~ 1.0 cm. It is spindle-shaped or oval, often causing severe pain and difficult to heal. However, the surface laceration of anal canal cannot be regarded as the cause of anal fissure, and it is often asymptomatic. Anal fissure is a common anal canal disease, and it is also a common cause of severe anal canal pain in young people. Anal fissure is most common in middle-aged people, but it can also occur in the elderly and children. Generally, men are slightly more than women, but there are also reports that women are more than men. Anal fissure often occurs in the back and front of anus, mostly in the back of anus and less on both sides. At first, there was only a small crack in the skin of anal canal, and sometimes it could crack to the subcutaneous tissue or the superficial layer of sphincter. The cracks are linear or prismatic. If the anus is opened, the wound surface of the fissure will be round or oval. The clinical symptoms of anal fissure are pain and bleeding. Its pain is very characteristic, that is, when defecating, there is a sudden knife pain (caused by feces cutting the skin of anal canal), and then it is temporarily relieved, and then there is a long-term anal pain (caused by spasm after anal sphincter stimulation). Common clinical patients are afraid to defecate because of fear of pain, and there is a vicious circle phenomenon of "fear of pain-forbearance of defecation-dry defecation-more pain". Hemorrhage caused by anal fissure is also more or less due to the degree of vascular tear, which is common in cases of anemia caused by long-term anal fissure or massive hemorrhage. If the early anal fissure is not treated in time, there will be three diseases: anal canal ulcer (fissure fibrosis, also known as chronic anal fissure), anal nipple hypertrophy (polypoid tumor) and sentinel hemorrhoid (skin hyperplasia). If it continues to develop, there will be anal sinusitis (chronic inflammation of anus) and anal fistula (purulent inflammation of anus), which together with the first three diseases are called "five characteristics of anal fissure". There is also the possibility of anal canal cancer caused by long-term chronic inflammatory stimulation. Typical symptoms are pain, constipation and bleeding. When defecating, dry and hard feces directly rub the ulcer surface, opening the gap and causing severe pain. After the feces are discharged, the pain is temporarily relieved. A few minutes later, due to sphincter reflex spasm, it caused severe pain for a long time, and some of them needed painkillers to relieve it. Therefore, patients with anal fissure are afraid of defecation, which leads to increased constipation and a vicious circle. There may be a small amount of bleeding when the wound is split, and there may be blood drops on the surface of feces or after defecation. During the examination, you can see the ulcer surface by gently separating the anal orifice with your thumbs. The edge of the new anal fissure is neat and soft, the ulcer base is shallow, there is no scar tissue, the color is red and it is easy to bleed. Chronic anal fissure is deep and hard, gray and white, and it is not easy to bleed. Below the fissure is "sentinel hemorrhoid". Anal digital examination and anal endoscopy can cause severe pain in patients and should not be performed. Most of them are blood heat, intestinal dryness, constipation, and excessive defecation, which makes the anal skin rupture and recur. "Golden Mirror of Medical Zong: Essentials of Surgical Psychology" says: "If the anus is wrinkled, the fire will dry up." This paper briefly expounds constipation caused by hot colon dryness or body fluid due to yin deficiency, defecation force, anal skin laceration, secondary infection and gradually forming chronic and spindle ulcer. But there are also infections such as anal canal stenosis, anal eczema and hemorrhoid injury. Specifically, the occurrence of this disease is mainly related to the following factors: 1. Anatomical factors: the superficial part of the external anal sphincter, from the coccyx to the posterior part of the anus. Divided into two bundles, which surround the front of the anus along both sides of the anal canal and combine with each other. So there is a gap before and after the anus. Moreover, levator ani is mostly attached to both sides of anal canal, and less before and after. It can be seen that the front and rear parts of the anus are not as firm as the sides, and it is easy to get hurt. Make an angle of nearly 90 degrees with the rectum downward and backward. Therefore, anal fissure is caused by high fecal pressure at the back of anus, insufficient blood circulation at the back of anal canal, poor elasticity and many anal glands. 2. Trauma theory: dry feces or foreign bodies are easy to damage the skin of anal canal, which is the main factor causing anal fissure. 3. Infection theory: it is mainly the infection of anal recess behind anus, and the inflammation spreads to the subcutaneous of anal canal, leading to the rupture of subcutaneous abscess and anal fissure. 4. Internal sphincter spasm theory: due to anal canal injury or inflammatory stimulation, anal sphincter is in a state of spasm, which leads to the increase of anal canal tension and easy to damage anal fissure. 5. anal stenosis's theory: The slow development of anal canal skin leads to anal canal stenosis, which is easy to be damaged into anal fissure. When self-checking the stool, the stool just passes through the anus, that is, it feels burning or knife-like pain, accompanied by bright red blood or anal blood drops on the surface of the stool. After defecation, the pain was slightly relieved, and then unbearable pain occurred, which lasted for several hours or even 1 day. These symptoms may be anal fissure. The difference between hemorrhoids and anal fissure is that anal fissure is accompanied by sentinel hemorrhoids, especially for patients who have been neglected for a long time. After developing into chronic anal fissure, it is often accompanied by external hemorrhoids and internal hemorrhoids. At this time, the characteristics of the two outside the anus are basically the same. Therefore, it is of great benefit to understand the difference between anal fissure and hemorrhoids and improve the vigilance against anorectal abnormalities. Anal fissure is mainly manifested as anal canal skin fissure and anal canal ulcer, which is not easy to heal. Hemorrhoids are caused by varicose veins around anus, venous vessels and sliding mucosa at the lower end of rectum. 1. Anal fissure is mainly pain and bloody stool. Hemorrhoids are mainly bleeding, and only when the external hemorrhoids are red and swollen will hemorrhoids be severely painful. 2. Anal fissure can be seen as anal canal skin cracking, hemorrhoids are not. Anal finger examination can be confirmed, but anal fissure patients can not be examined by anal finger examination or endoscopy; 3. Anal fissure is often accompanied by anal papilla hypertrophy and anal papilloma, while hemorrhoids are not accompanied by anal papilla hypertrophy or papilloma; 4. When anal fissure occurs, the appearance of anus is narrow, while patients with hemorrhoids often see prolapse and eversion of internal hemorrhoids. Treatment can be cured by non-surgical therapy, such as local hot water sitz bath, followed by potassium permanganate solution sitz bath, which can promote anal sphincter relaxation; Apply anti-inflammatory and analgesic ointment (including dicaine, berberine, metronidazole, etc. ) on the ulcer surface to promote ulcer healing; Oral laxatives make stools soft and slippery; Patients with severe pain can use procaine to locally block or retain enema to relax sphincter. Chronic anal fissure is ineffective after the above treatment. Surgical resection can be used, including excision of ulcer and vegetation (sentinel hemorrhoid), or cutting off some external sphincter fibers, which can reduce postoperative sphincter spasm and facilitate healing. The wound was not sutured, and the defecation was kept unobstructed after operation, and hot water sitz bath and wound dressing change were carried out until it was completely healed. In recent years, liquid nitrogen cryosurgery for anal fissure has achieved satisfactory results, with mild postoperative pain, no bleeding and no anal incontinence. There are several surgical treatments: 1. Excision: suitable for stage ⅲ or chronic anal fissure, with good postoperative effect and less recurrence. 2. Posterior internal sphincterotomy: The main purpose is to eliminate internal sphincter spasm. 3. Lateral internal sphincterotomy: The main purpose is to reduce and prevent anal dysfunction. 4. Anal canal dilatation: it is mainly used for the disappearance and contraction of anal canal elasticity, sphincter dysfunction and organic stenosis caused by various reasons. 5.V-Y anal canal plasty: it is suitable for anal canal skin defect and obviously narrow anal fissure. 6. Treatment of perianal skin crack: surgery should be selected according to the cause and condition. 7. Anal fissure with stage I or small stage I internal hemorrhoids: lateral internal sphincterotomy should be done first, and then injection should be used to treat internal hemorrhoids after anal fissure is cured. Other therapies: such as laser and electrocautery. How to prevent anal fissure caused by constipation? As we all know, constipation is easy to cause anal fissure, so how to prevent anal fissure caused by constipation? Anal fissure is often accompanied by anal pain besides bloody stool. In severe cases, the pain can last for several hours, and anal fissure makes the patient very painful. The key to prevent anal fissure is to prevent constipation. Patients often try to relieve pain by enduring defecation for a long time and reducing the frequency of defecation. As a result, the stool stays in the large intestine for a long time, and the water is absorbed and becomes harder and harder. When defecating again, it will stimulate the anal fissure wound more and cause more severe pain. The key to prevent anal fissure is to solve constipation. Drinking water therapy has always been the most effective and cheapest way to prevent constipation. According to the physiological needs of adults, the daily intake of liquid should reach 2000 ~ 3000 ml, which is especially important in dry autumn climate. You can drink boiled water, light salt water, honey water and soup before and after meals. Don't drink too much strong tea or coffee. Because tannic acid in tea can converge stool, coffee has diuretic effect and accelerates water loss. The defecation time that meets the physiological requirements is to get up in the morning or after breakfast. After a night of digestion and absorption, feces have been stored in the sigmoid colon. The "standing reflex" when getting up and the "gastrocolonic reflex" after breakfast can increase the peristalsis wave of the colon, increase the internal pressure of the colon, produce defecation, and make the feces discharged smoothly. In addition, you should eat more foods with high crude fiber content, such as fresh vegetables, fruits, sweet potatoes and cereals. Crude fiber food can soften the stool, increase the amount of feces discharged and stimulate colon peristalsis. Patients with anal fissure caused by constipation can only relieve their symptoms through the above methods, which shows the importance of preventing constipation to prevent anal fissure. How to prevent anal fissure? Anal fissure is one of the more painful anal diseases, which can be accompanied by a variety of anal discomfort. Therefore, we should pay attention to the prevention of anal fissure. 1. To keep the stool unobstructed, we should develop the habit of defecating regularly every day. When we find dry stool, we should avoid taking pains to defecate, but inject warm saline enema or kaisai dew into anus to moisten the intestines and relax the bowels. 2, timely treatment of anal recess inflammation, in order to prevent the formation of ulcers and subcutaneous fistula after infection. 3. When using the anoscope, it is forbidden to use the speculum for rough operation and damage the anal canal. 4, timely treatment of various diseases that cause anal fissure, such as ulcerative colitis and other diseases, to prevent anal fissure. 5, drink less, don't eat spicy food, don't eat too much, coarse grains flour and rice collocation, try to eat food rich in fiber, keep normal stool. 6, who have perianal eczema, dermatitis, itching and other diseases should be actively treated to prevent perianal skin hardening, elasticity weakening and anal skin tearing. 7, to have anal skin damage, should be actively treated to prevent the formation of ulcers due to infection. 8. Patients with anal cryptositis and anal papillitis should be cured as soon as possible to prevent anal fissure. 9. When doing anorectal digital diagnosis, avoid using rough force to avoid damaging the anal canal. I hope my answer can help you! You can keep asking me questions. You must know everything and say everything. I hope to get well soon.