1. General therapy
The principle of non-surgical treatment is to relieve sphincter spasm, relieve pain, help defecation, interrupt vicious circle and promote local wound healing. The specific measures are as follows: after defecation, take a bath with 1: 5000 potassium permanganate warm water to keep local cleanliness; Take laxatives or paraffin oil orally to make the stool soft and smooth; Increase drinking water and food rich in fiber, correct constipation and keep defecation unobstructed; After local anesthesia of anal fissure, the patient lies on his side, first dilate the anus with the index finger, and then gradually extend into the two middle fingers, and keep dilating for 5 minutes. Dilation can relieve sphincter spasm, enlarge wound surface and promote fracture healing. However, the recurrence rate of this method is high, and it may be complicated with bleeding, perianal abscess, fecal incontinence and so on.
2. Surgical therapy
(1) Anal fissure excision is to remove all hyperplastic margins, sentinel hemorrhoids, enlarged anal papilla, inflamed crypts and deep unhealthy tissues until the anal sphincter is exposed. At the same time, part of the subcutaneous part of the external sphincter or internal sphincter can be cut off, and the wound surface is open for drainage. The disadvantage is that it heals slowly.
(2) Anal sphincter amputation The sphincter in anal canal is an annular involuntary muscle, and its spasmodic contraction is the main cause of anal fissure pain. The operation method is to make a small incision on one side of the anal canal at a distance of 1 ~ 1.5 cm, reach the lower edge of the internal sphincter, determine the groove between the internal sphincter, then separate the internal sphincter to the dentate line, cut off the internal sphincter, and then expand to the four fingers. After electrocautery or compression to stop bleeding, suture the incision, and the hypertrophy of anal nipple and sentinel hemorrhoid can be removed together, and the anal fissure will heal itself after several weeks. This method has a high cure rate, but improper operation will lead to anal incontinence.