According to Professor Peng Peng from the Yangzhou Armed Police Hospital's Anorectal Center, anal fissures can be classified as acute or chronic. Acute anal fissures have a shorter disease course, appear red, are superficial, and have fresh and neat fissure openings without scar formation. Chronic anal fissures last longer, recur frequently, are deep and irregular at the bottom, often accompanied by hypertrophic papillae at the upper end and sentinel hemorrhoids at the lower end, commonly referred to as the "anal fissure triad."
Sentinel hemorrhoids are caused by lymphatic stasis under the skin, resembling external hemorrhoids. Since they are seen first during examination before the fissure, they aid in diagnosis and are thus called sentinel hemorrhoids or fissure hemorrhoids. In late stages, perianal abscesses and subcutaneous fistulas may also develop.
The exact cause of anal fissures is still unclear, but the following factors are associated with their occurrence:
1. Anatomical factors: The external sphincter forms the anococcygeal ligament at the posterior part of the anus, which is relatively hard and has poor elasticity. The levator ani muscles mostly attach to the lateral sides of the anal canal, making the anterior and posterior parts less strong than the sides, leading to easy damage. The anorectal angle formed between the anal canal and rectum increases pressure on the posterior part of the anal canal, contributing to anal fissures.
2. Trauma: Chronic constipation patients experiencing bloody stools may develop fissures due to hard stools and excessive straining that damages the anal canal skin. Repeated damage leads to full-thickness skin fissures, forming chronic infectious ulcers. Constipation causes about 14%-24% of anal fissures, though it could also result from fear of defecation. Additionally, childbirth injuries account for approximately 3%-9% of cases. Diarrhea with frequent bowel movements can also cause anal canal sensitivity and contraction, leading to damage and chronic infectious ulcers.
3. Infection: Chronic inflammation near the dentate line, such as anal cryptitis in the posterior midline area, can spread downwards causing subcutaneous abscesses, breaking down into chronic ulcers. The reason why anal canal injuries fail to heal remains unknown, but some believe it is mainly due to combined injury and infection. During infections, inflammatory cells release collagenase, preventing epithelial tissue regeneration and extension.
4. Ischemia: Recently, some proposed that ischemia along the posterior midline of the anal canal is the reason why anal fissures occur there. This is because the distal anal canal is supplied by the inferior rectal artery, which traverses the ischio-rectal fossa, branching through the sphincter muscle to the mucosa. However, most posterior commissures lack branches of the inferior rectal artery (85%). Capillary morphology studies suggest that capillaries inside the internal sphincter in the posterior midline are more sparse. Laser Doppler flowmetry measurements indicate that blood flow in the posterior commissure of the anal canal is less compared to other quadrants. All these suggest that ischemia is indeed a major factor in the development of chronic anal fissures.
5. Anal canal stenosis: Congenital malformations, trauma, or surgery-induced anal canal stenosis make it easier for dry feces to cause damage and lead to anal fissures.
6. Internal sphincter spasm: Patients with anal fissures exhibit abnormal excessive contraction of the internal sphincter. Reflexive internal sphincter spasm is currently considered an important reason why anal fissures fail to heal easily.
HCPT Minimally Invasive Surgery for Anal Fissures
Traditional methods for treating anal fissures include fumigation, anal dilation, and incision. Fumigation is effective for initial small fissures, but old fissures are best treated surgically. While incision offers better results compared to fumigation and dilation, it has disadvantages like longer hospital stays (usually 20-30 days) and prolonged patient pain.
Yangzhou Armed Police Hospital's Anorectal Center recommends HCPT minimally invasive surgery for anal fissures. HCPT uses high-frequency capacitive field heating principles, inserting a rectal fiberoptic scope into the anus. Through a monitor, direct minimally invasive electrocoagulation is performed on the anal fissure, causing it to dry up and close. Clinical verification shows this technique effectively treats anal fissures with advantages like painlessness, no need for hospitalization, and short operation times, making it the optimal choice for anal fissure treatment.
Special Reports: [Hemorrhoids], [Anal Fistula], [Anal Fissure], [Rectal Bleeding], [Anal Itching], [Perianal Cysts]
[Yangzhou Armed Police Hospital Anorectal Center] http://www.yzwjyy.com
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Hospital Address: No., Jiangdu South Road, Yangzhou City, Jiangsu Province
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[Nanjing Armed Police Hospital Anorectal Center] http://www.njgcyy.net
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[Nanjing Armed Police Hospital Anorectal Center] http://www.wjgc.net
Consultation Phone: 025-85500079 Consultation QQ: 997287111
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