Anal sinusitis refers to the acute and chronic inflammation in the anal sinus (anal recess) and anal flap, often complicated by anal papillitis and anal papillary hypertrophy. It is a clinically common and frequently-occurring disease that can induce a variety of anorectal diseases. Such as perianal abscess, anal fistula , anal fissure, proctitis and so on. Therefore, early treatment of anal sinusitis and anal papillary inflammation is of great significance to the prevention of other perianal diseases.
【Etiology and pathogenesis】
Western medicine
Infection and injury Because the opening of the anal sinus is upward, it is easy to retain feces and be scratched by dry and hard feces. For a long time, the anal sinus is not drained smoothly, bacteria multiply, and cause the anus Sinus inflammation and swelling.
The effect of sex hormone levels Some studies have found that the level of sex hormones directly affects the proliferation and atrophy of anal glands, and androgen has the greatest influence among sex hormones. Males and young adults have high levels of androgen, so they are prone to perianal infections; the elderly have decreased sex hormone levels, so anal sinusitis and perianal infections rarely occur.
Traditional Chinese Medicine
It is mostly caused by inadequate diet, spicy, mellow wine, damp and hot endogenous, turbid qi is injected into the anorectal; or because of intestinal dryness and constipation, local rupture of the anal canal and poisoning caused qi and blood stasis, and meridian obstruction become.
【Clinical manifestations】
Anal sinusitis and anal papillitis are conscious of discomfort in the anal area at the initial stage, often with anal swelling, and a feeling of inconvenient defecation; anal dampness, itching, often accompanied by anal burning or tingling during the attack .
【Diagnostic points】
1 When onset, I felt swelling, itching and pain in my anus.
2 Digital Anal Examination Anal canal tightening, with obvious tenderness and induration in the inflammation area. In anal papillitis, the swollen and tender anal papilla may be palpable.
3 Anal crypts and anal papillae are red and swollen with purulent secretions under anoscope. The nipple is hemispherical or triangular or earthworm-shaped, and the larger nipple can protrude outside the anus.
【Differential Diagnosis】
Anal fissure has a longitudinal slit in the anal canal.The pain is long, intense, and periodic.
Rectal polyps Rectal polyps are located in the rectal mucosal area on the dentinal line. They are red in color and easy to bleed.
【Treatment measures】
conservative treatment
TCM internal treatment method
damp-heat type
Syndrome wet anus, itching pain, bulging pain, red constipation, red tongue, yellow greasy fur, slippery pulse number.
Therapeutic method clearing heat and removing dampness, removing blood stasis and relieving pain
prescription Longdanxiegan decoction modified
heat toxin type
syndromes of burning pain in the anus, irritability and thirst, constipation, red tongue, tongue Red, yellow moss, pulse number.
Therapeutic method to clear away heat and toxins, reduce swelling and relieve pain
prescription Xianfang Huoxing Decoction or Huanglian Jiedu Decoction addition and subtraction.
damp muddy type
Syndrome anal damp itching, erosion, anal sinus or nipple edema, pale, appetite, fatigue, loose stools, muddy urine, pale color, white greasy fur, pulse slip.
Therapeutic method to invigorate the spleen and promote dampness
Cao Xie Shen Damp Decoction Modified
Deficiency Type
Syndrome Anal discomfort and pain, pale anal sinus color, with hot flashes and night sweats, dry mouth, constipation, tongue Red, little moss, pulse count.
Therapeutic method to nourish yin and clear away heat
prescription Zengye Decoction addition and subtraction.
external treatment method
1 Chinese herbal medicine fumigation and washing bath patties 30g plantain 30g papaya 20g rhubarb 15g to 15g The county first smokes and then sits in a bath for 10-20 minutes,Twice a day.
2 Method of application Huanglian ointment or Kangtai ointment or Mayinglong hemorrhoid ointment applied to the anus.
3 medicine can be used as angtai suppository or hemorrhoid suppository or Ma Yinglong hemorrhoid suppository and so on.
4 Enema Rhubarb 15g Glauber's salt 15g Coptis 15g Ma Tezhu 15g Diyu 15g decocted in water to 100ml for two enema.
Western medicine
1 Antibiotics first choice metronidazole , second choice Qingda, norfloxacin and so on. Oral or anal administration.
2 Anal suppositories Indomethacin suppository or chlorhexidine suppository na anus.
Surgical treatment
1 Incision and drainage
Indications: Simple anal sinusitis is not cured for a long time.
Operation method Patients take the lateral position or lithotomy position, routine disinfection, local anesthesia, expose the diseased anal sinus, probe in, incise the anal sinus along the probe, trim the wound to make drainage smooth, check that there is no Active bleeding , use Huanglian ointment oil sand strips or comfrey oil sand strips to compress the wound in the operation area, take a bath with Chinese medicine every day after the operation, and change the dressing until healed.
2. Resection
Indications are suitable for those with invisible fistula or pus, or with anal papilla hypertrophy.
Operation method The patient takes the left side decubitus, routine disinfection, local anesthesia, and exposes the anal sinus and nipple of the diseased area. Separate the anal sinus to the root of the nipple and ligate and then excise. The wound medication and postoperative treatment are the same as above.
【Home Care】
1 Keep the stool smooth, do not squat for a long time, and aggravate symptoms such as local swelling.
2 Choose Chinese medicine three-grass lotion (paitongcao, verbena, plantain each 30g cork, double flower, yuanhu each 15g puxiao, alum each 10g) Sit bath twice a day or 1:5000 potassium permanganate bath.
【Prevention and Rehabilitation】
1 Actively exercise, strengthen physical fitness, improve disease resistance, do not sit for a long time, and do levator movements dozens of times a day.
2 Keep stool smooth, and actively treat diarrhea and other intestinal inflammatory diseases.
3 Be cautious of spicy foods, seafood, fish and shrimps and other irritating foods.
4 Keep the area around the anus clean, and insist on taking a warm bath after going to bed and before going to bed.
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