Have you ever asked a mouse to steal dung?

It is anal fistula for rats to steal feces. ...

Fistula refers to the infectious pipeline connecting anorectal and skin around anus, also known as "anorectal fistula". Its inner mouth is often located near the tooth line, and its outer mouth is located on the perianal skin, and the fistula has not healed for many years. According to its main symptoms, people constantly ooze pus and blood from the sores on the skin around the anus, just like a broken house often leaks water. Our ancestors named this disease fistula. Fistula is that there are two pipes connecting sores inside and outside the human body, which can leak secretions and pus from the inside to the outside. Serious anal fistula, feces can flow out, just like a rat stealing feces hiding in a sore hole, which harms people from time to time, so it is also called "the rat stealing feces" figuratively. The disease can occur at any age, but middle-aged people aged 30-40 are more prone to it, with more men than women.

Anal fistula is a fistula near anus and lower rectum. There must be an internal opening to the anal canal and rectal wall, one or more external openings to the perianal skin, and a fistula between the internal and external openings. The anal canal is mostly formed by perforation or incision of perianal abscess, and a few are tuberculous infection. Fistula often discharges a small amount of secretions or pus; The examination found that there were fistulas around the anus, varying in number, and pus flowed out when the edge was pressed. During digital rectal examination, after the thumb meets the index finger outside the anus, a rope-shaped fistula can be pinched at the affected part, and a small induration can be felt in the anus along the fistula, which is the inner opening; Use a silver probe to gently probe the fistula from the external port. If it penetrates into the intestinal cavity, confirm that there is an internal orifice. This kind of examination is generally used for anesthesia before operation.

Anal fistula is mostly caused by abscess around anal canal, so the internal orifice is mostly at the anal sinus on the dentate line, and the abscess ruptures itself or is cut and drained to form the external orifice, which is located on the perianal skin. Due to the rapid growth of external orifice, abscess often pseudo-heals, which leads to repeated rupture or incision of abscess, forming multiple fistulas and external orifices, making simple anal fistula become complex anal fistula. There is reactive dense fibrous tissue around pruritus and inflammatory granulation tissue near lumen, which can be epithelialized in lumen in the later stage. Specific inflammation such as tuberculosis, ulcerative colitis and Cohen's disease, malignant tumor and anal canal trauma infection can also cause anal fistula, but it is rare. There are many classification methods for anal fistula. Here are two simple ones.

First, according to the location of the fistula, ① low anal fistula: the fistula is located below the depth of the external sphincter. It can be divided into low simple anal fistula (only one fistula) and low complex anal fistula (with multiple soft mouths and fistulas). ② High anal fistula: The fistula is located deep above the external sphincter. It can be divided into high simple anal fistula (with only one fistula) and high complex anal fistula (with multiple fistulas and fistula arms). This classification method is commonly used in clinic.

2. Classification according to the relationship between fistula and sphincter ① Anal sphincter type: About 70% of anal fistula is caused by abscess around anal canal. The fistula is located between the internal and external sphincter, with the internal orifice near the dentate line and the external orifice near the anal margin, which is a low anal fistula. ② Trans-anal sphincter type: about 25%, mostly caused by abscess in the space of ischial anal canal, which can be low or high anal fistula. The fistula passes through the space between the external sphincter and ischiorectal space and opens on the perianal skin. ① Anal sphincter type: high anal relaxation, relatively rare, accounting for about 4%. ① The appearance of anal sphincter: the most rare, accounting for only 1%. This kind of anal fistula is mostly caused by trauma, intestinal malignant tumor and Crohn's disease. Treatment is more difficult.

Anal fistula cannot heal itself. Without treatment, perianal abscess will recur and must be treated surgically. The principle of treatment is to cut the fistula to form an open wound and promote healing. There are many surgical methods. The operation method should be selected according to the position of the internal orifice and the relationship between fistula and anal sphincter. The key of operation is to minimize the injury to anal sphincter, prevent anal incontinence and avoid fistula recurrence.

1. Fistulotomy is a method of opening all fistulas and healing wounds through granulation tissue growth. Suitable for low anal fistula, because the fistula is below the deep part of external sphincter. After the operation, only the subcutaneous and superficial parts of the external sphincter are damaged, and there will be no postoperative anal incontinence. The operation was performed under sacral anesthesia or local anesthesia. In lateral position or lithotomy position, methylene blue solution was injected into the patient from the external port to determine the position of the internal port, and then a probe was inserted into the gallstone tube from the external port to understand the operation of the fistula and its relationship with the sphincter. Under the guidance of the probe, the surface tissue on the probe is cut until the internal opening. Scrape the granulation tissue and necrotic tissue at the fistula, trim the skin edge to make the wound a V-shaped wound with a small inside and a large outside, and fill the wound with oil gauze to ensure that the wound grows from bottom to top.

2. Thread-hanging therapy is a method of slowly cutting anal fistula by mechanical compression of rubber band or corrosive medicine thread. It is suitable for simple anal fistula with low or high internal and external openings within 3-5 cm from anus, or as an auxiliary treatment for complicated anal fistula incision and resection. Its greatest advantage is that it will not cause anal incontinence. The ligated muscle tissue appears blood supply disorder, and gradually becomes necrotic and disconnected. However, due to fibrosis caused by inflammatory reaction, the severed muscles adhere to the surrounding tissues. The muscles will not contract too much and gradually heal, thus preventing anal incontinence caused by the retraction of the cut anorectal ring. At the same time, the thread hanging can also drain the fistula and eliminate the exudate in the fistula. Prevent the occurrence of acute infection. This method also has the advantages of simple operation, less bleeding, convenient dressing change and no skin incision adhesion before the rubber band falls off. The operation was performed under sacral anesthesia or local anesthesia, and the probe was inserted from the external orifice. Follow the direction of the fistula and pass through the internal orifice. Tie a sterilized rubber band or thick silk thread on the probe at the inner mouth, guide it through the whole fistula, cut the skin between the inner and outer mouth, and then tie the thread. After operation, take a bath in every mouth and clean the local area after defecation. If there are too many ligatures, ligature will be done after 3-5 days. Generally, the ligated tissue spontaneously breaks after 10- 14 days. 3. Anal fistula resection: pry the fistula, remove all the bone wall of the fistula to healthy tissue, and the wound surface will not be sutured; If the wound is large, it can be partially sutured, partially cut and filled with human oil gauze to make the wound grow outward from the bottom until it heals. Suitable for low simple anal fistula.

1, establish normal eating habits, because the occurrence of anal fistula is related to damp heat. For greasy diet, it can be endogenous damp heat and should not be eaten more.

2, should eat more light foods rich in vitamins, such as mung beans, radishes, melon and other fresh vegetables and fruits.

3. Chronic anal fistula is mostly deficiency syndrome. Eat more foods containing protein, such as lean meat, beef and mushrooms.

4, timely treatment of anal sinusitis, anal papillitis, so as to avoid anorectal abscess and anal fistula.

5, anal burning discomfort, anal bulge, to find out the reason in time, timely treatment.

6, prevention and treatment of constipation and diarrhea, is of great significance to prevent perianal abscess, because dry stool is easy to scratch the anal sinus, coupled with bacterial invasion and infection. Diarrhea patients often have proctitis and anal sinusitis, which can further develop inflammation.

7, active treatment, active treatment may cause perianal abscess systemic sexually transmitted diseases, such as ulcerative colitis, Crohn's disease, etc.

8. Develop good defecation habits and take a bath every day after defecation to keep the anus clean, which has a positive effect on preventing infection.