How to care for anal tear and fecal incontinence

If the anus is torn or causes fecal incontinence, the treatment should be taken seriously. A scientific method can be adopted, such as sitting bath with 1:5000 potassium permanganate solution. At the same time, good bowel habits should be developed, and the intake of fiber foods should be increased to avoid constipation.

1. Keep bowel movements smooth

Take laxatives orally to make stools soft and lubricated, increase the intake of high-fiber foods and change bowel habits, and gradually correct the occurrence of constipation.

2. Local sitz bath

Take a sitz bath with 1:5000 warm potassium permanganate solution before and after defecation to keep the area clean.

3. Anal canal dilation

Suitable for patients with acute or chronic anal fissures without concurrent papillary hypertrophy and sentinel piles. The advantages are that it is easy to operate, does not require special equipment, has a rapid effect, and only requires a daily sitz bath after the operation. Method: After local anesthesia, the patient takes a lateral position and first uses the two index fingers to forcefully dilate the anal canal, then gradually inserts the two middle fingers and maintains dilation for 5 minutes. Men should expand forward and backward to avoid contact between fingers and ischial tuberosity, which would affect expansion. Women have a wider pelvis and do not have this problem. After the anal canal is dilated, the spasm of the anal sphincter can be eliminated, so the pain can be relieved immediately after the operation. After dilation, the anal fissure wound expands and opens, drainage is unobstructed, and the superficial wound can heal quickly. However, the disadvantage of this method is that it may cause complications such as bleeding, perianal abscess, hemorrhoidal prolapse and short-term fecal incontinence, and the recurrence rate is relatively high.

4. Topical application of nitroglycerin ointment

Lund et al. (1997) reported the use of 0.2% nitroglycerin ointment applied to anal fissures twice a day for 4 to 6 weeks. The results showed that 20 minutes after medication, the maximum resting pressure of the anal canal dropped from 122.1±44cmH2O to 72.5cmH2O, which is equivalent to a one-time "chemical sphincterotomy". 39 cases of chronic anal fissures were treated, 33 were cured, 14 of which were cured within 4 weeks; the pain during defecation disappeared within 2 weeks; 5 cases relapsed, 4 of which were cured after re-administration of the medicine; no case of anal incontinence occurred, but 8 cases had mild pain during treatment. This method is a better non-surgical method for treating chronic anal fissure, but it still requires randomized controlled and long-term follow-up studies of large numbers of cases.