肛裂

An anal fissure is a tear in the opening of the anus that can cause pain, itching, and bleeding.

肛裂，就是肛门开口处裂开，引起疼痛、瘙痒、出血。

Anal fissures are common in infants but less so in older children. They occur in adults of all ages. The pain, which can be quite severe, usually occurs during and after a bowel movement. The most common cause of anal fissures is constipation, but diarrhea can be a cause as well. Anal fissures often result from a cycle in which you have pain as a result of constipation, avoid having a bowel movement, and thus worsen the constipation. Treatment involves changing your diet to eliminate diarrhea or constipation, or topical medications to help heal the tear. However, some people need surgery to treat an anal fissure. Anal fissures are not associated with cancer, but you should always talk to your doctor if you have bleeding with a bowel movement.

肛裂在婴幼儿较为常见，成年人相对少见。肛裂可以在任何年龄段发生。疼痛通常比较剧烈，一般在排便时或排便后出现。肛裂最常见的病因是便秘，但腹泻也可以引起肛裂。肛裂常常形成恶性循环：便秘导致肛裂，患者因为肛裂疼痛避免排便，又加重便秘。治疗包括改变饮食，避免腹泻或便秘，或局部药物治疗加速肛裂愈合。

SYMPTOMS AND DIAGNOSIS
症状以及诊断
The most common symptoms are pain when having a bowel movement and blood on the toilet tissue. Acute anal fissures usually get better quickly. A chronic fissure, which can be more difficult to treat, is one that has lasted more than 6 weeks.

最常见的症状时排便时疼痛、擦拭有血。急性肛裂一般恢复较快。慢性肛裂治疗相对困难，一般持续6周以上。

A doctor can usually easily see if you have an anal fissure. To make the diagnosis, he or she might use an instrument called an anoscope to examine the anal canal.

医生进行体格检查很容易发现肛裂。确诊需要使用肛门镜检查肛管。

CAUSES
病因
Constipation can cause the skin of the anus to tear. When that happens, the pain of a bowel movement can cause spasms in the anal sphincter muscle. This in turn means that less blood flows to the area, making it more difficult for the fissure to heal. The pain can also cause people to resist having a bowel movement, which worsens the constipation. Other causes include diarrhea and Crohn disease.

便秘可以导致肛周皮肤裂开。一旦发生，疼痛可使肛门括约肌痉挛，导致肛门周围血运减少，肛裂愈合更慢。疼痛也可能使患者避免排便，加重便秘。其他原因包括腹泻、克罗恩病。

If you have anal pain for more than 10 days, you should see a doctor to rule out an infection, a complication of inflammatory bowel disease, a hemorrhoidal condition, or anal cancer.

如果疼痛持续超过10天，应该咨询医生，排除感染、炎症性肠病、痔、肛管癌等。

TREATMENT
治疗
Home and over-the-counter treatments include sitting in a warm bath; treating constipation with a high-fiber diet, a fiber supplement, and plenty of liquids; and nonprescription ointments including petroleum jelly, 5% lidocaine or 2.5% lidocaine plus 2.5% prilocaine, zinc oxide, or 1% hydrocortisone cream.

家用、非处方药物治疗温水坐浴，高纤维饮食治疗便秘，纤维素添加剂，大量饮水。非处方药膏包括凡士林胶、5%利多卡因、或2.5%加2.5%丙胺卡因、氧化锌、或1%氢化可的松软膏。

A second line of treatment may be prescription-strength topical ointments containing medications such as nitroglycerin, diltiazem, or nifedipine to relax the sphincter muscles.

二线药物可采用处方局部药膏，包括硝酸甘油、地尔硫卓、或尼福地平来松弛括约肌。

Another treatment option is surgery, usually done in an outpatient setting. One type of surgery involves injecting botulinum toxin into the anal sphincter. Another kind of surgery involves an operation to cut a small portion of the internal anal sphincter. This improves blood flow to the tear and reduces spasm. Surgery does not heal the tear but is usually successful in preventing anal fissures from recurring.

另一种治疗方法是手术，一般可以在门诊进行。一种手术方式是局部注射肉毒素进入括约肌。另一种是切断部分内括约肌。这些手术可以改善肛裂的血运，减轻痉挛。手术本身不是使肛裂愈合，但常常可以有效地预防肛裂复发。

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