裂こうに対する治療法の工夫　　ＩＩ．裂こうの病態と診断について

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  • The Etiology and Diagnosis of Anal Fissure

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The etiology of anal fissure is uncertain, but it is considered that lifestyle related factors such as dietary habit, bowel habit, school life, working life, pregnancy and delivery and predisposing factors such as anatomical factors, local ischemia and anal function play an important role in the etiology of anal fissure. With some of these etiological factors, it would seem that trauma to the anal canal during the passage of a large hard motion is generally responsible for initiating the condition. It will be very useful to follow the guidelines on the prevention of lifestyle related diseases issued by the Japanese Ministry of Health, Labour and Welfare for the prevention and treatment of anal fissure. Regarding clinical features, acute fissures have sharply defined edges and a smooth base. With chronic fissures, the edges may become raised, hypertrophied anal papilla may develop externally, and the transverse fibers of the internal sphincter become visible in the base. A general physical examination, anoscopy and sigmoidoscopy must be performed to exclude other pathologies, especially malignant lesions in the perianal region. For such examinations, patients with severe pain should be examined under anesthesia. It is hoped that further clinical reseach will clarify the etiology of anal fissures.

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