2021年2月23日星期二

hemorrhoids ligation,Irritating anorectal swelling

    Irritating anorectal swelling

    Anal bulging is different from anal pain. In the mild cases, local fullness and falling, and severe cases are tense and heavy, frequent squatting in the toilet, and heavy falling after going to the toilet, which is very painful and clinically not uncommon. From my experience, sag is related to many perianal and rectal diseases, such as inflammatory irritation, swelling irritation, increased anorectal pressure, female gynecological diseases, male prostate diseases, etc., which can cause different degrees of sag, which requires careful clinical identification.

    ①A variety of inflammatory irritation: such as bacillary dysentery, various proctitis, early rectal submucosal abscess, etc. lead to increased rectal pressure; perianal diseases such as anal sinusitis, anal papillitis (that is, anal papillary hypertrophy and edema), external hemorrhoid edema and various Increasing the pressure of the anal canal caused by wound stimulation after various perianal diseases can all cause different degrees of anal drop.

    ②Tumor irritation: such as rectal cancer, prostate cancer, rectal polyps, including rectal villous papilloma, etc., pressure stimulates baroreceptors at the end of the rectum, causing frequent bowel movements.

    ③Intra-anal stagnation and compression: For patients with long-term constipation or fecal impaction, the feces cannot be smoothly resolved because the stool stimulates the anorectal baroreceptors.

    ④Stimulation of various prolapsed diseases: such as repeated prolapse of internal hemorrhoids, internal hemorrhoids incarceration (congestion caused by the inability to absorb after prolapse), rectal prolapse and other prolapsed objects repeatedly stimulate the anal canal and the end of the rectum.

    ⑤The male prostate is adjacent to the rectum and anus. Prostatitis, prostatic hypertrophy, prostate nodules, etc. will all cause certain anal irritation; in women, retroverted uterus, uterine fibroids, pelvic inflammatory disease, endometriosis, etc. will also appear to varying degrees Anorectal swelling. In addition, some people may suffer from very mild diseases, but they are always paying attention to their own condition every day. They are even terrified and have difficulty falling asleep. Eventually, they develop anal neurosis, leading to abnormal anal bulging.

    Anorectal swelling can be preliminarily distinguished from the duration and degree of swelling. Such as internal hemorrhoids incarcerated, rectal tumors, anal foreign bodies, the swelling is continuous and has nothing to do with defecation. If the condition is light, the swelling will be light, and vice versa; if the internal hemorrhoids prolapse, rectal prolapse, the swelling will increase after the swelling, when the swelling is absorbed The swelling in the anus is reduced; bacillary dysentery and proctitis are accompanied by significant increase in stools, irregular stools, or even pus and blood in the stool; deep perianal abscesses do not compress anal nerves, so anal pain is not obvious. However, there are often high fever and chills with swelling, and even difficulty in urination and unresolved stools; swelling after ligation of internal hemorrhoids, injection of internal hemorrhoids, or other perianal surgery has a significant history of surgery, that is, caused by the stimulation of the wound after the operation. As the wound grows or the ligature falls off, the swelling will gradually decrease. If there is significant bulging in the premenstrual period, the possibility of endometriosis should be considered, because the displaced endometrium is often located at the lowest point of the uterus and rectum (the place called daoglas fossa in medicine). When menstruation is coming, there is obvious congestion leading to swelling; if the anus swelling is accompanied by obvious groin soreness and nocturia, attention should be paid to exclude prostate disease.

    In short, once anorectal swelling occurs for a period of time, it is recommended that you do not make your own claim, let alone ignore it. You should actively look for the cause, investigate the condition, and treat the disease as early as possible.

lidocaine for hemorrhoids,100% of people ignore this pre-pregnancy check...

    When it comes to pre-pregnancy check-ups, everyone is saying:

    Should I check before pregnancy? -What to do

    Who should do it? ——Everyone who needs pregnancy should do it (men and women)

    When will it be done? ——It must be completed before the start of pregnancy, and if any problems are solved in time

    Why do it? -Eliminate genetic diseases; avoid fetal malformations; prevent miscarriage, premature delivery and infertility; prevent infectious diseases

    What else to pay attention to? ——Precautions before they happen: make an appointment for a dentist before pregnancy to deal with potential oral problems; balanced nutrition, weight control, and appropriate exercise; if chronic medication is used, please consult your doctor to change the medication that has little effect on pregnancy or change the safety dose.

    Is this over?

    Obviously not! This has something to do with me. I haven't played yet, how can it end here?

    By the way, today’s protagonist is...Dangdangdang

    Ass and its upstream neighbor

    Everyone knows to check the teeth before pregnancy. Because oral diseases are easily induced during pregnancy, no one pays attention to the problems below the oral cavity. In the eyes of anorectal department, this problem is bloody to deal with. Difficulties can also be partially prevented.

    1. Constipation

    Constipation is a big problem. Although normal people are considered normal 3 times a day to once every 3 days, many pregnant women may experience or worsen constipation due to the influence of appetite, dietary structure and increasing abdominal pressure during pregnancy. Moreover, breastfeeding is required for a long time after delivery, which is an important factor affecting doctors' medication. Therefore, it is very important to adjust your diet and bowel habits before pregnancy. Adjust your diet appropriately, see a doctor in advance, and treat intractable constipation. Otherwise, mothers-to-be, you will have to ninja pain to persist until delivery, oh no! It was after breastfeeding that I dared to really consider treating myself. However, there are still some drugs on the market that can be safely used by pregnant women, such as dietary fiber supplements and sugar products that are not absorbed by the gastrointestinal tract. However, you must ensure that these drugs work for you to be relieved. Therefore, conditioning before pregnancy is the most reliable.

    2. Hemorrhoids

    As the saying goes, “ten men with nine hemorrhoids, ten women with ten hemorrhoids”, the extra point is due to pregnancy and childbirth, but in today’s society, many female friends already have proud hemorrhoids before pregnancy and childbirth, and even You may have a huge anal papilloma. Usually, the anal swelling falls out. Don’t worry too much about it. It can recover on its own. However, with the increase in abdominal pressure during pregnancy and the influence of defecation, the swellings that fall out will no longer I can’t go back. It’s getting swollen and painful after being dragged outside the anus. I just remembered going to the anorectal department at this time. The doctor could only sigh, "What can I do to save you, my patient!" The incision in the anus wants to heal completely, let alone half a month, it is so close to the vagina, the incision here is so painful, who dares to give you a knife? In case of a mistake, what should I do if I am infected, and what if my fetus cannot be kept? How do I use medicine before and after surgery?

    For the safety of the next generation and the happiness of your family, 80% of you can only choose to carry it by yourself, what should I do! What is even more frightening is that if the hemorrhoids before pregnancy suddenly increase during delivery, they still cannot be operated on immediately, why? First, it is necessary to prevent vaginal infections after childbirth. New postpartum surgery is naturally not the best time because there is no way to take care of it. Second, breastfeeding during lactation, not to mention medication problems, cutting the size of hemorrhoids is also an operation, and it is more painful. How can I breastfeed if I can’t hold my body after giving birth? To sum up, no matter whether you know whether you have hemorrhoids (anal papilloma, anal fistula, perianal abscess...) before preparing for pregnancy, please check with the anorectologist to make sure that you don’t need immediate treatment. A good life during pregnancy.

    Some people say that I did not have hemorrhoids before pregnancy, how can I avoid it after pregnancy? This may not be completely controllable. However, keeping the stool smooth, avoiding hard work, sitting for a long time and defecation, and using reasonable force during delivery are all good preventive measures.

hemorrhoids early pregnancy,Anus-preserving radical resection is the "nemesis" of rectal cancer

    In recent years, colorectal cancer, which occurs more frequently every year, has become the third-most malignant tumor in the world. As people's lifestyle changes, the spectrum of cancer is also changing. Among them, colorectal cancer, commonly known as colorectal cancer, has a rapid increase in incidence. According to statistics, the incidence of colorectal cancer in China has increased from 12 per 100,000 in the early 1970s to 56 per 100,000 at present. The growth rate is about 4.2% per year, far exceeding the international level of 2%. Compared with Westerners, the incidence of rectal cancer in China is higher than that of colon cancer, about 1.5:1; the proportion of young people (<30< span="">years old) is higher, accounting for about 15%.

    [Reporter] Hello, Professor Ma, the incidence of rectal cancer in China is obviously increasing and younger. What are the clinical symptoms of rectal cancer?

    [Professor Ma] Early rectal cancer is mostly asymptomatic. When the tumor progresses to a certain period, it can cause bowel symptoms such as changes in bowel habits. Late rectal cancer can also cause systemic symptoms due to multiple distant metastases.

    1. Changes in bowel habits. The number of bowel movements has changed from once a day to two or three times. After each bowel movement, there is a feeling of incomplete stool; the shape of stool begins to change, for example, from thick to thin; stool becomes black or dark red, stool becomes thinner and has mucus; Increased frequency, but no stool.

    2. Mucous stools and pus and blood stools. When the cancer ruptures, the stool often contains bright red or dark red blood and mucus, and the stool and blood are mixed; there are pus or blood in the stool, frequent stools or diarrhea and constipation; stool shape changes, thinning, flattening or banding Groove.

    3. Anemia and weight loss. As the disease progresses, patients may experience chronic wasting symptoms, such as anemia, weight loss, fatigue and fever, and even cachexia, which is often accompanied by fatigue and unexplainable weight loss, blood in the stool, insufficient intake, and excessive consumption related.

    4. Abdominal pain and bloating. Intestinal cancer patients suffer from abdominal distension and abdominal pain due to intestinal obstruction, and the incidence of abdominal pain is higher than the incidence of abdominal distension. The pain is mostly in the middle and lower abdomen, with varying degrees of severity, mostly dull pain or fullness.

    5. Alternate diarrhea or constipation. If there are symptoms such as diarrhea and constipation alternately, it may be because the growth of cancer has affected the normal physiological functions of the intestine, and the possibility of cancer should be considered.

    6. Repeated hemorrhoids that do not heal, unexplained anemia, weight loss; unexplained stomach pains; unhealed anal ulcers, persistent anal pain. What needs to be highly vigilant is that in some cases, hemorrhoids and tumors coexist, which are often covered by hemorrhoids and delay the timely detection and diagnosis of tumors.

    [Reporter] Is the irregularity of modern people's daily life and diet the main cause of rectal cancer?

    [Professor Ma] The cause of rectal cancer is still unclear, and its incidence is related to social environment, eating habits, genetic factors, etc. Rectal polyps are also a high-risk factor for rectal cancer. At present, it is basically recognized that excessive intake of animal fat and protein and insufficient intake of dietary fiber are high-risk factors for rectal cancer.

    1. Dietary factors

    Previous studies have shown that high fat and high protein intake is related to the incidence of rectal cancer. Among them, the cause of the disease caused by high-fat diet may be that fat can promote the synthesis of bile acids, which indirectly inhibits the intestinal reabsorption of bile acids, increasing the concentration of bile acids in the colorectal. Cancer-promoting effect. In addition, the lack of multiple vitamins, intestinal flora imbalance and excessive intake of nitrite compounds may all play a role in the pathogenesis of rectal cancer.

    2. Impact of large intestine related diseases

    Ulcerative colitis, colorectal polyps, and adenomas are all related to rectal cancer. At present, it is believed that adenomatous polyps, villous adenomas, and familial multiple polyposis are precancerous lesions of rectal cancer. The formation of carcinogenesis follows the "inflammation-proliferation-carcinogenesis" pathway and is a multi-step, multi-stage evolutionary process, and this process is accompanied by changes in DNA methylation levels, growth factors, etc., leading to cell differentiation and growth Abnormal, and finally formed a malignant tumor characterized by invasion and metastasis.

    3. Influence of age and genetic factors

    1) Age factor: It has been thought that the incidence of rectal cancer increases with age. The prevalence age of colorectal cancer is 50 to 70 years old, and the malignant degree of rectal cancer is high in young and middle-aged patients aged ≤40.

    2) Genetic factors: In addition to colorectal cancer patients caused by familial polyposis or malignant transformation of ulcerative colitis, about 5-15% of other colorectal cancer patients have an obvious family history of tumors, collectively referred to as Hereditary non-familial polyposis colorectal cancer (Hereditary Nonpolyposis Colorectal Cancer, HNPCC), also known as Lynch syndrome. The specific manifestations are as follows: (1) More than three family members have colorectal cancer, two or more of them are of the same generation; (2) At least two similar generations have the disease; (3) At least one of them is before the age of 50 Diagnosed as colorectal cancer.

    [Reporter] According to statistics, colorectal cancer is the third largest malignant tumor in the world. What are the effective methods for the treatment of rectal cancer?

    [Professor Ma] Surgery is the main treatment for rectal cancer. If there is no contraindication to surgery, radical resection of rectal cancer should be performed as soon as possible. Adjuvant chemotherapy for rectal cancer is based on fluorouracil. Preoperative radiotherapy and chemotherapy can reduce the volume of rectal cancer, increase the rate of surgical resection, and reduce the rate of local recurrence.

    << span="">Surgical treatment>

    1. Radical surgical resection is still the main treatment for rectal cancer. If there is no contraindication to surgery for rectal cancer that can be removed, radical resection of rectal cancer should be performed as soon as possible. Rectal cancer is clinically divided into low rectal cancer (within 125px from the dentate line), median rectal cancer (5~250px from the dentate line) and high rectal cancer (over 250px from the dentate line). This classification has important reference value for the choice of radical surgery for rectal cancer. The selection of surgical methods should be comprehensively judged based on factors such as the location, size, activity, degree of cell differentiation, and bowel control ability before surgery.

    2. Local resection: suitable for early rectal cancer with small tumors, confined to the mucosa or submucosa, and highly differentiated. Local resection can be performed via anal and transsacral approach. The normal mucosa around the tumor should be removed 1cm, and the method of side-cutting and seaming can be used for local resection, which is convenient for operation and less bleeding. Local resection for early rectal cancer can achieve a 5-year survival rate of 80% to 100%.

    3. Radical resection of abdominal perineum combined with rectal cancer (Miles operation): It was first reported by Miles in 1908. It is suitable for lower rectal cancer below peritoneal reflex and middle and upper rectal cancer with late lesions and heavier invasion. The scope of resection includes the distal end of the sigmoid colon, the entire rectum, the inferior mesenteric artery and its regional lymph nodes, the total mesentery, the levator ani muscle, the fat in the sciatic rectal fossa, the anal canal and the skin around the anus, subcutaneous tissue and all anal sphincter. A permanent single cavity sigmoid stoma was performed in the left lower abdomen. In Miles operation, some people use gracilis or gluteus maximus instead of sphincter for in situ anoplasty, but the effect is uncertain.

    4. Transabdominal radical resection of rectal cancer (low anterior rectal resection, Dixon operation): First reported by Dixon in 1939, it is currently the most clinically used radical resection of rectal cancer with anal preservation. It is suitable for rectal cancer more than 125px from the dentate line. Dixon surgery is also reported for rectal cancer at a closer distance. But in principle, radical resection is the premise, and the distal resection margin is required to be more than 50px from the lower edge of the cancer. Its basic operation is to remove the tumor and a certain length of normal intestinal tube at the upper and lower ends through the abdomen, and perform colon-rectal anastomosis. Because the anastomosis is located near the dentate line, patients are prone to frequent bowel movements and poor bowel control ability during the postoperative period. Due to the application of double stapling technology, the operation is not complicated.

    In the early 1980s, Heald proposed the surgical principle of total mesorectal resection (TME), emphasizing that the spread of cancer cells in the connective tissue around the rectum should be followed. There are three main points: ①In the presacral space under direct vision Perform sharp separation in the middle; ② Maintain the integrity of the pelvic fascia visceral layer; ③ Resection of the distal mesorectum of the tumor shall not be less than 125px.

    5. Transabdominal rectal cancer resection, proximal stoma, and distal closure surgery (Hartmann surgery): It is suitable for rectal cancer patients who cannot tolerate Miles surgery or who are not suitable for Dixon surgery due to poor general general conditions.

    6. Colon-anal anastomosis (Parks operation): It was first proposed by Parks in 1972, that is, the rectum was excised through the abdomen and anus, and then the colon-anal anastomosis was performed in the perineum. It is suitable for tumors 5~150px from the anus, and the distal resection margin of the tumor is 2~75px long. The anastomosis can still be located on the dentate line, and because of the transabdominal operation, it can achieve good radical curative effect. Anal function.

    There are many surgical methods for radical resection of rectal cancer. But the classic surgical methods are still Miles surgery and Dixon surgery. Many scholars have modified the Dixon operation and evolved it into other surgical methods (such as various drag-out anastomosis). However, since the stapler can complete the anastomosis in any position of the rectum and anal canal, other modified surgical methods have been clinically used. Used less frequently. Laparoscopic Miles and Dixon operations have the advantages of less trauma and quick recovery. However, there is still controversy regarding the dissection of lymph nodes and the treatment of invaded surrounding organs. When rectal cancer invades the uterus, the uterus can be removed together, which is called posterior pelvic organ dissection; when rectal cancer invades the bladder, rectum and bladder (for men) or rectum, uterus, and bladder are removed, called total pelvic dissection.

    While performing radical resection of rectal cancer, the quality of life of the patient must be fully considered, and urinary function and sexual function should be protected as much as possible during the operation. The two sometimes have to weigh the pros and cons and choose the surgical method. For advanced rectal cancer, when the patient has difficulty defecation or intestinal obstruction, a sigmoid double-chamber stoma is feasible.

    << span="">chemotherapy>

    Adjuvant chemotherapy for rectal cancer is based on fluorouracil. The route of administration includes arterial infusion, portal vein administration, intravenous administration, postoperative intraperitoneal catheter infusion administration and warm perfusion chemotherapy, etc., mainly intravenous administration. The timing of chemotherapy, how to combine medication and dosage, etc. vary according to the patient's condition and personal treatment experience. Commonly used drugs are fluorouracil, oxaliplatin, mitomycin, cytarabine and so on.

    << span="">Neoadjuvant radiotherapy and chemotherapy>

    In Europe, neoadjuvant radiotherapy and chemotherapy for rectal cancer have been recognized by many medical centers. Rectal cancer received radiotherapy for 2Gy each time, 5 times/week, with a total dose of 46Gy before surgery, and was supplemented with fluorouracil-based chemotherapy, such as FOLFOX-6 regimen and MAYO regimen for 2 to 4 courses, followed by chemotherapy after surgery. Preoperative radiotherapy and chemotherapy can reduce the size of rectal cancer and achieve staging effect, thereby increasing the rate of surgical resection and reducing the rate of local recurrence. Multi-center, random, and large sample data show that neoadjuvant radiotherapy and chemotherapy are beneficial for the treatment of rectal cancer.

    [Reporter] Rectal cancer seriously endangers people's health. How to prevent rectal cancer and early diagnosis and treatment?

    [Professor Ma] Although the early symptoms of rectal cancer are relatively insidious and not very specific, if patients pay attention to some symptoms in the anorectal area, they can still be detected early:

    2. The following symptoms should be taken seriously. Such as the recent continuous abdominal discomfort, dull pain and abdominal distension, anal swelling; unexplained anemia or weight loss in a short period of time; sudden touching of an abdominal mass, etc. The above symptoms sometimes indicate that the tumor is progressing quickly, and should be paid attention to and go to the hospital for examination and treatment in time.

    3. Treat related diseases in time. For example, rectal benign lesions: polyps, adenomas, etc., are generally called precancerous lesions, which require timely endoscopic treatment or surgical treatment to prevent cancer. Chronic inflammatory bowel disease also requires timely and standardized treatment, which can reduce the occurrence of colorectal tumors.

    [Experts' key reminder] Now with the popularity of the Internet, many patients like to check the Internet for themselves after they develop symptoms. However, we also found that many patients either avoid medical problems and always think that they cannot be rectal cancer, and eventually delay the early diagnosis and treatment; or they like to sit in the table, always think that there is no cure for cancer, and they do not understand the current treatment of rectal cancer. The latest development, only to know that sighing all day, only increases the worry. In fact, it is not difficult to diagnose rectal cancer early. About 70% of rectal cancers can be found through "digital rectal examination", which is simple and painless. After discomfort and symptoms appear, as long as the patient goes to the anorectal specialist in time, the specialist can use digital rectal examination to find most rectal tumors, and a small number of patients can also be diagnosed with proctoscopy or colonoscopy. Therefore, the key to the early diagnosis and treatment of rectal cancer is to avoid fluke when symptoms appear and seek medical attention as soon as possible.

hemorrhoids natural remedy,Patients with liver cirrhosis, beware of "tragedy on the toilet" (constipation)

    Original: Gu Shengwang, a family with a heart-to-heart, September 6, 2019

    I remember that I had just graduated from the military academy and was assigned to work in a hospital. I was on duty one day and rescued two elderly tuberculosis patients in the middle of the night. Both died suddenly because of the trouble of going to the toilet. The two elderly people disappeared one after the other. Neither of the elderly died of tuberculosis. Was it due to sudden cardiac death caused by constipation (possibly); 15 years ago, a relative at home, 93 years old, had abdominal pain, and abdominal imaging revealed: bowel obstruction, bowel cancer? Observed in the hospital, the diagnosis was finally confirmed: fecal stone incarcerated in the intestines, and almost suffered a knife. This is the unsurprising "tragedy on the toilet" that often happens around us.

    With the official launch of antiviral treatment of hepatitis B in China in 1999, deaths related to severe liver and liver disease have been significantly reduced, and the life span of patients with liver disease has been significantly prolonged. There are more and more elderly patients with chronic hepatitis B with cirrhosis or liver cancer. Constipation may not only induce coronary heart disease and ischemia. Stroke, which may induce hemorrhoid bleeding or bleeding from esophageal gastric varices, hepatic encephalopathy, abdominal cavity infection, constipation is definitely not a trivial matter. It is very likely that due to small loss, a little negligence is a life.

    There are 4 characteristics of human defecation

    1. Food passes through the mouth to the esophagus, stomach, and small intestine. Nutrients are continuously absorbed, leaving unabsorbed waste residues into the large intestine. The water in the waste residues is continuously absorbed, and the stomach and colon reflex after eating, which promotes the acceleration of bowel movements and the formation of stool; The habit of defecation, waiting for tomorrow today, and waiting for the day after tomorrow, will form a vicious circle of "the more you wait for the bowel movement, the drier the bowel movement, the less time the bowel movement is, the less it will not be discharged". Solving a bowel movement is as difficult as having a child. Exerting all your strength, sweating profusely, panting and unsuccessful breathlessness, the older you are, the less activity you have, the lower your intestinal motility, the slower your bowel movements, and the drier your stools, the more likely to develop severe constipation; long-term constipation If it is not alleviated, it will bring a series of health problems, and severe cases can be life-threatening.

    2. Bad habits lead to constipation. As time goes on, constipation will gradually get worse. Some elderly people, especially young people, have constipation and simply "don't do one, never stop" and have long formed a bad habit of sitting on the toilet, reading a book or playing with a mobile phone. And this kind of people don’t like to exercise. If they don’t like drinking water, eating vegetables, or eating whole grains, the bad habits will not change, the constipation will be aggravated and hemorrhoids are prone to form, from a bowel movement on the 3rd to more than once on the 7th. Defecation, and finally stubborn constipation is difficult to cure.

    3. Bad emotions and constipation are a pair of difficult brothers who are inseparable. Bad emotions aggravate constipation, which in turn affects emotions, forming a vicious circle of "the more anxious the heart, the more serious the constipation, the worse the mood, the more severe the constipation". The constipation was severe and the tragedy of suicide by caesarean section. Constipation may be aggravated when people are in distressing emotions such as loneliness, anxiety and depression for a long time. Adhere to outdoor exercise every day, promote the acceleration of intestinal peristalsis, promote the secretion of dopamine, dopamine can make people feel happy and relaxed, and relieve psychological problems.

    4. The more you nurse the constipation, the more serious it is to eliminate ulcers and polyps. Old people with severe constipation can experience fecal stone impaction, similar to intestinal obstruction; part of the intestinal mucosa is ischemia due to long-term compression of dry and hard stools, hypoxia, necrosis, Ulcer is conducive to the proliferation of intestinal bacteria; if constipation alternates with diarrhea, bloody stools, etc., further examination should be performed to rule out bowel cancer.

    Literature report: with age, the prevalence of constipation in the elderly increases, the north is higher than the south, and the female is higher than the male. In addition to age, constipation in the elderly is also related to factors such as climate, dietary structure, and physical activity. An article published in The Lancet in April 2019 pointed out that China's cardiovascular disease mortality and cancer mortality caused by dietary problems are both ranked first; the top three issues that require the most attention are: salt consumption Too much, too little whole grains and fruits, and less intake of fruits and vegetables can lead to poor bowel movement, bad breath or oral odor, malnutrition, and even 19% of gastrointestinal cancers and 31% of ischemic hearts. 11% of strokes are related to insufficient intake of fruits and vegetables. Professor Ma Guansheng, a nutrition expert at Peking University, clearly proposes: a person should eat one catty of vegetables and half a catty of fruit every day; auxiliary treatment of constipation can be used: Kaiseliol, mannitol, rhubarb tea, lactulose, senna; through the assistance of drugs , Develop the habit of defecation regularly every day, do not wait for tomorrow for bowel problems, do not read a book or play with a mobile phone when you have a bowel movement.

    we suggest:

    1. Properly drink plenty of water, boil black rice, oats, red beans and other cereals porridge as a staple food for breakfast or dinner, and drink probiotics or yogurt appropriately;

    2. As long as there is no leg or foot disability, you can go and jog fast, 30 minutes each time, 3 times a day;

    3. Do three kinds of exercises frequently, the levator anus exercise, that is, force the levator, stay for 3 seconds, then relax, repeat this for 30 times, do it three times a day; rub the abdomen, overlap with the hands, cover the navel with the palms, and gently rub in a clockwise direction for 30 Push down, 3 times a day; push the spine with both hands behind, grasp the thumb of the right hand with the left hand, place the second metacarpophalangeal joints of both hands on both sides of the spine, start from the plane of the lower edge of the scapula, press and push down, until the tailbone Stop on both sides and repeat 30 times.

    Finally emphasized:

    1. Patients with liver cirrhosis, especially those with a history of bleeding from gastrointestinal varices or portal hypertension, should be cautious in eating crude fiber vegetables such as leeks, celery, etc., mainly small green vegetables, spinach, amaranth, etc., to prevent crude fiber from causing bleeding.

    2. Confidence is very important. Regardless of age or liver disease, as long as you work hard and the method is right, there is no constipation problem that cannot be solved.

hemorrhoids essential oils,★★★Breast cancer science——(my diagnosis and treatment) patients during chemotherapy, don’t forget to contact QQ

    All support during chemotherapy is solved through QQ, so add QQ friends immediately after discharge

    1. Add as a friend, my QQ number is: 940934099

    2. Tell me who you are, such as the patient or a family member (don't add it if you are not the patient I diagnosed and treated, I really don't have time, and I don't know your condition.

    3. Contact 1-2 times a week and leave a message. You need to write down who you are, the few days after chemotherapy, and where you are uncomfortable (such as fever, palpitation, shortness of breath, leg pain, backache, cold fear) , Sweating, insomnia, hemorrhoids, unable to hold back urine, diarrhea, constipation, abdominal distension, retching, coughing, sputum, palpitations, cold hands and feet, sores on the tongue, swollen gums, dry mouth and less fluid, no sweating, menstrual disorders ......) Tell me, copy the last Chinese medicine prescription below.

    4. I saw your message, write the changed prescription of Chinese medicine in the message and reply back, and just go to the nearby hospital to grab the medicine. I will also write down the diet plan together and prepare it myself; I will also do other precautions Will be written in the message.

    6. Save my business card and don't lose it. All of the above can find my contact information.

    Note: The first Chinese medicine prescription and diet therapy prescription are written in the precautions for discharge, and the ones on the gray background are. The first prescription is the same for everyone. With the progress of chemotherapy, everyone’s reaction is different. The main contradictions of each week within the three weeks of each cycle are also different. Each cycle is also different, so it cannot be a prescription. It is recommended to take 3-5 doses for each prescription and adjust according to changes.

    Note: Because everyone has different physiques, different chemotherapy regimens, and different responses, it is basically impossible to have two identical Chinese medicine prescriptions. So don't give your own prescriptions to others with good intentions. If you don't want to do bad things with good intentions, suggest that she go to see a doctor of Chinese medicine. The conditioning during chemotherapy requires patience and meticulousness, not very technically difficult.

are hemorrhoids dangerous,Spring blossoms are not difficult to bloom at the "export". Health and Wealth Report on 3.27

    Spring blooms, yang qi floating, dry mouth and nose, nose and mouth sores, itchy throat, constipation, blood in the stool, etc. Due to the change of seasons, when the body's regulatory function cannot keep up, the appearance of "little hairs" may actually be possible. Symptoms of hidden dangers, especially the anorectal problems, should not delay treatment because of embarrassment

    Spring flowers bloom, disease is not difficult to open at the "export"

    Our reporter Jiang Meiqin

    Speaking of anorectal diseases, the first thing we think of is hemorrhoids. The so-called "ten people with nine hemorrhoids", many people are troubled by this disease. However, in addition to hemorrhoids, there are many other types of anorectal diseases, such as anal fistula and anal fistula. Fissures, perianal abscess, perianal eczema, anal sinusitis, anal stenosis, anal polyps, anal papilla hypertrophy, rectal prolapse and even tumors.

    Seek medical attention in time, don't cause serious disaster

    Anal dysfunction: recurring anal fissures can cause anal contracture and difficulty in defecation; it may also infringe on the sphincter, complicated by anal papillary hypertrophy, rigid papilloma, subcutaneous fistula, etc., which can easily cause anal stenosis.

    Lead to sepsis, etc.: Bleeding and infection in the anorectal area form perianal abscesses. If the treatment is improper, bacteria etc. can easily invade the blood and cause sepsis, toxic blood or sepsis.

    Causes gynecological diseases: For female patients, due to the close proximity of the anus and vagina, blood in the stool or perianal inflammation leads to the proliferation of bacteria, which can easily cause gynecological inflammation.

    Autonomic disorders: It can cause painful bulging of the waist, epiphyseal bone, and posterior thigh, causing reflex dysfunction of the genitourinary system.

    Perianal skin eczema: The anal sphincter is loosened due to prolapse of hemorrhoids, and mucus flows out of the anus, which can easily cause perianal itching and skin eczema.

    Can cover up rectal cancer: Many anorectal diseases will have symptoms of blood in the stool. Blood in the stool is also a common symptom of intestinal cancer. Many people treat intestinal cancer as hemorrhoids, which delays the timing of treatment.

    It can be seen that there is a problem with the "export", and it is necessary to seek medical treatment in time to avoid serious illness.

    Life and diet, help prevention and treatment together

    Director Wang pointed out that many anorectal diseases are related to bad living and eating habits. Therefore, the development of good living and eating habits is of great benefit to the prevention and improvement of anorectal diseases.

    Develop defecation habits. Poor defecation habits, such as squatting and reading the newspaper when going to the toilet, will prolong the defecation time; excessive force during defecation will increase the burden on the rectal anus and pelvic floor muscles, which may lead to anorectal diseases. Therefore, it is necessary to develop the habit of defecation regularly every morning, drink a glass of cold water after getting up early to stimulate gastrointestinal peristalsis. Especially when you want to have a bowel movement, you can't force it, don't read a book or newspaper when you have a bowel movement, you can't squat for a long time, or use excessive force.

    Pay attention to diet and recuperation. People who drink for a long time or like to eat spicy food can stimulate the mucous membrane of the digestive tract to cause vasodilation, colonic dysfunction, and the incidence of anorectal diseases. Therefore, in terms of diet, do not drink a lot of alcohol, eat irritating foods such as peppers and mustard, and eat less salted, smoked, high-fat, and high-sugar foods. Eat more whole grains, beans, vegetables and fruits and other foods that contain more fiber.

    Pay attention to anal hygiene. Develop a habit of loving cleanliness and keep the anus clean and dry. Do not wash the anus frequently with hot water or high-concentration cleaning liquid, and change underwear frequently. Underwear should be made of thin and soft cotton cloth. These measures will help reduce the occurrence of anorectal diseases and promote the recovery of the disease.

    Actively exercise and take part in sports activities such as swimming, gymnastics, running, Tai Chi, Qigong, etc. You can also perform levator anus exercises to enhance or restore the contraction of anal sphincter muscles, and also help rectum, anus or hemorrhoids. Rehabilitation of patients.

    Maintaining optimism. TCM believes that emotional changes are very closely related to anorectal diseases. Excessive thoughts can damage the spleen and stomach, or irritability and anger can lead to stagnation of liver qi, leading to stagnation of qi and blood, blocking of meridians, and interlocking of collaterals. Anorectal disease. Liver fire in spring is vigorous, which can easily lead to dry stool and cause anorectal diseases. Therefore, the adjustment of emotions is also very important. Learn to adjust yourself, maintain a calm mind and an optimistic mood.

    In addition, Director Wang also reminded that some occupational factors have caused the occurrence and development of anorectal diseases due to long-term sitting and standing, and poor hemorrhoid venous return. Such people should pay attention to the combination of work and rest, proper rest and activities, and adjustments. Different poses.

    Expert profile

what does a hemorrhoids look like,How should anal fissure be prevented?

    The best treatment for anal fissure is to eat fresh vegetables, fruits and other foods rich in plant cellulose, develop the habit of defecation every day, drink a glass of cold water on an empty stomach every morning and take traditional Chinese medicine hemp pills, honey, etc. before going to bed Promote defecation and reduce the occurrence of anal fissures.

    If anal fissure has occurred, you must ask a specialist for treatment. The best treatment for anal fissures is currently not a specific medicine that can be cured after taking it. Anal fissures and "hemorrhoids" are two completely different diseases. Therefore, it is impossible to completely cure anal fissure with drugs for the treatment of "hemorrhoids". At present, a method recognized at home and abroad, "lateral resection", is simple, reliable, does not require hospitalization, and cures for life.

hemorrhoids pads,Perianal abscess

    What is a perianal abscess?

    The sudden appearance of a lump around the anus is a common phenomenon in life. The common causes are "getting angry", constipation, staying up late, sitting for a long time, etc. Patients or non-anorectal doctors (especially doctors in primary clinics) often diagnose hemorrhoids. Hemorrhoids are given infusions, oral medications and other treatments, but the effect is not satisfactory. The lumps often increase, the pain is aggravated, and even fever. . So besides hemorrhoids, what other diseases do lumps around the anus often cause? Let me talk about another common anorectal disease-perianal abscess. Perianal abscess is an acute purulent infection that occurs around the anus and rectum. The source of infection is at the junction of the anal canal and rectum in the anus. It is a tissue structure called anal sinus. The infection bacteria are mainly Escherichia coli in the stool. This disease is different from infections in other parts of the body. Its particularity is that once it occurs, there is basically no possibility of self-healing or drug cure. Therefore, misdiagnosis and treatment often happen, which not only wastes money, but also delays the condition. The age of onset of the disease is mainly young and middle-aged people aged 20-40, and it is more common in men.

    How does perianal abscess form?

    Although infections are prone to occur around the anus, there are all incentives. What is the cause of the onset of perianal abscess? By asking the medical history of some patients, we can get inspiration from leukemia, Crohn’s disease, tuberculosis, and diabetes. Weakness, decreased resistance and improper diet are the main causes of local infections. Many patients complained of irregular life before the onset of illness, lack of sleep, overwork, long-distance driving, excessive drinking, or excessive consumption of seafood, spicy, meat, etc.

    What is the pathogenesis of this disease? There is a kind of tissue called anal glands in the perianal area. The glands are located in the anal sphincter. Its opening is in the anal sinus on the dentate line of the anus. The secretions of the anal glands enter the rectal cavity through the opening in the anal sinus to lubricate the intestine. Tao role. The disadvantage is that the opening of the anal sinus is upward like a pocket, and the dirt in the intestinal cavity is easy to stay here. After these dirt enter the anal sinus, it can be infected and cause anal sinusitis. The inflammation reaches the anal gland orifice and the anal gland duct. The anal glands spread, and finally enter the space around the anorectum through the lymphatic vessels, causing the soft tissues to infect and purify and form this disease.

    How do you know that you have a perianal abscess?

    The main symptom of perianal abscess is pain in the anus, followed by most patients who can feel a lump around the anus, but the lump is not obvious from the appearance of the skin around the anus, and some patients can clearly see the lump in the anus. If all patients do a careful digital anorectal examination, almost a harder mass can be palpable, with obvious tenderness.

    Anal pain caused by perianal abscess is continuous and has nothing to do with whether to pass stool. When the pain is severe, restlessness, loud coughing, standing from a sitting position and other actions can cause pain to increase, especially when driving through a speed bump. Pain, accompanied by fever, causes loss of appetite, and symptoms such as difficulty in defecation. With this disease, different degrees of fever can occur. White blood cells increase. The degree of fever and white blood cell increase marks the depth and extent of the abscess, and is also one of the indicators to judge the severity of the disease.

    Superficial perianal abscesses are generally easy to identify, but the patients themselves are easily treated as hemorrhoids, including some non-anorectal doctors at the grassroots level. For deep abscesses, it is more likely to be misdiagnosed because only fever is the main cause and anal pain is not obvious. The local manifestation of this kind of patients is not pain, but anorectal swelling, frequent and inexhaustible defecation, which is easy to be ignored. Even some patients with fever are treated as "shanggan" and antibacterial and anti-inflammatory treatments for bronchitis, but the effect is not good, and the disease is diagnosed after consultation. Some patients are diagnosed late, have extensive local necrotizing fasciitis, and systemic sepsis. Patients of this degree may need to be operated in stages, causing great physical and mental pain and a heavy economic burden.

    Why should the perianal abscess be treated promptly?

    As mentioned earlier, once a perianal abscess occurs, there is no possibility of self-healing and medication. Only surgery can cure it. Timely treatment of perianal abscesses can first prevent the infection from spreading to the whole body and form sepsis, which is life-threatening; second, it can prevent the infection from spreading to the surroundings, leading to "horseshoe-shaped" abscesses and forming complex anal fistulas; third, it can prevent the abscess from rupturing Later it becomes an anal fistula; fourth, it can relieve pain earlier; fifth, it prevents damage to the anal sphincter and affects anal function.

    There are one-time operations and two operations for perianal abscess. What is going on?

    Perianal abscess can generally be cured once, and two operations are mainly based on the following considerations: ⑴Combined with other serious medical diseases, the body cannot bear the pain and injury of one operation; ⑵In women during pregnancy, simple treatment to relieve symptoms, not easy to do complicated Surgical operation and complicated anesthesia; (3) Older age and weak body; (4) The internal ostium is difficult to determine, and the blind radical treatment causes great damage, and the chance of recurrence and formation of anal fistula after surgery is high; (5) The traditional method is used, first incision and drainage, and after the fistula is formed , The second stage is treated as anal fistula

    We believe that unless the physical condition does not allow it, an operation should be taken as soon as possible to avoid the formation of anal fistula and then the operation, which can alleviate the patient's pain, save time and cost. As for whether there will be a recurrence after the operation, it is entirely due to the doctor's ability to accurately locate the direction of the internal mouth and sinus of the infection. If the positioning is wrong, the operation will be divided into two operations, and it is difficult to guarantee that there will be no recurrence after the operation.

    How should perianal abscess be treated?

    The principle of treatment of perianal abscess is that once the diagnosis is clear and the part has become pus, surgery should be done. However, for those who cannot be operated due to some special circumstances, conservative treatment can be temporarily performed. For example, the local infection is only manifested as an inflammatory mass, and it has not been successful. Pus, or abscess with leukemia, heart disease and other serious systemic diseases. Conservative treatment is mainly anti-inflammatory, divided into systemic administration and local administration. Anti-Gram-negative bacilli and anti-anaerobic drugs such as cephalosporins, ofloxacin, metronidazole, ornidazole can be used systemically. At the same time, it can cooperate with Chinese medicine. Chinese medicine treatment. Locally give Chinese medicines such as heat-clearing and detoxifying, promoting blood circulation and removing blood stasis for external washing or making ointment for external application, such as Qudu Decoction, Jinhuang ointment, and removing poison ointment. If the anal pain is severe, analgesics such as Dulanding, Qiantongding, Diclofenac Sodium Lidocaine, etc. can be appropriately selected.

    The purpose of surgical treatment of perianal abscess is to thoroughly cut the abscess cavity and the internal opening of the source of infection, so that the pus can flow out, the wall of the abscess cavity will gradually fall off, and then the abscess cavity will be slowly filled by granulation growth, and finally the abscess cavity will be cured. During the operation, attention should be paid to determine the internal orifice accurately, the incision should be sufficient, the compartment in the abscess cavity should be opened, no dead space is left, the drainage is smooth, and the internal orifice is high, the suture-hanging operation should be performed.

    When does a perianal abscess become an anal fistula?

    If the perianal abscess is treated promptly and reasonably, it can be cured at one time without forming an anal fistula. Anal fistula usually becomes anal fistula under the following conditions: ⑴ The abscess ulcerated spontaneously after becoming pus, and did not undergo surgical treatment after the ulceration. (2) Only the surface of the abscess cavity was cut to drain the abscess, but the entire abscess cavity and internal opening were not cut. ⑶ The internal opening was not accurately positioned during one-time surgical treatment, or multiple internal openings were not completely discovered, resulting in failure of the operation and postoperative recurrence. ⑷The postoperative wound treatment is not in place in time, the skin is "bridging" healed prematurely, and the granulation deep in the wound does not fill the abscess cavity. After the perianal abscess becomes anal fistula, it can be treated according to the anal fistula.

    Is hospitalization required for perianal abscess surgery? How long is the hospital stay?

    Only the superficial subcutaneous abscess around the anus can be treated without outpatient surgery. Most patients with perianal abscess require hospitalization for surgical treatment. The postoperative hospital stay varies from 1-2 weeks. Generally, you can leave the hospital within 5-7 days. After you leave the hospital, you can basically go to work. Come to the outpatient clinic every 3-5 days to receive dressing changes and treatments. At home, you can take a bath with Chinese medicine every morning and evening to take care of your wounds. Generally, there is no need to live for more than 20 days or even one month. This will delay work and be detrimental to personal financial burden and hospital bed turnover.

    Can perianal abscess be prevented?

    Although infection and suppuration are prone to occur around the anorectal area, it can be prevented if we pay attention to it at ordinary times. The prevention method is summed up with a 12-character policy, which is: "Regular daily life, regular diet, and combination of work and rest". Daily routines require us to have a regular life, including the development of regular bowel movements every day, which helps to maintain a certain degree of body resistance and maintain normal stool. A regular diet requires eating less fat, sweet, spicy, and stimulating products, and avoid overeating. The combination of work and rest requires us to exercise properly, especially not to be over-fatigued, to avoid long-term sedentary, to get up and exercise every 1 hour or so, and to do levator anus exercises to promote perianal blood circulation.

hemorrhoids and anal fissures,How to recover after mixed hemorrhoids, anal papilla hypertrophy, and anal fissure?

    Patient: Description of the condition (main symptoms of anal fissure, time of onset): Laboratory tests and examination results: The last hospital visited: Hello, Doctor Li! I got hemorrhoids when I gave birth to a child 16 years ago. I rarely committed it in the first few years. In recent years, I have committed 2-3 times a year. Since last year, every time I had a bowel movement, all the anal nipple and hemorrhoids came out. The hand was pushed forward. After examination by our local doctor, it was diagnosed as mixed hemorrhoids, anal papillary hypertrophy, and anal fissure, which must be operated on. I had an operation on December 29. The mixed hemorrhoids, anal papillary hypertrophy, and anal fissure were removed together. After being discharged from the hospital to rest at home, I would like to ask Dr. Li. Although I pay attention every day, the food is light and I also eat fruit, but my stools are still dry every day, and my head is a bit hard. It hurts a bit. What else should I pay attention to in this situation? Under what circumstances can I go to work normally?

    Every day, the stool is still dry, and the head is a bit hard. I am afraid that I can’t solve it anymore because you have not cleared the stool. This causes the stool in the rectum, and the intestine absorbs water quickly. In the case of dry stool and head, it is recommended to drink plenty of water besides eating fruits, exercise more, and do not sleep too late at night. If you are afraid of defecation, you can take some laxative drugs orally to avoid a vicious circle. It is recommended to take a bath after the toilet, and then apply Mayinglong hemorrhoid ointment. You feel like you can go to work as soon as you can, ha ha. thank you for your trust!

    ------Southern Hospital Li Shenglong

hemorrhoids natural remedy,Reasonable diagnosis and treatment of chronic constipation

    What is chronic constipation?

    Chronic constipation is a common clinical complex symptom rather than a disease. It mainly refers to long-term dry stool, difficulty or incomplete defecation, and reduced defecation frequency. Food is usually digested and absorbed through the gastrointestinal tract, and the residue is discharged within 24 to 48 hours. If the interval between bowel movements exceeds 48 hours, it can be considered as constipation.

    Is chronic constipation common?

    With the changes in people's diet and the influence of mental, psychological and social factors, the incidence of constipation tends to increase. The prevalence of constipation in the population is as high as 27%, but only a small percentage of constipation patients will see a doctor. Constipation can affect people of all ages. There are more women than men, and more old people than young and middle-aged people. Due to the high incidence of constipation and the complicated etiology, patients often have a lot of distress, and severe constipation will affect the quality of life.

    What are the hazards of constipation?

    Since chronic constipation is a relatively common symptom, the symptoms vary from severity to severity, and most people often do not go for special

    Regardless, I think that constipation is not a disease and does not need treatment, but in fact, constipation is very harmful.

    1. Chronic constipation plays an important role in the occurrence of some diseases such as colon cancer, hepatic encephalopathy, breast disease, and Alzheimer's disease. There are many research reports in this area.

    2. Constipation can lead to life accidents in patients with acute myocardial infarction and cerebrovascular accidents. There are many painful cases

    We are alert.

    3. Part of constipation is closely related to anorectal diseases such as hemorrhoids and anal fissure.

    Therefore, early prevention and reasonable treatment of constipation will greatly reduce the serious consequences of constipation and improve

    The quality of life reduces the burden on society and families.

    What is the cause of chronic constipation? How to classify?

    Chronic constipation can be divided into two categories: organic and functional.

    1. Organic causes

    mainly includes:

    (1) Intestinal organic disease: Intestinal stenosis or obstruction caused by tumor, inflammation or other reasons.

    (2) Rectal and anal lesions: internal rectal prolapse, hemorrhoids, anterior rectal bulge, puborectalis hypertrophy, puborectalis separation, pelvic floor disease, etc.

    (3) Endocrine or metabolic diseases: diabetes, hypothyroidism, parathyroid disease, etc.

    (4) Systemic diseases: scleroderma, lupus erythematosus, etc.

    (5) Nervous system diseases: central brain disease, stroke, multiple sclerosis, spinal cord injury and peripheral neuropathy, etc.

    (6) Intestinal smooth muscle or neurogenic disease.

    (7) Colonic neuromuscular disease: pseudo-obstruction, Hirschsprung's disease, giant rectum, etc.

    (8) Neuropsychological disorders.

    (9) Drug factors: iron, opioids, antidepressants, antiparkinsonian drugs, calcium channel antagonists, diuretics and antihistamines.

    If chronic constipation has no clear cause such as the above, it is called chronic functional constipation (CFC). Among people with a history of constipation, functional constipation accounts for about 50%.

    2. Functional etiology

    mainly includes:

    (1) Excessive mental stress.

    (2) Eat less, especially the dietary fiber content is too low.

    (3) Or excessive obesity.

    (4) Less exercise.

    What are the manifestations of chronic constipation?

    Chronic constipation often manifests as: less urge to defecate, less frequent defecation; difficult and laborious defecation; poor defecation; dry stool, hard stool, unclean feeling; constipation accompanied by abdominal pain or abdominal discomfort. Some patients also have mental and psychological disorders such as insomnia, irritability, dreaminess, depression, and anxiety.

    Which symptoms of constipation patients are "alarm" symptoms?

    Alarm signs include hematochezia, anemia, weight loss, fever, melena, abdominal pain, etc. and family history of tumors. If there are alarm signs, you should go to the hospital immediately for further examination.

    Which patients with constipation need colonoscopy?

    It is generally believed that colonoscopy should be done in any of the following situations

    1. Over 50 years old

    2. There are alarm signs

    3. Refractory constipation

    How to diagnose chronic functional constipation?

    First of all, constipation caused by organic diseases should be clearly excluded.

    The current diagnostic criteria for chronic functional constipation use the internationally recognized Rome III criteria:

    1. Must include 2 or more of the following:

    (1) At least 25% of bowel movements feel laborious

    (2) At least 25% of defecation is dry ball and hard feces

    (3) At least 25% of bowel movements have incompleteness

    (4) At least 25% of bowel movements have anorectal obstruction/blockage

    (5) At least 25% of bowel movements require manual assistance

    (6) Defecation less than 3 times a week

    2. Rarely loose stools without laxatives

    3. Does not meet the diagnostic criteria for irritable bowel syndrome

    *Symptoms appear for at least 6 months before diagnosis, and meet the above diagnostic criteria in the past 3 months

    What is intractable constipation?

    The severity of constipation can be divided into mild, moderate, and severe. Mild means that the symptoms are mild, do not affect life, and can get better after general treatment, without medication or less medication. Severe refers to the persistent symptoms of constipation, the patient is abnormally painful, which seriously affects the life, the drug cannot be stopped or the treatment is invalid. Moderate is somewhere in between. The so-called refractory constipation is often severe constipation, which can be seen in outlet obstructive constipation, colon weakness, and severe constipation-type irritable bowel syndrome (IBS).

    Is constipation necessary for a comprehensive examination?

    Clinically, not every patient with constipation needs to be checked. Inspections should be conducted in a targeted manner, not that the more inspections, the better. Too many unnecessary examinations for patients with constipation will increase the burden of patients. We are opposed to untargeted, "casting a big net" type of examination for patients.

    In the diagnosis and differential diagnosis of chronic constipation, necessary inspections should be done according to clinical needs. First of all, pay attention to whether there is evidence of alarm symptoms and other organic diseases of the whole body; for patients over 50 years of age, with a history of long-term constipation, and short-term symptoms, colonoscopy should be performed to eliminate the possibility of colorectal tumors; for long-term abuse of diarrhea Colonoscopy can determine whether there is cathartic colon or (and) melanosis of the colon; barium enema can help diagnose Hirschsprung's disease. If OOC is suspected, digital anal examination and defecography are necessary. Special inspection methods include: gastrointestinal transit test (GITT), rectal and anal manometry (ARM), rectal-anal reflex test, tolerance sensitivity test, balloon expulsion test (bal2loon expulsion test) BET), pelvic floor electromyography, pudendal nerve latency measurement test, and anal canal ultrasound examination, etc. These examinations are only selected for refractory constipation.

    What are the commonly used inspection methods for intractable constipation?

    1. Stool routine and occult blood.

    2. Checks related to biochemistry and metabolism.

    3. Digital anorectal examination, can understand whether there is a mass and the function of anal sphincter.

    4. Colonoscopy or barium enema helps to determine whether there is an organic cause.

    5. Gastrointestinal transit test (GITT) is very helpful for judging whether there is slow transit, and it is often taken at 48h and 72h.

    6. Defecography can dynamically observe the anatomical and functional changes of the anorectum.

    7. Anorectal manometry can check the anorectal function without barriers.

    8.24h colonic pressure monitoring has certain guiding significance for whether to operate. If the lack of specific propulsive systolic wave (SPPW) and the colon's lack of response to waking up and eating, both indicate colon weakness, and surgical resection may be considered.

    9. Anal pressure measurement combined with ultrasound endoscopy can show whether the anal sphincter has mechanical or anatomical defects, which can provide clues for surgery.

    10. The application of perineal nerve latency or electromyography can distinguish whether constipation is myogenic or neurogenic.

    How to treat and prevent constipation?

    1. Analyze the causes of constipation and adjust your lifestyle. Develop regular bowel habits; quit smoking and alcohol; avoid drug abuse.

    2. Promote a balanced diet, increase dietary fiber appropriately, and drink more water.

    (1) High-fiber diet: Dietary fiber itself is not absorbed, and can absorb water in the intestinal lumen to increase stool capacity, stimulate the colon, and enhance motivation. Foods rich in dietary fiber include wheat bran or brown rice, vegetables, fruits rich in pectin such as mangoes, bananas, etc. (Note: immature fruits containing tannic acid will increase constipation). 

    (2) Supplement water: drink plenty of water and beverages to keep the intestinal tract with sufficient water and facilitate the excretion of stool.

    (3) Supply sufficient amount of B vitamins: Using foods rich in B vitamins can promote the secretion of digestive juice, maintain and promote bowel movements, and facilitate defecation. Such as coarse grains, yeast, beans and their products. Among vegetables, spinach and cabbage contain a lot of folic acid, which has a good laxative effect.

    (4) Increasing gas-producing foods: eating more gas-producing foods can accelerate bowel movements and facilitate defecation; such as onions, radishes, garlic sprouts, etc. 

    (5) Increase fat supply: appropriately increase high-fat foods. Vegetable oil can directly moisturize the intestines, and the decomposition product fatty acids have the effect of stimulating bowel movements. The kernels of dried fruits (such as walnut kernels, pine nut kernels, various melon seeds, almonds, peach kernels, etc.) contain a lot of oil, which has the effect of lubricating the intestines and laxative.

    3. Appropriate exercise: Medical gymnastics are the main ones, which can be combined with walking, jogging and abdominal self-massage.

    (1) Medical gymnastics: mainly to enhance the strength of abdominal muscles and pelvic muscles. Practice method: standing in place can do high-leg walking, squat, abdominal and back exercises, kicking exercises and turning exercises. In the supine position, you can raise one leg in turn or raise both legs at the same time, raise it to 40°, and then lower it after a short pause. The legs take turns in flexion and extension to imitate cycling. Raise your legs in a circle from the inside to the outside and sit ups.

    (2) Brisk walking and jogging can promote bowel peristalsis: help relieve constipation.

    (3) Deep and long abdominal breathing: When breathing, the amplitude of diaphragm activity is increased than usual, which can promote gastrointestinal peristalsis.

    (4) Abdominal self-massage: Lie on your back on the bed, flex your knees, and rub your hands together, place your left hand flat on your belly button, and your right hand on the back of your left hand, centering your belly button and rubbing in a clockwise direction. Do it 2 to 3 times a day for 5 to 10 minutes each time.

    4. Device assistance If the stool is hardened and stagnated in the rectum near the anal orifice, or the patient is elderly, weak, poor or lacking in defecation motivation, colon hydrotherapy or cleaning enema can be used.

    5. Medication

    (1) Prokinetic agent: Mosapride can promote gastrointestinal motility.

    (2) Laxatives

    ①Volume laxatives: magnesium sulfate, sodium sulfate, methylcellulose, agar, etc.; ②irritating laxatives: senna, castor oil, diesterphenine, etc.; ③stool softeners: liquid paraffin, lactulose, etc.; ④Intrarectal administration: glycerin suppository, Kaisailu, etc.

    6. Biofeedback therapy may be effective for some patients with constipation who have dysfunction of the rectal anus and pelvic floor. Biofeedback therapy is the use of special equipment to collect information about your own physiological activities to process and amplify, and display it with familiar visual or auditory signals, so that the cerebral cortex can establish a feedback connection with these organs, and learn to control at will through continuous positive and negative attempts Physiological activity, to correct the physiological activity that deviates from the normal range, so that the patient can achieve the purpose of "change self".

    7. Cognitive therapy Patients with severe constipation often have psychological factors or disorders such as anxiety or depression. Cognitive therapy should be given to relieve the tension of the patient, and antidepressant and anti-anxiety treatments should be given if necessary.

    8. Surgical treatment The above treatments are not effective for severe and intractable constipation. If the colonic transit dysfunction is chronic constipation and the condition is severe, surgical treatment may be considered. However, the long-term effect of the operation is still controversial, and case selection must be cautious.

    What is Melanosis?

    Colonic melanosis is caused by long-term use of anthraquinone laxatives, which leads to colonic epithelial cell apoptosis and intra-macrophage pigmentation, colonic mucosa is covered with brown spots, and colonoscopy shows leopard skin-like changes. Melanosis of the colon is generally considered harmless and reversible. Most people disappeared 6 months after stopping anthraquinone laxatives.

    I used to have normal stools, but I often have constipation recently. What should I do?

    1. If this occurs in the middle-aged and elderly people, first be alert to colon tumors, pay attention to observe whether there is blood in the stool, whether the stool is deformed, whether there is weight loss, fatigue, etc. You should see a doctor right away and do repeated stool occult blood tests. Do colonoscopy if necessary.

    2. If you have recent changes in your life pattern, excessive fatigue or depression, and eat less food, you can take a rest first, focus on diet adjustment, eat more high-fiber and laxative foods, and drink more water.

    3. If hemorrhoids and anal fissures have occurred recently, constipation may also occur due to the suppression of normal bowel movements. Hemorrhoids should be treated first, and if they do not get better, seek medical attention in time for colonoscopy.

    4. If you take certain drugs recently, including sedatives such as Valium, chlordiazepoxide, etc.; analgesics such as morphine, etc.; antacids such as aluminum hydroxide; antispasmodics such as 652-2, atropine, etc.; and iron , Antidepressants, antiparkinsonian drugs, calcium channel antagonists, diuretics and antihistamines. You can stop the drug first and observe whether it can be corrected. If it cannot be corrected, seek medical attention in time.

    Why do patients with constipation have diarrhea?

    The thickness of feces is related to its water content. If the intestine moves too fast, the water in the intestinal contents will not be absorbed in time, and the stool will become thinner. Patients with constipation often experience diarrhea after taking laxatives. There are also a small number of outlet obstructive constipation whose clinical manifestations are similar to "colitis", with diarrhea and incontinence as the main complaints. Doctors often mistake constipation as treatment for "colitis" and perform antidiarrheal treatment. Therefore, digital anorectal examination for patients with constipation is very necessary.

    Can irritant laxatives be used for a long time?

    Laxatives are one of the important methods in the treatment of functional constipation. However, long-term use of irritant laxatives is not appropriate. It will cause laxative colon, or (and) colonic melanosis, which is manifested by damage to the intestinal submucosal neurons and intestinal muscular layer, and the ability of intestinal peristalsis is severely affected. Injury, the intestine becomes tubular and expands, and the colon pocket disappears. For patients with slow transit constipation whose gastrointestinal transit time is significantly slowed, it is best to use some prokinetic drugs first, which can help defecation. If the effect is not good, use laxatives appropriately. Now more volumetric or osmotic laxatives are used. Such as polyethylene glycol 24000 (Fosong) or lactulose (Dumic). It is not advisable to use a laxative for a long time. If you really need to use it, it is recommended to use different drugs alternately to avoid adverse reactions and dependence on one drug.

    Can surgical removal of part of the colon prevent constipation?

    Some patients are often troubled by constipation and require surgical removal of part of the colon to treat constipation. But the results of surgery vary.

    At present, there are mixed opinions on the efficacy of surgical treatment of constipation, and there are different opinions on the timing and indications of surgery. The basic consensus now is: if strict non-surgical treatment, including psychological treatment, is still ineffective, and various special examinations show clear pathological anatomy and conclusive functional abnormalities, surgical operations can be performed, and indeed Achieve satisfactory results.

    The indications for surgery include secondary megacolon, part of the colon is lengthy, colon weakness, severe prerectocele, rectal intussusception, and rectal mucosal prolapse.

hemorrhoids external causes,Clinical experience of incomplete external stripping and internal ligation for treatment of circular mixed hemorrhoids

    1. Definition

    l Circular mixed hemorrhoids are not clearly defined in textbooks. Because of its relatively difficult treatment, clinical practice treats them as special or severe hemorrhoids. The disease is one of 16 refractory diseases in the anorectal department announced by the State Administration of Traditional Chinese Medicine.

    l "Circular" does not refer to the internal hemorrhoids, but the mixed external hemorrhoids. "Ring" has relative and absolute. Relative refers to the number of external hemorrhoids, generally more than three, which are connected as a whole or basically as a whole, but there is a natural groove between the two hemorrhoids. The external hemorrhoids are definitely connected together into a lip-like protrusion, and the boundary between the two hemorrhoids cannot be distinguished.

    l Therefore, ring-shaped mixed hemorrhoids refer to a type of hemorrhoids that have more than 3 external hemorrhoids or are completely connected to form a lip-like protrusion.

    2. Classification and reasons

    l According to the pathological classification of the external hemorrhoids of mixed hemorrhoids, ring-shaped mixed hemorrhoids can be divided into varicose-type ring-shaped mixed hemorrhoids and hoof-type ring-shaped mixed hemorrhoids.

    l Through the pathological observation of a large number of hemorrhoid specimens, we found that the pathological changes of hemorrhoids are mainly high venous dilation, tissue inflammation and edema, and even intravascular thrombosis. The modern "anal cushion theory" classifies the onset of hemorrhoids as "hole-shaped blood vessel" varicose or adjustment disorder, and Ttritz muscle aging or rupture.

    We believe that the abnormality of the anal sphincter, especially the internal sphincter, is an important reason for the formation of circular mixed hemorrhoids, and the normal resting pressure of the anal canal is an important sign of anal health. The ring-shaped mixed hemorrhoids formed by different abnormal states of the internal anal sphincter are also different. Internal anal sphincter spasm, contracture, high resting pressure of the anal canal to form knotted circular mixed hemorrhoids, internal anal sphincter relaxation, low resting pressure of the anal canal to form varicose-shaped circular mixed hemorrhoids.

    l Hoof knot tissue in mixed hemorrhoids is the product of tissue regeneration and repair after local inflammation and edema of the anal margin. Due to the stimulation of chronic inflammation, the anal sphincter continues to spasm and thicken, resulting in tightness and poor elasticity of the anal canal, and compression of stool during defecation, resulting in increased pressure of the anal marginal capillaries, lymphatic drainage disorder, and local edema. On the one hand, it causes the proliferation of interstitial fibroblasts and the formation of collagen fibers;

    l On the other hand, because lymph fluid is a good culture medium for bacteria and fungi, it causes repeated regenerative inflammation. With the continuous production and subsidence of edema and inflammation, the local hoof tissue is also continuously regenerated, resulting in the formation of mixed hemorrhoids with hoof tissue. Varicose-type mixed hemorrhoids are the product of local compensatory reactions. Due to congenital anal sphincter hypoplasia and long-term acquired constipation, excessive defecation time leads to excessive fatigue of the anal sphincter, resulting in relaxation of the anal canal, lower resting pressure, locally compensatory varicose veins, and eventually varicose mixed hemorrhoids.

    3. History and current situation

    l The classic procedure for the early treatment of annular mixed hemorrhoids in foreign countries is the “circumcision of hemorrhoids” created by Whitehead in 1882. Due to its well-known reasons, the three major complications of anal stenosis, mucosal ectropion, and moist anus are relatively high. It has long been rejected by most scholars. Half a century later, in 1937, the "hemorrhoid ligation resection" founded by Milligan-Mougan of St. Mark's Hospital in the United Kingdom was named after the surgical method of removing the hemorrhoids by ligating the root vessels connecting the roots of the internal hemorrhoids. Ligation&Exision method, referred to as LE technique. This operation was the most standard surgical method in the world at that time and opened a new era of mixed hemorrhoid surgery, so far it still has important clinical value.

    l In 1979, Mr. Takano of Japan published the "Ligation and Resection Method for Preserving the Anal Epithelium as much as possible". After that, he based on the medical theory of anal padding and after 10 years of painstaking research, in 1989 he published "Preserving the anal epithelium and Radical hemorrhoidectomy with pads", the main points of this procedure are: ① Make a dumbbell-shaped incision; ② Peel the internal and external hemorrhoids and internal hemorrhoid tissue from the incision to the area of ​​the suprahemorrhoidal artery for ligation; ③ Peel off the internal hemorrhoid tissue and varicose veins from the incision and retain Anal pad tissue and Ttreitz muscle; ④ Purse-string suture the wound within 0.5 cm below the tooth line and fix it to the ligation point of the suprahemorrhoidal artery area; ⑤ Suture the skin incision to close the incision.

    The surgical treatment of annular mixed hemorrhoids has the following advantages: ①The hemorrhoid skin incision is dumbbell-shaped, which fully preserves the anal skin and mucous membrane; ②It not only removes the varicose veins in the liner, but also retains the important support of the anal liner The structure is like Ttreitz muscle; ③The purse-string suture restores the descending anal canal skin, tooth line, and mucous membrane to the normal position, thereby solving the problem of hemorrhoid prolapse; ④Fix the purse-string on the internal hemorrhoid area and hang it on the rectal wall The curative effect is more reliable; ⑤The suprahemorrhoidal artery is sutured first during the operation, which can reduce the possibility of bleeding during and after the operation; ⑥When the incision skin is sutured, the retained skin and mucous membrane bridges close to the wound surface and heal with the wound granulation adhesion. Shorten the course of treatment; ⑦There is no exposed wound in the anal canal, which reduces postoperative anal pain. The main disadvantage is: improper operation may produce anal edema, skin tags, incision dehiscence, necrosis, and even anal stenosis.

    In 1995, Morinaga and others in Japan reported using Doppler and a specially designed proctoscope to find and ligate the hemorrhoid artery to treat 105 hemorrhoid patients, which was considered a successful operation without pain and low complications. In 2003, Shelygin reported that this method was used to ligate the terminal branches of the superior rectal artery. It was believed that it could reduce the blood supply to the hemorrhoid mass, fix the hemorrhoid mass and the muscle wall, thereby eliminating the symptoms of prolapse. The effective effect was 82.6% in 102 patients. In 2005, Ramirez reported using the same method to treat 32 patients with stage III and IV hemorrhoids. During the operation, an average of 5 arteries were ligated, 19 cases disappeared, 6 cases improved, and 7 cases failed. Postoperative complications such as anal discomfort, tenesmus, and lower rectal bleeding occurred. The clinical effect of this method needs to be further verified. At the same time, the method requires corresponding equipment and mastering certain related operation techniques, which is currently difficult to promote in China.

    In 1998, Italian scholars proposed a new method for the treatment of annular prolapsed hemorrhoids by circular resection of the lower rectal mucosa and submucosal tissue. This method can reset the prolapsed anal cushion and block the blood supply of the suprahemorrhoidal artery to the hemorrhoid area. Atrophy of hemorrhoids. In 2002, Trentin reported using this method to treat 100 cases of hemorrhoids and 6 cases of rectal mucosal prolapse. 42% of patients did not take analgesics and could return to work alone in 9.9 days. In 2003, Dixon reported that 62 patients with severe hemorrhoids who used this method were followed up. As a result, 6 people had complications, including 1 case of urinary retention, 1 case of death, 2 cases of pain, and 2 cases of bleeding.

    Hemorrhoid stapling surgery well protects the anal function, and can reset the prolapsed anal cushion, which is easy to operate and less painful after surgery. However, disposable staplers are expensive, single or semilateral hemorrhoids prolapse and other non-circular hemorrhoids are not suitable for use, and the scope of control of the mucosal resection is not ideal. The amount of mucosal resection depends on experience, and the reduction of severe hemorrhoids is insufficient. It is good, and different degrees of bleeding can still occur after anastomosis. According to literature reports, about 7% of patients need to undergo other surgical treatments after surgery. The long-term effects, especially stenosis and hemorrhoid recurrence, need further clinical observation.

    l The early treatment of hemorrhoids in China is the method of dry hemorrhoids, the Song "Tai Ping Sheng Hui Fang" from 982 to 992 AD. The earliest recorded ligation therapy in "Treatment of Hemorrhoids and Anal Side of Rat Milk", such as "Use spider silk on the right side to tie the hemorrhoids nipple, unconsciously fall".

    l Most of the current domestic treatments for annular mixed hemorrhoids are modified LE procedures. Aiming at the "anal cushion theory", some new procedures for preserving the tooth line and protecting the anal cushion are used, for example:

    1. Segmented tooth stripping and internal ligation to prevent postoperative anal stenosis

    l Based on the traditional external stripping and internal ligation, reasonable segmentation is adopted, and the ligation point near the tooth line is dislocated up and down to avoid the same plane to prevent postoperative anal stenosis.

    2. Treatment of internal and external hemorrhoids separately

    l Ligation of internal hemorrhoids: Clamp the base of internal hemorrhoids with a vascular clamp, pull it outwards moderately, and double ligate the suprahemorrhoidal artery area with silk thread. The ligation point is about 0.5cm away from the tooth line without damaging the tooth line.

    l Treatment of external hemorrhoids: Clamp the skin of the external hemorrhoids outside the anal margin with vascular forceps, and make a radial incision with surgical scissors. The upper edge of the incision extends to about 0.5cm below the tooth line. The skin margins on both sides are retracted, and the external hemorrhoid tissue is peeled off sneakily. , And to be removed, try to preserve the anal skin, trim the skin edge, suture the incision, and leave no dead space.

    l Dental floss is an important sensor in the anal canal. Less damage to the dental floss during the operation is also a protection for anal function. However, the scope of this operation is limited. If the dental floss prolapses with internal hemorrhoids, this method is not suitable.

    3. External stripping and internal ligation and broken bridge suture

    l After segmentation, make a radial "V" incision in the external hemorrhoids to peel off the subcutaneous hemorrhoids to 0.5cm on the tooth line. Use large curved forceps to clamp the base of the hemorrhoids completely. A round needle No. 7 silk thread penetrates the lower "8" of the forceps Sew the hemorrhoids and peel off the tissue, cut off one-half of the ligated stump and return it to the anus. If there are many hemorrhoids and the connecting ring is unclear, it is difficult to leave the skin and mucous membrane bridges. Choose relatively flat hemorrhoids as the skin and mucosal bridges. The lengthy and completely detached hemorrhoid skin bridge ascends the bridge.

    l Use small curved forceps to lift the lower edge of the skin bridge to fully peel off the skin and mucous membrane subbridge venous mass and hemorrhoid tissue. At this time, the skin bridge is in a free shape, avoiding the dentition and cutting off the excess bridge, and then carefully trim the skin and mucosa The bridge is smoothly covered on the sub-bridge tissue, and the skin bridge is carefully aligned and sutured with No. 0 silk thread. The needle thread passes through the muscle under the suture to fix the skin bridge on the subbridge sphincter, and strive to make the new anal canal skin bridge and mucosal bridge smooth.

    4. Suspension of hemorrhoids with internal anal cushion

    lEach external hemorrhoid is incised longitudinally along the natural depressions on both sides of the hemorrhoid, and the hemorrhoids and the cutaneous venous plexus on both sides are stripped to the muscle layer, and the upper end is 0.5cm below the tooth line. The hemorrhoids are removed in the same way as other external hemorrhoids, used between skin bridges 420 microbuckwheat thread sutures to eliminate wounds. The suprahemorrhoidal artery at the top of the hemorrhoid is punctured through the suture, and the suture is used to continue to penetrate the upper 1/3 of the hemorrhoid, tighten the knot and form a point suspension. The principle of this method is ligation of the hemorrhoid artery and suspension of the anal cushion, which reduces the blood supply of the hemorrhoid, breaks the disorder of blood vessel regulation in the hemorrhoid area, reduces the pressure in the anal cushion, and reduces recurrence. At the same time, the anal cushion is suspended and lifted to restore the normal position of the anal cushion.

    5. Multi-point high suspension of anal cushion

    l Applicable to those who have annular mixed hemorrhoids protruding out of the unbounded groove. During the operation, use the anal retractor to pull open the anal canal and rectum, clamp the external hemorrhoids with tissue clamps, pull the internal hemorrhoids without closure with the larger curved vascular clamp, expose the rectal mucosa of the hemorrhoids, and close the rectal mucosa with the larger curved vascular clamp to form a Long spindle-shaped strip, the top cut is 4-5cm away from the dentate line. Use a large round needle to hang a 7-gauge silk thread and insert the needle from the foremost end of the vascular clamp. Deeply perform single thread ligation in the submucosal layer, and insert the needle from the lower end of the vascular clamp and the upper end of the internal hemorrhoid. Then, the lower end of the vascular clamp is wound back to the upper end of the internal hemorrhoids and the needle is inserted again, and the ligation is carried out. No matter whether the internal hemorrhoids are corroded or not, they are not treated.

    l Treat the rectal mucosa of other hemorrhoids in the same way. The rectal mucosal ligation area that is ligated more than 3 points, that is, the upper end width should be small, and the distance from the dentate line can be reduced appropriately, but do not damage the anal cushion tissue. After the suspension ligation is completed, the external hemorrhoids can be seen to move up significantly and the anal canal skin Move up completely. External hemorrhoids are cut and peeled in an arc shape and sutured.

    6. Anal cushion injection and stripping

    l Injection of sclerosing agent into the loose rectal mucosa above the 3 anal pads and the upper 1/3 of the 3 female hemorrhoids and larger internal hemorrhoids. Set the stripping incision, stripping the inside out according to the usual method.

    7. External resection and internal ligation and external stripping and internal ligation

    l According to the different types of circular mixed hemorrhoids, external resection and internal ligation are used for hoof knot type circular mixed hemorrhoids, and external dissection and internal ligation are used for varicose vein type circular mixed hemorrhoids.

    l External resection and internal ligation (hoof knot type circular mixed hemorrhoids): According to the natural depressions on both sides of the hemorrhoid, 4-6 surgical areas are generally selected. First, a vascular forceps are clamped on each side of the cut line. , Cut longitudinally between the two forceps to make it an independent hemorrhoid tissue. Use a large curved full-tooth vascular forceps to clamp the base of the hemorrhoid along the longitudinal axis of the rectum, and place the surgical scissors close to the bottom of the vascular forceps. Cut to the tooth line, and then ligate it with silk thread, leaving part of the internal hemorrhoid stump to prevent the ligation line from slipping off and causing hemorrhage and bringing it into the anus. Treat internal hemorrhoids in other parts with the same method.

    l External stripping and internal ligation (varicose-shaped ring-shaped mixed hemorrhoids): Because the hemorrhoids are not obvious, the 3 and 9 o'clock positions of the lithotomy are selected as the stripping incision, radial incision, free anal flap, blunt stripping resection After peeling off the subcutaneous venous plexus on both sides of the incision for the varicose vein clusters and thrombus under the skin flap, trim the excess skin flaps and align them neatly, so that the skin flaps on both sides are flat and integrated.

    8. Multiple incision drainage

    l Adopt multiple small incisions for drainage of annular mixed hemorrhoids without resecting or damaging skin bridges and mucosal bridges in a large area at one time, which not only shortens the path of the surrounding skin to the incision hyperplasia, shortens the treatment course, and prevents the operation Anal edema, pain and scar contracture to avoid sequelae such as anal stenosis. It is not difficult to see from the above-listed treatment methods that while treating diseases, more consideration is given to reducing the damage to anal function, especially the protection of anal cushions and dental lines has become a current trend. Traditional circumcision has been basically give up.

    Four, problems and causes

    l Huang Jiasi Surgery clearly pointed out that the treatment of the disease is difficult to relapse, and improper surgery can easily cause sequelae such as anal stenosis, anal canal defect, mucosal ectropion, and leakage of secretions. We believe that the difficulty of ring-shaped mixed hemorrhoids is the contradiction between "going" and "staying". If we consider the thoroughness of the treatment, if we go for more and keep less, it is very likely that complications and sequelae such as skin defects and anal stenosis will occur after surgery. ; If considering safety, go less and stay more, thoroughness is not enough. It is a big clinical problem to be able to balance the efficacy and safety, and to master the degree and skills of "going" and "staying" well. Although many useful attempts have been made in clinical practice, problems still exist, which are summarized as follows:

    1. Anal canal stenosis: Excessive stripping and removal of the anal canal, anal marginal skin and subcutaneous soft tissue, resulting in a large area of ​​skin defects, scar contracture after healing, resulting in anal canal stenosis.

    l2. Rectal stenosis: ligation of excessive internal hemorrhoids or circular resection, or injection of sclerosing agent.

    l3. Rectal mucosal ectropion: excessive damage to the skin of the anal canal, large-scale defect, and compensatory outgrowth and coverage of the mucosa.

    l4. Secondary anal fissure: excessive skin damage, unreasonable incision, and excessive tension of the anal canal cause the surgical wound to not heal for a long time.

    l5. Sensory anal incontinence: It usually occurs after circumcision, when the tooth line and the skin of the anal canal are all removed, causing local sensory disturbances in the anus.

    l6. Anal incontinence: mainly fluid incontinence, mostly caused by internal hemorrhoids and excessive dental floss injuries.

    l7. Skin bridge edema: the incision is unreasonable, the skin bridge is too narrow, the subcutaneous vein mass is not damaged, and the anal canal is too tight.

    8. Residual external hemorrhoids: Skin bridges are treated reasonably, and external hemorrhoids are aggravated after skin bridge edema.

    Five, incomplete external stripping, internal tie and internal injection

    l Surgery is a double-edged sword. It can also cause local trauma while removing hemorrhoids. How to cause the least local invasion while ensuring the curative effect is the most difficult degree to master. In 1939 Calman pointed out that the principles of hemorrhoid surgery are: 1. Restore the anus, anal canal and rectum to the closest normal state without causing stenosis; 2. The operation is simple and the wound is small and can be completed in a short time; 3. The operation can be done. After the pain, the amount of bleeding is minimized. It is easy for us to do this for simple mixed hemorrhoids, but it is very difficult for circular mixed hemorrhoids.

    l We believe that the method of avoiding the hemorrhoids at the source of hemorrhoids can only be used in a limited range, and the treatment of circular mixed hemorrhoids is not a fundamental solution. In our clinical practice, we improved the traditional Milligan-Morgan technique and took advantage of the injection method, combined the two organically to maximize the strengths and avoid weaknesses, and basically fulfilled Calman's treatment requirements.

    1. Operation

    l Anesthesia and disinfection: The patient is placed in a lateral position, sacral canal block anesthesia is performed, and local infiltration anesthesia is performed for sacral hiatus deformities. Iodine and alcohol disinfect the perianal skin, and iodine disinfects the hemorrhoid area on the anal canal and dental line 3 times, and then fill the rectal cavity with 2 dry cotton balls.

    l Stripping point positioning method: follow the principle of "large first, then small, cross, outer hemorrhoids first, inner hemorrhoids second" principle, choose 3-5 external hemorrhoids with the most obvious bulge as the peeling point. Choose the external hemorrhoids corresponding to the larger internal hemorrhoids as the peeling point. The tissue between the two peeling points is the skin bridge and the mucosal bridge to be retained.

    l External hemorrhoids peeling method: Use tissue forceps to clamp the top of the external hemorrhoids and lift gently, cut the skin at 0.5cm from the base of the hemorrhoids on both sides of the hemorrhoids raised from the outer edge of the anal margin, and peel off the subcutaneous knot tissue and venous plexus. The tissue is freed into the anus to the tooth line or 0.2cm above the ligation. The incision should be gradually adducted when free. Pay attention to the ligation of the hemostatic point while peeling.

    l Ligation of internal hemorrhoids: use large curved hemostatic forceps to clamp the base of the external hemorrhoids from free to the dentate line together with the upper 2/3 part of the internal hemorrhoids on the dentate line, and perform simple ligation or "8" penetrating suture at the lower end of the hemostatic forceps Tie, keep the 0.5cm long stump, cut off the rest, and then push it back into the anus, keeping the two adjacent ligation points up and down.

    l Internal hemorrhoid injection method: (1) Medicine Shaobei injection, the concentration is 1:1, that is, 1 part of Shaobei injection plus 1 part of 0.5% lidocaine. (2) Location ①Unligated internal hemorrhoids; ②Under the rectal mucosa at the upper end of the skin bridge; ③Under the loose mucosa at the lower rectum. (3) The injection method follows the sixteen-character injection principle of "seeing hemorrhoids into the needle, first up and down, withdrawing the needle for administration, and fullness". When the injection needle pierces the hemorrhoid mucosa, the speed should be fast, and the needle should be withdrawn slowly to make the medicine fill the hemorrhoid evenly. After the injection, take out the dry cotton ball that filled the rectal cavity before the operation.

    l Renovation of small incisions at the anal margin: trim the skin margins on both sides of the incision, peel off subcutaneously swollen veins and thrombi, and appropriately extend the incision outside the anal margin so that the external hemorrhoid incision is a fusiform radial outward. If the anal margin is still uneven, use a small incision to strip and trim the raised area.

    l After the operation, the wound is filled with hemostatic sponge, and the tower-shaped gauze is compressed and fixed with a bandage.

    2. Description

    l (1) Incomplete external stripping and internal ligation is a simple and effective method for ring-shaped mixed hemorrhoids to fully preserve the skin and mucosal bridges. The preservation of skin bridge and mucosal bridge is an important indicator to measure the effect of mixed hemorrhoid surgery, and is the key to avoid postoperative complications and sequelae. The surgical procedures we have seen in the past have emphasized the importance of the preservation of the skin bridge and the width of the skin bridge should be preserved, but there are no specific measures for how to operate it. Milligan-Morgan's "external stripping and internal ligation" is a classic and effective method for the treatment of mixed hemorrhoids. So far, it can be said that no surgical procedure can completely replace it.

    l But this technique has obvious shortcomings in the treatment of circular mixed hemorrhoids, and only improvements can be made to adapt to the requirements of the new situation. Some circular mixed hemorrhoids have natural dividing grooves, and some do not. If it is considered that the anal margin or the lower end of the rectum can only be kept flat, many operations may be difficult to perform. By retaining the 0.5cm skin under the external hemorrhoids and the 1/3 mucosa under the internal hemorrhoids, the skin bridge and the mucosal bridge can be fully preserved regardless of whether there is a boundary between the hemorrhoids.

    l (2) Incomplete external stripping and internal ligation must be combined with internal hemorrhoid injection to ensure the completeness of the treatment. Retaining part of the "internal hemorrhoid" tissue during ligation is not only the need to retain the mucosal bridge, but also the need to retain the "anal cushion", but also the need for safety. The tension of the ligation point is small, which can effectively avoid the bleeding of the ligature after the operation. But to keep it, one must master the degree, and in addition, it is necessary to simultaneously inject drugs into the tissues outside the ligation point. "Shaobei injection" has strong atrophic hemorrhoids and local fixation, and at the same time does not form induration and has a higher safety. After injection, residual hemorrhoids can be eliminated, skin bridges adducted, and incomplete external stripping and internal ligation can be used to complement each other.

    l (3) Incomplete external stripping and internal ligation must be combined with stripping pruning to ensure the smoothness of the anal margin. If the base of external hemorrhoids does not retain tissue to prevent it from becoming residual hemorrhoids, subcutaneous tissue dissection must be carried out carefully. In principle, the swelling can be eliminated. It is not necessary to peel all the soft tissues from subcutaneous to muscular layer. Just destroy the varicose veins under the skin bridge. Don't become a "hanging bridge". The wide and raised skin bridge can be trimmed with small incisions.

    l (5) Dislocation of the ligation point up and down. This method has reached a consensus in China, and many methods have been adopted. The adjacent ligation points are slightly misaligned up and down, forming a tooth shape, so that the ligation points are not on the same level, so that the postoperative scar contracture is not on the same level, which can effectively prevent sequelae such as anal stenosis.

    l (6) The wound in this operation is not sutured and the internal sphincter is not cut to release the anal canal.

    l (7) This method can also be applied to mixed hemorrhoids or circular mixed hemorrhoids incarceration.

    l (4) Do not hurt "false hemorrhoids". In many cases, the raised tissues of the anal margin are not all hemorrhoids, especially those with heavier internal hemorrhoids. When the larger hemorrhoids prolapse, the normal skin of the anal margin connected to it will also be brought out to form false hemorrhoids. In order to prevent false hemorrhoids from accidentally being injured, we propose a surgical sequence of "large first, then small, crossover". The big goes first, the small is still an inch, you can go, the small is normal, you can keep it. Crossing and very sequentially is also an effective means to avoid accidental injury to false hemorrhoids.

    (8) Preservation and treatment of skin bridge:

    l In 2000, the “Chinese Journal of Anorectal Diseases” reported in the 25302 cases of hemorrhoids in the whole year that 9077 cases of hemorrhoids were surgically operated. In these cases, it seems that it has become a consensus to minimize the damage to the anal canal anatomy and protect the physiological function of the anal canal. , Hemorrhoidectomy with different names unanimously proposes that when hemorrhoids are removed, a fairly wide "skin bridge" or "mucosal bridge" must be kept between the two hemorrhoids.

    l But in clinical practice, the remaining skin bridges often become residual external hemorrhoids. Some skin bridges even appear edema and necrosis and have to be surgically removed again. We use the following methods to solve these two problems through years of summary.

    l①The width of the leather bridge should be greater than 0.5cm. The narrow skin bridge is the main reason for reservation failure. At present, when external hemorrhoids dissection and excision in China, a "V" mouth with a small bottom and a large mouth is used. The reason is to make the wound drainage smooth, which is difficult to ensure the width of the skin bridge. External hemorrhoid incisions are different from abscesses and anal fistulas, and there is no need to consider whether drainage is unobstructed. We use a "V"-shaped fusiform incision. During the operation, the incisions on both sides of the external hemorrhoids are lifted from the base by about 0.5cm, leaving this part of the hemorrhoid tissue, retaining the skin, and peeling the subcutaneous tissue, so that the width of the skin bridge between the two incisions Fully guaranteed.

    l ②The venous mass and thrombus were removed subcutaneously. In order to prevent the remaining skin bridge from becoming residual hemorrhoids, the underlying tissue and pathological products of the skin bridge should be properly treated. Use sharp scissors to peel off the thrombus and destroy the venous plexus that is not stretched, but the subcutaneous tissue cannot be completely removed and the skin bridge can be suspended.

    l ③Drug injection under the rectal mucosa near the heart of the skin bridge. Shaobei injection has astringent and atrophic effects. Injecting into the rectal mucosa at the medial end of the skin bridge can cause the skin bridge to be raised and adducted, and at the same time, it can block the venous return path of the skin bridge and maintain local levelness.

    (9) Causes and prevention of anal edema:

    l The formation of edema is because the operation destroys the local venous return, the venous intravascular pressure at the edema site is too large, the permeability of the vessel wall is improved, the lymphatic fluid is concentrated in the local area, and even the extravasation of blood in the blood vessel causes local thrombosis . Edema can cause unbearable pain in the anus after surgery, or even necrosis of the skin bridge. Therefore, avoiding postoperative anal edema is an important content to be considered in surgical operations and postoperative care. We mainly use the following methods to solve.

    l①The skin bridge cannot be the "bottleneck" of venous return. As mentioned earlier, the width of the skin bridge must be maintained, but it is not enough. It must also be maintained at a suitable length. If it is too short, the local blood will become a "bottleneck" effect, blood flow will be blocked, and it will inevitably cause local tissue edema. Therefore, it is necessary to extend the leather bridge and establish a "buffer" at both ends. The surgical operation is to extend the incisions on both sides of the skin bridge outwards, and try to keep the incisions parallel to the skin bridge.

    l②Reduce the burden on the leather bridge. The tissue under the skin bridge does not need to be completely stripped and resected, and the subcutaneous venous mass can be properly destroyed and the thrombus can be stripped off, blocking the venous access to reduce the burden of the skin bridge. The above-mentioned injection of Shaobei injection at the upper end of the skin bridge can also play this role.

    l③ Avoid excessive resection and ligation of the anal margin during the operation, and avoid excessive exposure of the internal sphincter, which may cause postoperative spasm and affect the blood return of the anal canal.

    l④After the operation, the tower-shaped gauze pad compresses the anus to keep the pressure evenly around the anus.

    l⑤ After dressing change, the anal gauze should not be too much, and the anal canal should not be compressed into a mass.

    l⑥ After the first defecation after the operation, to prevent the toilet and the long defecation time, Kaisailu enema can be used to assist defecation.

    (10) Causes and prevention of anorectal stenosis

    l Because there are more than 2 wounds in the external dissection and internal ligation of circular mixed hemorrhoids, the skin and anal margin tissues removed during the operation make the anal canal tighter than before the operation, and the elasticity is poor, which is likely to cause anal canal stenosis. Some scholars believe that if too much tissue is removed during circular mixed hemorrhoid surgery, there may be a certain degree of anal incontinence or anal stenosis after the operation. Excessive ligation of internal hemorrhoids can also cause rectal stenosis.

    l The most commonly used method to prevent postoperative anorectal stenosis is to cut off the internal anal sphincter during the operation to loosen the anal canal.

    l In clinical practice, we do not cut off the internal anal sphincter to loosen the anal canal to prevent stenosis. Instead, we design a more scientific and reasonable surgical plan to minimize trauma to avoid postoperative stenosis, which is a more active method.

    l①Increase the width of the leather bridge (above)

    l②Small incisions replace large incisions with multiple incisions. The number of leather bridges can be increased.

    l③ The incision is a long and narrow fusiform mouth. Reduce the tension of the incision.

    l④ The subcutaneous tissue of the anal canal at the anal margin is properly retained. The complete stripping of the venous plexus leads to heavier scars after healing, and anal fissures may also occur. During the operation, a small amount of vascular plexus and hoof tissue are retained on the surface of the muscle, which is conducive to wound healing and can reduce scars after healing.

    l⑤ The tissues under the tooth line should be ligated as little as possible.

    We take the following measures to prevent rectal stenosis:

    l ① 2/3 of the internal hemorrhoids are ligated, and the base 1/3 remains. This will not only retain sufficient mucosal bridges, but also protect the anal cushion tissue. The anal cushion is a dynamic component of closing the anus, it participates in assisting the normal closure of the anus and helps control the stool. If the anal cushion is excessively damaged or defective, complications such as anal sclerosis, stenosis, low sensory function, and incomplete closure can occur.

    l② The ligation points of internal hemorrhoids are slightly misaligned. Avoid ligation points on the same level.

    l③ Try to use "8" ligation. Reduce the tension at the ligation point.

    l④ Cooperate with ligation and drug injection. Shaobei injection is used for mucosal bridges, unligated internal hemorrhoids and loose rectal mucosa to ensure local atrophy and ensure the effect. At the same time, the drug does not damage the surface mucosa, does not produce induration and non-scarring repair, and can also prevent stenosis The role of.

    Six, discussion

    1. Preoperative design?

    The first step of circular mixed hemorrhoid surgery is to segment to determine where to remove and where to remain. How to segment? At present, there is no clear principle and unified standard in China. Junichi Iwataru of Japan pointed out that the design question of where and where to leave the whole hemorrhoids is very important. Domestic scholars have grouped the prolapsed anal pads naturally, and selected the peeling and cutting points in the traditional three female hemorrhoid areas. This classification method is relatively blind. In clinical practice, the main lesions of many circular mixed hemorrhoids are not in these three positions.

    l Although the same ring, but specific to each individual, its performance is very different. It is impractical to develop a unified segmentation model. Our principle is: ①"Large first, then small, external hemorrhoids first, internal hemorrhoids second", first remove the larger external hemorrhoids. If the external hemorrhoids are equal in size, the external hemorrhoids corresponding to the larger internal hemorrhoids are used as the incision. . ②3-5 points are appropriate. ③At the same time, it is necessary to consider the balance of the 12 points of the front, back, left, and right anus. Not all incisions should be concentrated on one side, otherwise it will affect the function and long-term effect of the anus after the operation.

    2. Loosen the anal canal?

    l   At present, when circular mixed hemorrhoids are performed in China, more than 90% of them are cut off the sphincter to loosen the anal canal. The reason is that cutting the internal sphincter head can prevent postoperative complications. According to the "button hole", the main cause of hemorrhoids is that internal sphincter spasm or abnormal activities lead to obstruction of the hemorrhoidal venous return, and a large amount of blood in the hemorrhoids blood vessels form hemorrhoids. Cutting or dilating the internal sphincter can reduce the intraanal pressure and improve the hemorrhoids. Clinical symptoms. At the same time, it can reduce postoperative pain, urine retention and anal stenosis caused by internal sphincter spasm.

    l We have found in long-term clinical practice that cutting off the anal sphincter is not a theoretical advantage. We believe that it does more harm than good for the following reasons:

    l (1) Reasonable surgical methods can avoid postoperative anal sphincter spasm. We believe that there are three reasons for postoperative sphincter spasm: ①The wound is too large and the skin bridge and mucosal bridge are insufficiently retained; ②The soft tissue in the wound is stripped too much and the sphincter is exposed; ③The skin bridge edema and thrombosis under the skin bridge occur after the operation. If these reasons can be overcome without cutting the sphincter, postoperative cramps can be avoided.

    l (2) Cut off the sphincter muscle, leading to local mechanical imbalance, which is very easy to cause hemorrhoids on both sides of the incision to increase or skin bridge edema.

    l (3) Blind relaxation leads to more relaxation of the anal sphincter, which affects long-term efficacy. Some domestic scholars have found through research that decreased anal sphincter function is an important cause of hemorrhoids. Some scholars have reported that cutting off the main anal nerve of rabbits and giving anoscope to continue to over-expand the anus can form pathological changes similar to human hemorrhoids in the anus. Yishan et al. [4] also reported that relaxation of the anal sphincter can reduce the function of anal static pump and form hemorrhoids. The author also observed in the clinic that some patients with anal sphincter damage and congenital anal sphincter relaxation are mostly accompanied by severe internal hemorrhoids. In fact, this is a compensatory response.

    l3. Stitching?

    There are sutures in the lM-M operation, and in Takano's anal preservation operation, sutures are also used in some current domestic methods. From the early suture of internal hemorrhoids, to the current suture of external hemorrhoid incisions and transverse seams of skin bridges.

    l We believe that the wound should not be sutured if it is not fasting or confinement. The first is internal hemorrhoids, ligation is better than suture. Long-term clinical practice has confirmed that ligation is a safer and effective treatment for internal hemorrhoids. Mucosal suture is very difficult, especially multiple sutures, especially multiple sutures. Even if it can be sutured smoothly, postoperative safety is a big problem. The second is external hemorrhoids, open is better than closed. If multiple incisions at the anal margin are sutured, the anal opening will be reduced, stool will be difficult, and stool pain will be severe. At the same time, the suture opening is prone to infection, and the healing time is not shorter than the opening. The third is that skin bridges are best not to be sutured with broken bridges, because there are not many skin bridges that really need to do this in clinic, and the quality of sutured skin bridges is not high after survival.

    4. Vein mass peeling?

    l In the past, external peeling was done to completely peel the vein mass and knot tissue from subcutaneous to muscle layer. Some scholars believe that complete stripping of the venous plexus can avoid anal edema. We believe that the thorough stripping of the venous plexus and soft tissues will lead to slow healing of the wound after healing, heavier scars, sphincter spasm, and secondary anal fissures. We keep a small amount of vascular plexus and knot tissue on the surface of the muscle during the operation, and try to cut the blood vessel method, which is conducive to wound healing and can reduce scars after healing.

    5. Keep the tooth line?

    l Past circumcision ignores the role of dentition, resulting in sensory anal incontinence. Now some operations are going to the other extreme, and the dental floss surgery that treats internal and external hemorrhoids separately. The author believes that this procedure is suitable for simple internal or external hemorrhoids, but not for mixed hemorrhoids, especially circular mixed hemorrhoids. What is mixed hemorrhoids? The internal and external hemorrhoids are connected as a whole, and the tooth line has left its normal position, bulged or prolapsed. How to retain such a tooth line, and what is the use of retention? We believe that although the usual external stripping and internal ligation will remove part of the tooth line, it will certainly not have much impact on the anal sensory function, and there is no need to cast a rat trap.

    6. Suspended?

    l Under the influence of PPH, "suspension" has become a fashion in anorectal surgery, and has become synonymous with protecting anal cushions. The author believes that the suspension method has a certain effect on internal hemorrhoids and rectal mucosal relaxation, but it is difficult to achieve results by suspending instead of external hemorrhoids. Even for varicose external hemorrhoids, it is better to destroy the venous mass through a small incision.

    7. Conclusion

    l Incomplete external stripping and internal ligation and internal injection method. By improving the traditional external stripping and internal ligation and organically combining with the injection method, it fully preserves the skin bridge and mucosal bridge while taking into account the thoroughness of the treatment, without cutting off the internal anal sphincter It can prevent anal stenosis and is an effective, low-invasive, and safe method for the treatment of circular mixed hemorrhoids. It has realized the surgical principle proposed by Calman 40 years ago.

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