What is hemorrhoids?
1. Blood in the stool: Painless intermittent blood after the stool is its characteristic, and it is also a common symptom of internal hemorrhoids in the early stage. The mild cases are mostly blood on the surface of the stool, followed by dripping blood, and the severe cases are jet-like bleeding. Blood in the stool often stops spontaneously, which is important for diagnosis.
2. Hemorrhoids prolapse: It is often a late symptom, with blood in the stool first and then prolapse. Mild cases only prolapse during defecation and can recover on their own after defecation, severe cases need to be pushed back with hands, and more severe cases prolapse out of the anus with a little abdominal pressure.
3. Pain: Simple internal hemorrhoids have no pain. When internal hemorrhoids or mixed hemorrhoids come out of incarceration, embolism and edema, infection, and necrosis, thrombotic external hemorrhoids and connective tissue external hemorrhoids will have varying degrees of pain.
4. Itching: Late internal hemorrhoids, hemorrhoid prolapse, connective tissue external hemorrhoids, etc., perianal often have itching and discomfort, and even skin eczema, which makes the patient extremely uncomfortable.
According to medical history and anorectal examination, the diagnosis of hemorrhoids can be confirmed. According to the location of hemorrhoids, it is divided into the following three categories:
1. Internal hemorrhoids: located above the tooth line, the surface is covered by mucous membranes and formed by the venous plexus of internal hemorrhoids. It is common in the middle on the left, front right and back right. He often has a history of blood in the stool and prolapse. Internal hemorrhoids are divided into four stages. The first stage: No obvious conscious symptoms, only bleeding, dripping or spurting during defecation, with more bleeding. No hemorrhoids prolapsed outside the anus. Anoscopy showed that the rectal column was enlarged on the tooth line and showed nodular protrusions. The second stage: intermittent blood, dripping or spurting blood during defecation, with moderate bleeding. Hemorrhoids protrude out of the anus during defecation, and come back after defecation. The third stage: Hemorrhoids prolapse during defecation, or when tired, walking for a long time, or coughing. The internal hemorrhoids cannot be taken back by themselves after prolapse, and must be supported by hands or after lying in bed and resting. Less bleeding. The fourth stage: The hemorrhoids stay outside the anus for a long time and cannot be received or come out immediately after receiving. Hemorrhoids develop into mixed hemorrhoids in the latter three stages.
2. External hemorrhoids: located below the tooth line, the surface is covered by skin and formed by the external hemorrhoid venous plexus. The common ones are thrombotic external hemorrhoids, connective tissue external hemorrhoids (skin tags), varicose external hemorrhoids and inflammatory external hemorrhoids.
3. Mixed hemorrhoids: near the tooth line, it is covered by the skin and mucous membranes. It is formed by the anastomosed veins between the internal hemorrhoidal vein and the external hemorrhoidal venous plexus. It has two characteristics: internal hemorrhoids and external hemorrhoids.
1. Rectal cancer: Clinically, rectal cancer is often misdiagnosed as hemorrhoids, and treatment is delayed. The main reason for the misdiagnosis is the failure to perform digital rectal examination and anal endoscopy. Therefore, the above two tests must be done in the diagnosis of hemorrhoids. Rectal cancer is an uneven mass or an ulcer with a raised edge, which is brittle and easy to bleed.
2. Rectal polyps: If a low-lying rectal polyp with a pedicle protrudes outside the anus, it is sometimes misdiagnosed as hemorrhoidal prolapse, but it is more common in children. The polyp is round, substantial, pedicled, and highly mobile.
3. Anorectal prolapse: Sometimes it is misdiagnosed as circular hemorrhoids, but the rectal prolapsed mucosa is circular, with a smooth surface, and the sphincter is relaxed; the latter has a plum petal-like mucosa, and the sphincter is not relaxed.
【 Treatment principles 】
The treatment of hemorrhoids focuses on reducing or eliminating the main symptoms, rather than radical hemorrhoidectomy. Therefore, relieving the symptoms of hemorrhoids is more meaningful than the size change of hemorrhoids, and is regarded as the standard of treatment effect.
1. Asymptomatic hemorrhoids do not need treatment, just pay attention to diet, keep the stool smooth, keep the perineum clean, and prevent complications. Only coexisting blood, prolapse, thrombosis and incarceration need treatment.
2. The purpose of various non-surgical treatments of internal hemorrhoids is to promote hemorrhoid vein occlusion and tissue fibrosis around hemorrhoids, to fix the prolapsed anorectal mucosa on the muscular layer of the rectal wall to fix the loose anal cushion, thereby achieving hemostasis and prevention The purpose of prolapse.
3. Surgery is only considered when conservative treatment fails or the connective tissue supporting the hemorrhoids is extensively destroyed in the third or fourth stage, or when thrombotic external hemorrhoids and connective tissue external hemorrhoids are infected.
【 Surgical treatment 】
(1) Injection method: Indications: Injection therapy can be used for internal hemorrhoids without complications. In the first stage of hemorrhoids, those who complain of blood in the stool without prolapse, are most suitable for injection therapy, and have obvious effects on controlling bleeding. In the second and third stages, hemorrhoids can be injected to prevent or reduce prolapse, and hemorrhoids can be injected again after hemorrhoids or prolapse. For the elderly, weak, severe hypertension, heart, liver, kidney and other diseases, injections can be considered. Contraindications: Any external hemorrhoids and internal hemorrhoids with complications (such as embolism, infection or ulceration) should not be treated with injection;
(2) Ligation: Indications: Hemorrhoids and internal hemorrhoids of mixed hemorrhoids in each period. Contraindications: various acute diseases, severe chronic diseases, acute anorectal inflammation, internal hemorrhoids with complications (such as embolism, infection or ulceration, etc.), diarrhea, dysentery, bleeding;
(3) Band ligation: Indications: Hemorrhoids and internal hemorrhoids of mixed hemorrhoids in each period. Contraindications: various acute diseases, severe chronic diseases, acute anorectal inflammation, internal hemorrhoids with complications (such as embolism, infection or ulceration, etc.), diarrhea, dysentery, bleeding;
(4) Resection: Indications: Applicable to hemorrhoids in the second, third and fourth stage, especially mixed hemorrhoids dominated by external hemorrhoids. Contraindications: various acute diseases, severe chronic diseases, acute anorectal inflammation, diarrhea, dysentery, bleeding;
(7) Laser resection (due to the greater negative effect, professional anorectal departments are no longer needed).
(8) PPH (staple resection) is minimally invasive, and is currently the first choice for the treatment of internal hemorrhoids (ⅡⅢ), mixed hemorrhoids and severe hemorrhoids.