2020年10月23日星期五

hemorrhoids and anal fissures,Prolapse (rectal prolapse)

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    (Anal prolapse) is a disease in which the anal canal mucosa, the entire thickness of the rectum, and even part of the sigmoid colon are displaced and prolapsed through the anus. The clinical features are prolapse of anal mass, swelling feeling, constipation or anal incontinence, moist itching in the anus, bleeding, prolapsed bowel incarceration, etc. Prolapse accounts for only 0.4% to 2.1% of anorectal diseases. It can occur at any age, but it is more common in children, the elderly and infirm, and women who have undergone labor. The peak incidence of children is between 1 and 3 years old, mostly rectal mucosal prolapse, and the peak incidence of adults is between 50 and 70 years old, mostly full-thickness rectal or combined with partial sigmoid colon prolapse. The incidence of this disease is higher in men in children, and more women than men in adults. China’s oldest prescription book "Fifty-two Sick Remedies" records that "people who cannot enter from the state...the people who fall down the county (hang), and the confidants are swept (splashed) by the cold water", "people leave the state" It is rectal prolapse, which is the earliest record of rectal prolapse and its resumption in the world, and the name of "prolapse of the anus" first comes from "Shen Nong's Materia Medica". This disease is equivalent to rectal prolapse in western medicine.

    The etiology and pathogenesis of children’s qi and blood are not prosperous, the elderly’s qi and blood decline, lack of qi, women’s labor exhaustion, loss of qi and blood, and chronic diarrhea, habitual constipation, and long-term cough can all easily lead to qi deficiency and sinking, and loss of solid intake. As a result, the rectum and anal canal prolapse outward. In addition, improper diet leads to damp and heat endogenesis, betting on the large intestine, forcing the rectum to prolapse, and incarceration cannot be repaid.

    Western medicine believes that rectal prolapse is related to the immature development of infants and young children, weak pelvic floor tissues, long-term increase in intra-abdominal pressure, and various neurological diseases.

    Diagnosis points: The main symptoms are prolapse of anal mass, swelling feeling, constipation or anal incontinence, moist itching in the anus, bleeding, prolapsed bowel incarceration, etc. On inspection of the anus, the perianal skin was moist and pigmented, and the anal orifice and anal sphincter muscles were loose on the digital rectal examination, and the contraction was weak. The prolapsed intestine could be touched, especially when standing or patted behind the back. Clinically, type 2 and 3 degree classification is often used to classify and grade rectal prolapse. ⑴ Classification: ①Incomplete rectal prolapse: The prolapse is hemispherical, and a circular mucosal groove centered on the rectal cavity can be seen; ②Complete rectal prolapse: The prolapsed bowel is cone-shaped, and the prolapsed part is visible in the rectal cavity It is a mucosal annular groove arranged in concentric circles in the center; ⑵ is divided into three degrees: ①degree I: also called rectal mucosal prolapse, the prolapse is light red, 3 to 5 cm long, mucosal folds are radial, and the prolapsed part is two layers It is composed of mucous membrane, which is soft to touch, inelastic, not easy to bleed, and can be absorbed naturally after defecation; ②degree II: full-thickness prolapse of the rectum, 5-10 cm in length, conical, light red, ring-shaped and layered Mucosal folds, the prolapsed part is composed of two layers of folded intestinal folds. The palpation is thick and elastic. There is a peritoneal space between the two intestinal walls. The anus is loose and sometimes needs to be restored by hand after going to the toilet; ③ Degree III: Due to the displacement of various layers of the rectum, the rectum and part of the sigmoid colon prolapse, up to 10 cm Above, it is cylindrical and thick to touch. The anal mouth is loose and weak. It can be prolapsed when standing, walking or coughing. The appearance is sausage-like or spherical. Sometimes it is difficult to recover. Because the rectal mucosa is often exposed, the mucosa is often dry, congested and ulcerated. It is easy to occur, and may be accompanied by falling pain in the lower abdomen, swelling and heaviness in the waist, groin and both sides of the lower limbs.

    Differential diagnosis Annular internal hemorrhoids: the hemorrhoids are divided into pieces and the normal mucosa appears between the hemorrhoids. The color is dark red or blue-purple, the sphincter is strong, and the prolapse of the rectum is cone-shaped, bright red or light red, and the sphincter is loose and weak.

    Treatment TCM treatment mainly focuses on invigorating qi, lifting up and solidifying. According to the specific situation, the treatment is based on syndrome differentiation. It has a certain effect. The principle of surgical treatment is to correct various anatomical abnormalities of rectal prolapse as much as possible.

    Internal treatment ① Syndrome of spleen deficiency and qi depression: Clinical manifestations are the prolapse of anal mass during defecation, with varying degrees of severity, light red color, accompanied by anal swelling, blood in the stool, fatigue, lack of appetite, and even dizziness and tinnitus. Sore waist and knees, pale tongue, thin white fur, thin pulse. Governance: Tonic middle energy and qi, rising sun and sinking. Fang Xuan Buzhong Yiqi Decoction addition and subtraction. Commonly used drugs: Astragalus, Codonopsis, Atractylodes, Angelica, Tangerine peel, Cimicifuga, Bupleurum, and licorice. For those with constipation, add Citrus aurantium and raw rhubarb to relieve heat and relieve heat; for those with thin stools, add atractylodes, phellodendron, etc. to clear away heat and remove dampness. Chinese patent medicine: Buzhong Yiqi Pills can be used for oral administration. ②Damp-heat betting syndrome: clinical manifestations of prolapse of anal mass, purple or dark red color, or even surface ulceration, erosion, pain in the anus, burning sensation during digital examination in the anus, hot face, dry mouth, bad breath, and abdominal distension Constipation or diarrhea, short red urine, red tongue, yellow and greasy fur, pulse string. Governance: clearing away heat and dampness, rising sun and sinking. Fang Xuan Shengyang Dehumidification Decoction addition and subtraction. Commonly used drugs: Cohosh, Atractylodes, Bupleurum, Astragalus, Codonopsis, Alisma, Poria, Atractylodes, Fangfeng, Pueraria lobata. For severe heat evil, increase the amount of yellow, coptis, and phellodendri to clear away heat and dampness. Proprietary Chinese medicine: Can choose to use dirty pills.

    External treatment ①Fumigation and washing with traditional Chinese medicine: Fumigation and washing with Sophora flavescens decoction, pomegranate peel, dried alum, and gallnut decoction, once or twice a day; 30 grams of nitrate can also be used, placed in a basin, and washed with hot water before smoking ,Approximately 10-15 minutes each time; ②External application of traditional Chinese medicine: use Chinese gallnut powder or Mabo powder for external application.

    Other therapies ①Acupuncture: It can be treated with body acupuncture, electric acupuncture, and plum blossom acupuncture. The points are Changqiang, Baihui, Zusanli, Chengshan, Baliao, Tianus, and Ashi, which corresponds to the external sphincter. ②Injection: It is mainly suitable for Ⅰ and Ⅱ degree prolapse. Commonly used drugs are Xiaozhiling injection, Shaobei injection or 5% sodium morrhuate and other sclerosing and atrophic agents. There are two main injection methods: submucosal injection and perirectal injection. ③Surgery: Commonly used surgical methods include rectal mucosal ligation, anus constriction, intrarectal scar support and fixation, rectal prolapsed tissue resection and repair, external rectal fixation, and triple rectal prolapse. ④ Anus levator exercise therapy: usually practice anal suction and lifting exercise, 2 times a day, each time continuously relax and tighten the anus 20 to 30 times, it has the effect of enhancing the function of anal sphincter, which is effective in preventing rectal prolapse and preventing anal relaxation. Have a positive effect.

    Prognosis of prognosis In children, rectal prolapse usually heals itself with growth and development. Adult rectal prolapse generally cannot heal by itself and tends to get worse. Therefore, treatment measures should be taken as soon as possible.

    Prevention and care ①Avoid long-term activities that increase abdominal pressure and the bad habit of defecation and squatting time; ②Internal hemorrhoids, rectal polyps and other diseases that frequently prolapse should be treated in time; ③Actively treat diseases such as diarrhea, constipation, cough and asthma; ④ Frequent exercises of the levator anus have a certain effect on strengthening the function of the sphincter and preventing rectal prolapse.

    references

    [1] Qian Haihua, Jin Heiying, Zeng Li. New advances in the diagnosis and treatment of colorectal and anal canal diseases [M]. Shanghai: Shanghai University of Traditional Chinese Medicine Press, 2009: 165-171

    [2] Lin Yi, Cai Bingqin. TCM clinical diagnosis and treatment of surgical special diseases [M]. Second edition. Beijing: People's Medical Publishing House, 2005: 402-403

    [3] Lu Deming, Lu Jingen. Practical Chinese Medical Surgery [M]. Second edition. Shanghai: Shanghai Science and Technology Press, 2010: 346-350

    [4] Zhou Daqiao, Wan Lisheng. Thinking of diagnosis and treatment of traditional Chinese medicine surgery[M]. Beijing: People's Military Medical Press, 2011: 367-371

    [5] Lu Deming, He Qinghu. Traditional Chinese Medicine Surgery[M]. Beijing: China Press of Traditional Chinese Medicine, 2004:358-362

    [6] Gu Bohua. Practical Chinese Medicine Surgery [M]. Shanghai: Shanghai Science and Technology Press, 1985: 342-346

    [7] Li Chunyu, Zhang Yousheng. Practical Anal Surgery[M]. Shenyang: Liaoning Science and Technology Press, 2005:181-196

    [8] Tan Xinhua, Lu Deming. Traditional Chinese Medicine Surgery[M]. Beijing: People's Medical Publishing House, 1999:618-626

    [9] Tang Hanjun. Clinical research on traditional Chinese medicine surgery [M]. Beijing: People's Medical Publishing House, 2009: 350-356

    [10] State Administration of Traditional Chinese Medicine. The diagnostic efficacy criteria of TCM disease and the diagnostic efficacy criteria of prolapse [S], 1995

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