2020年10月24日星期六

hemorrhoids and ibs,Anorectal series knowledge and question and answer-perianal abscess

    Perianal abscess

    Acute purulent infection occurs in the soft tissue around the anal canal and rectum or in the space around it, and an abscess is formed, which is called anal canal and perirectal abscess. It is characterized by spontaneous ulceration, or anal fistula often formed after surgical incision and drainage. It is a common anorectal disease. It is also the acute stage of the anal canal and rectal inflammation pathological process, and anal fistula is the chronic stage. Common pathogenic bacteria are Escherichia coli, Staphylococcus aureus, Streptococcus and Pseudomonas aeruginosa, and occasionally anaerobic bacteria and Mycobacterium tuberculosis. It is often a mixed infection of multiple bacteria. Recently, it has also been found to be related to the damage of the anal line. Subcutaneous abscesses around the anus are the most common, mostly caused by anal gland infection spreading outward or directly from the underside of the external sphincter skin.

    Clinical symptoms

    The common symptoms of anorectal abscess are: first feel a small lump or lump around the anus, and then

    Rectal irritation such as increased pain, swelling and fever, falling discomfort, restlessness, sleeplessness, constipation, and poor urination into tenesmus. And subsequently, symptoms of systemic poisoning such as general malaise, mental exhaustion, increased body temperature, loss of appetite, chills and high fever appear. Generally, an abscess can form in about 1 week. A soft, tender, and fluctuating mass can be felt in the rectum around the anus. The pus can be drawn out by puncturing with a syringe. If the pain is relieved or disappeared after the self-ulceration or incision to drain the pus, the body temperature drops and the general condition improves. However, the wound with pus is not easy to heal or it recurs after temporary healing. If it does not heal for a long time, it becomes an anal fistula. The symptoms are also different due to the different locations of abscesses.

    1. Perianal subcutaneous abscess is mainly pain, initially it is swelling pain, throbbing pain during suppuration, and aggravated pain during defecation. Abscess may cause urinary retention in the front of the anus, and abscess may cause pain in the sacral region behind the anus. The symptoms of systemic poisoning are mild, with local swelling, redness, tenderness, and fluctuating sensation.

    2. Ischiorectal fossa abscess The patient has symptoms of systemic poisoning such as general malaise, fever and chills, and elevated body temperature. Locally, swelling, redness, burning pain, throbbing pain, tenderness, restlessness on the side of the anus, increased pain during activity and defecation, and difficulty in urination were seen locally.

    3. Pelvic and rectal fossa abscess The patient has severe systemic symptoms, first chills and high fever, and fatigue, and severe cases may have symptoms of sepsis. Local symptoms are mild, with only rectal falling feeling, soreness or discomfort, and dysuria may also occur.

    4. Posterior rectal abscess The systemic symptoms are similar to pelvic rectal fossa abscess, but the local symptoms are mainly swelling and pain in the coccosacral lumbar region, radiating to the back and both thighs, and coccyx tenderness, and the patient cannot sit upright.

    5. Rectal submucosal abscess The patient has general discomfort, fatigue, and fever. The local symptoms are mainly rectal irritation, such as tenesmus, falling, heavy stools or feeling of stool. Tuberculous anorectal abscess is different from the above-mentioned bacterial infections. The patient often develops chronically. The abscess can only form after several weeks or months. The local pain is not severe, accompanied by low-grade fever, and the local redness and swelling are not obvious. It flows out after ulceration. The pus is clear and milky white, the pus mouth is sunken, the surrounding skin is blue or blue-white, and there are often multiple pus-out outer mouths that do not heal for a long time. Systemic examination can find tuberculosis lesions in the lungs, large intestine or other parts, and pus culture can find tuberculosis bacilli.

    Causes

    There are many causes of perianal abscess, the main reasons are as follows:

    1. Infectious factors: Modern medicine believes that infection is the main cause of this disease.

    2. Iatrogenic factors: clinically iatrogenic peri-anorectal abscesses are not uncommon.

    ① Submucosal abscess is formed due to improper operation or unclean infection of internal hemorrhoids.

    ② Injection of chemical drugs around the rectum stimulates tissue necrosis and causes abscesses around the rectum.

    ③ Sigmoidoscopy, causing peritoneal perforation infection, causing abscess in the retrorectal space.

    ④ Local anesthesia infection, or poor absorption after injection of oil solution, resulting in abscess.

    3. Postoperative factors: clinically, infections caused by anorectal surgery can also be seen, and perirectal abscesses formed, as well as post-urethral infections, post-perineal infections, postpartum perineal ruptures and sutures, and coccosacral osteomyelitis. And so on caused by abscess.

    4. Others: infection after foreign body injury in the rectum, actinomycosis, rectal diverticulitis infection, anorectal cancer rupture or infection spreading to the deep part, weak body, low resistance, or chronic wasting disease, or Malnutrition is the cause of peri-anorectal abscess.

    Complications of perianal abscess

    1. Low anal fistula.

    2. Ischial rectal fossa abscess.

    Pathogenesis and classification

    1. Pathology Peri-rectal infection can be divided into three stages: ① stage of anal gland infection; ② stage of peri-rectal abscess; ③ stage of anal fistula formation.

    After the anal gland is infected, an abscess is formed between the internal and external sphincter, and then it spreads to all sides along the joint fiber, and various abscesses occur. Down to the perianal skin to form perianal subcutaneous abscess; inward to the subcutaneous tissue of the anal canal to form an abscess or ulcer; outwardly through the external sphincter to the ischial rectal fossa to form an ischial rectal fossa abscess, sometimes continuing upward through the levator ani muscle Pelvic and rectal space abscess. The abscess can spread around the anal canal and the lower part of the rectum from one side to the other to form a horseshoe-shaped abscess.

    2. Classification

    (1) Classified by infectious bacteria: ① Non-specific perianal abscess: caused by mixed infections of Escherichia coli, anaerobic bacteria, etc.; ② Specific infection: relatively rare in clinical practice, mainly tuberculous abscess.

    (2) According to the location of abscess: ①Liver abscess (low abscess): including perianal subcutaneous abscess, ischiorectal space abscess, low horseshoe abscess, etc.; ②Liver abscess (high abscess): including pelvic rectal space Abscesses, retrorectal space abscesses, and high horseshoe abscesses.

    (3) Classification according to the final outcome of the abscess: Eisenhammer (1978) divided the anorectal abscess into two categories: fistula abscess and non-fistula abscess. ①Non-fistula abscess: Those who have nothing to do with the anal sinus and anal glands, and no anal fistula eventually remain, are all non-fistula abscesses; ②Fistula abscess: it is caused by infection of the anal sinus and anal glands, and finally left anal fistula.

    Diagnose based on

    1. Anal burning or throbbing pain, aggravated during defecation or walking, a few have difficulty urinating.

    2. It may be accompanied by chills, fever, and general malaise.

    3. B-ultrasound can detect and abscess cavity.

    4. The count of white blood cells and neutrophils increased.

    5. There are induration or lumps around the anus, local temperature increase, tenderness or fluctuation. For abscesses located above the levator ani muscle, a tender mass can be palpable on digital rectal examination, and pus can be extracted by intrarectal puncture.

    How to diagnose perianal abscess:

    ①Extrusion method: the lobular anoscope is used to dilate the crypt at the exposed part of the abscess, and then the abscess is compressed to observe where the pus is discharged, and the internal mouth can be determined.

    ②Double diagnosis: insert the index finger into the anal canal, touch the thumb on the skin, and the thinnest area of ​​the skin and mucous membrane where the abscess fluctuates, that is, the location of the mouth and the outer mouth.

    ③Anoscopy: local congestion of the anal crypt can be seen, and purulent secretions may be present.

    ④ Probe examination: Under the anus speculum, hook the crypt with a probe, which is easier to enter, and if there is pus, it is the internal mouth. It can also be used to explore the inner mouth during incision and drainage. Violence must be avoided during the operation, so as not to cause artificial false internal mouth and cause the operation to fail.

    ⑤ Methylene blue solution staining.

    Discrimination theory

    Perianal abscess should be differentiated from the following diseases:

    ①Folliculitis: It usually occurs around the coccyx and anus, with external openings for draining pus and short shallow sinus tracts, characterized by hairs and small hair follicles in the external openings.

    ② Hidradenitis suppurativa... (Word limit, see details)

    Prevention and health care of perianal abscess

    Acute purulent infection occurs in the soft tissues around the anal canal, rectum or in the surrounding space,

    And form an abscess, called anal canal, perirectal abscess. It is characterized by spontaneous ulceration, or anal fistula often formed after surgical incision and drainage. It is a common anorectal disease, and it is also an acute stage of the anal and rectal inflammation pathological process.

    1. Actively exercise, strengthen physical fitness, improve blood circulation, strengthen local disease resistance, and prevent infection.

    2. Keep the anus clean, change underwear frequently, and clean the anus after going to the toilet, which has a positive effect on preventing infection.

    3. Actively prevent and treat other anal diseases, such as anal cryptitis and anal papillitis, to avoid perianal abscess and anal fistula.

    4. If not treated in time, it can cause other diseases with perianal abscess as clinical manifestations, such as ulcerative colitis and intestinal tuberculosis.

    5. Avoid sitting on the wet ground for long periods of time to prevent the anus from getting cold and wet and causing infection.

    6. The prevention and treatment of constipation and diarrhea is of great significance for preventing the formation of perianal abscess and anal fistula.

    7. Once the anorectal abscess occurs, it should be treated early to prevent its spread and spread.

    8. Actively prevent and treat other anorectal diseases, such as anal sinusitis, anal papillary hypertrophy, anal fissure, inflammatory hemorrhoids, proctitis, etc. The timely, correct and effective treatment can avoid and reduce the occurrence of perianal infections, abscesses and anal fistulas.

    Patients with perianal abscess should eat light and easy to digest food. Avoid fishy and spicy food. Because improper diet can lead to dry stools. When dry and hard stools are discharged, they can tear the anal flap and scratch the anal skin and mucous membranes, making it easy for bacteria to enter the perianal tissues from the wound to cause infection and form abscesses, so you usually eat more fiber. Foods such as sweet potatoes, celery, eggplant, bananas, corn, etc. Using dietary adjustments to prevent constipation and maintain smooth stools will help the recovery of the disease.

    Reasonable allocation of diet. Not only can increase appetite, correct constipation and improve gastrointestinal function, but also develop the habit of regular bowel movements. In your daily diet, you can choose more vitamins and fiber-rich diets such as vegetables, fruits, and beans, and less spicy and irritating foods, such as peppers, mustard, and ginger.

    Perianal abscess should eat more green food

    Vegetables such as spinach, celery, wax gourd, loofah, pumpkin, mung bean, soybean, rape, daylily, fungus, kelp, radish, and water chestnut are light and contain a lot of cellulose, which can clear away heat and detoxify. They are often used , It can relieve the symptoms of local swelling and pain of anus and pus and water.

    Today we will choose two of them to make a winter melon and double bean soup. You need to prepare winter melon, broad beans and mung beans. Wash the wax gourd, peel and cut into pieces, put it in a casserole with broad beans and mung beans, and add an appropriate amount of water.

    Here, fruit is an indispensable thing in our lives, and the same is true for friends suffering from perianal abscess, but you must be selective when eating fruit, you should choose watermelon apples, pineapples, oranges, pears, etc. Because they all have a laxative effect.

    Spicy foods that should be avoided or eaten less, such as wine, chili, ginger, garlic, cinnamon, etc., can stimulate local inflammation and aggravate the condition of abscesses around the anorectum.

    It should also be noted that when taking drugs to treat perianal abscess, some drugs and some diets cannot be taken at the same time. If you are taking heat-clearing and detoxifying agents, you should avoid eating fish, shrimp, mutton, coriander, leeks, etc. It is best not to eat bamboo shoots, dog meat, seafood and other foods.

    Treatment measures

    A small number of perianal abscesses can be resolved with antibiotics, hot water baths and local physical therapy, but most require surgical treatment. There are two ways to operate.

    (1) Treatment of simple abscess

    You can use local anesthesia or spinal anesthesia in the lithotomy position or on your side, and make a radial incision at the abscess site. After the pus is released, the index finger can be extended to explore the size of the abscess cavity and separate the interval. If necessary, cut a little skin on the edge of the incision to facilitate drainage, and finally put a Vaseline gauze into the abscess cavity for drainage.

    (2) Abscesses where the abscess cavity and anal fistula communicate

    After incising the abscess, carefully check the internal opening with a probe, and then incise the fistula, appropriately remove the skin and subcutaneous tissue, and also slightly excise the tissue around the internal opening to make drainage smooth. If the internal mouth is deep and the fistula passes through the anal sphincter, thread hanging therapy can be used. The advantage of the above operation is that the abscess is cured in one stage and anal fistula is no longer formed. However, in acute inflammation, when it is difficult to find the internal ostium, you should not blindly look for it to prevent the inflammation from spreading or the formation of false passages. Only perform incision and drainage. After the anal fistula is formed, perform anal fistula surgery. The advantages of second-stage surgery are accurate results and high cure rates.

    Postoperative care

    The cure of this disease is mainly to change the dressing after the operation, the incision is changed regularly, metronidazole is used to fight infection, the wound is covered with comfrey gauze, the abscess cavity is washed with Kangfuxin liquid, and the gauze soaked with Kangfuxin liquid is used to cover the wound . After abscess surgery, Kangfuxin liquid combined with conventional drug change can form a protective film on the wound surface, which not only keeps the wound surface moist, but also promotes the growth of incision granulation tissue and speeds up the incision healing.

    Treatment of perianal abscess is contraindicated

    Since most perianal abscesses require surgical incision and drainage, attention should be paid to the treatment of some perianal abscesses. The application of antibiotics after routine incision and drainage of uncomplicated perianal abscess is unnecessary.

    In the treatment of perianal abscess, the addition of antibiotics after routine incision and drainage of skin abscess will not improve the healing time or reduce the recurrence, so it is usually not used. However, high-risk patients, such as immunosuppression, diabetes, diffuse cellulitis, or implants, should consider antibiotics.

    In addition, the American Heart Association recommends treatment of artificial heart valves, bacterial endocarditis, complicated congenital heart disease, congenital heart malformations, acquired heart valve disease (such as rheumatic heart disease), hypertrophic cardiomyopathy, and left atrium Patients with abscesses with ventricular valve prolapse with valvular regurgitation and/or cusp hypertrophy should be treated with antibiotics before incision and drainage.

    Perianal abscess does not heal on its own

    If the abscess is deep, there may be systemic symptoms such as fever and fatigue, and the pain and redness of the perianal area are often not obvious.

    Anorectal abscess generally cannot heal by itself. If it is allowed to develop, the abscess will eventually rupture to the perianal skin or the anorectal cavity to form an anal fistula. If the pus is drained, the symptoms can be temporarily relieved, and then the ulcer can heal. The pus continues to accumulate again, the infection continues to spread to the surroundings, and symptoms reappear, and new abscesses may appear, and multiple ulcers may form. Such recurrences will not heal for a long time.

    Therefore, once the anorectal abscess appears, it should be treated in time. A small number of superficial perianal abscesses can be treated with antibiotics, hot water baths, local physiotherapy, etc., but most patients need to surgically incise the abscess and fully drain the pus. Prevent its continuous spread to reduce pain and other symptoms.

    Accompanied by anal fistula around the anorectal abscess, the anal fistula must be treated first to cure the anal fistula. Potassium permanganate solution can be used locally to take a bath to keep the perineum clean.

    At the same time, antibiotics are used to control the infection. About 3 months after the abscess is ruptured or incised and drained, the inflammation around the anal fistula will subside and the fibrous duct will be formed. Then the anal fistula will be treated surgically.

    How to cure perianal abscess?

    The method of radical treatment of perianal abscess is to prevent the intermuscular abscess above and below the levator ani muscle from spreading across the internal anal sphincter to prevent the formation of various types of abscesses and fistulas. It is worth mentioning that: Abscess cavity debridement and drainage, abscess dark cavity removal, has the same meaning as excision of anal recesses and choice of incision. This is a very important link in the radical operation and should not be ignored.

    Experts remind: Once an anal abscess is formed, it should be cut early to reduce local tension to block its spread and spread to the surroundings; when the abscess is debrided, the diseased anal crypt should be removed, and the inner mouth should be found as much as possible; No matter what kind of perianal abscess, it should be given a one-time radical treatment without leaving anal fistula; for different types of perianal abscess, different incisions should be selected to ensure the complete success of the radical operation.

    After choosing the correct position of the abscess incision, the treatment principle for the treatment of perianal abscess is: excise the diseased anal crypt and search for the internal opening as much as possible. Thorough debridement of the dark cavity with incision and drainage, all symptoms can disappear with incision and drainage. During the operation, choose 1 point and 11 point incisions. Abscesses in this area are more common in subcutaneous and intersphincteric abscesses. When scraping after incision, attention should be paid to gender:

    As a radical cure for perianal abscess, women are contraindicated to cut off the skin of the external anal sphincter in front of the anus to prevent anal dysfunction; men often have a dark cavity extending to the penis after incision of the abscess, and scratching should avoid damaging the urethra and adjacent areas. organization.

    In addition, explore the corresponding anal sinus, if the probe easily enters the abscess, it is a primary abscess, the probe can be extended to cut off the internal anal sphincter to facilitate the drainage of the intermuscular abscess into the rectum. Finally, the incision is extended downward, and the subcutaneous external sphincter is cut off, so that the drainage is smooth.

    The above methods for radical treatment of perianal abscess: abscess cavity debridement and drainage, abscess dark cavity removal has the same meaning as excision of anal recess and choice of incision. This is a very important link in the radical resection and should not be ignored.

    Do perianal abscesses need to be drained?

    How will it develop when an abscess is formed around the anorectum and pus is formed? In most cases, pus destroys normal healthy tissues and the lesions gradually increase. If the mesentery is destroyed, the pus will drain into the anal canal, and it can also return to the anal canal by the original path, that is, draining pus from the anal fossa, but in most cases it is ulcerated to the skin, which is the so-called natural draining.

    As the pus was discharged, the pain gradually eased, and finally the inflammation subsided completely. When the condition is mild, the pus can flow out naturally as mentioned above, and it is healed before the patient pays attention. However, it is extremely rare to heal through natural drainage. In most cases, patients have severe pain and require incision and drainage. Unless the condition is very mild, the lesions generally expand day by day, so it is best to incise and drain the pus as soon as possible.

    Although it is an incision, an operation is performed on the site where the pus is stored, so there is no need to make a fuss. There is a lot of pus and the tension is large, and the pus will be ejected at the moment of incision, and the pain will disappear immediately after the pus is drawn out. Most people think that it is cured in this way, but in fact the abscess is still going on. If the treatment is not continued, anal fistula may form.

    By the way, do not apply heat when the abscess is very painful. Hemorrhoids and anal fissures can be relieved by bathing, hot and humid towels and hot compresses. Abscesses are sometimes caused by inflammation. Repeated hot compresses can aggravate the inflammation, and the patient feels uncomfortable. At this time, apply ice-water towels to the affected area and go to the hospital for treatment.

    Treatment measures for fever caused by perianal abscess

    Perianal abscess causes fever because after suffering from perianal abscess, due to bacterial infection in the body, the white blood cell classification count increases. Before the anal abscess ruptures and discharges pus, many patients will have symptoms of chills and fever similar to a cold. This is a normal phenomenon that occurs during the development of the disease, so there is no need to panic. So how should this situation be handled?

    When perianal abscess causes fever, if you cannot go to the hospital in time, antipyretic drugs such as paracetamol and Banlangen can be taken orally according to the instructions. At the same time, drink more boiled water, drink more soup, preferably seaweed soup, winter melon soup, cucumber soup, etc., you can also use mung beans to make mung bean porridge. Pay attention to rest, avoid strenuous activities and physical labor.

    If the body temperature does not return, you can use a hot water bottle to hold the ice water or ice cubes in the refrigerator for external application, and apply it to the forehead, the swelling and painful area around the anus, etc. If you have a heat-clearing and detoxifying medicine at home, you can take it orally. The changes in the condition should be closely observed. Family members should cooperate with the patient to pay attention to changes in breathing and pulse, pay attention to mental status, etc., and always care about the patient's condition. The body temperature can be measured once an hour, pay attention to the changes in body temperature, and be prepared to go to the hospital for treatment if the body temperature is continuously high.

    Perianal abscess fever is also an early symptom of perianal abscess. Therefore, fever accompanied by perianal pain should be checked and treated in the hospital in time, and perianal abscess should be treated early.

    Treatment measures of perianal abscess in children

    Perianal abscess in infants and young children can be treated conservatively or surgically according to different conditions. However, many parents worry that the child is too young and the operation will affect anal function, and they want to wait until he grows up to do it. In fact, this view is wrong. Because if you get a perianal abscess, if it is not treated in time, the abscess will spread and spread, making the disease worse, and it will turn from a minor disease to a serious disease. Those who need surgical treatment should not rely on anti-inflammatory drugs or traditional Chinese medicine plasters and excessively adopt conservative treatments, so as not to delay the timing of surgery. In particular, parents should be reminded not to puncture or squeeze the abscess on their own to avoid accidents such as infection.

    Examination of perianal abscess

    Conventional methods: touch method, probe inspection, dye injection, hydrogen peroxide perfusion, intervention method, low incision and high latex tube drainage method, hydrogen peroxide perfusion method.

    The hydrogen peroxide perfusion method is suitable for various fistulas, especially the high and complex ones. Method: Put 3 to 4 dry cotton balls above the inner tooth line of the rectum under a trumpet anoscope to prevent hydrogen peroxide from flowing into the rectal cavity and burning the intestinal mucosa. Connect the needle tube filled with hydrogen peroxide to a thin plastic tube and insert it into the outer mouth of the anal basket. The outer mouth is moderately compressed with gauze, and the injection is slowly pushed from the outer mouth into the pipe. Under the anal mirror, white foam can be seen flowing out of the inner mouth.

    Interventional method is also very important for the diagnosis of complex and refractory anal fistula. There are two commonly used methods:

    Lipiodol inspection surface: clean the intestines before the inspection, slowly inject the contrast agent from the outer mouth under the guidance of X-ray, and then observe and take pictures from different positions under fluoroscopy.

    Ultrasound: Ultrasound for complex and refractory anal fistula can be accurately diagnosed and effectively treated. Traditional surgical operations are prone to form anal fistula. Ultrasound can accurately determine the location, size, contour, shape and relationship of the abscess around the anus, and at the same time determine whether the abscess is completely liquefied. Not only that, but ultrasound can accurately determine the puncture site. , The direction and angle of the needle and the depth. So as to drain completely, thoroughly and cleanly.

    Precautions

    Attention should be paid to the self-examination of perianal abscess:

    1. Abscesses under the pelvic diaphragm can be seen around the anus or the ischiorectal fossa, swelling, hardening, and even palpable fluctuations. The abscess above the pelvic diaphragm has no abnormal appearance.

    2. Increased white blood cell and neutrophil counts.

    The difference between perianal abscess and anal fistula

    Perianal abscess is caused by inflammation of the rectum and spread to the surroundings to form a thick cavity. When there is less pus, it can be treated with large doses of anti-inflammatory drugs. However, when there is more pus, it should be incised and drained, and a large dose should be used for a long time. Anti-inflammatory medication (generally 7-10 days). If the perianal abscess is not treated in time, anal fistula will develop after the thick cavity is ruptured. The treatment of anal fistula is relatively complicated. Therefore, it is recommended that you treat it with anti-inflammatory treatment under the guidance of a doctor. If there is too much thick fluid that cannot be controlled, cut and drain as soon as possible .

    The difference between perianal abscess and buttocks boil

    1) Peri-anorectal abscess: mostly from anal sinus infection and inflammation, spreading along the anal gland duct to the anorectal area. The onset is sudden and painful, accompanied by systemic symptoms, the abscess is easy to spread, and it is easy to form anus after rupture.

    2) Buttocks boils: The lesions are subcutaneous around the anus. Buttocks boils are superficial and acute purulent diseases with superficial skin. It is characterized by redness, burning, pain, shallow protrusions, and limited swelling, mostly about 3 cm. The center of the swelling is consistent with the opening of the hair follicle. There is a pus plug in the center that has nothing to do with the anal sinus. Most of them rupture spontaneously, and the suppuration will heal. Generally, there is no systemic symptoms and no postoperative anal fistula.

    The difference between perianal abscess and hemorrhoids

    The difference between perianal abscess and hemorrhoids is: perianal abscess is an infectious disease of the anus. At first, it only manifests as a small induration or lump around the anus, and then the pain worsens, redness and fever, swelling and discomfort, dry stool, and inability to urinate Chang and other rectal irritation. The symptoms of systemic poisoning such as general malaise, mental fatigue, chills and high fever, and even sepsis and toxic shock will follow; hemorrhoids are caused by anal varicose veins. The symptoms of external hemorrhoids are mainly pain and itching, while internal hemorrhoids are bleeding and after defecation. Hemorrhoids prolapse mainly.

    The difference between the treatment of perianal abscess and hemorrhoids:

    The treatment of hemorrhoids mainly includes: medicine, local injection, traditional surgery, PPH minimally invasive surgery, etc., which need to be selected according to the actual situation of the patient.

    Perianal abscess is mainly used for anti-infection treatment. Abscesses are formed by incision and drainage. A small number of perianal abscesses can be resolved with antibiotics, hot water baths and local physical therapy, but most require surgical treatment. There are two ways to operate.

    Perianal abscess harm

    Perianal abscess draining pus drags into anal fistula

    Anal fistula is a fistula that connects the outer mouth of the skin of the anal canal with the dental line or the inner mouth of the rectal wall. There is a history of anal swelling and pain before the formation of anal fistula. Anal fistula discharge was intermittent, the anus was swollen and painful before the discharge, and the swelling and pain was relieved after the discharge. In addition, anal discharge also has the following diseases:

    Perianal folliculitis, this disease usually occurs in the tailbone and around the anus. It has an outer mouth that drains pus and a short shallow sinus tract. It is characterized by hair and small hair follicles in the outer mouth.

    Suppurative sweating inflammation, which usually occurs under the skin around the anus, has a wide range of diseased areas and multiple pus-filled sores. The sores can communicate with each other to form a subcutaneous fistula, but the fistula does not communicate with the anal dentition and the rectum. Extensive chronic inflammation and scarring.

    Sacrococcyx bone orange nucleus, the course of the disease is longer, there is a history of systemic orange nucleus and symptoms of orange nucleus, bone damage can be seen after X-ray film, and it has nothing to do with anorectal disease.

    The anterior sacral teratoma is sometimes clinically similar to a retrorectal abscess, but the retrorectal mass is smooth, without obvious tenderness, cystic and lobulated. X-ray examination showed a mass in front of the sacrum, pushing the rectum to the front or one side, and calcification shadows such as scattered teeth can be seen.

    No matter what kind of disease, it is always wrong to be paralyzed by one's own health. Experts remind: While work is important, good health is more important. Whether it is anal disease or other diseases, you should see a doctor in time when symptoms occur, so that early detection, early treatment, and early recovery can be achieved. So that it will not bring more trouble to work and life.

    Related Links: Is the perianal abscess a small boil beside the anus?

    The full name of perianal abscess is perianal abscess, which is called "anal carbuncle" in Chinese medicine. Refers to an abscess formed by infection of the soft tissue around the anus, characterized by the final formation of anal fistula. Abscesses occur in different parts, with different morbidity. The disease develops rapidly, the location is limited, the pain is persistent, the sitting is limited, and the systemic symptoms include aversion to cold and fever. Perianal abscess should be anti-inflammatory, and topical anti-swelling and pain-relieving drugs should be used to achieve the purpose of abscess resolution. However, if the treatment of severe perianal abscess is delayed, it can even form sepsis and life-threatening, so emergency diagnosis and surgical treatment are the main reason. According to the severity of the abscess, incision and drainage, one-time incision and thread-drawing can be used for surgery.

    There are many causes of anorectal abscess, the main reasons are the following:

    (1) Infectious factors: Modern medicine believes that infection is the main cause of the disease:

    1. Perirectal abscess can be formed due to infections such as anal fissure, hemorrhoids, anal sinusitis, hidradenitis of the skin around the anus, and skin diseases around the anus.

    2. There are also certain diseases such as leukemia, diabetes, tuberculosis, ulcerative colitis, aplastic anemia, systemic malnutrition, etc., which make the body weak, reduce resistance, and induce abscesses around the anus.

    (2) Iatrogenic factors: clinically iatrogenic abscesses around anus and rectum are not uncommon.

    1. Submucosal abscess caused by improper operation or unclean infection of internal hemorrhoids.

    2. Injecting chemical drugs around the rectum stimulates tissue necrosis and causes abscesses around the rectum.

    3. Sigmoidoscopy, causing peritoneal perforation infection, causing abscess in the retrorectal space.

    4. Local anesthesia infection, or poor absorption after injection of oil solution, resulting in abscess.

    (3) Postoperative factors: Clinically, infections caused by anorectal surgery can also be seen in the clinic. Perirectal abscesses, infections after urethra surgery, infections after perineum surgery, infections after postpartum perineal rupture sutures, and osteosacral osteomyelitis can also be seen. Abscesses caused by infections.

    (4) Others: such as gun and knife wounds, infection after foreign body injury in rectum, venereal lymphogranuloma, actinomycosis, rectal diverticulitis infection, anorectal malignant rupture or infection spreading to the deep part, and body weakness, resistance Low strength, chronic wasting disease, or malnutrition are all causes of peri-anorectal abscess.

    What to do with recurrent perianal abscess

    Perianal abscess is caused by acute purulent infection in the soft tissues or surrounding spaces around the anorectal canal. If the treatment is not thorough, it often recurs and lasts forever.

    The common causes of perianal abscess are mainly anal fissures, dry stools, or forced defecation, which cause small injuries in the anal canal and rectum. Bacteria in the intestine can infiltrate into the space around the anal canal and rectum through the injured anal glands to form infections and then form abscesses. .

    If the abscess is deep, there may be systemic symptoms such as fever and fatigue, and the pain and redness of the perianal area are often not obvious.

    Anorectal abscess generally cannot heal by itself. If it is allowed to develop, the abscess will eventually rupture to the perianal skin or the anorectal cavity to form an anal fistula. If the pus is drained, the symptoms can be temporarily relieved, and then the ulcer can heal. The pus continues to accumulate again, the infection continues to spread to the surroundings, and symptoms reappear, and new abscesses may appear, and multiple ulcers may form. Such recurrences will not heal for a long time.

    Therefore, once the anorectal abscess appears, it should be treated in time. A small number of superficial perianal abscesses can be treated with antibiotics, hot water baths, local physiotherapy, etc., but most patients need to surgically incise the abscess and fully drain the pus. Prevent its continuous spread to reduce pain and other symptoms.

    Accompanied by anal fistula around the anorectal abscess, the anal fistula must be treated first to cure the anal fistula. Potassium permanganate solution can be used locally to take a bath to keep the perineum clean.

    At the same time, antibiotics are used to control the infection. About 3 months after the abscess is ruptured or incised and drained, the inflammation around the anal fistula will subside and the fibrous duct will be formed. Then the anal fistula will be treated surgically.

    New method to treat perianal abscess

    Anorectal cavity swelling (referred to as perianal abscess) refers to the result of acute and chronic purulent infection of the soft tissues around the anus. Most of the abscesses come from anal gland infection and purulent, spreading to the space around the anal canal, or abscesses formed under the skin and mucosa of the anal canal. This disease is more common in young adults between 20 and 40 years of age.

    Complex condition and rapid development

    The general characteristics of perianal abscess are: sudden onset, severe falling pain in the anus, unbearable pain, and significant clinical symptoms. After the anal abscess is formed, it is easy to spread to the surrounding soft tissue space to form a new abscess. After the abscess matures, it naturally ruptures and discharges pus. Due to the pressure change in the rectum, the gas and liquid in the intestinal cavity continuously enters from the crypts, anal sinuses or nipple openings in the anus, making the abscess cavity difficult to adhere to and heal and form an anus. Fistulas, or infections that branch along the glands of the anal sinus, spread out through the lymphatic vessels and spread along the intermuscular spaces of the sphincter, making the abscess more serious.

    Complications are more harmful

    Perianal abscess is extremely harmful to the human body. It can cause complications such as anemia, skin eczema, anal dysfunction, sepsis, toxemia, sepsis, autonomic disorders, and can also cause gynecological inflammation and other gynecological diseases, leading to impotence, Sexual dysfunction such as premature ejaculation and spermatorrhea, and even induce rectal cancer

    Timely treatment is important

    Therefore, once the disease occurs, it must be treated in time. First, it can prevent the infection from spreading to the whole body, which is life-threatening; second, it can prevent the infection from spreading to the surroundings, leading to horseshoe abscesses and forming complex anal fistulas; third, it can prevent the abscess from becoming anal fistula after rupture; fourth, it can relieve pain; 5. Prevent damage to the anal sphincter and affect anal function.

    Outer clear and inner seal   completely cured within a week

    A large number of clinical cases show that once a perianal abscess occurs, no matter how severe it is, there is no possibility of self-healing. Drug treatment can only assist in reducing inflammation and reducing symptoms. Only surgical treatment can achieve the purpose of healing. According to the etiology and mechanism of perianal abscess, the anorectal disease experts of Shanghai Zhenmei Gynecology Hospital summarized and introduced the "external cleansing and internal sealing surgery" in a large number of clinical treatments. The perianal abscess disease can be completely cured within a week, and gratifying therapeutic effects have been achieved.

    The surgical method includes two parts: "external cleaning operation" and "internal sealing operation". The purpose is to cut the fistula, remove the internal opening, completely eliminate the source of infection, allow the fistula to drain smoothly, and allow the new granulation tissue to grow upward from the bottom of the wound, gradually filling the wound, and thus completely healed.

    The most important thing in "external cleaning operation" is to cut and drain pus in time, and carefully distinguish different types of abscesses such as perianal subcutaneous abscess, rectal submucosal abscess, pelvic rectal fossa abscess, ischiorectal fossa abscess, etc., and adopt targeted drainage and drainage methods. , To achieve smooth drainage, and with the entire course of anti-inflammatory treatment measures, quickly block the spread of inflammation and spread to the surrounding, so that the inflammation can be completely controlled.

    "Internal sealing operation" is a key operation based on the fact that perianal abscess generally has a fixed source of infection in the anus or rectal cavity (that is, the internal mouth). While "external cleansing", carefully search and accurately determine The primary infectious internal mouth is fully incised to completely remove the pus, make the wall of the abscess cavity fall off, and then fill the abscess cavity through granulation growth, and finally cure the abscess.

    A large number of clinical treatments indicate that the success of perianal abscess surgery depends on whether the pus drainage can be completely removed, and on the other, whether the internal orifice can be accurately determined and treated scientifically. The "external cleansing and internal sealing surgical therapy" is precisely to grasp these two joints to implement scientific treatment, and complete cure can be achieved within a week, achieving the purpose of treating both symptoms and root causes and blocking recurrence.

    Why do perianal abscesses need timely surgery

    Perianal abscess is a common anorectal disease, which refers to acute or chronic purulent infections that occur in or around the soft tissues of the anorectum and form an abscess. The onset of perianal abscess is more rapid. After the onset, patients generally suffer from severe pain and limited mobility, and some patients will also experience symptoms such as fever. Long-term incurable, perianal abscess can easily form anal fistula, and it will also bring a series of harm to the body. Therefore, if you want to completely cure perianal abscess, you must perform surgical treatment in time.

    Why should the perianal abscess be operated in time?

    According to hospital experts, suffering from a perianal abscess, if the abscess delays the early surgical treatment, the infection may spread to the surrounding spaces and form a large abscess. Pus can spread from the skin to the ischiorectal fossa, from the affected side to the opposite side through the interstitial space, enter the anus through the internal and external sphincter muscles, penetrate the levator ani muscle upwards and enter the pelvic cavity to form peritonitis, or to adjacent tissues and organs such as The rectum, bladder, vagina, urethra, etc. are eroded and punctured, forming various types of complex anal fistulas. Once a perianal abscess develops into an anal fistula, it is more harmful to the human body. There are four main aspects.

    1. Infection and discharge: Once an anal fistula is formed, there is very little chance of self-healing and it will bring a series of harms. First, after the anal fistula is infected and inflamed, the anus is painful. After the rupture, the pus contaminates the underwear, the pus irritates the local skin, and the anus is itchy. Over time, it can make the body weaker, weaker, less resistant to disease, and more frequent attacks, forming mutual cause and effect.

    2. Increased fistulas and fistulas: Repeated attacks of anal fistula, pus can penetrate the wall and spread along the sphincter space to form multiple and complex anal fistulas, which not only brings difficulties to treatment, but also affects the physiological functions of the anus .

    3. The risk of cancer: The multiple anal fistulas can form rectal-vaginal fistulas, rectal-urethral fistulas and rectal-vesical fistulas, endangering the surrounding organs, and old anal fistulas that have not been cured or mistreated for many years may become cancerous.

    4. Anal incontinence: Allowing the development of anal fistula can cause serious damage to the sphincter and may even cause complications such as anal incontinence.

    There are many reasons for perianal abscess, mainly the following aspects:

    (1) Infectious factors:

    Modern medicine believes that infection is the main cause of this disease:

    1 Due to infections such as anal fissure, hemorrhoids, anal sinusitis, hair follicle inflammation of the skin around the anus, and skin diseases around the anus, perianal abscess can form.

    2 There are also certain diseases such as leukemia, diabetes, tuberculosis, ulcerative colitis, aplastic anemia, systemic malnutrition, etc., which make the body weak and weaken the resistance, and induce abscesses around the anus.

    (2) Iatrogenic factors:

    Clinically, iatrogenic peri-anorectal abscesses are not uncommon.

    1 Internal hemorrhoids are inserted into the hemorrhoids or injection therapy. Submucosal abscess is formed due to improper operation or unclean medicine infection.

    2 Injection of chemical drugs around the rectum stimulates tissue necrosis and causes abscesses around the rectum.

    3 Sigmoidoscopy, causing peritoneal perforation infection, causing abscess in the retrorectal space.

    4 Local anaesthetic infection, or poor absorption after injection of oil solution, resulting in abscess.

    (3) Post-operative factors:

    Clinically, infections caused by anorectal surgery can also be seen. Perirectal abscesses, as well as abscesses caused by postoperative infections of the urethra, postoperative infections of the perineum, postpartum perineal rupture sutures, and postoperative infections of coccosacral osteomyelitis.

    (4) Other:

    Such as gun, knife wounds, infections caused by foreign bodies in the rectum, venereal lymphogranuloma, actinomycosis, rectal diverticulitis infection, anorectal cancer rupture or infection spreading to the deep part, as well as physical weakness, low resistance, or suffering Chronic wasting disease, or malnutrition, are all causes of peri-anorectal abscess.

    How is perianal abscess classified

    The symptoms of anorectal abscess are mainly swelling and pain around the anorectum, swelling, or systemic infections such as fever. The signs are redness and swelling around the anus and rectum, palpable induration and tenderness. According to the specific location, the clinic has the following classifications:

    1. Submucosal abscess of anal canal

    Occurs near the tooth line, local pain, swelling, tenderness, loose anus, and submucosal abscess often communicates with subcutaneous abscess.

    2. Subcutaneous abscess around the anus

    The systemic symptoms are mild, with fever and general malaise. Local pain.

    3. Posterior anal abscess

    Local pain, redness and swelling at the back of the anus, mild systemic symptoms.

    4. Pelvic and rectal fossa abscess

    Local symptoms are not obvious but systemic symptoms are severe. I feel that the rectum and anus are falling down heavily, and I have frequent bowel movements, and the bowels are aggravated, and urination is difficult. The whole body is manifested as fever and fatigue. In severe cases, there are symptoms of toxemia, such as headache, high fever, vomiting, and sweating. The rectal mucosa can be seen locally, and the levator ani can be palpable as a mass, tenderness, and fluctuation. Puncture of abscess cavity can extract pus.

    5. Intersphincter abscess

    Occurs between the internal and external sphincter muscles, local pain, swelling, tenderness, and relaxation of the anus.

    6. Horseshoe abscess

    It is divided into half horseshoe-shaped abscess and full horseshoe-shaped abscess, which are mostly developed by protracted treatment of sciatic rectal fossa abscess, and the performance characteristics are similar to that of ischial rectal fossa abscess.

    7. Rectal submucosal abscess

    Local symptoms are mild and systemic symptoms are severe. Obviously localized swelling and redness of the rectal mucosa can be seen under the rectoscope. Digital rectal examination can feel a limited localized soft mass on the rectal wall, tender and fluctuating, and puncture can extract pus.

    8. Posterior rectal abscess

    The anus is normal, the pain can radiate to the buttocks, and symptoms of systemic poisoning such as fever and general discomfort can occur. The posterior wall of the rectum can be palpable with swelling, tenderness, and fluctuation.

    9, ischial rectal fossa abscess

    Local and systemic symptoms are more obvious. There is redness, swelling, tenderness or fluctuation on one or both sides of the anal margin. The whole body showed symptoms of infection.

    Is surgery necessary for perianal abscess?

    For perianal abscesses that have not become pus at the beginning, use traditional Chinese medicine for cooling blood and detoxification, clearing away heat and dampness. Commonly used medicines include atractylodes, phellodendri, shengdi, red peony root, peony root, sophora japonicus, silver flower, purple dianthus, Sichuan achyranthes, etc. Certain antibiotics can also be used to promote its dissipation. If the person has become pus, it is advisable to cut and drain the pus early to prevent inflammation from invading the space and loose tissues around the anorectum, forming a large abscess cavity. The principles of surgery are:

    1. Choose the lower part of the most obvious part of abscess, make a radial incision, blunt separation, and drain the accumulated pus. If the edges of the incision overlap, the margin of the wound can be trimmed to facilitate drainage without leaving a dead space.

    2. For superficial subcutaneous abscesses, while incising and draining the pus, look for the infected anal sinus at the dental line, that is, the internal opening; then extend the incision to communicate with the internal opening; trim the edge of the incision so that the incision goes outside the anus properly Extend, juxtapose drainage to facilitate drainage.

    3. For submucosal abscess, the abscess should be exposed under anoscope, and a longitudinal incision is made in the center to drain the pus; then the abscess cavity is separated with a vascular forceps to drain the remaining pus, and red ointment gauze is placed for drainage.

    Severity of perianal abscess

    Many patient friends ask, is the perianal abscess serious? According to experts, perianal abscess refers to acute and chronic suppurative infections of the soft tissue around the anus, mostly from anal gland infection and purulent, spreading to the space around the anal canal, or the subcutaneous and mucosa of the anal canal Abscesses formed under. The severity of perianal abscess is manifested in:

    (1) This disease is more common in young adults between 20 and 40 years old. There are more men than women, and infants and young children also occur from time to time.

    (2) The onset is abrupt, with severe falling pain in the anus, unbearable pain, and significant clinical symptoms.

    (3) After the anal abscess is formed, it is easy to spread to the surrounding soft tissue space, and can bypass the back of the anus and spread to the opposite side to form a new abscess. This phenomenon of spreading to surrounding tissues to form multiple abscesses is the main feature of anorectal abscesses.

    (4) After the abscess matures, it naturally ruptures and drains pus, forming an anal fistula.

    Are perianal abscesses serious? Because of the different locations and causes of the abscesses, the clinical manifestations are also different. Symptoms of perianal abscess:

    The main symptoms of anorectal abscess caused by bacterial infection are: at first a small hard lump or mass around the anorectum is found; then local sudden severe pain is unbearable, redness and fever, swelling and discomfort, restlessness, tenesmus, constipation , Poor urination, symptoms of rectal irritation, followed by symptoms of systemic poisoning such as increased body temperature, loss of appetite, chills, fatigue and fatigue. Generally, an abscess can form in about 1 week. After the abscess is formed, a fluctuating, soft abscess cavity can be palpable around the anus or on the digital rectum. At this time, pus can be drawn out by puncturing with a syringe. If an incision is performed to drain the pus, or after the pus is self-ulcerated, the symptoms such as local pain and fever will alleviate or disappear, the body temperature will drop, and the general condition will improve.

    The clinical manifestations of tuberculous anorectal abscesses are often chronic onset. The abscesses can take several weeks or months to form. The local pain is not severe and often accompanied by low-grade fever. The pus flowing out after ulceration is clear and milky white, the pus mouth is sunken, and there are often multiple pus outside mouths that do not heal for a long time. A systemic examination can find tuberculosis lesions, and a pus culture can find tuberculosis bacilli.

    Once a deep abscess is formed, if the early surgical treatment of the abscess is delayed, the infection may spread to the surrounding space and form a larger abscess. Pus can spread from the subcutaneous to the ischiorectal fossa, from the affected side to the contralateral side through the interstitial space, enter the anus through the internal and external sphincter muscles, penetrate the levator ani muscle upwards and enter the pelvic cavity to form peritonitis; or to adjacent tissues such as The rectum, bladder, vagina, urethra, etc. erodes, forming a complex anal fistula.

    Therefore, after the abscess is formed, it must be treated in time, otherwise, it will not only increase the physical pain for the patient, but also cause serious harm to the human body.

    Daily care of perianal abscess

    1. Sit as little as possible and stand more. Sitting for a long time will aggravate hemorrhoids.

    2. Cultivate the habit of sleeping on the side. When sleeping on your back, the hemorrhoids are located under the layer of the heart. As a result, blood flows to the hemorrhoids, which aggravates the congestion and enlargement of blood vessels.

    3. To keep the anus clean, use potassium permanganate warm water for a bath.

    4. After each bowel movement, remember to wash the anus with warm water and dry it.

    5. Eat more fruits and vegetables to correct constipation. Eating more foods rich in dietary fiber such as oats and brown rice, and properly eating new radishes, lettuce, cucumber, lettuce, and Chinese cabbage heart on the table can improve the condition of hemorrhoids.

    6, pay attention to eat less fried and smoked food, eat less fragrant and fat greasy food, do not eat too dry, too full for dinner.

    7. Vitamin E can be taken at ordinary times, which can help treat intractable constipation.

    8. Under the guidance of mind, make the anus loose and tighten, 5 minutes each time, 2 times a day.

    9. Cold compress: Put a wet towel in a plastic bag, then put it in the refrigerator for 20 minutes, take it out of the plastic bag, and apply it around the anus for about 10 minutes.

    10. Avoid constipation and have regular bowel movements.

    Prevention and rehabilitation of perianal abscess

    (1) Preventive health care: There is no better preventive method for this disease. Comprehensive measures should be adopted to improve local blood circulation and enhance the body's ability to resist disease. The main point of prevention is to pay attention to anal cleanliness, frequent washing or bathing. At the same time, it is necessary to prevent constipation and diarrhea.

    (2) Rehabilitation and health care: Once perianal abscess is formed, anti-infection treatment should be carried out immediately; bed rest should be paid attention to; activities should be reduced. The diet should be light and easy to digest, avoid irritating food. Partially can be fumigated, bathed or hot compress; after the frail elderly or infants suffer from perianal abscess, due to poor resistance, inflammation is easy to spread, and should be treated as soon as possible.

    Perianal abscess is not cut in time, harm

    Once the abscess is formed and not cut in time, it will not only increase the patient’s pain, but may also

    Lead to serious consequences or even sequelae. If an early incision is made in time after the abscess is formed, the tension in the abscess cavity will suddenly weaken after the pus is discharged, the abscess will not invade the surrounding spaces and tissues, the patient’s pain can be greatly relieved, and the chance of forming a fistula is relatively small. Even if a fistula is formed, it is relatively simple, and its position is relatively low, and it is easy to cure.

    Perianal abscess should be prevented before it occurs; after it occurs, non-surgical treatment with integrated traditional Chinese and western medicine should be actively used to make it dissipate as soon as possible; and once the lump is mature, surgical incision should be used for treatment in time.Because after the abscess is formed, the internal pressure gradually increases. Due to the loose tissue around the anus, there are more gaps. When the tension in the abscess is greater, the pus will flow and spread to the surrounding gaps, thereby forming a larger area of ​​abscess, such as pus The fluid can spread from the superficial subcutaneous to the deeper ischiorectal fossa, and even to the deeper pelvic rectal space; from one side of the anus through the lymphatic tissue space to the opposite side, it can also enter the anus through the internal and external sphincter muscles. It can penetrate the levator ani muscle upward and enter the pelvic cavity to form peritonitis. In more serious cases, the adjacent tissues and organs such as rectum, bladder, vagina, urethra, etc. can be eroded and punctured to form a variety of complex anal fistulas.

    There is a kind of tissue called anal gland in the perianal area. The gland is located in the anal sphincter. Its opening is in the anal sinus on the tooth line of the anus. Usually the secretion of the anal gland enters the rectal cavity through the opening at the anal sinus, which lubricates the intestine effect. The opening of the anal sinus is upward, like the pocket of a person’s clothes. The fluid and feces in the intestinal cavity are easily retained here. When the infectious substance in the feces enters the anal sinus, it can cause anal sinusitis. The inflammation can be along the anal gland orifice and the anal gland duct. It spreads to the anal glands, and finally enters the space around the anorectum through the lymphatic vessels, causing the soft tissue to infect and purify and form the disease.

    The infection around the anus is easy, but there are incentives for infection. What is the cause of the onset of perianal abscess? By asking the medical history of some patients and enlightenment from leukemia, Crohn’s disease, tuberculosis, diabetes prone to this disease, physical fatigue or Weakness, decreased resistance and poor diet are the main causes of local infections. Many patients complained of irregular life before the onset, lack of sleep, overwork, or excessive drinking, or excessive consumption of seafood, spicy, meat, etc.

    Irregular diet: Overeating is pungent, spicy, thick, full-bodied so as to be damp and turbid, damp-heat endogenous, damp-heat scars and poison flow in the anus to form a mass.

    Exogenous wind-heat: The body feels the external evil, and the evil spirit does not dissipate. Cause the anus to swell up and become lump.

    Deficiency of the lungs, spleen and kidneys, betting due to dampness and heat deficiency, depression due to dampness and heat, weight-bearing running, non-stop labor and fatigue after illness, all of the above factors hurt vitality, and Qi injury causes dampness. , Dampness gathers heat, and damp heat is injected into the large intestine to cause an abscess.

    Adjust your diet to prevent constipation: Improper diet can lead to dry stools. When dry stool is discharged, it can tear the anal flap and scratch the anal skin, destroying the first line of defense against diseases. Bacteria can easily enter the wound and cause infection and form abscess. This is the reason why many patients with anal fissure have secondary abscesses. So usually eat more foods containing more fiber, such as sweet potatoes, celery, eggplant, bananas, corn, etc. to promote smooth stool.

    Experts on perianal abscess knowledge remind: the nursing of abscess patients is to reduce activities, rest in bed, mainly light and easy to digest food, avoid eating soy milk, tofu, fresh fish, etc. Wash the anus more frequently and don't soak it in hot water. Do not puncture the abscess by yourself. The topical ointment should be changed twice a day. Elderly and infirm people who suffer from abscess due to poor resistance and easy to spread, should go to the hospital for treatment as soon as possible.

    Why are men more susceptible to perianal abscess?

    Clinical statistics show that there are more perianal abscesses in men than women. Generally, the ratio of male to female in newborns is 8-9:1, while that in young adults is 5-6:1. Perianal abscesses are mainly caused by men. The anal glands are particularly developed and there are many secretory glands, so the chance of infection increases.

    Like the sebaceous glands, the development and function of the anal glands of the human body are mainly regulated by sex hormones. The level of sex hormones directly affects the proliferation and atrophy of anal glands, and androgen has the greatest influence among sex hormones. Therefore, the level of sex hormones is closely related to the incidence of paraanal abscess.

    In a person's life, the androgens from the mother's body in newborns show a high level in a stage, which makes the neonatal anal glands particularly developed, so peri-anal infections are more common, especially in male infants. With the development and growth of newborns, the transient androgen levels physiologically decline, so the incidence of children and around puberty has decreased.

    At puberty, sex hormones in the body begin to become active. Androgen levels in men and young adults increase, making the anal glands grow faster and more obvious than women, so the incidence of paraanal abscesses increases significantly. In old age, androgen levels decrease significantly and anal glands shrink, so paraanal abscesses are extremely rare in the elderly.

    Compared with women, men have more alcohol and work pressure, which may also be one of the reasons why men have more paraanal abscesses. Because anal fistula is a sequelae of paraanal abscess, the incidence of anal fistula in men is significantly higher than that in women.

    How to cure perianal abscess at one time

    For the treatment of perianal abscess, how can perianal abscess be cured at one time? First, if you want to cure perianal abscess in one go, incision should be made at the early stage of perianal abscess formation to reduce local tension to block its spread and spread to the surroundings; In the debridement of the abscess, the affected anal crypt should be removed, and the internal opening should be found as much as possible; no matter what kind of perianal abscess, it should be radically cured at one time without leaving anal fistula and other sequelae; for different types of perianal abscess, it is appropriate Different incisions to ensure the complete success of the radical operation.

    After choosing the correct position of the abscess incision, the principle of treatment of perianal abscess is to remove the diseased anal crypt and search for the internal opening as much as possible. Thorough debridement of the dark cavity with incision and drainage, all symptoms can disappear with incision and drainage. During the operation, choose 1 and 11 o’clock incisions. Abscesses in this area are more common in subcutaneous and sphincter interstitial abscesses. When scraping after incision, attention should be paid to gender: Women should not cut off the skin of the external anal sphincter in front of the anus to prevent anal function Obstacles; men often have dark cavities extending to the penis after incision of the abscess. Avoid damaging the urethra and adjacent tissues when scraping.

    In addition, explore the corresponding anal sinus, if the probe easily enters the abscess, it is a primary abscess, the probe can be extended to cut off the internal anal sphincter to facilitate the drainage of the intermuscular abscess into the rectum. Finally, the incision is extended downward, and the subcutaneous external sphincter is cut off, so that the drainage is smooth. The above surgical root treatment method can prevent the intermuscular abscess of the upper and lower levator ani muscle from spreading across the internal anal sphincter to prevent the formation of various types of abscesses and fistulas.

    In the treatment of perianal abscess, it is necessary to pay attention to: abscess cavity debridement and drainage, abscess dark cavity removal has the same significance as excision of anal crypts and choice of incision. This is a very important link in the radical treatment of perianal abscess. ,Can not be ignored.

    Will perianal abscess complicate anal fistula?

    Will anal fistula be complicated by perianal abscess? The answer is yes, more than 95% of patients with anorectal abscess will be complicated by anal fistula. Why is this?

    It turns out that the abscesses around the anorectum are mostly from anal gland and anal sinus infection. Because the anal duct opens in the anal sinus, the opening of the anal sinus is funnel-shaped upwards. The anal duct can pass through the internal sphincter to the joint longitudinal muscle; some believe that the anal duct can pass through the levator ani muscle and the external sphincter Into the space around the anorectum, fecal residues, foreign bodies, inflammatory secretions, Escherichia coli, staphylococcus, streptococcus, tuberculosis, anaerobic bacteria enter the anal sinus and cause anal sinusitis and anal ductitis. The inflammation spreads along the anal gland duct to the subcutaneous anal duct, between the internal and external sphincter and the joint longitudinal muscle.

    In addition, the abundant lymph and blood vessels are the way to spread around the anus, leading to inflammation of the anus. Since anal gland infection is the cause of anorectal abscess, anorectal abscess and anal fistula are different stages of the same disease.

    In addition, after the original anal gland continues to be infected, the root cause of the disease still exists, and the repeated stimulation of inflammation can cause the surrounding connective tissue to proliferate and the abscess cavity to shrink into a curved and narrow channel, making local drainage difficult and unable to heal. At the same time, bacteria and dirt can also enter from the abscess ulcer, causing infection and inflammation, sometimes ulceration, and repeated attacks.

    Therefore, most patients suffering from perianal abscess will merge into anal fistula. Therefore, after getting a perianal abscess, we must treat it in time, and eliminate the perianal abscess in the bud before it merges into an anal fistula.

    Why must perianal abscess be treated early?

    When suffering from a perianal abscess, once the deep abscess is formed, the internal pressure gradually increases. At this time, as in early surgery, not only can the abscess cavity heal early and prevent its spread, but also it is not easy to form an anal fistula. Even if it forms, it is easier to treat . If the abscess delays the early surgical treatment, the infected focus is likely to transfer to the surrounding space, forming a larger abscess. The pus can spread from the subcutaneous to the ischiorectal fossa, from the affected side through the interstitial space to the opposite side. It can enter the anus through the internal and external sphincter muscles and penetrate the levator ani muscle upwards into the pelvic cavity to form peritonitis; or it can erode and puncture adjacent tissues and organs such as the rectum, bladder, vagina, and urethra, forming various types of complex anal fistulas.

    Therefore, after the abscess is formed, if the early incision is not performed in time, it will not only increase the invisible pain, but also cause serious harm to the human body.

    The hospital experts suggested that the examinations needed for perianal abscess:

    1. Digital examination: Digital examination plays an important role in checking the shape and nature of the abscess, whether there is a fistula, the running of the fistula, and the muscle level.

    2. Probe inspection and Methylene blue inspection: determine the fistula running and the position of the internal mouth.

    3. Endoscopy: observe whether there are internal openings, fistulas and other diseases in the rectum.

    4. X-ray lipiodol imaging.

    5. Pus bacterial culture and biopsy.

    Will perianal abscess be complicated by anal fistula?

    It turns out that the abscesses around the anorectum are mostly from anal gland and anal sinus infection. Because the anal duct opens in the anal sinus, the opening of the anal sinus is funnel-shaped upward, and the anal duct can pass through the internal sphincter to the joint longitudinal muscle; some believe that the anal duct can pass through the levator ani muscle and the external sphincter Into the space around the anorectum, fecal residues, foreign bodies, inflammatory secretions, Escherichia coli, staphylococcus, streptococcus, tuberculosis, anaerobic bacteria enter the anal sinus and cause anal sinusitis and anal ductitis. The inflammation spreads along the anal gland duct to the subcutaneous anal duct, between the internal and external sphincter and the joint longitudinal muscle.

    In addition, the abundant lymph and blood vessels are the way to spread around the anus, leading to inflammation of the anus. Since anal gland infection is the cause of anorectal abscess, anorectal abscess and anal fistula are different stages of the same disease. In addition, after the original anal gland continues to be infected, the root cause of the disease still exists, and repeated stimulation of inflammation can cause the surrounding connective tissue to proliferate and shrink the abscess cavity into a curved and narrow channel, making local drainage difficult and unable to heal. At the same time, bacteria and dirt can also enter from the abscess ulcer, causing infection and inflammation, sometimes ulceration, and repeated attacks. Therefore, after suffering from anal abscess, most of them will merge into anal fistula.

    The anus is a very private place, but it is also a place that is prone to accidents. A little attention to hygiene can cause various diseases. Anal pain is one of them. Anal pain is caused by many diseases. We must not Ignore.

    Postoperative nursing measures for perianal abscess

    1. The diet is based on high protein and low fat. Drink plenty of soups to promote nutrient absorption. Avoid spicy and stimulating wines, and eat more fruits and vegetables to keep stool smooth. Avoid eating cold and greasy products to prevent diarrhea or clogging of the anal sinuses with feces.

    2. Adhere to anal sitz bath after defecation, use potassium permanganate solution or physiological saline, or use traditional Chinese medicine to fumigate the anus.

    3. Replenish liquids or antibiotics according to doctor's orders, or take various drugs orally.

    4. Pay attention to whether there is blood oozing on the wound. If the dressing has become wet, it should be replaced in time. It is better to live with fresh red granulation during dressing change. If the granulation tissue grows higher than the epidermis, it should be trimmed; if the wound bridge is healed or the suture wound is infected, the open opening should be stripped, or the suture open should be removed. For those who have sutures, if the sutures fall off at 7-9 days after the operation, the sutures should be replaced and re-hanged. The suture wound should be removed within 5-7 days. It is also necessary to keep the drainage of the wound smooth and fill the vaseline gauze. Or medicine strips should be close to the wound, and the inner mouth should be in place, so that the granulation of the wound should grow from the bottom to the top, from the inside to the outside, so that bridge healing can be avoided and the best surgical effect can be obtained.

    Fifty-two method to prevent perianal abscess

    Kangtai experts advocate the use of the "May 12" method to prevent perianal abscess: "May 1" means five "a cup", that is, drink a glass of boiled water after getting up in the morning, a glass of soy milk at breakfast, and a bowl of soup at lunch Drink a bowl of porridge at dinner and a glass of milk half an hour before going to bed. "Two" means to drink two cups of tea in the morning and the afternoon. In addition, to prevent perianal abscess, you can also eat some sour foods such as vinegar. Second, we must actively participate in sports. People who sit for a long time and stand for a long time are prone to obstacles to local blood circulation in the anus, resulting in reduced local disease resistance and infection. Active participation in sports is beneficial to increase the disease resistance of the anus. Third, keep the anus clean. The anus is a place where bacteria can easily grow and multiply. It should be cleaned frequently and underwear should be changed frequently.

    Five common manifestations of perianal abscess

    Acute purulent infection occurs in the soft tissue around the anal canal and rectum or in the space around it, and an abscess is formed, which is called perianal abscess. It is characterized by spontaneous ulceration, or anal fistula often formed after surgical incision and drainage. So, what are the common symptoms of perianal abscess, let's take a look at it together.

    Five common symptoms of perianal abscess:

    1. Perianal subcutaneous abscess is mainly pain, initially it is swelling pain, throbbing pain during suppuration, and aggravated pain during defecation. Abscess may cause urinary retention in the front of the anus, and abscess may cause pain in the sacral region behind the anus. The symptoms of systemic poisoning are mild, with local swelling, redness, tenderness, and fluctuating sensation.

    2. Ischiorectal fossa abscess The patient has symptoms of systemic poisoning such as general discomfort, fever and chills, and elevated body temperature. Locally, swelling, redness, burning pain, throbbing pain, tenderness, restlessness on the side of the anus, increased pain during movement and defecation, and difficulty urinating were seen locally.

    3. Pelvic and rectal fossa abscess The patient has severe systemic symptoms, first chills and high fever, and fatigue, and severe cases may have symptoms of sepsis. Local symptoms are mild, with only rectal falling feeling, soreness or discomfort, and dysuria may also occur.

    4. Posterior rectal abscess Systemic symptoms are similar to pelvic rectal fossa abscess, but the local symptoms are mainly swelling and pain in the coccosacral lumbar region, radiating to the back and both thighs, coccyx tenderness, and the patient cannot sit upright.

    5. Rectal submucosal abscess The patient has general discomfort, fatigue, and fever. The local symptoms are mainly rectal irritation, such as tenesmus, falling, heavy stools or feeling of stool.

    Symptoms of perianal abscess in different parts are also different

    According to the different locations of perianal abscesses, we can divide them into five types: perianal subcutaneous abscess, ischiorectal fossa abscess, pelvic rectal fossa abscess, retrorectal abscess and rectal submucosal abscess. The incidence of perianal abscess is different, so its symptoms are also different. Let's take a look at it in detail below!

    Different symptoms of perianal abscess:

    1. Ischiorectal fossa abscess: The patient has symptoms of systemic poisoning such as general discomfort, fever and chills, and elevated body temperature. Locally, swelling, redness, burning pain, throbbing pain, tenderness, restlessness on the side of the anus, increased pain during movement and defecation, and difficulty urinating were seen locally.

    2. Pelvic and rectal fossa abscess: The patient has severe systemic symptoms, first chills and high fever, and fatigue, and severe cases may have symptoms of sepsis. Local symptoms are mild, with only rectal falling feeling, soreness or discomfort, and dysuria may also occur.

    3. Perianal subcutaneous abscess: It is mainly pain, at first it is swelling pain, throbbing pain during suppuration, and aggravated pain during defecation. Abscess may cause urinary retention in the front of the anus, and abscess may cause pain in the sacral area behind the anus. The symptoms of systemic poisoning are mild, with local swelling, redness, tenderness, and fluctuating sensation.

    4. Rectal submucosal abscess: The patient has general discomfort, fatigue, and fever. The local symptoms are mainly rectal irritation, such as tenesmus, falling, heavy stools or feeling of stool.

    5. Posterior rectal abscess: The systemic symptoms are similar to pelvic rectal fossa abscess, but the local symptoms are mainly swelling and pain in the urosacral lumbar region, radiating to the back and both thighs, and the coccyx has tenderness. The patient cannot sit upright.

    Can perianal abscess be infected?

    Perianal abscess is an acute and severe disease in the anorectal department. It refers to acute or chronic purulent infections that occur in or around the soft tissues of the anorectum and form an abscess. It is characterized by spontaneous ulceration, or anal fistula often formed after surgical incision and drainage. It is a common anorectal disease.

    Perianal abscess is very harmful if it is not treated in time

    1. Infection and discharge: Once an anal fistula is formed, there is very little chance of self-healing, and it will bring a series of harm. First, after the anal fistula is infected and inflamed, the anus is painful. After the rupture, the pus contaminates the underwear, the pus irritates the local skin, and the anus is itchy. Over time, it can make the body weaker, weaker, less resistant to disease, and more frequent attacks, forming mutual cause and effect.

    It is necessary to prevent perianal abscess during the dry season. The wind has been particularly strong during the recent period, and the climate is dry. Therefore, the number of people suffering from constipation has increased. Tearing the anal flap and scraping the skin of the anus, bacteria can easily enter from the wound and cause infection to form an abscess. This is the reason why many patients with anal fissure have secondary abscesses.

    How to prevent perianal abscess in the dry season?

    1. Pay attention to diet first

    Try to eat less spicy food and avoid white wine, so as not to add dryness. Eat more fruits such as white pears, bananas, apples, cantaloupe, lychees, and increase water and liquid food intake, such as boiled winter melon soup, lotus root soup, white radish and peanuts Soup, Chinese cabbage soup, white pear and white fungus soup, etc.

    Treatment of perianal abscess

    Perianal abscess is a late symptom of perianal infection. If the perianal abscess is not effectively controlled, it is an anal fistula. If the pustule of the perianal abscess is not large, the skin can be metabolized, and it will generally not develop into an anal fistula. Peripheral abscess is very large, and the pus head is out, and the pus is broken. 70% of people have anal fistula. For this reason, severe perianal abscess must be treated with surgery to be completely cured.

    A small number of patients with perianal abscesses can use antibiotics, hot water baths and local physical therapy to dissipate the abscesses, but most require surgical treatment. There are two ways of surgery: treatment of simple abscesses, abscesses that communicate with anal fistula, as detailed below We will introduce these two methods in detail.

    1. Treatment of simple abscess: You can use local anesthesia or spinal anesthesia in the lithotomy position or lying on the side, and make a radial incision at the abscess site. After releasing the pus, extend your index finger to explore the size of the abscess cavity and separate the interval. If necessary, cut a little skin on the edge of the incision to facilitate drainage, and finally put a Vaseline gauze into the abscess cavity for drainage.

    2. Abscesses in which the abscess cavity and anal fistula are connected: After incising the abscess, use a probe to carefully check the internal opening, then incise the fistula, and appropriately remove the skin and subcutaneous tissue. The tissue around the internal opening is also slightly removed to make drainage smooth. If the internal mouth is deep and the fistula passes through the anal sphincter, thread hanging therapy can be used. The advantage of the above operation is that the abscess is cured in one stage and no anal fistula is formed. However, in acute inflammation, when it is difficult to find the internal ostium, you should not blindly look for it to prevent the inflammation from spreading or the formation of false passages. Only perform incision and drainage. After the anal fistula is formed, perform anal fistula surgery. The advantages of second-stage surgery are accurate results and high cure rates.

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