Common anorectal diseases
Anorectal diseases refer to diseases that occur in the anorectal area. Common diseases include hemorrhoids, anal cryptitis, anal fissures, anal carbuncle, anal leakage, prolapsed anus, polyps, hemorrhoids, and anal occluded hemorrhoids. They are collectively referred to as hemorrhoids and hemorrhoids in ancient literature.
Etiology and pathogenesis
The main pathogenic factors of anorectal diseases are wind, dampness, dryness, heat, qi deficiency and blood deficiency. The wind is good and the number changes, and it is easy to trap heat, heat the intestines, and the blood does not follow the meridian, so the blood in the stool caused by the wind is fresh and bleeding is violent. Severe damp turbidity, often first injury, dampness and heat, local qi and blood in the anus crisscross, tendons and veins to intersect, and the hair is hemorrhoids; dampness and heat accumulation, meridian blocking, qi and blood stagnation, heat and blood rot into pus, forming abscess; Damp heat into the large intestine, unfavorable qi, blood stasis condenses, and polyps are easy to form; heat is easy to damage the body fluid, heat accumulates the intestines, constipation is blocked, local Qi and blood are not smooth, stasis does not disperse and is caused by hemorrhoids, or pressure Blood rash in the stool. Internal congestion of dryness and heat, loss of body fluid, constipation; or blood deficiency, intestinal dryness, blood in the stool caused by hard defecation, etc. Deficiency of qi is often due to loss of spleen and stomach and insufficient qi. If qi deficiency sinks, rectal prolapse and internal hemorrhoids can not be absorbed by ingestion; qi deficiency cannot overcome the evil and cannot be toxin to go out. Therefore, the abscess is difficult to eliminate and collapse after ulceration. Pus is thin; blood deficiency is often due to excessive blood loss or spleen deficiency and lack of source of blood; blood deficiency leads to qi deficiency; qi deficiency leads to blood ingestion, forming a vicious circle; blood deficiency leads to dryness, constipation, and damage to the anus; Wounds are nourished by blood, but blood deficiency is difficult to heal, and it is easy to cause carbuncle and fistula.
1. Blood in the stool is the most common symptom, or a line like an arrow or dripping, and it is more common in hemorrhoids, anal fissures, rectal polyps, and anal lock anal hemorrhoids.
2. Swelling and pain is a common manifestation of perianal abscess, incarcerated hemorrhoids, external hemorrhoids edema, and thrombotic external hemorrhoids. According to the situation of swelling, combined with moss veins, it can be treated according to syndrome differentiation.
3. Prolapse is a common symptom of hemorrhoids, polyps, hemorrhoids, and rectal prolapse. Prolapse of internal hemorrhoids will cause redness, swelling and pain. Some patients have difficulty in resetting. If re-infected with poison, local erosion and necrosis will occur; if Qi deficiency sinks, prolapse will be easy.
4. Pus is more common in anal fistula and anal carbuncle. Those who have yellow and thick pus have more damp-heat accumulation group; those who have thin pus and do not smell, or have sunken wound, have more Qi and Yin deficiency.
5. Constipation is a common symptom of anal fissure, hemorrhoids, anal carbuncle and other diseases. Accompanied by bad breath, body heat, red urine, red tongue, yellow coating, and pulse count, most of them have internal congestion of dryness and heat; accompanied by yellow and white complexion, fatigue, weak tongue, thin and weak pulse, mostly blood deficiency and intestinal dryness.
6. Secretions are common in prolapse of hemorrhoids, rectal prolapse, and anal fistula. Hot and humid betting or heat toxin accumulation, usually accompanied by local swelling and pain, dry mouth, body heat, red urine, loss of appetite, chest tightness, red tongue, yellow greasy coating, pulse string, etc.; the secretion is clear Dilute, mostly due to qi deficiency and prolapse of the anus, deficiency syndrome anal fistula, etc.
Common inspection methods
Anal diseases are often represented by the bladder lithotomy position, which is marked with 12 equal divisions on the clock face. Thrombosis and external hemorrhoids are more likely to occur at 3 or 9 o'clock, anal fissures are more likely to occur at 6 or 12 o'clock, and internal hemorrhoids are more likely to occur at 3, 7, and 11 o'clock. External hemorrhoids usually occur at 6 or 12 o'clock. Generally, if anal fistula is far away from the anal margin, the internal opening is mostly located at 6 o'clock at the stone cutting site; if the distance is relatively close, it is mostly located near the corresponding point of the external opening. Common examination and treatment positions include lithotomy position, knee-thoracic position, lateral lying position, squatting position, and bending position.
The examination of anorectal diseases must be performed on the basis of the history. Common examination methods include anal inspection, digital anorectal examination, speculum (anoscopy), colonoscopy, etc., of which digital anorectal examination is the most common. The method is: in the case of local relaxation of the patient, apply lubricant on the finger cots, first touch the fingertips to the anal edge, and then penetrate into the anus. The process is gradual and not missed, and touch and check for at least 2 turns in clockwise and counterclockwise directions. , Check for lumps, ulcers, stenosis, cracks, etc., and check for blood and secretions on the finger cot.
The treatment of anorectal diseases is divided into two categories: internal treatment and external treatment. The internal treatment is generally used for patients who are in the early stage of anal disease or who are accompanied by severe organ diseases and are not suitable for surgical treatment. Common treatment methods: heat-clearing and cooling blood method, heat-clearing and dampening method, heat-clearing and detoxifying method, heat-clearing and dampening method, activating blood and removing blood stasis method, nourishing qi and blood method, promoting body fluid and moisturizing dryness, invigorating middle and sinking method, etc. External treatment methods include fumigation and washing, application of medicine, suppository, and operation.