Author: Xing Yunli
Anorectal dieases about anorectal disease
Q: Is it necessary to treat hemorrhoids?
Answer: Hemorrhoids are universally present in all ages, genders, and races. Asymptomatic, no treatment is required. However, when hemorrhoids attack, it affects normal life and physical health, called hemorrhoids, and needs to be treated.
Q: Can hemorrhoids be treated with medicine?
Answer: Medications can improve the symptoms of hemorrhoids, external hemorrhoids swelling and pain, thrombosis, internal hemorrhoid bleeding and slight prolapse, etc. Oral and topical drugs can be used. The symptoms of hemorrhoids disappear, the impact on life is eliminated, and the purpose of treatment is achieved. Hemorrhoids can not be completely eliminated, and there is no need to eliminate them. Usually, through a good diet and defecation habits to avoid symptoms of hemorrhoids.
Hemorrhoid attacks, improvement of diet and bowel habits, the first choice for treatment, the symptoms significantly affect the quality of life, especially bleeding and prolapse symptoms can not be relieved, consider surgery.
Q: What are the medicines for hemorrhoids?
Answer: Including sitz bath medicine, topical and oral medicine, which can improve the symptoms of hemorrhoids to a certain extent or completely. External medicines include hemorrhoid creams and suppositories, as well as traditional Chinese medicine and western medicine. Oral drugs can also significantly eliminate the uncomfortable symptoms such as bleeding, swelling and pain caused by hemorrhoids. Western medicines are intravenous enhancers to improve venous return. Traditional Chinese medicines are mainly used to cool blood to stop bleeding, moisturize the intestines and relieve swelling and pain.
→Reference article: "Hemorrhoids struck, how much do you know about the power of drugs"
Q: Do you need surgery for external hemorrhoids?
Answer: External hemorrhoids generally do not need to be considered for surgery. Inflammatory external hemorrhoids or thrombotic external hemorrhoids can be severely painful and can be treated surgically, or when combined with internal hemorrhoids require surgical treatment, the external hemorrhoids should be removed or stripped at the same time.
(1) Thrombotic external hemorrhoids: The smaller thrombus is absorbed in about a week, the pain is relieved, and it can heal itself. Larger thrombus is more difficult to absorb. Although the pain is relieved after treatment, but the local mass is hard, surgical removal of the thrombus may be considered.
(2) Varicose external hemorrhoids: surgical method to strip the external venous plexus of hemorrhoids,
(3) External hemorrhoids of connective tissue: No special treatment is needed. If the external hemorrhoids have too large skin tags that affect the hygiene of the perianal area, or those with repeated inflammation and edema, they can be treated surgically.
(4) Inflammatory external hemorrhoids: Inflammatory edema, swelling, pain or long-term non-regression, surgical removal.
Q: Under what circumstances does hemorrhoids need surgery?
Answer: Hemorrhoids have recurring attacks, and the symptoms continue to be unable to improve after medication, and further examination and treatment are required in the hospital.
Internal hemorrhoids develop to stage 3-4, with repeated bleeding, prolapse from the anus after defecation or walking tired, or if the prolapse cannot return to the anus, the medicine cannot be relieved and requires surgical treatment.
External hemorrhoids are generally not recommended for surgery. When thrombosis and inflammatory connective tissue external hemorrhoids occur, the swelling cannot be reduced by medication or the combined internal hemorrhoids require surgical treatment, they should be removed or stripped.
Q: Will hemorrhoids become cancerous without surgery?
Answer: Anorectal malignant disease itself has nothing to do with hemorrhoids, and hemorrhoids will not become cancerous.
Question: What should I do if the mixed hemorrhoids prolapse and cannot be returned to the anus and are swollen and painful?
Answer: Mixed hemorrhoid incarceration is a common emergency in the anorectal department. Usually, patients with hemorrhoids, prolapse of hemorrhoids cannot be reset in time, internal hemorrhoids and lymphatic drainage are blocked and thrombosis is formed, internal hemorrhoids swell and become hard and incarcerate outside the anus, and anal sphincter spasm worsens Local circulation disorder. It can cause hemorrhoid ulcer, erosion and local necrosis, external hemorrhoid edema and severe pain.
Internal hemorrhoids should be restored and reset in time within a few hours of prolapse. It can be combined with oral medications to improve venous reflux and topical ointments to relieve symptoms, or active surgical treatment.
Q: Will hemorrhoid surgery be painful?
Answer: Open wounds are mostly used for anorectal diseases, and the recovery period takes 3 weeks to 1 month. Due to daily defecation, the stool passing through the wound in the anus will cause pain, and the anal sphincter will be stimulated and spasm will cause pain. But through good postoperative pain management, current hemorrhoid surgery, pain can be well controlled
Question: What are the main surgical methods for hemorrhoids?
Answer: The difference in hemorrhoid surgery is the way to deal with internal hemorrhoids. Divided into two categories, one is the non-resection of hemorrhoids, including sclerosing agent injection, infrared coagulation therapy and cryotherapy, bipolar diathermy, ultrasound Doppler guided hemorrhoid artery ligation, band ligation, etc.; Hemorrhoidectomy, including closed resection, open hemorrhoidectomy, Ligasure hemorrhoidectomy, laser hemorrhoidectomy, etc. The operation of external hemorrhoids is basically a resection.
Q: I often see sclerosing agent injection treatment on the Internet. Is it useful?
Answer: The sclerosing agent injection treatment is suitable for internal hemorrhoids with 1-2 stage bleeding, and the short-term effect is obvious. Injection therapy can also prevent or reduce the symptoms of hemorrhoids prolapse in stage II and III.
→Reference article: ""One Needle for Hemorrhoids" | Past and Present of Sclerosing Agent"
Question: Some people say that hemorrhoids can be treated by threading, right?
Answer: Ligation is a traditional treatment for hemorrhoids. It is a method of treating internal hemorrhoids. Silk thread or medicated silk thread is used to wrap around the roots of the hemorrhoids to block the blood flow of the hemorrhoids, so that the hemorrhoids will fall off and the wound will be gradually repaired and healed. There are two types of ligation methods: suture the hemorrhoids and directly ligate the hemorrhoids.
Q: What is the so-called RPH therapy?
Answer: The RPH or COOK gun therapy mentioned now is the apron ligation method, which is also a method for the treatment of internal hemorrhoids. The basic principle is to insert the apron into the root of the internal hemorrhoid through the instrument, and use the elastic apron to continuously and gradually increase the root of the hemorrhoid. Tightening the strangulation, thereby blocking the blood supply of internal hemorrhoids, causing ischemia, necrosis, and shedding of hemorrhoid tissue, and the wound tissue is repaired and healed.
Q: What is going on with minimally invasive PPH surgery?
Answer: PPH is a method for the treatment of rectal prolapse and prolapsed internal hemorrhoids. It is called "stapled prolapse and hemorrhoidal mucosal circumcision and nailing". Part of the mucosa and submucosal tissue above the internal hemorrhoids at the lower end of the rectum is circularly removed and nailed. Restore the normal anatomical structure of the lower rectum, suspend and fix the prolapsed hemorrhoids and block the blood supply to the hemorrhoid area, thereby causing the hemorrhoid body to shrink. At the same time, it can treat the external hemorrhoids to some extent through traction effect. Compared with ligation therapy, PPH wounds only use nailing to shorten the healing time. The wounds are not small, and complications and sequelae will not reduce the chance of occurrence. In addition, the treatment of external hemorrhoids is limited. For patients with obvious external hemorrhoids, resection is still needed.
→Reference article: "Why doesn't Dr. St Mark’s like "PPH"? 》
Q: How is laser treatment of hemorrhoids?
Answer: Laser is an optoelectronic technology. It has been used in the treatment of hemorrhoids since the 1970s. It uses laser radiation to the body tissues to generate heat, pressure, photochemistry, and electromagnetic fields. The three most commonly used surgical lasers are carbon dioxide laser, argon laser, and neodymium. : Yttrium aluminum garnet laser.
Low-power laser irradiation expands blood vessels, promotes blood circulation, improves metabolism of nuclear cell nutrition, inhibits bacteria, enhances tissue anti-infection ability, and accelerates wound healing. The higher power laser can make the tissue temperature of the treatment site reach 45～50℃ in a very short time, make the tissue protein coagulate and denature, cause cell metabolism and blood circulation disorder. The high-power laser chars and vaporizes the tissue cells at the treatment site, so that the hemorrhoid tissue becomes charred and separated from the basal tissue. The higher power laser has strong penetrating power, can penetrate the tissue of the irradiated site, cut the tissue, and stop bleeding. It is called "laser knife" and can directly remove hemorrhoids.
Evidence-based medical evidence shows that laser treatment of hemorrhoids is not inferior to other surgical treatments in terms of postoperative pain, complications, and sequelae. Laser treatment requires special training and equipment, and the effect of the operation is closely related to the equipment and physician skills.
Q: The doctor has mentioned the application of cryotherapy, is it effective?
Answer: Cryotherapy is to use liquid nitrogen at 196℃ or liquid carbon monoxide at 89℃ to contact internal hemorrhoids through a special probe, and achieve the purpose of tissue cell necrosis through rapid freezing of hemorrhoid tissue and subsequent thawing.
Freezing can quickly freeze the intracellular fluid and destroy the cell membrane. Due to ion changes, protein denaturation, liquefaction, and tissue destruction, so freezing can directly lead to hemorrhoid tissue cell degeneration and necrosis. At the same time, freezing can also act on the vascular plexus in the hemorrhoids, causing edema of microvessels, intimal hyperplasia, and narrowing of the lumen. In addition to platelet aggregation and other factors, blood flow stagnation, vascular embolism, and avascular necrosis of hemorrhoid tissue , And then through tissue repair, fibrous tissue shrinkage, internal hemorrhoids atrophy to achieve the purpose of treatment.
Cryotherapy is mainly suitable for hemorrhoids in stage I and II, and should be used with caution in patients with perianal infection and severe hypertension. This therapy has disadvantages such as long duration of pain and slow wound healing.
Question: Is the HCPT computerized therapy device an advanced minimally invasive therapy?
Answer: HCPT is a multifunctional therapeutic instrument developed by using the principles of high-frequency capacitive field to produce endogenous heat on organisms, electrolysis produced by direct current in organisms, and direct current drug ion introduction. The heat generated by the instrument comes from the object itself , Relying on the charged ions in the tissue and the high-speed oscillation of the dipole to generate heat energy, which can cause local tissue damage, ulcer formation and fibrosis to achieve the purpose of treatment. Postoperative pain, bleeding, exudation and other discomforts as well as the risk of complications exist, and the postoperative recovery time is not significantly different from other treatments, and there is no recommendation in the international treatment guidelines.
Q: Can surgery completely cure hemorrhoids?
Answer: Hemorrhoids are treated only when they have symptoms. Treatment is not to eliminate hemorrhoids, but to improve the symptoms of hemorrhoids. Whether it is physical therapy, medication, or surgical treatment, the purpose is to relieve the symptoms of hemorrhoids. For problems that cannot be solved by drugs, surgery can be performed to improve the symptoms, and the purpose of treatment can be achieved. Surgical treatment can maintain the therapeutic effect for many years.
Q: Will hemorrhoids recur after surgery?
Answer: Whether it recurs after surgery is affected by many factors. The surgical method used, the experience and skills of the surgeon, the treatment of the lesion during the operation, the postoperative care, as well as the patient's own physique and living eating habits are all related to the postoperative effect and the problem of postoperative recurrence.
Q: How long do I need to stay in hospital for hemorrhoid surgery?
Answer: Our anorectal team has established a complete perioperative medical process and medical management, complete surgical treatment with minimal psychological and physical intervention, implement day surgery, stay in the hospital for 1-2 days, and return to normal life as soon as possible.
Q: How long does hemorrhoid surgery take?
Answer: The duration of the operation is about 20 minutes, depending on the degree of hemorrhoids.
Q: What kind of anesthesia is used for surgery?
Answer: We use intravenous anesthesia plus local anesthesia, or you can choose local anesthesia alone for surgery.
Q: Are antibiotics used when needed during surgery?
Answer: According to international standards, infusion of antibiotics half an hour before surgery can prevent postoperative infections.
Q: Are there risks in hemorrhoid surgery? Will it hurt after the operation?
Answer: There are risks in any surgery. Hemorrhoid surgery also has the risk of bleeding, infection, postoperative complications and sequelae. However, the doctor handles the wound properly, plus complete and safe medical management and postoperative follow-up, and the patient has a bowel movement and diet after surgery. Regular, appropriate activities, and controllable postoperative risks. There is corresponding pain management after surgery, which can be painless or within a tolerable range.
Q: Will the urine and stool be affected after the operation?
Answer: During the perioperative period, the medical staff will provide psychological counseling and nursing guidance. The pain during and after the operation is well controlled, and the urination is easy and natural. The implementation of day surgery has changed the traditional intestinal cleansing process, without disrupting the intestinal movement and rest, returning to a familiar environment as soon as possible after the operation, restoring the usual living conditions and regular bowel movements, and then defecation will be normal.
Q: I have had hemorrhoids for many years, and I am going to get pregnant next year. Do I have to undergo surgery first?
Answer: Whether or not hemorrhoids are treated surgically before pregnancy, you need to see the size of the hemorrhoids and whether there are recurrent bleeding or prolapse symptoms. During pregnancy and childbirth, the symptoms of hemorrhoids will be aggravated, so it is necessary to ask a professional anorectal doctor to do a detailed description before pregnancy. Check to determine whether pre-pregnancy surgery is needed.
→Reference article: "Coping with the worries of "Paomen" during pregnancy-treatment"
Q: What should I do if hemorrhoids occur during pregnancy?
Answer: During pregnancy, oral and topical drugs have uncertain effects on the fetus. Use as little or no drugs as possible. It is recommended to treat according to the different stages of pregnancy, the onset of hemorrhoids and the different types of hemorrhoids under the guidance of a doctor.
Q: What should I do if a perianal abscess occurs?
Answer: Once the diagnosis is clear, incision and drainage should be done early. For some patients, doctors can choose to do one-stage radical resection according to the specific condition, drain the pus cleanly and make the inflammation completely dissipate, and at the same time treat the inflamed internal mouth to avoid the formation of anal fistula.
Q: Why did the doctor say that my perianal abscess should be treated with two operations?
Answer: Perianal abscess is an acute infection of the subcutaneous and anorectal spaces around the anus. The subcutaneous soft tissue becomes purulent and will erode and spread. It is necessary to get up early and incise and drain to avoid the spread of the abscess or the spread of blood to cause more thorny problems. If the mouth is large and the internal mouth is not clear, it is necessary to cut and drain the pus to reduce the inflammation and form an anal fistula before performing the anal fistula operation, which is divided into two operations. In some cases, the inner orifice of the perianal abscess is clear and the scope is clear. One-stage radical resection can be considered.
Q: What should I do if I have anal fistula?
Answer: Anal fistula with recurrent swelling, pain and pus requires surgical treatment. Perianal abscess requires incision and drainage or one-stage radical resection.
Question: Does anal fissure need surgery?
Answer: Fresh anal fissures can be restored by improving diet, softening stools, and timely medication. Old anal fissures complicated by sentinel hemorrhoids and hypertrophic anal papillae need to be treated with surgery.
Q: The doctor said I have rectal polyps, do I have to have surgery?
Answer: The diagnosis of rectal polyps must be treated. According to the size of the polyp and the level of invasion of the intestinal wall, different surgical methods are used for removal.
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