Perianal abscess has become a common disease that bothers everyone, and perianal abscess
The patient will be very painful, and the incidence rate has increased in recent years.
It can be affected from children to young adults, and patients are often at a loss.
I was invited by Rizhao TV Station to give a lecture on perianal abscess
, Here I share some common problems with you:
Q: What is a perianal abscess? What are the characteristics of perianal abscess?
Let me give you a brief introduction to what is a perianal abscess. Perianal abscess is an abscess caused by acute and chronic infection that occurs in the space around the anorectal canal. It is called anal carbuncle in Chinese medicine. It is common in all seasons. It is more common in summer. In summer, the temperature is high, sweating is easy, body fluids are lost, and constipation is easy to occur. In addition, some people are delicious and spicy, like to drink, and eat too greasy, which makes hot and humid endogenous. Anorectal, perianal abscess, perianal abscess is actually a kind of bacterial infection, the main infection bacteria are Escherichia coli, Staphylococcus aureus, anaerobic bacteria, Mycobacterium tuberculosis. The primary diseases that cause infection are anal fissure, anal sinusitis, constipation, diarrhea, etc. It is characterized by rapid onset and obvious pain, which can be a sudden onset. Many patients have just drunk at night and found severe pain in the anus the next day. In severe cases, they may have fever, and anal fistula may develop after a long time. It usually occurs in young adults between 20-30 years old. It is more common in men. The ratio of male to female can reach 6:1, which is related to the high secretion of male male hormones and strong secretion of anal glands.
Q: What are the specific symptoms of perianal abscess?
The symptoms of perianal abscess vary according to the location of the disease. We divide the perianal abscess into two types according to the location of the disease: (1) Low abscess (abscess with the abscess cavity in the lower part of the levator ani muscle, we use the levator ani muscle as Boundary): such as anal subcutaneous abscess, sciatic rectal space abscess, posterior anal space abscess, low shoe-shaped abscess. (2) High abscess (abscess in the upper part of the levator ani muscle): such as rectal submucosal abscess, pelvic rectal space abscess, posterior rectal space abscess, high horseshoe abscess.
The clinical manifestations of the two types of perianal abscess are not exactly the same. A low abscess can have no systemic symptoms, because the abscess is relatively shallow, and mainly local symptoms. The patient's anal part of the patient can find that compared with normal skin, the skin temperature is significantly higher than that of normal skin, and a local lump can be felt and tender. Obviously, because the local nerve endings in the anus are very sensitive, they are very afraid to sit upright, or take a half-buttock sitting position. The pain gets worse during defecation, walking, and coughing. Many people walked in from the clinic and I took a look at his gait. , You probably know what disease he got. High abscess because of its deep location, on the top of the levator ani muscle, the toxin absorption is fast, the systemic symptoms are obvious, there may be fever, general malaise, fatigue and weakness, blood test routine, blood picture can be elevated, a bit like cold symptoms, local symptoms It is not obvious, sometimes it just feels like falling. But many high abscesses develop from the low position. Therefore, some abscesses have symptoms of high-status abscesses. Both local pain and systemic symptoms.
Question: Some babies also have perianal abscesses. What should I do if I get them?
In clinical practice, we can often see such patients, especially infants less than 3 months old, because the infant’s intestinal immune structure is not mature and the immune function is weak, that is, the rectal mucosa is resistant to bacteria. The barrier is imperfect, and once diarrhea occurs, it is easy to cause infection of the anal glands. Generally, by about 14 months, the immune function of infants and young children is enhanced, and the disease will be reduced. This disease is also more male than female, and the ratio can reach 9:1, which is higher than the ratio of young men and women. Infants and young children with perianal abscess may heal slowly on their own, and they can be cleaned after defecation to maintain local hygiene, but our experience is to deal with it and release the pus to prevent further development of the disease. If the child has repeated attacks that affect the growth and development of the child, radical surgery can be performed under basic anesthesia.
Question: Then there is an abscess at such a small age, is it congenital?
This disease is not congenital, because in the mother, the fetus is sterile, and the first meconium is also sterile, so there will be no infection. Only within 24 hours after taking breast milk, the intestine will start to grow bacteria. There is a possibility of infection, so perianal abscesses in infants and young children are acquired and infected. Anal sinus infection is usually caused by diarrhea.
Question: Perianal abscess is caused by infection. We all know that diabetic patients are prone to infection if blood sugar is not well controlled. Are diabetic patients prone to perianal abscess?
The host is right. Statistics have shown that the prevalence of concurrent infections in diabetic patients is over 32.5%, because high blood sugar is conducive to the reproduction of bacteria, and the sterilization ability of white blood cells in patients is also lower than that of normal people, and immunity is low. , The chance of infection is greater than that of ordinary people, and once a person with diabetes is infected with a perianal abscess, its scope and severity are greater than that of ordinary people, and the disease progresses rapidly. If the infection is not treated in time, the infection spreads, and it is easy to produce some serious complications, such as Speaking of necrotizing fasciitis, sepsis, etc., the condition will be very critical.
Question: What should we do if a diabetic patient has a perianal abscess?
This situation is also relatively common, because diabetes is already a high incidence, but everyone does not pay enough attention to diabetes. Many patients do not know that they have diabetes, but are hospitalized for perianal abscess and undergo preoperative examinations. At that time, I found out that I had diabetes. At this time, it is found that the patient has diabetes. It should be relatively lucky for the patient. Therefore, the preoperative physical examination is very important. Many patients do not understand the preoperative blood sampling. They think that I have an operation. Why do I have to draw so much blood? . The purpose of blood draw is mainly to eliminate surgical contraindications. When blood sugar is high, radical surgery is risky. Therefore, our principle of dealing with this situation is to treat the symptoms if urgent, and cure the root if slow. You can first make an incision and drainage to release the pus to prevent the disease from developing further and relieve the patient’s pain, and then use insulin to quickly lower blood sugar until the blood sugar is suitable, generally controlled below 8mmol/l, and undergoing radical surgery . Strictly control blood sugar after operation, control blood sugar, and prevent infection.
Q: What are the risks of surgery for patients with high blood sugar?
The postoperative wound of this kind of patient is difficult to heal or even does not heal. Coupled with the stress of the operation, it will cause higher blood sugar and greatly increase the possibility of postoperative infection. Even if the blood sugar is controlled to a reasonable range, the patient The wounds are also about 10 days slower than normal. So we must eat a reasonable diet and be careful of diabetes.
Question: We usually think that getting hemorrhoids is very painful. Now that we have listened to Doctor Ding's introduction, perianal abscesses are also very painful. So how should we distinguish between these two diseases?
The symptoms of hemorrhoids are mainly blood in the stool and prolapse of the mass in the anus after stool. The pain mainly occurs when the hemorrhoids prolapse and cannot return to the anus. At this time, local congestion, thrombosis, edema, and some pain. The pain is mainly tingling. The pain of perianal abscess is dominated by continuous burning and throbbing pain. There will be this burning sensation, and the lumps can be felt around. The pain of the two diseases is still different, but it may not be easy for us ordinary people to distinguish, so once the anal pain is unbearable, we should go to the clinic for examination. See what disease it is.
Question: If I get a perianal abscess, will the anti-inflammatory injection disappear?
Never blindly use anti-inflammatory injections. Antibiotics will not only fail to control inflammation, but will spread the abscess to the depths and make the operation difficult. It may also form a localized induration, which will not dissipate for a long time, and will become purulent sooner or later, because the root of the disease is inside the anus, and it will be contaminated by the secretion of mucus after a bowel movement. It is not like a wound on our arms and legs that can be kept clean. And perianal abscess is always in an infectious environment, so this disease can never be cured by antibiotics, and many patients who have antibiotics, we culture its pus for bacterial culture, many of which are multi-drug resistant bacteria, that is This bacterium is not sensitive to many antibiotics, which brings difficulties to our treatment. China is a big country of antibiotics, and the abuse of antibiotics is very serious. We can use 160,000 tons of antibiotics in China a year, accounting for about half of the world. Now our hospitals have strictly controlled antibiotics. If we continue to use them in this way, in a few years, we May be facing a situation where no medicine is available.
Question: What should we do if we have a perianal abscess?
Therefore, surgery should be done as soon as possible.
Question: I heard from a friend that it is not easy to change the dressing during the hospitalization. What effect does it have?
One very important thing after the operation is to change the dressing after the operation. Some people are afraid of pain and trouble and are unwilling to change the dressing. This is not conducive to the recovery of the patient. If the dressing is not changed properly, the wound may not heal. False healing, infection, recurrence, etc., after dressing change can play a role in cleaning the wound, preventing infection, and at the same time, it can drain the wound smoothly and avoid the accumulation of exuded pus and cause infection. When changing the dressing, some medicines that promote wound healing can be used externally to speed up the growth of the wound. The daily dressing change can also ensure that the wound grows from the base and prevent false healing.
Question: What should I pay attention to when doing perianal abscess surgery?
First, eat some low-residue diet, such as noodles, porridge, etc., the day before the operation, and fast for 6 hours before the operation. Our operation is mainly to fast for 6 hours after spinal anesthesia. After 6 hours, we can eat a small amount of food, but it is not advisable to eat food with more oil. You can eat normally from the first day after the operation, except for spicy foods, you can eat according to the patient’s daily eating habits. In order to keep the stool smooth, patients can eat some fresh fruits and vegetables, such as bananas, spinach, fish soup and other low-digestible foods with low fat content, but can not eat full, not too greasy. And encourage patients to defecate on time. You can eat some crude fiber foods, which help soften feces, such as shiitake mushrooms, green vegetables, Chinese cabbage, etc.; the staple food should be coarse grains to enhance the laxative effect, such as polenta, millet porridge, and other coarse grains. Eating 2-3 teaspoons of honey every day can help with bowel movements.
Question: I heard that fecal incontinence will occur after surgery, is that true?
This is a question often asked by patients in outpatient clinics, and it is also a common misunderstanding. Let me explain to you that the muscles we control defecation, we call the anorectal ring, are part of the external sphincter, internal sphincter, anal levator Muscles, combined with longitudinal muscles. For low abscesses, the abscess cavity is below the levator ani muscle. Therefore, the damage to the sphincter muscle will be minimal and will certainly not affect the patient’s anal function. For high abscesses, the abscess cavity is above the sphincter. Incorrect operation methods can damage the patient's sphincter, so many hospitals adopt two operations. The operation we are doing now is called incision and thread-hanging operation, which is beneficial to the elasticity of the rubber band. It is cut and repaired. It can well protect the patient's sphincter function. This operation can not only make the abscess cavity drain smoothly, but also protect the sphincter muscle. Function is a major contribution of our people to the development of anorectal diseases in the world, which is a unique operation method of our Chinese medicine. The thread-hanging therapy was first used in the Ming Dynasty.
Without surgery, an anal fistula will form. Long-term inflammatory stimulation will cause sphincter fibrosis, which is sphincter sclerosis. For some patients, we give him a digital examination. The sphincter is like wood, and its elasticity is weakened, which affects anal function. Therefore, this disease should be operated as soon as possible.
Q: Will this operation be painful?
It is impossible to do this operation without pain at all, but the pain is definitely much lighter than when it was onset. Our operation method is to slowly incise the patient’s abscess cavity, which is equivalent to a minimally invasive operation. The pain of the operation has been reduced to At the lowest point, after the operation, the patient's pain can be effectively relieved by fumigating and washing with Chinese medicine for clearing heat, removing dampness, relieving pain and reducing swelling. After the operation, we give the patient a local injection of long-acting analgesic drugs, together with some oral analgesic drugs, which can significantly reduce the patient's pain. If you are really afraid of pain, you can use a pain pump. So this pain can be endured by most people, and it can be controlled by many means.
Question: What if you have a perianal abscess and don’t have time to be hospitalized for surgery?
If you have a perianal abscess, if you have a radical operation, you usually have to stay in the hospital for about 1-2 weeks. If you don’t have time, you can have a temporary drainage to release the pus and the pain will be significantly reduced. More importantly, the disease will not develop further. At this time, we can take some traditional Chinese medicine for clearing away heat and detoxification, such as Xianfang Huoming Decoction, Huanglian Jiedu Decoction, etc. Wait until there is time, or when the crime is repeated, then come back for surgery.
Question: How should we prevent perianal abscess in daily life?
We can take the following preventive measures. First, actively exercise, strengthen physical fitness, and avoid sedentary sitting. Nowadays, people can say that the amount of activity is getting less and less. Basically, traffic is driven by car, and we prefer to surf the Internet and play computer games. Sitting for a long time will lead to poor blood circulation in the anus and increase the chance of infection. You can do relatively gentle and not vigorous exercises such as walking, jogging, and so on to promote blood circulation in the anus. The second is to keep the anus clean and pay attention to personal hygiene. You can take a bath with warm salt water every day after going to the toilet. Do not sit for a long time in a humid place. The third is to adjust the diet to prevent constipation and diarrhea, try not to drink alcohol and eat less spicy food, eat lightly, and develop a lifestyle of regular bowel movements. Actively prevent and treat other anorectal diseases.