Hemorrhoids are one of the most common anal diseases, which can occur at any age. The pathogenesis of hemorrhoids is temporarily not completely clear, but it is generally believed to be related to many reasons such as long-term sitting, constipation, pregnancy, long-term drinking, eating a lot of irritating food, perianal infection, and malnutrition. Modern surgery believes that hemorrhoids come from the anal cushion of normal people, and the anal cushion is an important structure used to assist the anal control function and distinguish the nature of the discharge.
Hemorrhoids are divided into internal hemorrhoids, external hemorrhoids and mixed hemorrhoids. Internal hemorrhoids are mainly manifested as bleeding and prolapse. Painless intermittent blood after defecation is the most common symptom of internal hemorrhoids; while external hemorrhoids are mainly manifested as anal discomfort, occasional pain or itching; mixed hemorrhoids occur at the same time as internal and external hemorrhoids. Mixed hemorrhoids aggravate and prolapse outside the anus in a ring shape, called ring hemorrhoids; when the hemorrhoids prolapse and are incarcerated by the spasm of the anal sphincter, edema and necrosis cause severe pain, called incarcerated hemorrhoids or strangulated hemorrhoids.
Diagnosis of hemorrhoids mainly depends on anorectal examination. Observation of the perianal condition and digital anus examination are routine examination methods; in order to rule out rectal diseases, anoscopy and colonoscopy are also routine examination methods.
The treatment of hemorrhoids should follow three principles: 1) Asymptomatic hemorrhoids do not need to be treated; 2) Symptomatic hemorrhoids are to reduce and eliminate symptoms, rather than radical cure; 3) Hemorrhoids should be treated conservatively. General conservative treatment mainly includes improving eating habits and increasing dietary fiber intake; improving bowel habits, avoiding exertion and prolonged defecation; hot bathing, using lubrication or suppositories in the anal canal, etc. Surgical treatment is mainly for more severe hemorrhoids. There are many treatment options: apron ligation treatment, internal hemorrhoid injection treatment, external hemorrhoid peeling and internal ligation, and prolapse and hemorrhoid circumcision. For patients who have undergone surgery, routine softening, laxative, swelling and pain relief are required after the operation. As for the prognosis of hemorrhoids, hemorrhoids often recur. Improving personal bad habits is the most effective measure to reduce the recurrence of hemorrhoids.
Perianal abscess, anal fistula
Perianal abscesses generally originate from infection of a tiny gland (anal gland) inside the anus. Some enteritis, such as inflammatory bowel disease, can also cause it. After the perianal abscess is drained (spontaneously or therapeutically), a duct from the anal gland to the perianal skin is formed, called anal fistula. The existence of an anal fistula can cause continuous exudation or discharge of pus from the perianal skin opening. If the skin opening heals, an abscess will form again. Symptoms include persistent pain unrelated to defecation, with or without swelling, perianal discharge, fever, and other discomforts. Perianal abscess or anal fistula must be treated surgically. Although the seemingly simple fistula can be treated simply, it is recommended to be treated by a professional colorectal and anal surgeon due to its potential complications such as recurrence and incontinence. A variety of anal fistula surgery can be selectively applied to various types of anal fistulas, including anal fistula incision, anal fistula resection, LIFT, BIOLIFT, mucosal flap advancement, anatomical anal fistula resection, anal fistula resection, and so on. Moderate to severe pain is the most common one week after surgery, and drug analgesia can be selected. After returning home for treatment, it is necessary to adhere to a sitz bath three to four times a day, and drugs can be used to keep the stool smooth. Pay attention to taking measures to prevent seepage from contaminating clothing. Defecation does not affect wound healing. If the healing is complete, there is usually no recurrence. It should be noted that following the treatment advice of a specialist is the most important guarantee for a good prognosis.
Anal fissure is damage to the anus and anal canal.
Most reasons are:
1. When dry knots or large pieces of stool pass through the anal canal;
2. Long-term constipation and excessive bowel movements;
3. Chronic diarrhea;
4. Inflammation of the anal area of the rectum (such as Crohn's disease and other inflammatory bowel diseases);
Other common causes can be anal tumors, HIV virus, syphilis, herpes virus infection, or tuberculosis.
Occasionally, some patients have anal fissure due to iatrogenic factors (such as rectal temperature measurement, enema tube, colonoscope or ultrasound probe inserted into the anus).
The typical clinical manifestations of anal fissure are severe pain and a small amount of bleeding during defecation. Sometimes it can cause pain again due to the contraction and spasm of the annular muscle around the anus (anal sphincter). Anal fissure patients are often unwilling to defecate for fear of pain, which may cause constipation or even feces incarceration for a long time; however, constipation causes more dry knots and huge stools and aggravates the anal fissure, forming a vicious circle.
Through detailed medical history and gentle anal examination, the diagnosis of anal fissure can basically be confirmed.
Most anal fissure patients can be cured within a few weeks, as long as:
Maintain soft stools through diet therapy (eating dietary fiber and fruits);
Sit bath in warm water several times a day (10-20 minutes, better after defecation) can relax the anal muscles to promote healing;
Use paraffin oil to lubricate the anorectal area;
Use some special suppositories or ointments.
However, after the above observation and treatment, the symptoms still persist, and surgical intervention must be sought.
Surgical treatment often cuts off a small part of the internal anal sphincter, reducing its spasm and pain to promote the healing of the gap (internal anal sphincterotomy). Surgery can be performed under sacrococcyx anesthesia or epidural anesthesia.