2020年10月23日星期五

hemorrhoids symptoms,General knowledge of anorectal disease

    Anorectal diseases, in a broad sense: the various stalk diseases that occur on the anus and large intestine are called anorectal diseases, with more than 100 common diseases. In a narrow sense: various diseases that occur on the anus and rectum, there are more than 30 common diseases, such as: internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, anal fissure, anal fistula, perianal abscess, anal skin disease, anal sinusitis, proctitis, Rectal ulcer, export constipation, rectal prolapse, rectal protrusion, rectal mucosal prolapse, anorectal stenosis, anal incontinence, anal cancer, rectal cancer, anal papilloma, rectal polyps, anorectal tuberculosis, anal neurosis, Condyloma acuminata, anorectal congenital malformations, anorectal trauma, etc.

    1 What is anorectal disease

    Anorectal disease is a common and frequently-occurring disease unique to humans. According to relevant census data, the incidence of anorectal diseases such as hemorrhoids is 59.1%, and hemorrhoids account for 87.2% of all anorectal diseases. Among them, internal hemorrhoids are the most common, accounting for 52.19% of all anorectal diseases. Both men and women can get the disease. The incidence rate of women is 67%, and the incidence rate of men is 53.9%. The incidence rate of women is high [Because female patients are generally unwilling to receive hemorrhoid treatment, some statistics on clinical treatment of hemorrhoids show that men There are more patients with hemorrhoids than women]; the disease can occur at any age, and it is more common in people between 20-40 years old, and it can gradually get worse with age, so there is a saying of "ten people with nine hemorrhoids". Broadly speaking, the various stalk diseases that occur on the anus and large intestine are called anorectal diseases, with more than 100 common diseases. In a narrow sense: various diseases that occur on the anus and rectum, there are more than 30 common diseases, such as: internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, anal fissure, anal fistula, perianal abscess, anal skin disease, anal sinusitis, proctitis, Rectal ulcer, export constipation, rectal prolapse, rectal protrusion, rectal mucosal prolapse, anorectal stenosis, anal incontinence, anal cancer, rectal cancer, anal papilloma, rectal polyps, anorectal tuberculosis, anal neurosis, Condyloma acuminata, anorectal congenital malformations, anorectal trauma, etc.

    2 Types of anorectal diseases

    There are many types of anorectal diseases, mainly including: hemorrhoids, blood in the stool, diarrhea, constipation, anal fistula, anal fissure, rectal cancer, proctitis, perianal abscess, proctitis, colon cancer, acute enteritis, chronic enteritis, intestinal polyps, duodenum Intestine, anal sinusitis, anal genital warts, anal eczema, anal itching and other infectious viral diseases.

    3 Common symptoms of anorectal disease

    Common symptoms of anorectal disease include: pain in the anus and abdomen, blood in the stool, constipation, prolapse of something from the anus, mucus or blood in the anus, lumps in the anus, foreign body sensation in the anus, diarrhea, blood in the stool, difficulty in defecation, changes in the shape of the stool, Chills and fever, full belly, nausea and vomiting, abdominal mass, anemia, etc.

    4 Anorectal disease examination steps

    1. In anal inspection, use the thumbs of both hands to gently separate the patient's buttocks to observe whether there are any prolapsed objects in and around the anus, external hemorrhoids, fistulas, abscesses, anal fissures, etc.

    2. Digital rectal examination is also called anal finger examination. The examiner puts on a glove on his right hand or a finger cot on his right index finger and applies lubricating oil. Place the tip of the index finger of his right hand on the anal opening. After the patient adapts, he gently inserts it into the anal opening. First, test the tightness of the anal sphincter, and then touch the anal canal. Check the surrounding area of ​​the rectum in turn, and pay attention to whether there are tenderness, lumps, fluctuations, and stenosis around the intestinal wall. In the anterior wall of the rectum, men can palpate the prostate and women can palpate the cervix. When the fingers are withdrawn, observe whether there is blood and mucus on the gloves.

    3. Anal mirror inspection: Apply lubricating oil to the anal mirror, slowly insert it into the anus, pull out the core, adjust the light, observe the color of the rectal mucosa from deep to shallow, rectal flap, ulcers, polyps, tumors, foreign bodies, etc., slow down the anal mirror Exit slowly, and observe whether there are any lesions near the rectum and dental line, such as the internal opening of the fistula and hemorrhoids.

    5 Causes of anorectal disease

    The occurrence of anorectal disease is caused by a variety of factors, which can be divided into two categories: internal and external.

    Internal cause:

    (1) Normal human anatomical factors are particularly prone to form hemorrhoids.

    (2) Physiological factors: The colon and rectum are the main organs for transporting food residues and storing feces. After the food is decomposed and absorbed in the body, the residues often contain a large amount of harmful substances, which can be retained in the colorectal for a long time and can induce tumors.

    (3) Genetic factors: due to genetic defects, multiple colonic polyps, p-j syndrome (melanoma-colon polyposis) and other hereditary anorectal diseases can occur.

    (4) Congenital diseases.

    External cause:

    (1) Poor defecation habits: When going to the toilet, squatting and reading the newspaper will cause the squat and defecation time to be prolonged, which can easily cause blood stasis in the anus and rectum and induce diseases. Smoking while going to the toilet can buffer the brain's defecation reflex, which can easily cause constipation. Excessive force during defecation, some people, regardless of whether the bowel feeling is strong or not, blindly and constantly strive hard, which can only increase the unnecessary burden on the rectal anus and pelvic floor muscles and local blood stasis, leading to the occurrence and development of the disease.

    (2) Abnormal defecation: Diarrhea and constipation are both important pathogenic factors of anorectal diseases. Constipation is the biggest curse. Long-term retention of toxic substances in the rectum can not only induce rectal cancer, but also the accumulation of stool, which affects blood circulation. Exercising the dry fecal mass will inevitably cause a series of pathological changes such as blood stasis, swelling and cracks in the anus. Diarrhea is often a clinical manifestation of colon disease. Diarrhea can also increase the chance of local infection in the anus, resulting in anal sinusitis, inflammatory external hemorrhoids, perianal abscess and other diseases.

    (3) Dietary factors: In daily life, it is natural that the dietary pattern or diet variety will inevitably change. For example, the quality of food, changes in vegetable types and quantity, the amount of protein, fat, starch, cellulose, etc., and water intake can directly affect the composition of stool and cause anorectal diseases. People who drink alcohol for a long time or eat spicy food can stimulate the mucous membrane of the digestive tract, causing vasodilation, colonic dysfunction, and anorectal diseases. According to the national census data, the incidence of spicy food is 61.6%, and the incidence of drinking alcohol is 64.6%, which is significantly higher than the total incidence.

    (4) Occupational factors: standing or sitting for a long time. The anus and rectum lie in the lower part of the human body due to the upright or sitting posture, and the hemorrhoid veins are not smooth.

    (5) Chronic diseases: such as long-term malnutrition and weak physique, causing relaxation and weakness of the anal sphincter. Suffering from chronic bronchitis and emphysema for a long time, abdominal pressure rises due to cough and asthma, and pelvic blood stasis. Chronic hepatitis, cirrhosis, diarrhea, colitis, etc. are all triggers for anorectal diseases. Therefore, in prevention, attention should be paid to the patient's general condition and reasonable and effective preventive measures should be taken.

    6 Anorectal disease prevention

    1. Eat less high-fiber foods. Such as potatoes, pasta, beans and vegetables such as cabbage, cauliflower, onions, etc., they are all easy to produce gas in the intestines and stomach, which leads to the appearance of bloating.

    2. Do not eat food that is not easy to digest. Hard foods such as fried beans and hard pancakes are not easy to digest, so they will stay in the intestines and stomach for a longer time, producing more gas and causing abdominal distension.

    3. Change the habit of devouring. Bad habits such as eating too fast or eating while walking can easily swallow a lot of air; in addition, drinking beverages with straws can also cause a lot of air to sneak into the stomach and cause abdominal distension.

    4. Overcome bad emotions. Anxiety, worry, sadness, depression, depression and other bad emotions may also weaken digestive function, or stimulate the stomach to cause excessive stomach acid. As a result, there will be too much gas in the stomach and increase bloating.

    5. Pay attention to exercise. Appropriate exercise should be maintained for about 1 hour a day, which not only helps overcome bad emotions, but also helps the digestive system maintain normal functions.

    6. Supplement fiber food moderately. High-fiber foods do not only cause bloating, sometimes on the contrary, after eating high-fat foods, sometimes it can reduce bloating. The reason is that high-fat foods are difficult to digest and absorb, so they tend to stay in the stomach for a long time. Once fiber is added, the blocked digestive system is likely to be quickly unblocked.

    Years of scientific research has concluded that some dietary defects are related to the incidence of colon cancer. These include:

    Calcium and Vitamin D

    Americans have found that the mortality rate of colorectal cancer is significantly lower in areas exposed to sunlight, especially high levels of B ultraviolet rays. Studies have confirmed that it is closely related to the metabolism of calcium and vitamin D. Someone further found that people who consume more than 15O international units of vitamin D in their daily diet have only half the incidence of colorectal cancer than those who consume a small amount of vitamin D; and people who consume more than 1,200 mg of calcium per day have colorectal cancer. The morbidity is only equivalent to a quarter of the daily intake of less than 625 mg of calcium. So scientists have concluded that calcium intake is negatively related to the risk of colorectal cancer, and vitamin D has potential anti-cancer effects.

    fat

    Epidemiological studies have found that the diet of countries with a high incidence of colorectal cancer is characterized by high fat, while the diets of countries with low incidence have lower fat content. Research in Shanghai also found that the increase in the incidence of colorectal cancer is related to the increase in fat in the diet. In-depth research found that a high-fat diet can increase the bile acid metabolites (deoxycholic acid and lithocholic acid), cholesterol metabolites (steroids and steroids) in the stool, and the β-glucuronidase activity of bacteria. , These are carcinogens or carcinogens, which may cause colorectal cancer. Therefore, excessive fat diet is directly or indirectly related to colorectal cancer.

    Cellulose

    The incidence of rectal cancer among black African residents is very low. Researchers found that this is closely related to their diet based on foods rich in fiber such as corn and vegetables. Further studies have found that the lack of fiber in food can reduce stool volume and slow down intestinal movement. Therefore, the concentration of carcinogens in the intestine increases, and the time for carcinogens to interact with the intestinal wall mucosa is prolonged, and colorectal cancer is prone to occur.

    Pickled foods with onions and garlic

    Chinese scientists have found that carotene, vitamin B2, vitamin C, and vitamin E all have the effect of reducing the occurrence of colorectal cancer. Therefore, if you lack these vitamins in your diet for a long time, you are susceptible to colorectal cancer. Chinese scholars also found that people who often eat pickled foods have an increased chance of developing colon cancer, which may be related to carcinogens produced in the process of food pickling. Many statistical analyses have found that regular consumption of onions and garlic can reduce the occurrence of colon cancer, and its anti-cancer mechanism may be related to reducing the damage of carcinogens to the colon wall mucosa. In addition, the lack of trace elements such as molybdenum and selenium in food may increase the incidence of colon cancer.

    7 Tips for preventing anorectal diseases

    ◆Work and rest

    Do not stand and squat for long periods of time, and do not ride bicycles for long periods.

    ◆Care for the anus

    After each bowel movement, avoid repeatedly wiping the anus with rough toilet paper. You can wash it with warm and cold water, then dry it with a dry cloth or absorbent paper, and constrict the anus with consciousness. Before going to bed, you can use Chinese medicine or warm water to wash the sitz bath, avoid using soap, alcohol and other irritating liquids.

    ◆Develop good bowel habits

    Achieve regular defecation daily; do not squat in the toilet for a long time; do not read books or newspapers when defecation; it is best to expel inconvenience in the shortest time without effort to reduce local stimulation.

    ◆Diet conditioning

    Eat a regular and reasonable diet to avoid partial eclipse; eat less spicy and irritating food, eat more cellulose-containing vegetables, and drink more water. When the stool situation changes, it is necessary to change the diet in time to adjust.

    ◆Prevent constipation

    It can be regulated by diet and drugs. It can also be used as a single-flavored Chinese medicine Cassia seed to be brewed with boiling water instead of tea for drinking, or decocted with Cistanche, Polygonum multiflorum and other water and added with honey.

    8 Stay away from anorectal diseases and eat correctly

    Chinese medicine believes that poor eating habits are an important cause of illness. Therefore, if you want to prevent anorectal diseases, you should pay attention to your diet first. In principle, pepper, mustard, spirits, and greasy, fried, seafood, raw and cold foods should be eaten as little as possible or not, and more vegetables, whole grains, etc. should be eaten. food.

    Eat more vegetables and fruits. They contain a lot of cellulose. When cellulose passes through the digestive tract, it can absorb water to swell itself. On the one hand, the swollen cellulose stimulates and strengthens gastrointestinal motility and digestion through its swollen volume. , Absorption and excretion functions are strengthened; on the other hand, it can also wrap certain indigestible ingredients in food, secretions of the digestive tract, intestinal bacteria and harmful substances produced in body metabolism to form feces, thereby making feces smooth and easy OK, it not only reduces the pathogenic factors, but also has the effect of preventing cancer. Peppers and alcohol have a direct stimulating effect on the rectal mucosa. Excessive eating can cause the rectal mucosa to congest and expand and form hemorrhoids. Chili and alcohol can also stimulate the anal flap and anal sinus, causing local inflammation and leading to anal sinusitis, anal papillitis, and other diseases. Fatty, sweet and thick taste is very easy to cause, and long-term constipation is an important cause of anorectal disease.

    It is generally believed that a high-fat, high-protein, and low-fiber diet can increase the bile fluid and anaerobic bacteria in the intestine, while the anaerobic Clostridium bacteria in the intestine can convert deoxycholic acid into a carcinogen 3- Methylanthracene. In addition, certain components in high-fat foods may be broken down into carcinogenic unsaturated cholesterol in the intestine. Cold food is very easy to cause, diarrhea is also the cause of anorectal disease.

    9 Harm of anorectal disease

    1. Lead to anemia: Patients with hemorrhoids whose blood is the main symptom often have anemia. If you don't get timely treatment, you will experience paleness, fatigue, dizziness, and weakness. Sudden standing after sitting for a long time and squatting can cause collapse or fainting.

    2. Lead to skin eczema: Due to the prolapse of hemorrhoids and sphincter relaxation, mucus flowing out of the anus irritates the skin, causing itchy skin and anal eczema.

    3. Lead to deterioration of the rectum: If hemorrhoids cannot be treated in time, the lesions will continue to aggravate, causing lesions in the cells in the lesion area, leading to rectal lesions.

    4. Women with hemorrhoids can cause gynecological inflammation: If the hemorrhoids bleed or become inflamed, they will often cause the bacteria to multiply, leading to various vaginitis, urethritis, cystitis, adnexitis and other urinary gynecological inflammation.

    10 Diet for patients with anorectal diseases

    In anorectal diseases, hemorrhoids have the highest incidence. Many patients have misunderstandings about the treatment of hemorrhoids and believe that their treatment must require surgery. This concept needs to be corrected, because not all hemorrhoids require surgical treatment. Clinically, hemorrhoids are generally divided into four types: mild (type Ⅰ) and moderate (type Ⅱ). No operation is required. Because the patient's disease is not very frequent and very serious, conservative treatment is generally taken, focusing on improving daily diet and living habits. , Together with some external application of Chinese medicine, generally can control or reduce the condition. Management method Hemorrhoids are type Ⅲ and type Ⅳ. If patients with such hemorrhoids have frequent attacks and cannot completely improve their diet and lifestyle, surgery is required. The main operation currently used is external resection and internal ligation. The use of anesthetics or analgesia can minimize the pain, and the wound can be moved down the next day after the wound is small.

    Experts remind patients that diet for surgery is important, eat more foods rich in dietary fiber, such as whole grains, taro, celery, etc., and drink plenty of water. You should not blindly think that eating fruits can replace drinking water. Eat less spicy, fried food, etc. food. In addition, we must develop a good habit of defecation regularly every day. Many people like to read books and newspapers while defecation. This is an incorrect toilet habit. When defecation, take a deep breath, close the glottis, bend your arms, and press the abdominal wall. Some bad habits should be abandoned without constipation.

    How to defecate after anorectal disease

    (1) Defecation once as much as possible: Some patients are afraid of defecation due to pain in the anus after the operation, or end up defecation without emptying the stool due to pain in the anus, which causes the stool to stay in the rectum for too long and excessive water absorption. The feces become dry and difficult to pass.

    (2) Do not squat too frequently in the toilet: Some patients frequently squat in the toilet because the anus is swollen after the operation, and the feeling of inconvenience is obvious, and squatting in the toilet for too long can easily lead to anal edema or wound bleeding. Patients can judge whether their stools are cleared at one time based on their usual defecation volume and the volume of each defecation after surgery. If the stool volume is large and soft for the first time, and there is little or no stool discharge each time, it may be caused by inflammation and other stimuli. The number of bowel movements should be reduced, or the doctor should be notified of his condition in time and accept the doctor Guidance.

    (3) Defecation time: It should be controlled within 24 hours after surgery. Normal defecation. Premature defecation may cause wound contamination and bleeding. Even if the stump of the excised tissue is ligated and turned out of the anus, it cannot be returned, causing tissue necrosis, thrombosis, and congestion. Into serious consequences. If the defecation time is too late, it will cause difficulty and pain in defecation.

    (4) Use of catharsis drugs: clean the intestines before surgery, it is best to use enema to ensure that the surgical field is clean, try not to use fruit-guided catharsis drugs, otherwise it will increase intestinal peristalsis and loose stools to the rectum after surgery , Making stool difficult to control. After 24 hours after the operation, in order to be able to defecate normally, so as to prevent the anal wound from narrowing and severe defecation pain, laxatives should be routinely used after the operation, so that the stool can be easily discharged, and can be formed without contaminating the wound. Postoperative Take 2 pills of Maren Runchang Pills every night, or use Kaisailu before defecation.

    11 How to reduce the pain caused by anal disease surgery?

    After anal disease surgery, sometimes the pain is heavier. Therefore, the following aspects must be taken to reduce the pain.

    Surgery operations should minimize tissue damage: minimize sphincter damage during surgery, reduce clamps, excessive shear, and friction on the wound surface. Only in this way can nerve and muscle damage, edema, and anal pain after surgery be reduced. ;

    The anal sphincter should be relaxed as much as possible during the operation: an anesthetic technique should be used during the operation to fully relax the anal sphincter. If the internal anal sphincter contracture or hypertrophy, it should be fully released. If necessary, cutting it can also reduce anal pain;

    The incision should be made during the operation: the incision should be long and wide enough during the operation, the wound surface should be flat, and the edges should be neat, so that drainage can be sufficient, wound surface stimulation is reduced, and anal pain is reduced;

    Control infection and rational use of analgesics: The surgical incision is good, and the incidence of infection and edema is low, but appropriate antibiotics must be taken after the operation to prevent infection. At the same time, proper administration of analgesics can also relieve the patient's anal pain;

    Less activity, more sleep: Take appropriate sedatives, reduce activity, reduce the chance of anal wound friction, and also reduce postoperative anal pain.

    12 Treatment of anorectal disease

    12.1 1. HCPT ablation:

    PPH anastomosis uses a special device called "PPH stapler" to circularly excise the rectal mucosa of the hemorrhoids and anastomose them simultaneously (the anastomosis principle is the same as that of a stapler), which is blocking the blood supply of hemorrhoids. At the same time, the prolapsed anal cushion "bounces back" upwards and returns to its normal position.

    Advantages: The therapy is less traumatic, less painful, fast recovery, preserves the anal cushion tissue, reduces complications, and has a very good effect on severe hemorrhoids.

    12.3 3. COOK gun therapy for hemorrhoids:

    The special effect fumigation method is to take traditional Chinese medicine decoction and fumigate and rinse the affected area while it is hot. With the help of medicinal power and heat, it acts on the body through the skin and mucous membranes to promote the smoothing of the rhythm, the harmony of the veins, and the smoothness of the blood to achieve the purpose of treatment and prevention. , Adapt to the initial treatment of various anorectal diseases and postoperative rehabilitation treatment.

    12.5 5. Other treatment methods for hemorrhoids:

    The internal causes of anorectal diseases

    1. Physiological factors: The colon and rectum are the main organs for transporting food residues and storing feces. After the food is decomposed and absorbed in the body, the residues often contain a large amount of harmful substances, which can be retained in the colorectal for a long time and can induce tumors.

    2. Anatomical factors: There are a lot of special structures in the anorectum, such as anal recesses, anal glands, anal papilla, rectal valve and special vascular structures. There is a lack of venous valves in the rectal veins, and blood tends to pool. The portal vein and the vena cava are located at the lower end of the rectum. There are many venous plexuses and anastomoses. The vein wall is weak, the resistance to pressure is reduced, and the submucosal tissue of the rectum is loose, which is conducive to the expansion of varicose veins and the formation of hemorrhoids.

    3. Genetic factors: due to genetic defects, multiple colonic polyps, p-j syndrome (melanoma-colon polyposis) and other hereditary anorectal diseases can occur.

    4. Factors of abnormal embryonic development: the anorectum is formed by the fusion of the endoderm and ectoderm during the embryonic development of the human body. If the development process is abnormal, many congenital anorectal diseases can occur in the anorectum, such as congenital anus , Congenital rectovaginal (urethral) fistula, Hirschsprung's disease, etc. Reference materials: https://www.zllie.com

    13.2 2. External causes leading to anorectal diseases

    1. Dietary factors: In daily life, it is natural that the dietary rules or types of diet will inevitably change. For example, the quality of food, changes in vegetable types and quantity, the amount of protein, fat, starch, cellulose, etc., and water intake can directly affect the composition of feces and cause anorectal diseases. People who drink alcohol or eat spicy food for a long time, because alcohol and spicy food can stimulate the mucous membrane of the digestive tract, cause vasodilation, colonic dysfunction, and anorectal diseases. According to the national census, the incidence of spicy food is 61.6%, and the incidence of drinking alcohol is 64.6%, which is significantly higher than the total incidence.

    2. Occupational factors: standing or sitting for a long time. The anus and rectum lie in the lower part of the human body due to the upright or sitting posture, and the hemorrhoid venous return is not smooth.

    3. Chronic diseases: such as long-term malnutrition, weak physique, causing relaxation and weakness of the anal sphincter. Suffering from chronic bronchitis and emphysema for a long time, abdominal pressure rises due to cough and asthma, and pelvic stasis. Chronic hepatitis, cirrhosis, diarrhea, colitis, etc. are all triggers for anorectal diseases. Therefore, in prevention, attention should be paid to the patient's general condition and reasonable and effective preventive measures should be taken.

    4. Poor defecation habits: When going to the toilet, squatting and reading the newspaper will cause the squat and defecation time to be prolonged, and it is easy to cause blood stasis in the anus and rectum and induce diseases. Smoking while going to the toilet can buffer the brain's defecation reflex, which can easily cause constipation. Excessive force during defecation, some people, regardless of whether the bowel feeling is strong or not, blindly and constantly strive hard, which can only increase the unnecessary burden on the rectal anus and pelvic floor muscles and local blood stasis, leading to the occurrence and development of the disease.

    5. Abnormal defecation: Diarrhea and constipation are both important pathogenic factors of anorectal diseases. Constipation is the biggest curse. Long-term retention of toxic substances in the rectum can not only induce rectal cancer, but also the accumulation of stool, which affects blood circulation. Exercising the dry fecal mass will inevitably cause a series of pathological changes such as blood stasis, swelling and cracks in the anus. Diarrhea is often a clinical manifestation of colon disease. Diarrhea can also increase the chance of local infection of the anus, resulting in anal sinusitis, inflammatory external hemorrhoids, perianal abscess and other diseases.

    14 Incidence shows a trend of younger age

    Experts remind that the incidence of anorectal diseases is increasing, and a variety of diseases may attack people at any time. The cruel reality tells people to attach importance to anorectal diseases and be vigilant.

    Experts explained that in recent years, with the improvement of material life, the dietary structure has changed, eating too many fine foods with high protein, high fat, and high cholesterol, while the intake of crude fiber is insufficient. Young people generally prefer western fast food and eat more fried food. When you are busy at work, you can choose lunch and fast food. Young people also like to make friends. They smoke and drink excessively when they eat together. The rich nightlife of young people leads to lack of sleep. All the above factors can induce anorectal diseases.

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