1. What is "hemorrhoids"?
It is generally believed that hemorrhoids are masses formed by pathological hypertrophy, displacement of the anal pad and stagnant blood flow in the subcutaneous vascular plexus perianal. Hemorrhoids are the most common and most common anorectal disease. According to the epidemiological survey results released by the Anorectal Branch of the Chinese Society of Traditional Chinese Medicine in 2015, the prevalence of hemorrhoids is as high as 49.14%.
2. What factors are "hemorrhoids" related to?
The cause of hemorrhoids is not fully understood in modern medicine, but it is currently believed to be mainly related to the following factors.
1. Anatomical factors
(1) The theory of anal cushion shifting down. It is believed that hemorrhoids are originally the normal anatomical structure of the anal canal, that is, the vascular cushion, which is a circular spongy tissue band 1.5 cm above the dentate line. Only when the anal cushion tissue is abnormal and symptomatic, can it be called hemorrhoids.
(2) Varicose Vein Theory It is believed that hemorrhoids are venous clusters formed by congestion, expansion and flexion of the venous plexus under the mucosa of the rectum and under the skin of the anal canal.
2. Constipation factors and poor bowel movements
If the toilet takes a long time. During constipation, dry and hard stools compress the wall of the rectum and block the return of the hemorrhoidal veins. At the same time, the increase in abdominal pressure causes the anal cushion to move downward or prolapse. Lead to the occurrence of hemorrhoids.
3. Eating habits
Long-term spicy food stimulates eating and drinking. For example, there is less cereals, a lack of crude fiber, a small amount of hard stools, and a longer residence time in the intestine. Dry and hard stools greatly increase the pressure on the rectal ampulla, which makes it easy to produce hemorrhoids.
4. Genetic factors
There is no conclusive evidence for the relationship between hemorrhoids and heredity. The familial phenomenon may be the result of similar living conditions and habits of these family members.
5. Pregnancy and childbirth factors
Uterine compression, increased abdominal pressure, decreased pelvic floor, and nerve traction caused abnormal sphincter function.
6. Disease factors
Some factors that increase abdominal pressure, such as intra-abdominal tumors, portal hypertension, and long-term cough, can easily cause increased abdominal pressure, compression of hemorrhoidal veins and varicose, leading to the occurrence or aggravation of hemorrhoids.
7. Occupational factors
The incidence of hemorrhoids is related to certain occupations, and it is more common for people who stand for a long time or sit for a long time.
8. Age factor
Children and adolescents rarely suffer from hemorrhoids. Hemorrhoids are prone to suffer from adulthood, and the older the age, the higher the incidence.
From the range of known etiology theories, the occurrence of hemorrhoids is related to many factors, and comprehensive research from multiple aspects is necessary to make a more complete explanation.
3. What are the clinical manifestations of "hemorrhoids"?
1. Blood in the stool
This is the main symptom of internal hemorrhoids. Early internal hemorrhoids are dominated by frequent blood in the stool; late internal hemorrhoids are due to severe fibrosis of the hemorrhoidal mucosal surface, and blood in the stool decreases.
2. Get out
Prolapse is the main symptom of the development of internal hemorrhoids in the middle and late stages. The hemorrhoids in the middle stage prolapse during the stool and can be absorbed by themselves after the stool. In the third stage, the hemorrhoids need to be hand supported or rested in bed for a while. It can also come out during normal activities, standing for a long time, when tired, and when coughing. Some patients can not support the hemorrhoids back into the anus with their hands after hemorrhoids come out. They become incarcerated internal hemorrhoids, or the internal hemorrhoids are incomplete and show continuous partial prolapse. status.
3. Anal bulge
Internal hemorrhoids above stage II can have different degrees of anal bulging. Stage II is lighter, and stage III is heavier. Especially after being tired, after standing for a long time or in the afternoon. The cause of anal swelling may be due to the irritation of the rectal mucosa by the enlarged hemorrhoids or the inflammation of the hemorrhoid mucosa surface.
Simple internal hemorrhoids have no pain, such as internal hemorrhoids incarcerated or infected, thrombosis, ulcers can cause more severe pain. When hemorrhoids are incarcerated, the patient's anus is often painful, defecation and qi are blocked, and some also reflexively cause dysuria, and it can last for 7 to 10 days.
5. Mucus outflow, wet or itching anus
Internal hemorrhoids of stage II or higher often have secretions in the intestinal cavity flowing out of the anus due to the relaxation of the anal sphincter. In mild cases, they can flow out during defecation, and in severe cases, they can flow out naturally when they do not defecate, especially after standing for a long time or after fatigue. When internal hemorrhoids prolapse, the secretions flow directly into the perianal area. After the mucus flows out, it can cause moist or itching discomfort in the anus.
4. What inspections need to be done?
The examination includes two categories: general general condition examination and local anal examination. Local specialist examinations of the anus mainly include inspections, digital examinations, and anoscopy.
Side lying position is generally adopted. Observe in turn the position, shape, size and nature of the external mass of the anus, the color and flatness of the surface of the hemorrhoid, whether there is ulceration and bleeding, the change of the size of the hemorrhoid and its relationship with the body position, whether there are blood stains and blood color in the anus, anus Whether the part is moist or secretion, whether there are changes in the perianal skin, etc. When there is mass prolapse, pay attention to the location of the white mass, the size and shape of the white mass, the color of the surface mucosa, whether there are ulcers, necrosis, bleeding points, the fibrosis of the mucosal surface, and whether the prolapse can be absorbed by itself. In order to observe the prolapse situation sometimes need to use squatting observation.
2. Finger Examination
The digital examination mainly checks the texture of the outer anus mass, whether there is induration, tenderness, surface temperature, anal sphincter and intersphincter groove. It is also necessary to pay attention to whether the anorectal ring is abnormal, and whether there is hypertrophy of the mucosa above the tooth line , Whether there is injection induration, etc.
Observe whether the anoscope is inserted smoothly, the size, position, shape, surface mucosa color, erosion, bleeding, and fibrosis of the masses on the dentition line, and the relationship between the masses on the dentition line and whether there is blood and mucus in the intestinal cavity Etc. and its color, quality, quantity, whether the rectal mucosa is loose or overlapping, whether the tooth line groove exists, etc.
5. How to treat?
The choice of treatment for hemorrhoids should firstly adopt conservative treatments such as oral and topical drugs. If the effect is not satisfactory, then consider surgical treatment.
1. Conservative treatment
Symptomatic treatment with western medicine is mainly aimed at the clinical symptoms of various hemorrhoids. Choose effective hemostatic drugs, analgesics, antibiotics, antiphlebitis agents, etc., if you have anemia, you can also give iron, if necessary, blood transfusion to correct severe anemia. External medicine: various ointments, fumigation lotions, suppositories. According to different clinical manifestations, choose the agent to use.
2. Surgical treatment
(1) External hemorrhoids peeling and ligation of internal hemorrhoids: Willow-shaped resection and stripping the subcutaneous venous plexus of external hemorrhoids to the dentinal line, the incision near the dentinal line is adducted, and the base of the internal hemorrhoids is clamped for ligation or suture. Indications: Mixed hemorrhoids in various stages.
(2) Injection therapy Injection of sclerosing agent into internal hemorrhoids and hemorrhoids, indications: hemorrhoids in stage I and II, mixed hemorrhoids.
(3) Ligation therapy Use medical silk thread to simply ligate or suture the base of internal hemorrhoids to block the blood supply of hemorrhoids and cause hemorrhoid tissue to be avascular necrosis and fall off to achieve the purpose of treatment. Indications: Ⅱ and Ⅲ internal hemorrhoids.
(4) The apron band ligation therapy The band ligation apron is a special apron, which is ligated to the root of internal hemorrhoids and tightens by its natural elasticity, causing hemorrhoids to be avascular necrosis and fall off. Indications: Ⅱ and Ⅲ internal hemorrhoids.
(5) PPH operation, that is, stapling rectal mucosal circumcision, indications: internal rectal mucosal prolapse, Ⅱ, Ⅲ internal hemorrhoids.
(6) Others There are cryotherapy, laser therapy, infrared coagulation therapy, classical surgery (Milligan-Morgan open hemorrhoidectomy, Whitehead hemorrhoidectomy) and so on.
6. What is the prognosis of "hemorrhoids"?
Most patients can be relieved by conservative treatment and cured by surgery. Some patients may regenerate hemorrhoids due to bad living habits and other factors, and need to be treated again.
7. How to prevent "hemorrhoids"?
1. Develop good bowel habits and hygiene habits
The best time is to get up in the morning and defecate after breakfast. The cardia-rectal reflex can help the feces to be discharged smoothly. At the same time, avoid prolonged squatting in the toilet, and correct the bad habits of squatting, reading, cellphone, newspaper or smoking. And pay attention to hygiene around the anus.
2. Eat healthy
Avoid alcohol and spicy foods, eat more fiber-rich foods, such as fresh fruits, vegetables and whole grains. You can eat honey, black sesame and other moisturizing foods in moderation, and drink plenty of water.
3. Warm water bidet
You can soak your buttocks in warm water for about 15 minutes a day to help promote blood circulation in the affected area.
4. Anal exercises
Lift and contract the anus forcefully, keep the contraction state to your limit, and then slowly and slowly relax the anus. It is recommended that each group do 20-30 retraction and retraction movements, and do 3 groups a day. The main point is to apply force quickly when lifting and contracting, and slowly when relaxing.