2020年10月19日星期一

what does a hemorrhoids look like,How does anorectal stricture feel?

    Yeonhee underwent hemorrhoid surgery a month ago. She was confused and sent me questions.

    "Hello, Dr. Xing, I had rectal mucosal prolapse and circular internal hemorrhoid surgery last month, and I was ligated by Cook. Now my stool is a little dry and it’s hard to come out. I don’t feel like I can’t get in. I’m stuck in my anus. I have the pain of scar cracking, and there is a feeling of tightness. Our doctor here said that the anus is a little narrow because of the scar, and it is recommended to expand the anus. I am so scared! I am afraid that all this scar will be opened when it is expanded, and there is It’s just grown and cracked, and there is a wound on the mouth. You said what should I do now, as long as it’s a little dry, it’s difficult to pull it out. Every time I have to use Kaisailu for help, I suddenly feel after the Kaisailu The scar is about to split. Is my anus narrowed? Will the scar get worse in the future or will it alleviate? Is it too late to expand the anus in the future?"

    Q: What is the feeling of anorectal stenosis?

    Discomforts such as abdominal distension, difficulty defecation, tenesmus, and anal pain. According to the degree of stenosis, there are three types.

    Mild: Can discharge soft or loose stools, but requires hard work or light pressure perianal assistance, and stool becomes thin. It is difficult for the index finger to pass through the stenosis when examining the anorectum.

    Moderate: Difficulty in defecation, sometimes unable to control loose stools and gas. There is resistance and a sense of fixation when checking the anorectal stenosis on the finger, the index finger cannot pass through, and it is tender.

    Severe: Difficulty in defecation and exhaust, combined with anal incontinence, moisture around the anus, pollution of clothes and pants, often need to wear pads and rely on enema to defecate, and even symptoms of intestinal obstruction. It is difficult for the little finger to pass through the fibrous ring of the anorectal stenosis during digital examination, and the tenderness is obvious.

    Q: How does anorectal stricture happen?

    1. Congenital:

    Congenital malformations, often combined with rectal-vaginal fistula or rectal-urethral fistula.

    2. Acquired:

    Surgical trauma: injection of internal hemorrhoids, stapler and traditional resection of hemorrhoids, complicated anal fistula surgery, intestinal surgery.

    Drug effects: Long-term use of laxatives or corrosive suppositories.

    Inflammation: late stage of inflammatory bowel disease, intestinal tuberculosis, venereal disease, etc. This stenosis is more tubular and can be combined with fistula. Anal infections and old anal fissures can also cause anal stenosis.

    External injuries: trauma, traffic accident injuries, chemical injuries, burns and scalds, etc.

    Tumors: Intestinal epithelial tumors, such as adenocarcinoma and squamous cell carcinoma, with rapid growth of infection or advanced tumors; intestinal wall tumors, such as leiomyomas or sarcomas, carcinoids, etc.; extraintestinal tumors can also force anorectal stenosis, intrauterine Membranous ectopic disease is located around the rectum, stenosis will also occur.

    After anorectal inflammation or injury, there will be inflammatory cell infiltration, fibrous tissue hyperplasia, and scar tissue formation in the process of tissue repair and healing, causing pathological changes in the intestinal mucosa and intestinal wall. If the incision is improperly selected during the operation and after the stapler circular resection, if the stool is loose, it will aggravate the inflammation, or the wound will become infected, which may lead to anorectal stenosis. Most of the lesions are dominated by the mucosal layer, and there are cases where the entire intestinal wall is affected. When the lesions occur in the anus and lower rectum, the anal sphincter loses its ability to contract due to fibrosis, showing the coexistence of stenosis and incontinence.

    Q: How to treat anorectal stenosis?

    When stenosis occurs, choose the appropriate treatment method according to the primary disease, nature, extent, scope and treatment history of the stenosis.

    Mild to moderate anorectal stenosis should be treated conservatively without surgery.

    medical treatement

    Oral laxatives, external suppositories, warm water baths, enemas, etc. to make the stool unblocked, and topical ointments for shallow fissures or ulcers.

    Expansion method

    Slight stenosis after surgery or injury can be treated with dilation. Use fingers, dilator or anoscope to dilate, once a day or 1-2 times a week, gradually increase the diameter of the dilator and extend the dilation interval time.

    After anorectal surgery such as hemorrhoids and anal fistulas, first prevent loose stools. Slack stools will aggravate the inflammatory reaction of the wound and excessive proliferation of fibrous tissue. Shaped stool can effectively avoid the occurrence of anorectal stricture.

    Mild or moderate stenosis that does not improve for more than 3 months, and severe or hard scar stenosis, surgical operation.

    There are scar removal or sphincter incision, such as linear incision behind the anal canal, internal rectal incision, and anoplasty. High rectal stenosis can be considered for combined transabdominal perineal resection of the rectum to preserve the anus and sphincter. When chronic obstruction, physical weakness or stricture causes acute complete intestinal obstruction, a colostomy is used to divert. Anorectal stenosis caused by tumor is treated as tumor.

    Yeonhee’s hemorrhoid surgery is a ring-shaped internal hemorrhoid. There are many rectal mucous membranes that are ligated. In addition, the postoperative stool is loose and the scar is excessively proliferated during postoperative recovery. Therefore, for Yeonhee’s current symptoms and local scars, she is recommended to perform anal expansion. treatment.

    At present, patients with anorectal stenosis clinically diagnosed mostly occur after anorectal surgery, especially the risk of rectal stenosis in stapler surgery. Therefore, when hemorrhoids need surgery, understand the connotation of surgical methods, clarify the nature and characteristics of hemorrhoids, choose suitable surgery, and do not blindly pursue certain so-called "minimally invasive" risks that are more risky. Pay attention to good bowel habits after surgery. The key to avoiding acquired anorectal stenosis.

    (In order to protect the privacy of patients, the name of the person used in the text is a pseudonym)

    Author: anorectal surgery Xingyun Li doctors

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