2020年10月18日星期日

what does a hemorrhoids look like,Why do anorectal examinations always use fingers to touch the anus?

    Touching the anus with fingers, also known as digital anus examination, is a simple, easy-to-use and important anorectal examination method. Many anorectal diseases can be detected early only by digital anal examination, such as 80% of rectal cancers Found during digital anus examination. It is worth noting that about 85% of the delayed diagnosis of rectal cancer is due to the failure of digital anal examination, and some even lost the opportunity for surgery. This is worthy of attention and vigilance by both doctors and patients. The inspection method is: the examiner wears a finger cot on the index finger of the examiner's right hand, and applies a lubricant (commonly used soap, liquid paraffin or petroleum jelly) to facilitate its insertion into the anus and reduce the patient's discomfort. First check the skin around the anal margin. If there is redness, tenderness, or lumps, it often indicates a perianal abscess; there is tenderness in the middle of the front and back, which often indicates that there may be an anal fissure. You can further open the anus to see if there is an anal canal crack; There is a rupture on the outside and a cord under the skin leading to the anus, which is often an anal fistula. After the inspection around the anal margin, the right index finger gently massages the anal margin, while instructing the patient to take deep breaths to relieve abdominal pressure and relax the sphincter, and then slowly extend the index finger into the rectum; if the finger is suddenly inserted into the anus, the sphincter will be suddenly affected. Stimulus and spasm, not only difficult to insert, but also painful. Digital anal examination has the following contents and significance: 1. The first thing to be done is the tightness check of the anal sphincter and anorectal ring. The anorectal ring is composed of the upper edge of the internal and external sphincter and the puborectum. The internal and external sphincter are ring-shaped around the junction between the anal canal and the rectum, while the puborectalis muscles are only present on the back and on both sides. Therefore, during digital anal examination, they should be touched on the back and on both sides of the anal canal. The front of the anal canal is not easy to touch. When the anal sphincter and anorectal ring are normal, the index finger can smoothly extend into the anus. If the index finger is difficult to pass or cannot pass, it means that the anus has different degrees of stenosis, and if the anal sphincter is too loose and weak, it may There will be anal incontinence; 2. Check the anterior and posterior walls of the anal canal and the surrounding area for tenderness, pulsation, and lumps. Pay attention to the size, hardness and mobility of the lumps. For higher tumors, digital anal examinations can be performed in a squatting position or a lithotomy position. These two positions can move the tumor down and palpate the higher rectal cancer. If necessary, double rectal and abdominal examination or rectal and vagina double examination can be done, which can provide valuable information on the extent of cancer invasion; 3. In the front wall of the rectum, men can touch the prostate and women can touch the cervix , Should not be mistaken for a pathological mass; 4. After the examination is completed, the finger is taken out, to see whether there is blood or mucus on the finger cover, and a smear should be taken if necessary. During the digital anal examination, several common anorectal lesions can be palpable: 1. Rectal cancer: uneven lumps can be felt on the intestinal wall, the surface may have ulcers, the intestinal cavity is often narrow, and the The sleeve is often stained with pus, blood and mucus. 2. Rectal polyps: soft and pushable masses can be felt, blood stains are often stained on the finger cots. 3. Internal hemorrhoids: Generally, internal hemorrhoids are soft. Even if you touch it, you can't tell the size and number of them, but if there is thrombosis, you can feel smooth induration. 4. Anal fistula: The cord can be felt, and sometimes a small induration or depression can be palpated at the internal mouth of the anal fistula. 5. Perirectal abscess: pelvic and rectal space abscess and posterior rectal space abscess, tender lumps can be felt in the rectum, the surface is smooth. For other interstitial abscesses, two-finger palpation can be performed with thumb and index finger, that is, the index finger is placed in the rectum, the thumb is placed on the perianal skin, and the thumb and index finger are palpated, and the abscesses in the anterior and posterior deep interstitial spaces of the anal canal and the ischiorectal space can be found Abscess or perianal abscess. 6. Anal papilloma: You can feel a medium-textured and pushable, long-pedicle mass, and the finger cots are clean. Because the digital examination has such an important function, the doctors of all patients who go to the anorectal department for the first time will touch the anus, and they will touch the anus more deeply and carefully to avoid misdiagnosis. The patient may feel more uncomfortable, but please be sure Cooperate. In clinical practice, there are often patients who are not aware of the importance of the referral examination. Not only do they refuse to cooperate, but they also complain that they will never have this examination in the future. Fortunately, in recent years, more and more patients are aware of this, and often take the initiative to request an index check, and will come regularly.

    -----Excerpted from "The Secret of Hemorrhoids" edited by Li Shenglong and Yin Tingbao

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