Anal bulging is an uncomfortable symptom that occurs in the rectum, anus, and perineum. It is a group of syndromes caused by various diseases. The causes of anal bulging are complex, and there are many uncertain pathogenic factors, which can exist alone or can be accompanied by other diseases.
1. Prolapsed anal disease (1) Prolapse of internal hemorrhoids, rectal mucosal prolapse, polyps, etc. can stimulate the dentinal area (highly specialized sensory nerve terminal tissue zone, which is the inducing area of defecation movement) to produce anal swelling The sensation then causes the sensation of bowel movement.
(2) Uterine prolapse and vaginal prolapse often have a feeling of falling. In patients with internal rectal prolapse, the mucous membrane sinks into the anal canal, stimulating the nerve endings of the tooth line to produce a feeling of bulging.
2. Inflammatory diseases (1) Colitis, proctitis, anal cryptitis, and anal papillitis can cause anal swelling in the dental line area due to inflammation.
(2) Rectal submucosal abscess, pelvic rectal space abscess, etc. Due to inflammation, pelvic floor nerves are stimulated, and the anus and rectum are mostly swollen.
(3) Perineal swelling can occur in acute bacterial prostatitis.
(4) Anorectal foreign bodies can cause bleeding and ulceration of the rectal mucosa, poor defecation, and anal swelling.
3. Compressive diseases
(1) The contents of the pelvic floor hernia compress the rectum and anal canal, which can cause anal bulging. The innervation of the rectum and surrounding organs mainly comes from the pelvic plexus. Once the sacral nerve, a component of the pelvic plexus, is compressed by the herniated lumbar intervertebral disc, the patient may experience discomfort due to intraanal bulging. (2) The posterior position of the uterus can cause anal bulging. If blood accumulates in the rectum and uterus, anal swelling may occur. (3) Anal swelling can also occur when the rectum is compressed by the late cervical cancer.
4. Surgical stimulation
Anal bulging after anorectal disease may be caused by surgery and inflammation that stimulate defecation receptors. If bulging occurs 1 to 2 days after the injection of internal hemorrhoids, it is due to the temporary enlargement of the hemorrhoids due to the injection of liquid medicine; the external peeling and internal ligation of mixed hemorrhoids can stimulate the anal canal to produce bowel movements when the internal hemorrhoid ligature has not fallen off. Anal canal bulging occurs; high anal fistula incision and thread-hanging operation, in the initial stage of the rubber band falling off, because part of the anus muscles are strangled, anal fall often occurs. After undergoing negative pressure suction band ligation for hemorrhoids, they felt unbearable anal swelling. After complicated anal fistula, large scars can cause discomfort of anal bulging. Anal bulging after prolapse and hemorrhoid circumcision (PPH) is mainly due to the low level of operation, which may also be related to anastomotic inflammation and rectal traction reflex.
5. Autonomic dysfunction
Anal bulging caused by autonomic dysfunction is also called anal bulging. It is an anal neurosis. The condition is real, but there is no positive sign, and it is mostly related to emotional changes. About 70% of patients with this disease are women, which is related to suspicious feelings and cancer fear.
Clinical manifestations: local falling, swelling and pain, foreign body sensation, stool sensation, ant walking sensation, burning sensation. In severe cases, there are symptoms of radiation to the lumbosacral and lower limbs. The condition persists for a long time, often with psychiatric symptoms, such as anxiety, hypochondria, and insomnia.
1. Specialist examination
(1) There may be no positive signs during inspection, and may also be accompanied by symptoms of anal diseases such as external hemorrhoids and internal hemorrhoids prolapse. (2) Patients with internal hemorrhoid prolapse on digital rectal examination can touch smooth and soft masses near the tooth line, and some masses can protrude outside the anus. Patients with anal papillary hyperplasia and anal papillitis can touch one or more masses near the tooth line, which are smooth, soft or tough. Patients with anal sinusitis and proctitis may have a burning sensation when the index finger enters during a digital examination, and may also be accompanied by local tenderness. In patients with rectal prolapse, the mucosa in the rectal cavity can be palpable during digital rectal examination. It is soft and smooth, moves up and down, and has a sense of obstruction. There is an annular groove between the internal prolapsed part and the intestinal wall. (3) Sigmoidoscopy or anorectoscopy: mixed hemorrhoids, anal papillary hyperplasia, anal papillitis, and rectal polyps in patients with anus and rectal endoscopy can show internal hemorrhoids uplift, tumor near the tooth line, and rectal tumor respectively. In patients with anal sinusitis and proctitis, congestion and edema of the intestinal mucosa may be combined with erosion. In patients with prolapse of the rectal mucosa, a slight abdominal pressure can see the accumulation of the rectal mucosa like a bottle plug protruding into the opening of the lens barrel, and a ring or cervical mucosal inversion appears at the junction of the rectum and anal canal; proctoscope shows excessive rectal mucosa. It can be seen that it is embedded in the mirror cavity or appears under the tooth line when doing forced defecation. The patient can see mucosal edema, fragility, hyperemia, or ulcers, polyps and other lesions.
2. Defecation imaging
Defecation imaging is an inspection method that combines dynamic and static observation of the anorectal area during defecation by injecting a contrast agent into the patient's rectum. It can show functional and organic diseases of the anorectal area. Patients with internal rectal intussusception or prolapse can see intestinal mucosa or full-thickness intussusception during defecography.
3. Other imaging examinations
CT and magnetic resonance examinations can help clarify the abnormal structure of the surrounding anorectal canal.
The patient's conscious symptoms are mainly discomfort due to anal bulging. Patients often feel that the anal bulging is unbearable, sometimes radiating to the lumbosacral, buttocks and thighs, and there is a feeling of foreign body prolapse, anal obstruction, tenesmus, frequent bowel movements, accompanied by lack of energy and doubt , And even symptoms such as irritability and anxiety.
Anal bulging is a subjective symptom of the patient, and currently it can only be judged by the patient's narrative.
Patients with the primary disease should be treated first. As the primary disease is cured, most of the anal swelling can be relieved by itself. Patients with primary disease who have indications for anorectal surgery can be treated with surgery, and those with no indications for surgery can be treated symptomatically.
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