hemorrhoids external causes,To prepare for the second child, remove hemorrhoids first!

    With the liberalization of the second-child policy, a large number of elderly pregnant women have emerged, and the troubles during pregnancy caused by this have also made these expectant mothers uneasy. According to statistics, the incidence of hemorrhoids in elderly pregnant women is as high as 80%. After pregnant women suffer from hemorrhoids, surgery is not recommended. It is best to take preventive care before pregnancy to avoid hemorrhoids during pregnancy. Regardless of the fact that hemorrhoids are a trivial matter, if hemorrhoids during pregnancy are not prevented in time, it will affect the health of the mother and fetus, and even affect the delivery process.

    Expert advice: To prepare for the second child, it is best to remove hemorrhoids first. Avoid hemorrhoids aggravated during pregnancy, leading to anemia, and even hemorrhoids incarcerated and necrotic, and emergency surgery will be necessary, which will cause adverse effects on pregnant women and fetuses!

    1. The dangers of hemorrhoids in pregnant women

    Pregnant women are a high incidence of hemorrhoids. With the growth of the fetus after pregnancy, the uterus gradually increases, forming pressure on the inferior vena cava, which hinders the blood return in the pelvic cavity. The blood in the venous plexus around the anus is stagnant and tortuous. It is easy to form hemorrhoids or make the original Hemorrhoids get worse.

    Long-term large amounts of blood in the stool can lead to insufficient nutrition of the mother, weak physique, and developmental delay of the baby. For "pregnant mothers", curing hemorrhoids is a pre-pregnancy "compulsory course", not only to avoid the torture of hemorrhoids during pregnancy, but also to consider the health of the pregnant baby. During pregnancy, females are affected by hemorrhoids such as blood in the stool, prolapse, pain, itching, etc., which can lead to anemia, dizziness, shortness of breath, fatigue, and poor spirits, which are not conducive to the development of the fetus, and even cause the fetus in severe cases. Miscarriage, premature delivery or other complications, there are many cases of fetal death in clinical.

    Anorectal health is important

    "Guoyu" Carbomer Hemorrhoid Gel: It is composed of Carbomer Gel, a variety of precious materials and a gel dispenser. The specific gel has a strong adsorption function, which can reduce inflammation, reduce swelling and relieve pain. It is used to relieve the symptoms of internal hemorrhoids, external hemorrhoids and mixed hemorrhoids caused by anal swelling pain, mucous membrane bleeding and constipation.

    Second, pregnant women are more likely to suffer from hemorrhoids

    1. After pregnancy, it can cause abdominal pressure to gradually increase. With the gradual increase of the uterus, the compression of the inferior vena cava is also increasing, especially when the fetal position is not correct, the compression is more obvious, which directly affects the veins of the lower rectum and anal canal The backflow of blood causes congestion and dilation of the hemorrhoidal veins and induces hemorrhoids.

    2. During pregnancy, on the one hand, the enlarged uterus compresses the intestine; on the other hand, women generally have less activity due to inconvenience during this period, the gastrointestinal peristalsis is obviously slowed down, and the stool stays in the intestinal cavity for a long time. , The water in the stool is absorbed excessively, causing dry stool, difficulty defecation and other symptoms of constipation. Dry feces can cause hemorrhoids to expand and expand to form hemorrhoids. In addition, dry and hard feces can easily rub the hemorrhoid mucosa and cause bleeding, and even cause the original hemorrhoids to detach from the anus and cause hemorrhoids incarceration, causing severe anus A series of symptoms such as pain and walking inconvenience.

    3. During pregnancy, hormone levels in the body have undergone more fundamental changes. The progesterone and relaxin in the female body will increase greatly, making the fibrous connective tissue in the body soft and elastic, causing water and sodium retention and vasodilation. This makes the hemorrhoidal veins more prone to congestion, varicose and enlargement.

    3. Prevention of hemorrhoids in pregnant women

    Reasonable diet: Pregnant women should be careful not to eat or eat less spicy foods and condiments, and at the same time develop the habit of drinking more water, it is best to drink light salt water or honey water. Pregnant women with constipation and hemorrhoids should consciously drink more water, eat more fruits and fresh vegetables. Especially vegetables and fruits rich in crude fiber. Eat less irritating foods such as chili, pepper, ginger, garlic, and green onions.

    Try to choose the left side sleeping position: When pregnant women adopt the left side sleeping position, it helps to avoid the enlarged uterus from compressing the abdominal aorta, inferior vena cava and ureter, reducing the pressure on the rectal veins, and increasing the blood flow of the uterus and placenta The amount of perfusion and renal blood flow are more conducive to the growth and development of the fetus and prevent pregnancy complications such as hemorrhoids and supine syndrome during pregnancy, and reduce the morbidity and mortality of pregnant women and fetuses during the perinatal period. Of course, in a long sleep, it is impossible to maintain a posture, you can alternate left and right, but it is best to take the left side lying position more.

    Appropriate exercise: Pregnant women should not sit for a long time, and should exercise appropriately to promote blood return to the anorectal area. Insist on doing 10-30 levator movements every day (that is, consciously contracting the anus). This can reduce the congestion of the hemorrhoidal venous plexus, improve local blood circulation, and reduce the incidence.

    Prevent constipation and diarrhea: Do not bear bowel movements for a long time, develop regular bowel habits, do not read books and newspapers in the toilet during defecation, avoid prolonged squatting in the toilet, prolonged squatting can easily cause dilatation or varicose of the anal veins, so as not to stimulate the anus. , The time for squatting in the toilet is generally no more than 10 minutes. If you can’t get it out at a time, you can get up and rest for a while. When it’s difficult to defecate, you can use some laxative drugs, such as Maren Runchang pills, fruit guide tablets, etc. Laxatives are not suitable, let alone pressure enema, etc. Method to lax, so as not to cause miscarriage or premature delivery.

    Expert advice: To prepare for the second child, it is best to remove hemorrhoids first. Avoid hemorrhoids aggravated during pregnancy, leading to anemia, or even incarcerated necrosis of hemorrhoids, and emergency surgery will be necessary, which will cause adverse effects on pregnant women and fetuses!

    Q: What are the complications of anorectal disease?

    A: It is easy to cause some anal diseases: the stool is too hard, leading to increased abdominal pressure, making blood circulation in the anal veins poor, anal fissure, hemorrhoids, rectal prolapse, blood in the stool, and difficulty in stool.

    Q: What should I pay attention to for anorectal diseases?

    A: Mainly soften stools. 1. Eat more vegetables with high fiber content. Potatoes (stewed), pumpkin, leeks, celery, spinach, etc. can be a cup of honey water before going to bed, and more honey. Drink a large glass of warm water after getting up in the morning (drink it all in one breath). Eat two bananas 1 hour after dinner

hemorrhoids essential oils,Dr. Liu Fuyingcong's operation: high-frequency electrosurgical treatment of male severe circular mixed hemorrhoids!

    Doctor Liu Fuyingcong led the case

    Patient: Male, 45 years old, from Meishan City, Sichuan

    Main complaint: anal mass prolapsed with blood in the stool for more than 10 years, and worsened by 3 months.

    Specialty status: (lithotomy position) prolapsed ring-shaped hemorrhoids can be seen on the anal margin. The wound is 4*3.5 in size, soft and can be pushed. Hemorrhoid nodules can be seen on the upper circle of the inner tooth line of the anal canal, especially at 1-4 points, 7 Significantly at -11 o'clock, mucosal erosion and bleeding were obvious.

    Diagnosis: circular mixed hemorrhoids with internal hemorrhoid bleeding

    Surgeon: Chief surgeon: Liu Fuyingcong, First assistant: Dr. Wang Tingting

    Operation method: Original plan: External stripping and internal ligation of circular mixed hemorrhoids and injection of internal hemorrhoid stump sclerosing agent; as the anal margin incision and internal hemorrhoid erosion were found to have significant bleeding during the operation, the hemorrhoids were gently clamped and the bleeding was found to be excessive. High frequency electrosurgical surgery.

    Anesthesia: sacral block anesthesia + basic anesthesia

hemorrhoids symptoms,How does anal fistula form? Symptoms of anal fistula? How is anal fistula treated? Does it recur after surgery?

    Anorectal fistula is a granulomatous tube connecting the anal canal or rectum to the perianal skin. It mainly invades the anal canal and rarely involves the rectum, so it is often called anal fistula. The inner mouth is mostly located near the dentate line and the outer mouth is located in the perianal skin. Place. The entire wall of the fistula is composed of thickened fibrous tissue, with a layer of granulation tissue inside, which does not heal for a long time. The incidence is second only to hemorrhoids, and is more common in young men. It may be related to the strong secretion of sebaceous glands, one of the male sex hormone target organs. Anal fistula is not self-healing advice or to go to a professional hospital for examination and treatment in time is the key

    Anal fistula-overview

    Anal fistula refers to the granulomatous duct around the anus, which consists of three parts: the inner mouth, the fistula, and the outer mouth. The internal orifice is often located in the lower rectum or anal canal, mostly one; the external orifice is on the perianal skin, which can be one or more, which is unhealed or intermittently recurrent. It is one of the common rectal and anal canal diseases, any age It can be affected, and it is more common in young men. The incidence is second only to hemorrhoids, and is more common in young men. It may be related to the strong secretion of sebaceous glands, one of the male sex hormone target organs.

    Anal fistula-cause

    Most anal fistulas are formed by rupture of anorectal abscess or after incision and drainage. The abscess gradually shrinks, but the contents of the intestine continue to enter the abscess cavity. In the process of healing and shrinking, a tortuous cavity is often formed, which is not easy to heal due to poor drainage. After a long time, there are many scar tissues around the cavity, forming a chronic infectious duct . Walking near the internal and external sphincter, the skin of the external mouth grows faster, often with false healing, causing repeated attacks. Most of the infections of the pipeline are purulent infections, and a few are tuberculosis.

    1. Abscesses around the anorectum are often ruptured or cut outside the anus, and pus flows out from the outside mouth, but the primary infection is mostly in the anal sinus. The anal sinus is the gateway to secondary infections, repeated infections, forming a fistula.

    2. The fistula usually passes between the anal sphincter. Because the sphincter constantly contracts and relaxes, it compresses the fistula and affects the elimination of pus. It is prone to pus infection and difficult to heal.

    3. There is a certain amount of pressure in the rectum, and rectal infections such as feces and gas can often enter the fistula from the internal opening, irritating the cavity wall, and being discharged from the external opening after secondary infection, which is also the cause of the fistula.

    4. After the anorectal abscess is ruptured, the pus is discharged, the abscess cavity is gradually reduced, and the external ulcer and incision are also reduced. The cavity wall forms a hard duct wall with connective tissue hyperplasia, so it cannot be closed naturally.

    5. The fistula is curved, or there are sinuses or branches, the drainage is not smooth, the pus is retained, and repeated infections make the fistula difficult to heal.

    6. Poor anal venous return, frequent local congestion, and malnutrition of tissues, affecting healing.

    7. Abscesses caused by tuberculosis, actinomycetes and other infections, Crohn's disease, etc. are difficult to heal on their own and form specific anal fistulas.

    Anal fistula-the cause of anal fistula recurrence

    1. Improper handling of anal glands: According to recent studies, anal gland infection is an important cause of anal fistula. Therefore, it is necessary to remove the internal mouth, as well as the anal glands and ducts with inflammation near the internal mouth.

    2. The position of the inner mouth is difficult to find: Sometimes the inner mouth cannot be accurately found, or the primary infection is still left in the inner mouth.

    3. Anal sinusitis: The complicated anal sinusitis is not treated in time, causing anal sinusitis to develop into anal fistula again.

    4. Newly formed anal fistula: Most patients have perianal abscess due to anal gland infection, which leads to a new anal fistula, which is mistaken as a recurrence. It is not difficult to distinguish in clinical practice.

    5. Complicated internal orifice: When there are two or more internal orifices in the fistula, the search for the internal orifice is incomplete, leading to recurrence.

    Anal fistula-harm

    1. Infected discharge

    One of the main symptoms of anal fistula is the discharge of pus or even fecal water after infection. It not only pollutes underwear, but also irritates the skin around the anus, causing obvious symptoms of anal itching, which makes the patient miserable, and also produces peculiar smell, which causes the patient There is a lot of embarrassment in public.

    2. Increased fistula

    If an anal fistula is not treated in time, it will recur, and the number of fistulas will continue to increase, and even fistulas will form in the anal sphincter space, which will evolve into a complex and intractable anal fistula. It will affect the normal physiological function of the patient's anus.

    3. Anal incontinence

    If anal fistula is left untreated for a long time and allowed to develop, it will cause serious and irreversible damage to the anal sphincter, causing patients to have varying degrees of anal incontinence, which will bring patients a lifetime of pain.

    Anal fistula-pathology

    Anal fistula

    Anal fistula has primary internal orifice, fistula, branch tube and secondary external orifice. The internal mouth is the entrance to the source of infection, mostly in and near the anal sinus, on both sides of the posterior midline, but it can also be in the lower rectum or any part of the anal canal. Fistulas are straight and curved, and a few have branches. The outer mouth is the place where the abscess ruptures or the incision and drainage is located. It is mostly located in the skin around the anal canal. Because pathogenic bacteria continue to enter the duct through the inner mouth, and the duct tortuously walks around the inner and outer sphincter, the wall of the duct is composed of fibrous tissue and there are Granulation tissue, so it will not heal for a long time.

    Generally, simple anal fistulas have only one internal port and one external port. This type of anal fistula is the most common clinically. If the outer mouth is temporarily closed and the local drainage is not smooth, infection will gradually occur and an abscess will form again. The closed outer mouth can be pierced or another outer mouth can be formed elsewhere. Such repeated attacks may expand the scope of the disease or sometimes cause several external openings that communicate with the internal openings. This anal fistula is called a complex anal fistula, that is, there are one internal opening and multiple external openings. However, some people believe that complex anal fistulas should not be divided into the number of external openings, but refer to those whose main fistula involves the anorectal ring or above. Although this type of anal fistula has only one external port and one internal port, the treatment is more complicated, so it is called complex anal fistula. On the contrary, sometimes anal fistula has multiple external openings, but the treatment is not complicated.

    Anal fistula-classification

    Types of anal fistula

    1. According to the location, depth, height and number of fistulas and fistulas, the classifications are:

    1. External fistulas and internal fistulas: external fistulas have at least two fistulas, one on the skin around the anus, most of which is 2 to 3 cm away from the anus, called the external opening, and the other in the intestinal cavity, mostly at the tooth line The inside of the anal sinus is called the internal orifice. A few internal orifices are above the middental line and on the wall of the rectum. The internal opening of the internal fistula is the same as the external fistula, there is no wound, and 90% of the clinical findings are external fistulas.

    2. Low fistula and high fistula: The fistula is located below the plane of the anorectal ring as a low fistula, and above this plane is a high fistula [2]. The latter is related to the choice of treatment.

    3. Simple anal fistula and complex anal fistula: the former has only one fistula, the latter can have multiple fistulas and fistulas.

    Anatomical classification of anal fistula

    2. From the perspective of clinical treatment, the relationship between anal fistula and sphincter is more important, which can be divided into:

    1. Intersphincteric type-the most common type, the inner mouth is located on the tooth line, the fistula runs between the inner and outer sphincter, and the outer mouth is on the skin around the anus;

    2. Transsphincter type-the fistula penetrates the skin around the anus through the space between the external sphincter and the ischial anal canal;

    3. Suprasphincter type—uncommon. The fistula penetrates the levator ani muscle as above and penetrates into the skin around the anus;

    4. Outer type of sphincter-rare, the inner mouth is on the dentinal wall of the rectum, the outer mouth is on the skin of the perianal distance, the fistula is outside the inner and outer sphincter, and goes down through the levator anus.

    Anal fistula-symptoms and signs

    Anal fistula is often a perianal abscess that ruptures spontaneously or the wound does not heal after incision and draining to form an external fistula.

    1. Clinical manifestations: A small amount of pus repeatedly flows out from the outer opening of the fistula, which contaminates underwear; sometimes the pus irritates the perianal skin and causes itching. If the outer mouth is temporarily closed and pus accumulates, there will be swelling, pain, redness and swelling in the local area. The closed outer mouth can be pierced again, or another new outer mouth can be formed nearby. Such repeated attacks can form multiple outer mouths. Communicate with each other. If the fistula drains smoothly, there will be no local pain, only slight swelling and discomfort, and patients often don't mind.

    2. Inspection: The outer mouth is a papillary protrusion or a bulge of granulation tissue, with a small amount of pus flowing out under pressure. Low anal fistulas often have only one outer mouth. If the location of the fistula is shallow, a hard cord can be felt under the skin. The outer mouth leads to the anal canal. The location of high anal fistula is often deep and it is not easy to touch the fistula, but there are often multiple external openings. Due to the stimulation of secretions, the perianal skin often thickens and redness. If there are external openings on the left and right sides of the anal canal, it should be considered as a "shoe-shaped" anal fistula. This is a special penetrating sphincter anal fistula, and also a high curved anal fistula. The fistula surrounds the anal canal and passes from one side of the ischiorectal fossa to the opposite side, forming a semi-circular shape like a shoe iron, hence the name. There is an inner orifice near the dentate line, and the number of outer orifices can be multiple, scattered on the left and right sides of the anus, and there are many branch tubes spreading around. Shoe-shaped anal fistula is divided into two types: front-shoe-shaped and back-shoe-shaped. The latter is more common, because the back tissue of the anal canal is looser than the front, and the infection is easy to spread.

    Anal fistula-common symptoms

    What are the common symptoms of anal fistula disease? Apart from prolapsed masses and lumps, what other common symptoms are there? [4]

    (1) The tumor prolapsed. A swelling prolapsed outside the anus after going to the toilet. It is common in internal hemorrhoids, papilloma, rectal polyps, rectal prolapse and so on. It should be noted that the tumor that protrudes from the anus should be sent back in time, otherwise it may cause the tumor to be incarcerated, difficult to repay, and cause pain and necrosis.

    (2) Lumps. The neoplasms or protrusions around the anus are common thrombotic external hemorrhoids, connective tissue external hemorrhoids, condyloma acuminatum, and anal squamous cell carcinoma.

    (3) Swelling. The swelling mentioned here mainly refers to perianal abscess and thrombotic external hemorrhoids. The swelling of perianal abscess is characterized by swelling, pain and throbbing, and often patients cannot straighten their waist. The swelling of thrombotic external hemorrhoids is limited to only one point. Does not affect body position. Incarcerated internal hemorrhoids. The anal margin is edema due to obstruction of blood return and lymph flow, swelling like a blooming crystal "violet", with dentate lines visible in the middle, and red hemorrhoid mucosa on or above it. In severe cases, it can be intensified to form a plug.

    (4) Secretions flow out of the anus. It can not only overflow from the fistula, but also from the anus, such as internal hemorrhoids, rectal prolapse caused by anal muscle relaxation, or overflow from the perianal skin, such as anal eczema. Clinical pus out of hemorrhoids and fistula. It is more common in anal fistula, abscess ulceration, inflammation of anal fissure, and proctitis.

    (5) Perianal itching. Itching and discomfort are mostly caused by irritation of the anus and surrounding skin. It is common in anorectal inflammatory lesions, skin diseases and enterobiasis. Severe itching, moist skin around the anus, and anal eczema for papules; unbearable itching, thick and rough skin, lightening or darkening of the skin is anal pruritus; if it is more itchy at night. Sometimes small white worms are seen around the anus, which is anal enterobiasis.

    (6) Changes in bowel habits. Healthy people have normal bowel habits, and changes in bowel habits are common in hemorrhoids, anal fistulas, anal fissures, and anorectal tumors.

    (7) Stool becomes thinner. Stool thinning is common in certain congenital diseases (such as congenital anorectal stenosis, anorectal lesions) or anorectal cancer. In addition, surgical injuries such as hemorrhoids, anal fistulas, and trauma can make stool thinner.

    (8) Abnormal stool. Any abnormalities in stool quality, volume, daily bowel movements, and bowel sensation are all abnormal stools. Many people usually think. Diarrhea and constipation are abnormal stools, in fact, this is only one aspect.

    In addition, if the stool contains mucus, bleeding, abdominal pain or bloating, as well as anal pain and itching, the occurrence, development, and relief are all related to defecation, and even cause and effect each other. Therefore, the above abnormalities can also be attributed in a broad sense. Abnormal stool.

    (9) Diarrhea. Patients often have more stools, thin or watery stool, and pus and blood in the stool. More common in dysentery and enteritis.

    (10) Constipation. Constipation is the most common symptom in patients with hemorrhoids, and it is a symptom that can occur in many diseases. Constipation refers to a decrease in the number of bowel movements, less than 2 to 3 times in 7 days, feces staying in the intestines for too long, too much water absorption, too dry and hard feces, which makes it difficult to discharge, which brings adverse effects on people's physical and mental health. It is not only the cause of hemorrhoid fistula and anorectal disease. It can also cause and aggravate many systemic diseases.

    Anal fistula-the distribution of fistulas

    There is a certain regularity in the distribution of the external and internal openings of anal fistula. Goodsall (1900) once proposed: draw a horizontal line in the middle of the anus. If the external opening of the anal fistula is in front of this line, the fistula often runs straight toward the anal canal, and the internal opening is located The corresponding position of the external opening; if the external opening is behind the horizontal line, the fistula is often curved, and the internal opening is mostly located in the middle of the anal canal. This is generally called Goodsall’s law. Most anal fistulas conform to the above rules, but there are exceptions. For example, the front high-shoe-shaped anal fistula may be curved, and the posterior low perianal abscess may be straight. Clinically, it has been observed that the straightness and curvature of anal fistula are not only related to the front and back of the anal canal, but also to the high and low positions of the anal fistula, and the distance between the external mouth and the anal margin. Cirocco (1992) once conducted a retrospective analysis of a group of anal fistula cases to test the accuracy of Goodsall's law in predicting anal fistula progression. He believed that this law was quite accurate in predicting the progression of anal fistula in the posterior external opening, especially for female patients, with 97% of internal openings. It is located in the posterior median anal crypt, but the prediction of the anal fistula of the anterior external mouth is not accurate. Only 49% of the radial fistulas conform to this rule, because Goodsall did not realize that 9% of the anterior anal fistula originated in the anterior median anal crypt.

    Anal fistula-development process

    Wuxi Kangtai experts pointed out that the formation of anal fistula is inseparable from the development of perianal abscess. The formation of anal fistula generally goes through four stages:

    The first stage: infection and inflammation of anal crypts and anal flaps. At first, it is limited to local inflammation. If it is not treated in time, the inflammation can spread around the anus.

    The second stage: Inflammation starts from the local anal recesses and anal flaps, and gradually spreads to form perirectal inflammation. If the inflammation cannot be controlled, it may invade into the tissue gaps with low disease resistance.

    The third stage: due to the decreased disease resistance of the tissues around the anorectal space, it becomes a place for germs to invade, spread, accumulate and multiply, causing the tissues here to be prone to infection and inflammation, which is invincible, and the formation of anorectal abscesses. If the anorectal abscess can be treated properly in the early stage, the abscess can often dissipate and heal without leaving sequelae; if the early treatment is delayed or improperly handled, the tissue necrotic pus can spread along the local space, making the condition aggravated and complicated.

    The fourth stage: The perianal abscess ruptures spontaneously or after treatment with incision, drainage and dressing, although the abscess cavity gradually shrinks, but the ulcer does not close for a long time. At this time, the cavity wall has formed a hard duct wall with connective tissue hyperplasia. The remaining space is the fistula. The pus often flows out of the fistula, with repeated infections and recurring attacks. It cannot heal itself for a long time and becomes a fistula.

    Anal fistula-diagnosis

    1. Medical history The patient often has a history of perianal abscess or incision and drainage, and the wound has not healed for a long time.

    2. Clinical manifestations: Repeatedly flowing out a small amount of pus through the fistula, perianal pus swelling and pain, perianal skin itching; pus outflow from the fistula when touched, hard cords can be palpable under the skin.

    3. Auxiliary examination: The probe can be inserted into the pipe through the external port; the methylene blue can be injected through the external port, and the gauze in the anal canal is stained blue; fistula angiography can show the image of the pipe.

    Anal fistula-auxiliary examination

    1. Digital rectal examination: There is mild tenderness on the inside and outside of the mouth, and a few can be palpable to induration.

    2. Methylene blue dyeing method: stuff white wet gauze into the anal canal and the lower end of the rectum, and inject 1-2ml of methylene blue into the fistula through the external mouth, and then take out the gauze from the anal canal. According to whether there is methylene blue staining on the gauze and Stain the site to determine the existence of the fistula and the location of the internal mouth.

    3. Probe inspection Use a probe to insert the pipe through the outer port to determine the location of the fistula and the inner port. This method is generally performed under anesthesia during the operation. If the operation is improper or unfamiliar with this method, it may cause false passages.

    4. Fistula angiography 30%-40% lipiodol is injected from the external mouth. X-ray film can be used to observe the distribution of fistula. It is mostly used for the diagnosis of high complex anal fistula and shoe-shaped anal fistula (Figure 6). Yang (1993) examined 17 cases of clinically suspected anorectal abscess or fistula, 6 cases of clinically suspected abscess, anal canal ultrasound AUS examination also showed abscess; another 82% (9/11) AUS found fistula, and clinical Routine inspection failed to find.

    5. Anal canal ultrasound is sometimes valuable for the diagnosis of intersphincteric fistula, but it cannot diagnose external sphincteric fistula and transsphincteric fistula.

    6. MRI Lunniss reported 35 cases of the results of this method, and the coincidence rates with the surgical results were: primary anal fistula (85.7%), secondary fistula and abscess (91.4%), hoof fistula (64.3%), fistula 80% of the inner mouth. Therefore, it is believed that the diagnosis of anal fistula position during MRI examination has extremely high accuracy. Correct use of MRI clinically can not only increase the success rate of surgery, but also monitor whether the complex anal fistula is completely healed.

    Anal fistula-differential diagnosis

    1. Perianal hidradenitis: This is the perianal skin disease that is most easily misdiagnosed as anal fistula, because its main feature is the formation of perianal abscess and residual sinus. There are often bulges and pus in the sinus, and there are multiple external openings, so it is easy to be misdiagnosed as multiple anal fistulas or complex anal fistulas. The main point of differentiation is that the lesions of perianal hidradenitis suppurativa are in the skin and subcutaneous tissues. The lesions are extensive and may have numerous sinus openings, which are nodular or diffuse, but the sinuses are shallow and do not communicate with the rectum. After incision of the sinuses There is no pus, fistula, and no internal mouth. Wiltz reported 43 cases of perianal hidradenitis suppurativa, 35 cases were first diagnosed as anal fistula, Tibetan hair cyst, sinus and anal abscess, and had a history of more than 6 years before diagnosis.

    2. Pelvic osteomyelitis: Pelvic osteomyelitis caused by pelvic purulent or tuberculosis lesions often occurs in the perineum sinus, which is very similar to the external opening of anal fistula. However, the former does not have an internal mouth, and X-ray shows that the pelvis is diseased.

    3. Anterior sacral fistula: The abscess between the sacrum and the rectum is punctured near the coccyx. The fistula is located in the sacral cavity. The external opening is often located on both sides of the tip of the coccyx. The probe can penetrate 8-10cm, and the fistula is parallel to the rectum.

    4. Sacrococcygeal bone tuberculosis: slow onset, no acute inflammatory changes such as redness, swelling, heat, pain, thin pus after ulceration, large outer mouth, irregular edges, and unhealed for a long time. X-ray film showed bone damage and tuberculosis foci in the sacrum.

    5. Sacrococcygeal teratoma: anterior coccygeal fistula or internal rectal fistula can be formed after rupture. Large teratomas can protrude from the sacrum and are easy to diagnose; small asymptomatic tumors can be palpated behind the rectum and smooth, lobed masses. X-ray film showed a mass between the sacrum and the rectum, with irregular scattered calcification shadows, bone or teeth.

    6. Advanced anorectal cancer: Anal fistula can form after ulceration, characterized by hard masses, pus and blood in secretions, and foul smell. Pathological sections can be diagnosed.

    Anal fistula-treatment options

    Schematic diagram of anal fistula thread therapy

    Once an anal fistula is formed, there is generally no possibility of self-healing, and surgical treatment is the only cure. However, in recent years, some people have used artificial materials to fill fistulas to treat anal fistulas. They believe that the effect is better and does not require surgical treatment. The principle of surgery is to cut or remove the fistula, making it an open wound and achieving the goal of gradual healing. The treatment should emphasize understanding the position of the internal mouth and the relationship with the deep part of the external sphincter to avoid damage to the sphincter and cause anal incontinence. There are several commonly used surgical methods [5].

    1. Fistula incision: It is suitable for simple low-position anal fistula. The probe is used to check the entire fistula during the operation, and all the fistula is cut through the probe, and the granulation tissue in the fistula is scraped to make the wound surface V-shaped. Fill the wound with oil gauze, and wash the wound with 1:5000 PP powder or hot water every day after 2 to 3 days. During the whole treatment process, care should be taken to ensure that the granulation tissue of the incision surface grows from the base to the superficial surface, and finally heals completely. Therefore, it is very important to observe the wound surface and change the dressing frequently. The topical application of Shengji ointment or growth hormone preparation for 2 to 3 days after the operation can accelerate the healing of the wound.

    2. Thread-hanging therapy is suitable for high simple or complex anal fistula. This method can avoid postoperative anal incontinence caused by sphincter incision, rupture and contraction at one time. It is widely used in clinical practice, easy to operate, and can be implemented in outpatient clinics. The disadvantage is that the postoperative recurrence rate is relatively high, which is mainly related to the incomplete exploration of the branch and internal mouth by the surgeon. High complex anal fistula can be changed into a simple anal fistula after repeated threading. Operation method: Under anesthesia, insert a probe from the outer port, pass the fistula through the inner port, tie a rubber band to the probe at the inner port, and then pull the rubber band from the inner port through the fistula to the outer port. Cut the skin between the inner and outer mouth and tighten the rubber band to ligate. The thread can be tightened again 3 to 5 days after surgery. Generally, the rubber band falls off within 2 weeks after surgery, leaving the open surface to heal gradually. If the rubber band does not fall off after 2 weeks, scissors can be used to cut the tissue bound by the rubber band.

    3. Anal fistula resection is generally suitable for low simple anal fistulas, but in recent years, many scholars have applied this method to high anal fistulas and complex anal fistulas. The method is to remove all the fistulas at one time, and the wound surface is healthy and normal tissue, and it is small inside and large outside. The superficial wound can be sutured in full thickness, and the stitches will be removed after 5 days, and the wound can be healed at first stage. The deeper wound should be opened. When the high anal fistula is resected, the deep part of the external sphincter should be separated, and those who need to be cut should pay attention to suture the reconstruction.

    Common dietary recipes for patients with anal fistula

    The occurrence of anal fistula is closely related to dampness and heat, so greasy food that generates dampness and heat should be tempered, and at the same time, we should quit smoking, alcohol and tea addiction. Eat more light and vitamin-rich foods, such as wax gourd, loofah, mung bean, radish, etc.

    Prolonged anal fistulas are mostly of the fictitious type. Foods such as lean meat, beef, mushrooms, jujube and sesame should be eaten in the diet. In addition, foods for prevention and treatment of deficiency syndrome include fungus, yam, coriander, leeks, eggplant, ginseng, water chestnut, lotus root, fennel, lychee, chicken, mutton, figs, etc.

    Common diet therapy:

    1. 1 piece of rice field eel, 100 grams of lean pork, 25 grams of astragalus, stir-fry, add salt, sugar, and rice wine, and eat after removing the astragalus. It is suitable for patients with virtual anal fistula.

    2. 100g each of rice and millet, wash, put in a pot, add appropriate amount of water to boil, wait until the porridge is cooked to half-cooked, add 500g of soy milk, stir well and cook, ready for consumption. It is suitable for patients with futility, both young and old.

    3. 6 grams of chrysanthemum, 6 grams of white sugar, and 3 grams of green tea leaves, put in a teacup and brew with boiling water. It is slightly stuffy for a while, with a light fragrance and elegant, which can clear away heat and detoxify, promote blood circulation, remove dampness, and relieve anal fistula swelling and pain.

    Anal fistula-TCM treatment of anal fistula

    Indications of TCM treatment of anal fistula:

    It can be said that drug therapy looks dull in the face of anal fistula, and only surgery can show its skills. However, some anal fistulas do not necessarily require surgery, and some patients are not suitable for surgery. Therefore, the traditional Chinese medicine treatment of anal fistula has its limitations. There are four scopes: first, patients with internal hemorrhoids and external hemorrhoids; second, elderly and weak people who are not suitable for surgery; third, the middle and late stages of internal and external hemorrhoids and other serious diseases. People who suffer from (such as liver disease, kidney disease, abdominal tumors, etc.); the fourth is anal fissure, anorectal abscess, fistula inflammation, and all anal infections.

    What are the traditional Chinese medicine treatment methods for anal fistula?

    The treatment of anal fistula in Chinese medicine is mainly based on internal treatment, which can be summarized into the three principles of elimination, care, and compensation, which can be used flexibly according to the severity of the disease. The specific decomposition is as follows.

    One: eliminate

    This is to use dissipating drugs to dissipate the initial perianal carbuncle and inflammatory external hemorrhoids, and avoid the pain of pus and incision. This method is suitable for perianal carbuncle, inflammatory external hemorrhoids, thrombotic external hemorrhoids and anal fissures without purulent. The specific usage depends on the nature of the disease. If there is evil expression, it is better to remove the surface; if the inside is solid, it is better to pass the inside; if the heat toxin accumulates, it should clear away heat and detoxify; Those with blood stasis should promote blood circulation and remove blood stasis.

    Two: support

    This is the use of medicines that nourish qi and blood to help the righteous qi and the leakage of poison to prevent the poison from invading. This method is suitable for the mid-stage of perianal abscess, weak righteousness, excessive toxins, inability to pass the toxin, perianal carbuncle flat and collapsed, loose roots and feet, and insufficiency and decay. If the poisonous qi is strong but the righteous qi is not decayed, pus-permeable drugs can be used to promote the early release of sepsis, reduce pain and swelling, so as to prevent the sepsis from running around and causing future problems.

    Three: make up

    This is to use tonic drugs to restore righteousness, help regenerate the affected area, and make sores and fistulas heal as soon as possible. This method is suitable for the elderly with physical weakness, weak qi and blood, late ulcers, or after anorectal disease, heat toxins have gone, and the lesions have been removed, and those who are mentally weak, weak in vitality, pus and water, and difficult to collect sores, and Patients with blood in the stool and prolapse. Those with weak qi and blood should replenish qi and blood; those with weak spleen and stomach should manage the spleen and stomach; and those with insufficient liver and kidney should replenish liver and kidney. But when the poisonous evil is not exhausted, do not use the tonic method as early as possible to avoid the evil's internal connotation, which will cause trouble over time.

    Anal fistula-preventive measures

    1. Prevention and treatment of constipation and diarrhea are of great significance to the prevention of perianal abscess and anal fistula.

    2. Treat anal cryptitis and anal papillitis in time to avoid the development of perianal abscess and anal fistula.

    3. Actively treat systemic diseases that can cause perianal abscess, such as Crohn's disease, ulcerative colitis, and intestinal tuberculosis.

    4. If the anus is burning and uncomfortable, and there is a feeling of falling, it is necessary to promptly diagnose and treat.

    5. Establish a normal life content (a balanced diet), develop good bowel habits, take a bath after defecation every day, and keep the anus clean, which has a positive effect on preventing infection.

    Diet after anal fistula operation

    Cocoa milk: half a catty of milk, 6 grams of cocoa powder, 10 grams of brown sugar, put the cocoa powder and brown sugar into the cup, flush the boiled milk into the cup, and then eat. Can be taken for a long time.

    Mung bean glutinous rice porridge: 50 grams of mung beans, 100 grams of glutinous rice, add appropriate amount of water and heat to cook the porridge[7], then eat.

    Eel medicated diet: 2 eels, eviscerated, cooked with 2 cups of wine, 1 bowl of water, and eaten with salt and vinegar.

    Egg melon seed soup: 2 eggs, shelled, 30 grams of melon seeds, add 2 bowls of water, and serve with sugar.

    Spinach mixed with bean sprouts: 100 grams of spinach, 100 grams of vermicelli, 50 grams of bean sprouts, 10 grams of leeks, cold dressing is enough.

    Anal fistula-how to determine the internal mouth of a complex anal fistula

    (1) Surgical examination, how to determine the internal orifice of complicated anal fistula? First, cut open the fistula and look for the internal opening along the fistula, which is generally easy to find.

    (2) Dyeing inspection. Put dry gauze into the rectum. If it is stained, it proves that there is an internal mouth.

    (3) Probe examination, how to determine the internal orifice of complicated anal fistula? Fingers can be inserted into the anus first, and a silver round-tip probe is used to gently probe into the intestinal cavity from the outer mouth along the pipe. Complete anal fistula. The fingers in the intestinal cavity can touch the probe near the tooth line to determine the inner mouth , Do not blindly use force when exploring, avoid false roads and spread the infection.

    (4) Anal endoscopy, all the dentition lines can be seen under direct vision. The internal mouth is often inflamed and inflamed with anal fistula with secretions. For suspicious anal crypts, a silver round tip probe can be used. [8]

    Anal fistula-cancerous anal fistula

    1. Causes of cancer

    1 Long-term chronic inflammation stimulation. The long-term existence of inflammation causes purulent secretions and feces to be discharged from the fistula, which stimulates the abnormal proliferation of tissue cells and leads to malignant lesions.

    2 Bacterial infection. Bacteria exist in the fistula for a long time, especially the infection of Pseudomonas aeruginosa or Mycobacterium tuberculosis, which can linger and cause cancer.

    Drug stimulation. Long-term and large-scale use of various topical drugs often stimulate the local area and cause cancer.

    2. The problem of cancer

    It can be explained clearly in three sentences

    1. Anal fistula is not directly related to cancer. Anal fistula is not a pre-cancer lesion; 2. Chronic anal fistula does have cancerous cases due to long-term inflammatory stimulation or scar tissue mutation; 3. Chronic anal fistula cancerous cases are very rare, and anal fistula cancerous The probability is very low.

    Anal fistula, when hemorrhoids, hides great harm

    Both anal fistulas and hemorrhoids occur in the anus, and both have symptoms of pain and bleeding, so it is easy to treat anal fistulas as hemorrhoids. One of the main symptoms of hemorrhoids is prolapse of internal hemorrhoids. The internal hemorrhoids protruding outside the anus are clamped by the sphincter, venous return is blocked, and the arterial blood is still infused to increase the volume of the hemorrhoids, until the arterial blood vessels are compressed, thrombosis occurs, the hemorrhoids become hard and painful, and it is difficult to send them back Inside. Anal fistula is also a common anal disease. It can also be called hemorrhoids, which is the sequelae of ulceration and incision of abscesses around the anal canal and rectum.

what does a hemorrhoids look like,Which diseases can cause stool bleeding?

    When a patient with recurrent blood in the stool was diagnosed with advanced rectal cancer, he said sadly: "If I had paid attention to blood in the stool, it wouldn't be the case." A few months ago, when he had blood in the stool, he simply treated it as hemorrhoids. Failure to do the corresponding examination in time, and the operation in time, resulted in today's result. In fact, there are many clinical lessons of this kind. Many people think that blood in the stool is nothing more than hemorrhoids. The most direct consequence of tolerating or neglecting blood in the stool is that many diseases miss the best time for treatment.

    So those diseases can cause stool bleeding?

    Hematochezia is a signal of no fewer than dozens of anal and digestive tract diseases. We can make self-judgments based on the comprehensive analysis of the way, amount, color and accompanying symptoms of blood in the stool, so as to make timely and reasonable treatments for them.

    1. Upper gastrointestinal bleeding, stools are tarry or black, and the bleeding sites are mostly in the upper gastrointestinal tract, that is to say, the possibility of bleeding in the stomach and duodenum is mostly. If the blood is red, it is mostly lower gastrointestinal bleeding. However, if the amount of bleeding in the upper gastrointestinal tract is large, because the blood stays in the gastrointestinal tract for a short time, the blood color can also be red. This needs attention.

    2. Hemorrhoids are the most common cause of blood in the stool. This type of blood in the stool occurs during or after defecation. The blood is bright red, the blood is not mixed with the feces, dripping down, or ejected. The amount of bleeding can be large or small, and can be self However, some still exhibit a certain periodicity. Some patients have small bumps protruding from the inside of the anus when they struggle to defecate, but there is no pain in the anus.

    3. Blood in the stool caused by anal fissure is also common in clinical practice. The blood is bright red, drips or wipes blood on toilet paper. Unlike hemorrhoids, it often has severe pain in the anus after defecation.

    4. Rectal polyps and blood in the stool in children are mostly caused by this disease. The blood in the stool caused by polyps is bright red, painless, and the blood does not mix with the stool. Some patients have grooves on the surface of the stool. The polyps can grow to a certain length and protrude out of the anus with the stool.

    5. Intestinal tumors. Among intestinal tumors, rectal cancer is the most similar to hemorrhoid bleeding due to its lower location. The blood in the stool is bright red and attached to the surface of the stool in the form of drops, but most of it is mixed with mucus and dark blood clots in the blood or in the stool, accompanied by foul smell, which is persistent, accompanied by anorectal drop and body weight loss in the late stage, and stool frequency Increasing, constipation and diarrhea alternately appear, based on these can be initially distinguished from hemorrhoids. Digital anus examination is one of the most convenient and economical examination methods to find anorectal tumors.

    6. Ulcerative colitis, dysentery and other diseases can also cause blood in the stool. Most of the blood in the stool caused by this type of colitis disease is mixed with mucus or pus and blood, accompanied by lower abdominal pain, fever, frequent stools and tenesmus. Adults See more.

    7. In addition, some rare diseases, such as typhoid fever, intestinal tuberculosis, intussusception, etc., may also have blood in the stool. Systemic diseases such as leukemia, aplastic anemia, primary thrombocytopenic purpura, hemophilia, coagulation disorders, collagen disease, uremia, and some rare infectious diseases such as plague, typhus, etc., will have blood in the stool . However, in these diseases, blood in the stool is only a part of the body bleeding. At the same time as the blood in the stool, there will be bleeding in other parts of the body. Therefore, it is not difficult to distinguish.

    It is still difficult to make a complete and accurate self-judgment based on the characteristics and symptoms of blood in the stool. It is best to go to the anorectal department for anal examination, especially the digital anus examination combined with colonoscopy, so that the diagnosis can be more accurate for early treatment.

hemorrhoids zinc oxide,Guidelines for the diagnosis and treatment of condyloma acuminatum-a must-read for patients with condyloma acuminatum

    1. You must go to the dermatology department of a large local hospital. Some hospitals claim to be specialized or have special effects, but in fact the treatment effect is average or not good, and the cost is quite high.

    2. The diagnosis must be clear, and it is easy for an experienced doctor to diagnose. If it is not typical, you can do an acetic acid white test, immunohistological examination, histochemical examination, pathological examination or HPV-DNA examination, but the latter can be used for the diagnosis of condyloma acuminatum , The general hospital does not.

    3. Condyloma acuminatum is easy to recur, but it can be cured as long as the method is appropriate.

    4. According to the size of the wart, the location of the wart, the number of warts, the recurrence and the patient's immunity, the appropriate treatment methods and drugs should be selected.

    5. Each medicine and method has its own advantages and disadvantages. It is not possible to say which medicine or method is the best. It depends on the situation of each patient.

    6. Many so-called unique, self-created special therapies in China are just a combination of several treatment methods, or the renaming of a certain treatment method or drug.

    7. Because of the limitations of the transmission of medical information on the Internet, and it is impossible to actually check the patient and observe the dynamic changes of the condition, online consultation cannot replace the traditional hospital visits, but can only provide general reference opinions, so you'd better go to the hospital for face-to-face consultation And treatment.

    8. Most of them are in the state of HPV carriers or subclinical infections. When the body's resistance drops, the virus multiplies in large numbers, and the disease can occur. If the body's immunity is strong, the infected HPV can be cleared, but the disease will not occur, but it is not cleared. Before, it is contagious.

    9. Local dampness, inflammation and increased secretions, pregnancy, excessive foreskin, hemorrhoids, and other venereal diseases can easily lead to disease, so pay attention to the treatment of other diseases.

    10. Individual habits such as smoking, drinking, staying up late, and eating irritating foods can easily lead to disease, so pay attention to lifestyle habits.

    Diagnosis, treatment and recurrence of condyloma acuminatum please click on my web article

    Condyloma acuminata treatment methods and drug selection https://lhj5198.haodf.com/wenzhang/69583.htm

    Distinguish right from wrong and self-discrimination --- Uncover the fog of condyloma acuminatum


    Can condoms definitely prevent the infection of genital warts and genital herpes? https://lhj5198.haodf.com/wenzhang/61375.htm

    Why does genital warts recur?


    What checks should be done for genital warts https://lhj5198.haodf.com/wenzhang/58436.htm

    After sexual contact with a patient with condyloma acuminata or HPV infection, will you get condyloma acuminata?


hemorrhoids bleeding treatment,Thank you letter, treatment experience-the woman stopped fetus once and became pregnant after two months of treatment

    I am a mother-to-be. I am now 15 weeks pregnant and set up a file in Jishuitan Hospital. Everything is fine.

    I just met Doctor Du this morning and wrote these words with great excitement and gratitude. I got pregnant for the first time in October 2013. I was not happy yet, and it was red. Then the 8th week B-ultrasound fetal heart rate was weak, the 11th week B-ultrasound fetus was stopped, no surgery was scheduled, and the spontaneous abortion occurred. I don’t know if I should be happy or worried. I got pregnant again in May 2014. Sadly, I had a spontaneous abortion in June. That time I was even more distraught, and for a long time, I didn't want to go out.

    Since September 2014, my husband and I have done all the tests. I didn't finish all the tests until May 15th. During this period, I also had follicle monitoring. The most memorable thing is that I took 14 tubes of blood a day. I ran to many hospitals without finding out the cause. I didn’t understand western medicine. I started Chinese medicine. At the beginning, my husband and I took medicine. My husband had hemorrhoids. He bleeds a lot every day for a long time. Because of this, my home is not very far from Xiyuan, and my husband started to check online and found Doctor Du. When I went to the hospital for the first time, Dr. Du said that her husband was okay and he didn’t need to take medicine. He hoped to see me and booked an appointment for me. I had a high hormone level. After two months of adjustment, I became pregnant. According to Dr. Du’s advice Carry out pregnancy-preserving treatment, follow up every week, check on time, and take medicine on time.

    Doctor Du is amiable and approachable. The most important thing is his medical skills, carefulness and dedication, and patience. I have a lot of questions every time I go, but he patiently answers them one by one, like a family member, like a teacher, I can't help calling Mr. Du every time. I was in the clinic for half a year and never caught up with Teacher Du’s vacation. Sometimes I thought, maybe the teacher did not vacation for half a year. I am pregnant, coupled with previous experiences, and emotionally unstable, the teacher will give me peace of mind in time. I wish Mr. Du smile often and help more families. I wish my baby grow up healthily under the guardianship of Teacher Du.

hemorrhoids essential oils,Summer is here, we need to be refreshed and prevent hemorrhoids!

    As the temperature gradually rises, cold beer, barbecue, and crayfish make us unstoppable. We enjoy our mouths, but with that comes the inadequate care of the buttocks. Many people begin to fidget because of hemorrhoids. The number of hemorrhoids coming to see a doctor is obviously increasing, so why do hemorrhoids happen frequently in summer? Is it just because of "can't control your mouth"?

    There are many factors for the high incidence of hemorrhoids in summer, mainly due to the hot summer weather, excessive fatigue, insufficient rest time, etc. In addition, people who like to eat cold drinks in summer can easily make the gastrointestinal turbidity unable to be discharged in time, and siltation in the anus causes hemorrhoids. Those white-collar workers who sit on soft seats for a long time during the day are one of these people. Lack of exercise can cause blood vessels to be blocked and blood vessels dilated, which can easily lead to hemorrhoids. People who like to eat barbecue, spicy food and cold beer in summer are also very common. Hemorrhoids may be induced by constipation. In addition, summer food is prone to spoilage, and a little carelessness can easily cause acute gastroenteritis, leading to diarrhea and hemorrhoids.

    ! ! "Posture is very important"! !

    Different postures of people have different effects on hemorrhoids. People in standing and sitting positions have the highest rate of hemorrhoids, followed by walking and squatting positions, and the lowest without positioning. Therefore, people in different industries have different rates of hemorrhoids. For example, drivers, fishermen, and white-collar workers have the highest incidence of hemorrhoids, followed by workers and farmers, and soldiers and students have the lowest. It is because the usual position of drivers and white-collar workers is the sitting position, and the usual position of fishermen is the standing position, which is easy to get hemorrhoids, while students and soldiers are often in an unpositioned position and the risk of hemorrhoids is relatively low.

    Editor's note: The onset of hemorrhoids in summer should be treated with caution. If hemorrhoids are not treated in time, the condition will continue to worsen, which may cause anemia, skin eczema, anal dysfunction, sepsis, toxemia, autonomic disorders, and cause gynecological diseases and induce rectum. Tumor and other diseases. Therefore, patients with hemorrhoids are best to seize the best time for treatment, so as not to cause more damage.

    Eat more whole grains, fruits and vegetables to prevent constipation

    The editor finds that in outpatient clinics, we often encounter such type of hemorrhoid patients. After they have hemorrhoids, although they are actively treated by themselves and even hospitalized for surgery, their condition is still repeated and often bloody stools. "Although hemorrhoids are difficult to treat, as long as we avoid them in our daily lives, it is entirely possible to prevent or reduce the onset of hemorrhoids."

    Although hemorrhoids are not a serious disease, they are also tormenting. Long-term chronic bleeding can cause anemia, often dizziness, weakness, lack of energy, reduced resistance, and all kinds of diseases. Not only that, hemorrhoids may often come out, making people restless. If the hemorrhoids are not taken back in time and complicated by infection, it is even more painful. To achieve the goal of preventing hemorrhoids from occurring, preventing hemorrhoids from developing, attacking or reducing attacks, the following points need to be done:

    One is to prevent constipation and keep the stool smooth, which is the most effective way to prevent hemorrhoids. Among them, diet is a key part. You should eat more whole grains, beans, vegetables, fruits and other foods containing fiber. Cellulose can increase intestinal peristalsis, is conducive to laxation, and eliminates harmful substances and carcinogens in the intestines. It is more suitable for people with habitual constipation. Getting up early and eating a good breakfast can strengthen the upright reflex and stomach and colon reflexes after waking up, and promote bowel movements. Drinking a glass of cold water after waking up in the morning can also help prevent constipation. In addition, when you feel the urge to have a bowel movement, don't endure the incomprehensible stool, otherwise it will easily cause habitual constipation. It is best to develop the habit of having regular bowel movements every day. When defecation, do not read books, smoke, squat for a long time, or use excessive force, otherwise, hemorrhoids will form over time. The general defecation time is 3 to 5 minutes.

    The second is not to eat or eat less stimulants. If you have a irritating burning sensation when you have a bowel movement the next day after eating chili and garlic, it means that you have exceeded your appetite and cannot eat more. Blood vessel congestion caused by alcohol is very obvious. Hemorrhoids can be congested and expanded due to this, so it is easy to cause hemorrhoids to attack. Avoid sitting for a long time, standing for a long time, and squatting for a long time. Proper adjustment and exercise are required to enhance physical fitness.

    The third is to promptly treat gastrointestinal diseases and inflammation around the anus, such as diarrhea, dysentery, and perianal skin diseases, to reduce the stimulation of inflammation on the anal canal and rectum, and to keep the perianal clean. At the same time, the heart, lungs, liver and other systemic diseases should be actively treated to reduce the occurrence of hemorrhoids.

    The fourth is to do two sets of levator exercises every morning and evening, methods (sitting, lying, standing): when inhaling, the anus is lifted up, tighten the anus, and relax when exhaling. Do about 30 times for each group, especially for the elderly, frail and sick. You can also massage the Changqiang acupoint at the tip of the tailbone by hand before going to bed to dredge the meridians and improve the anal blood circulation.

    The fifth is to take some Chinese medicines, such as black sesame seeds, raw rehmannia, fleece-flower root, cassia, Cistanche, Sanyu, etc., which can prevent hemorrhoids and cure hemorrhoids. After taking it, it can moisturize the intestines and relieve stools, cool blood and stop bleeding.

    To sum up, the prevention of hemorrhoids should not be considered unilaterally, but systemic conditioning, timely treatment and reduction of certain diseases and factors that may form hemorrhoids, can effectively prevent the occurrence of hemorrhoids.

hemorrhoids symptoms,Nine ways to prevent anorectal disease

    Pay attention to develop good living habits, especially the habit of regular bowel movements every day, which can prevent enteritis, diarrhea and constipation, and reduce the incidence of anorectal disease. At the same time, it is necessary to maintain anal hygiene to keep the perianal skin dry and comfortable, and pay attention to exercise. This can not only help everyone overcome bad emotions, but also promote the normal function of the digestive system and keep away from anorectal diseases.

    9 details that should be paid attention to to prevent anorectal disease

    1. Dietary adjustment to prevent enteritis, diarrhea and constipation: clinical manifestations mainly include abdominal pain, diarrhea, loose watery stools or mucus pus and bloody stools. ), reduce the predisposing factors of anorectal diseases. So pay attention to dietary hygiene, eat more fresh vegetables, fruits and whole grains, etc., and eat less spicy and irritating foods as much as possible to avoid causing anorectal diseases. Drink water scientifically. The elderly drink 300-400 ml of warm water on an empty stomach every morning, which can lubricate the intestinal tract, stimulate intestinal peristalsis, and relieve constipation. Drinking plenty of water can help soften stools and prevent constipation.

    2. 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 a drink with a straw will also cause a lot of air to sneak into the stomach and cause abdominal distension.

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

    4. 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.

    5. 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.

    6. Develop good living habits, especially bowel habits, so it is recommended that patients develop the habit of regular bowel movements, pay attention when defecation, and control the time of each bowel movement within 5-10 minutes. Do not sit on the toilet and wait for a bowel movement or squat after a long time. Don't ignore the stool, once you feel the stool, you should go to the toilet and defecate in time.

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

    8. Maintain anal hygiene. Many people pay little attention to the hygiene of the dry anus due to its position and function. One of the ways to prevent anal diseases is to pay attention to anal hygiene and keep the anus clean. The anus should be wiped clean as much as possible after defecation. It is best to wash the sitz bath with warm water or 1% warm salt water. Choose air-permeable, absorbent, loose, and soft underwear to keep the perianal skin dry and comfortable, and avoid perianal skin from damaging the perianal skin due to the rough and hard texture of the underwear, thereby causing secondary anorectal disease. Do not sit for a long time in a cool, humid place.

    9. 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.

    Reminder: Research data shows that people who often eat meat for dinner have 2 to 3 times higher blood lipids than vegetarians. If you eat too much fat, the body cannot absorb it and will stay in the intestine. Can increase blood lipids. This easily induces various anorectal diseases. Carbohydrates can generate more serotonin in the human body, play a calming and tranquilizing effect, and are especially beneficial for people with insomnia.

hemorrhoids essential oils,TST-a new method of minimally invasive treatment of hemorrhoids

    The operating principle of the disposable open-loop minimally invasive anorectal stapler (TST) is based on the theory of "anal cushion downward movement", combined with the theory of "varices" into hemorrhoids, absorbed modern hemorrhoid treatment concepts, and combined with Chinese medicine The advantages of the ligation method have developed a new method that is more in line with the pathological characteristics of hemorrhoids and the needs of anal function. Compared with PPH, TST is a holistic surgical solution based on different hemorrhoids theories.

    According to the number and size of the hemorrhoids, the operation of TST is to make a full purse or a half purse 2 to 3 cm above the dentate line, or "spot stitching", and simultaneously pull in the upper 1/3 of the hemorrhoids to remove the hemorrhoids The rectal mucosa and part of hemorrhoids are simultaneously "cut off", "suspended" and "reduced". Compared with PPH, TST is aimed at the number and size of different hemorrhoids, and there are more surgical methods.

    TST is the continuation and extension of the minimally invasive method for hemorrhoids. In addition to preserving the advantages of PPH surgery with less trauma, less postoperative pain, quick recovery, postoperative complications and low recurrence rate, it also has the following advantages:

    1. According to the number and size of hemorrhoids, the resection range of the hemorrhoid mucosa can be adjusted to achieve a good suspension effect.

    2. Controllable removal of part of the hemorrhoid top tissue, reducing the arteriovenous blood flow in the anal cushion, and achieving the effect of reducing the volume.

    Compared with PPH, TST is to maximize the preservation of normal mucosal bridges, maintain the fine sensation and contraction function of the anus, and further development of the minimally invasive treatment of hemorrhoids. As a unique technological innovation, TST currently holds 10 international and domestic patents.

    In terms of medical equipment, domestic products have always been inferior to imports, and high-quality medical products with independent intellectual property rights are even rarer. Although TST was developed on the basis of PPH, it surpassed the realm of PPH in terms of academic theory and product quality, and reached a new level of hemorrhoid treatment. Seeing the high-quality domestic TST going to the world, as a Chinese doctor, I am very proud!

    Since May 2011, I have performed nearly 20 TST operations. The results of the operation are comparable to those of PPH, but the side effects are significantly less than that of PPH, and the minimally invasive effect is more obvious. However, because the price is more expensive than PPH, it is difficult to generalize.

hemorrhoids diagnosis,Clinical diagnosis analysis of massive lower gastrointestinal bleeding

    Chinese Medical Journal 2003,2(7):1-3

    Li Chujun Li Guohua Hu Pinjin

    [Keywords] lower gastrointestinal tract "mass bleeding/causes" major bleeding/diagnosis

    Clinical Diagnosis of Massive Lower Gastrointestinal Hemorrhage LI Chu-jun, LI Guo-hua, HU Pin-jin. Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.

    【Abstract】Aims To study the causes and diagnostic methods of the massive lower gastrointestinal hemorrhage. Methods Clinical analysis of 45 cases of massive lower gastrointestinal hemorrhage in regard to etiology, bleeding site and manifestation. All the cases were confirmed by colonoscopy, operation or/ and pathological assessment. Results The results demonstrate that the tumor and the polyp comprise the majority of the causes of the massive lower gastrointestinal hemorrhage (37.8%, 17/45), with malignancy being predominant (76.5%, 13/17). All of the malignant tumor and the polyp are located in large intestine. The inflammatory diseases rank second (24.4%, 11/45), followed by the structure disorders of the intestinal wall (17.8%, 8/45), angiopathy (11.1%, 5 /45) and anal disease (8.9%, 4/45). Many of the patients are adult (88.9%, 40/45). Most of the inflammatory disease patients are youth (81.8%, 9/11) and all malignant tumors occurred in elder patients. The majority of the diseases located in large intestine (71.1%, 32/45) that include tumor, polyp, ulcerative colitis, diverticulum and hemorrhoids. The small intestinal diseases (28.9, 13/45) mainly comprise inflammatory diseases, Meckel diverticulum and hemangioma. The dramatic presentation of bleeding is hematochezia (93.3%,42/45), the other 3 cases of the diseases located in small intestine presented as melena. None of patients accompanied by hematemesis. Those with abdominal pains, tenderness of the abdomen or emaciation mostly suffer from tumor or inflammatory disorder of the intestine, and fever mainly occurred in the inflammatory intestinal disorder. Conclusions Most of the disorders that induced massive lower gastrointestinal hemorrhage are the large intestinal diseases and many of them are tumor. Hematochezia is the dramatic manifestation of bleeding. Urgent colonoscopy in an opportune moment is the most effective first test to detect the cause and the site of the bleeding and it can provide the therapeutic opportunity under endoscopy to stop bleeding in some patients. Angiography, radionuclide scanning, wireless endoscopy or small bowel endoscopy might promote diagnostic accuracy in some small intestinal disorders.

    【Key words】lower gastrointestinal tract; massive hemorrhage/etiology; massive hemorrhage/diagnosis

hemorrhoids diagnosis,Diagnosis and treatment of hemorrhoids


    1 definition

    Hemorrhoids have the same name in Chinese and Western medicine.

    Hemorrhoids are soft venous masses formed by the expansion of the venous plexus under the mucous membrane of the rectum and under the skin of the anal canal. Hemorrhoids are a common and frequent disease. The etiology is not yet fully understood. There are currently three theories: 1. Varicose veins theory; 2. Vascular hyperplasia theory; 3. Anal cushion shifting theory. Among them, the theory of downward movement of the anal cushion has been recognized and accepted by more and more experts, scholars and clinicians.

    2 categories

    Hemorrhoids are divided into internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids.

    a) Internal hemorrhoids are pathological changes and displacements of the supporting structure, vascular plexus and arteriovenous anastomosis of the anal cushion (anal vascular cushion) proximal to the dentate line.

    b) External hemorrhoids are expansion of the subcutaneous vascular plexus distal to the dentate line, blood stasis, thrombosis or tissue hyperplasia.

    c) Mixed hemorrhoids are the fusion of internal hemorrhoids and the vascular plexus of external hemorrhoids in the corresponding part.

    3 Risk factors for clinical progression of hemorrhoids

    A number of studies have shown that constipation factors, occupational factors, dietary factors, intra-abdominal pressure increase factors, local chronic irritation and infection factors, and age factors are related to the clinical progression of hemorrhoids.

    ——Constipation factors. Due to the prolonged pressure and stimulation of dry and hard stool and the prolongation of the time of each defecation, local congestion and blood flow of the anus are obstructed, resulting in increased hemorrhoidal vein pressure and decreased vein wall tension.

    ——Occupational factors Standing for a long time, sitting for a long time, and squatting for a long time can slow blood flow in the pelvic cavity, increase hemorrhoidal vein pressure and reduce vein wall tension.

    ——Dietary factors Low-fiber diet, excessive drinking, excessive consumption of spicy food and irregular diet can cause local congestion in the anus, leading to the occurrence of hemorrhoids.

    ——Intra-abdominal pressure increase factors. Intra-abdominal tumors, late pregnancy, and benign prostatic hyperplasia can increase intra-abdominal pressure and hinder venous blood return, leading to increased hemorrhoidal venous pressure and decreased venous wall tension.

    ——Local chronic irritation and infection factors Chronic colorectitis, anal sinusitis, diarrhea, and long-term stimulation of the anus with cold and heat can affect venous return and cause hemorrhoids.

    -Age factor The symptoms of hemorrhoids tend to get worse with age.

    4 diagnosis

    In order for patients with blood, prolapse, and pain to go to the doctor with the chief complaint, the possibility of hemorrhoids should be considered first. To confirm the diagnosis, the following clinical evaluations are required.

    4.1 Initial assessment

    4.1.1 Medical history inquiry The general condition of the patient. History of surgery and trauma, especially history of anal and rectal surgery or trauma. Past history and sexually transmitted diseases, diabetes, neurological diseases. Drug history, to understand whether the patient is currently or recently taking drugs that affect anal and rectal function. The characteristics, duration and accompanying symptoms of clinical symptoms.

    a) The main symptoms of internal hemorrhoids are bleeding and prolapse, which can be complicated by thrombosis, incarceration, strangulation and difficulty in defecation. Divided into 4 periods. Stage I: Blood and dripping in the stool, bleeding can stop after the stool; no prolapse of hemorrhoids. Stage Ⅱ: often have blood in the stool; prolapse of hemorrhoids during defecation, which can be repaid by itself after defecation. Stage III: There may be blood in the stool; defecation or standing for a long time, cough, fatigue, and prolapse of hemorrhoids when weight-bearing, need to be repaid by hand. Stage IV: There may be blood in the stool; the hemorrhoids continue to prolapse or are easy to prolapse after being received.

    b) The main symptoms of external hemorrhoids are soft tissue masses in the anus, anal discomfort, damp itching, or foreign body sensation. If thrombosis and inflammation occur, there may be pain and swelling. Divided into 4 categories. Inflammatory external hemorrhoids: skin injury or infection at the anal margin, protruding folds, and inflammatory manifestations of redness, swelling, heat and pain. Thrombotic external hemorrhoids: rupture of the subcutaneous venous plexus of the anus, thrombosis, manifested as a sudden blue-purple mass on the anal margin, severe pain. Connective tissue external hemorrhoids: local skin fibrosis, connective tissue hyperplasia, and skin tag formation at the anal margin, often without obvious discomfort or only mild foreign body sensation. Varicose external hemorrhoids: Masses of subcutaneous varicose veins below the dentate line. There is usually no obvious discomfort or only mild anal swelling. When the pressure of the anal canal increases, the varicose veins may appear or increase.

    c) Mixed hemorrhoids are mainly manifested by the simultaneous presence of internal and external hemorrhoids, and in severe cases, the prolapse of circular hemorrhoids.

    4.1.2 Physical examination Tongue coating, pulse condition Anal inspection

    Check for internal hemorrhoids prolapse, varicose external hemorrhoids, thrombotic external hemorrhoids, and skin tags around the anus. Squatting inspection is possible if necessary. Observe the location, size and bleeding of internal hemorrhoids, and whether the hemorrhoid mucosa has congestion, edema, erosion and ulcers. Digital anorectal examination

    It is an important inspection method. The digital examination of grade Ⅰ and Ⅱ internal hemorrhoids is mostly normal; for grade Ⅲ and Ⅳ internal hemorrhoids that prolapse repeatedly, the digital examination can sometimes touch the fibrotic hemorrhoid tissue on the dentate line. Digital anorectal examination can preliminarily rule out anorectal tumors and preliminarily judge anal function. Anorectoscope: It can clarify the location, size, number of internal hemorrhoids and whether there is bleeding, edema, erosion, etc. on the surface of internal hemorrhoids, and further exclude anorectal tumors.

    4.2 According to the results of the initial evaluation, some patients need further examination

    4.2.1 Stool occult blood test

    Stool occult blood test is a common screening method to exclude tumors of the entire digestive tract.

    4.2.2 Colonoscopy

    For patients with blood, patients with a family history of gastrointestinal tumors or a history of polyps, patients over 50 years of age, patients with hemorrhoids who have a positive stool occult blood test and iron deficiency anemia, full colonoscopy is recommended.

    4.3 Differential diagnosis

    Even if there are hemorrhoids, they should pay attention to diseases such as colorectal cancer, anal cancer, polyps, rectal mucosal prolapse, perianal abscess, anal fistula, anal fissure, anal papillary hypertrophy, anorectal sexually transmitted diseases, and inflammatory bowel disease Perform identification.

    5 syndrome differentiation

    5.1 Wind Injury Intestinal Collateral Syndrome

    Stool dripping blood, ejection or blood, red blood, dry stool, itchy anus, dry mouth and throat. Red tongue, yellow coating, floating pulse.

    5.2 Hot and humid betting certificate

    The stool is bloody red and the volume is large. Anal swelling, swelling, burning pain or hydration. Dry or loose stools, short red urine. The tongue is red, the coating is yellow and greasy, and the pulse is floating.

    5.3 Qi stagnation and blood stasis syndrome

    The mass prolapsed outside the anus, edema, thrombosis, or incarceration, the surface was dark purple, erosion, exudation, severe pain, obvious tenderness, and anal canal tightening. Constipation, poor urination. The tongue is dark purple or has petechiae, and the pulse is stringy or astringent.

    5.4 Syndrome of spleen deficiency and qi depression

    The tumor prolapsed outside the anus, not easy to reset, the anus swelled, defecation was weak, and the stool was bloody. Facial complexion, dizziness and fatigue, less food and fatigue, less gas and lazy talk. Pale tongue, thin white fur, thin and weak pulse.

    6 treatment

    6.1 Principles of treatment

    Asymptomatic hemorrhoids do not require treatment. The purpose of treatment of hemorrhoids is to eliminate and alleviate their symptoms. Relieving the symptoms of hemorrhoids is more meaningful than changing the size of hemorrhoids, and should be regarded as the standard of treatment effect. Doctors should adopt reasonable non-surgical or surgical treatments based on the patient's condition, personal experience and medical conditions.

    6.2 Watch and wait

    Watchful waiting is not just passive waiting, but a non-drug, non-surgical treatment measure, including patient education, lifestyle guidance, and follow-up. The development process of hemorrhoids is difficult to predict. For patients with occasional blood in the stool or prolapse, especially when the quality of life of the patient has not been significantly affected by the symptoms of hemorrhoids, watchful waiting can be a reasonable treatment.

    6.2.1 Patient education

    Patients should be informed of the need for regular follow-ups, and patients receiving watchful waiting should be provided with relevant knowledge of hemorrhoids, including clinical symptoms and clinical progress of hemorrhoids. In particular, patients should be informed about the effect and prognosis of watchful waiting. At the same time, knowledge about rectal cancer should be provided.

    6.2.2 Lifestyle guidance

    Drink more water, eat more dietary fiber, maintain smooth stools, develop the habit of regular bowel movements, take a bath in warm water, keep the perineum clean, eat less spicy food, avoid standing, sitting, squatting and other good lifestyles for hemorrhoid treatment. necessary.

    6.2.3 Follow-up

    Follow-up is an important clinical process of receiving watchful waiting patients. The purpose of follow-up is to understand the patient's condition, whether there is clinical progress and/or absolute surgical indications, and to switch to medical or surgical treatment according to the patient's wishes. The content of the follow-up is the content of the initial evaluation.

    6.3 Medication

    The short-term goal of drug therapy is to relieve the patient's clinical symptoms, and the long-term goal is to delay the clinical progression of the disease, improve the condition and then heal. It is the overall goal of drug therapy to maintain a high quality of life for patients while reducing the side effects of drug therapy.

    6.3.1 Chinese medicine decoction (treatment based on syndromes)

    Traditional Chinese medicine has made an indelible contribution to the development of China's medical and health industry and the health of the Chinese nation. Practice has proved that traditional Chinese medicine treatment based on syndrome differentiation has a significant therapeutic effect on hemorrhoids. Wind-injured bowel syndrome

    Treatment method: cooling blood and expelling wind

    Main Recipe: Addition and Subtraction of Liangxue Dihuang Decoction

    Commonly used medicines: Shengdi, Guiwei, Sanhua, Sophora japonicus, Coptis, Trichosanthes, Cimicifuga, Citrus aurantium, Astragalus, Nepeta, Platycladus charcoal, Raw licorice. Hot and humid betting certificate

    Treatment method: clearing away heat and dampness

    Main side: Huaihuasan addition and subtraction

    Commonly used medicine: Sophora japonicus charcoal, Platycladus orientalis charcoal, Diyu charcoal, Angelica sinensis, Nepeta charcoal, Shengdi, Sophora japonicus, licorice. Qi stagnation and blood stasis syndrome

    Treatment method: promoting blood circulation to reduce swelling

    Main prescription: Huoxue Sanyu Decoction

    Commonly used medicines: angelica tail, red peony root, peach kernel, rhubarb, chuanxiong, danpi, citrus aurantium, trichosanthes, sophora japonicus, sanyu, betel nut. Syndrome of spleen deficiency and qi depression

    Governing Law: Yiqi and Shengzi

    Main prescription: Buzhong Yiqi Decoction Modified

    Commonly used medicines: Astragalus, Codonopsis, Atractylodes, Tangerine peel, Angelica, Cohosh, Bupleurum, Chishizhi, Sophora japonicus, Sanguis elm, Roasted licorice.

    6.3.2 Chinese patent medicines and microcirculation regulators

    Traditional Chinese medicines taken orally generally have the effects of clearing heat and cooling blood, dispelling wind and moisturizing dryness, clearing heat and promoting dampness. For example, Diyu Huaijiao Pill can be used for hemorrhoid bleeding and swelling and pain. Intravenous enhancers, such as micronized and purified flavonoids, Molini extract tablets, Ginkgo biloba extract, etc., can alleviate the acute symptoms of internal hemorrhoids, but the combination of several intravenous enhancers has no obvious advantage; there is also anti-inflammatory and analgesic Medicine can effectively relieve the pain caused by internal hemorrhoids or thrombotic external hemorrhoids.

    6.3.3 Local drug treatment

    Including suppositories, creams, lotions. Chinese medicine decoction and sitz bath can reduce swelling and pain, dampness and itching. The main ingredients of traditional Chinese medicine are: gallnut, mirabilite, borneol, alum, rhubarb, coptis, scutellaria, cork, sophora flavescens, panax notoginseng, pearl, nepeta, fig leaves, etc. Suppositories and creams containing carrageenic acid mucosal repair, protection and lubricating ingredients have a good therapeutic effect on hemorrhoids. Drugs containing steroid derivatives can relieve symptoms in the acute phase, but should not be used for long-term and preventive purposes.

    6.4 Injection therapy

    Submucosal sclerosing agent injection is a commonly used effective method for the treatment of internal hemorrhoids. It is mainly suitable for internal hemorrhoids of degree I and II. The short-term effect is significant. Complications include pain, burning sensation in the anus, tissue necrosis ulcers or anal stenosis, hemorrhoid thrombosis, submucosal abscess and induration. External hemorrhoids and hemorrhoids during pregnancy should be disabled.

    6.5 Ligation therapy

    Wrap the roots of the hemorrhoids with silk thread or medicated silk thread or paper-wrapped medicinal thread to make the hemorrhoids necrosis and fall off, and the wound will heal after repair. 6.6 Device therapy

    6.6.1 Rubber band ligation therapy

    It is suitable for internal hemorrhoids of various degrees of internal hemorrhoids and mixed hemorrhoids, especially those with internal hemorrhoids of Ⅱ and Ⅲ degree with bleeding and/or prolapse. The ligation site is in the area of ​​the dentate line, and complications include rectal discomfort and swelling, pain, apron slippage, delayed bleeding, anal skin edema, thrombotic external hemorrhoids, ulcer formation, pelvic infection, etc.

    6.6.2 Physiotherapy

    Including laser therapy, cryotherapy, direct current therapy and copper ion electrochemical therapy, microwave thermocoagulation therapy, infrared coagulation therapy, etc. The main indications are internal hemorrhoids of degree I, II, and III. The main complications are bleeding, edema, delayed wound healing and infection.

    6.7 Surgical treatment

    6.7.1 Purpose

    Hemorrhoids are a progressive disease, and some patients eventually need surgery to relieve the symptoms and their impact on the quality of life.

    6.7.2 Indications

    Internal hemorrhoids have developed to stage III or IV or acute incarcerated hemorrhoids, necrotic hemorrhoids, and external hemorrhoids with significant symptoms and signs. In stage II hemorrhoids with severe bleeding, especially patients with poor drug treatment, surgery can be considered.

    6.7.3 Surgical methods

    ——In principle, hemorrhoidectomy is the complete or partial removal of hemorrhoids. Common surgical methods include: external stripping and internal ligation open wound (Milligan-Morgan) surgery; semi-open wound (Parks) surgery; wound closed (Ferguson) surgery; External stripping and internal ligation plus sclerotherapy injection. During the operation, care should be taken to reasonably reserve the location and number of skin bridges and mucosal bridges to shorten the wound healing time.

    ——Circumcision and nailing of the hemorrhoids, using a stapler to remove part of the rectal mucosa and submucosa through the anus. It is suitable for hemorrhoids in stage III and IV with annular prolapse and hemorrhoids in stage II with repeated bleeding. Postoperative care should be taken to prevent complications such as bleeding, anal bulging, stenosis, and infection.

    ——Doppler-guided Hemorrhoid Artery Ligation Using a special Doppler probe, the artery above the hemorrhoid is detected 2 to 3 cm above the dentate line and ligated directly to block the blood supply of the hemorrhoid to relieve symptoms. Applicable to hemorrhoids in the period II to IV.

    ——For other patients with degree Ⅰ and Ⅱ hemorrhoids and internal sphincter in a state of high tension, surgical methods for the internal anal sphincter can be used, including manual or balloon device for dilatation and posterior or lateral resection of the internal anal sphincter Open surgery. Complications include tearing of the anal mucosa, mucosal prolapse, and anal incontinence.

    6.7.4 Prevention and treatment of postoperative complications

    ——Bleeding Bleeding may occur in various hemorrhoid operations, and some patients may have delayed bleeding after the operation. Should pay attention to strict hemostasis during surgery and postoperative observation, if necessary, surgery to stop bleeding.

    —— Empty the bladder before urinary retention, control the infusion volume and rate, and choose the appropriate anesthesia to prevent urinary retention. If urinary retention occurs, acupuncture at Guanyuan, Sanyinjiao, and Zhiyin points can be used. Ear pressure and oral Chinese medicine can also be used for treatment, and catheterization if necessary.

hemorrhoids ligation,Irritating anorectal swelling

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