2020年11月21日星期六

hemorrhoids and anal fissures,Routine care after anal surgery (under local anesthesia)

    1. First of all, we should do a good job of explanation, perfect the examinations before the operation, understand the overall physical condition of the patient, and inform the patient of the possible complications and precautions after the operation.

    2. You should stay in bed after surgery. Due to anesthesia, orthostatic hypotension is prone to occur. Some patients have fainting during walking or going to the toilet after surgery. They should lie down immediately, lower their head, and drink a cup of hot water. They will recover slowly. The wound of the anus is mainly compressed to stop bleeding, and premature activity can easily cause the dressing to fall off and cause hemorrhage.

    3. Urinate for the first time after surgery. Difficulty in urination is the most common complication after anal surgery. Because the sensory nerves of the anus and the nerves of the bladder come from the 4th sacral nerve, the spasm and pain of the anal sphincter cause the contraction of the bladder to cause dysfunction. When urination is difficult, the following measures should be taken: 1) Eliminate ideological concerns and choose a suitable environment and natural posture to urinate. 2) Treat anal pain in time and promote anal exhaust. 3) Use a hot water bottle or hot towel to apply heat to the lower abdomen and massage locally to relieve the spasm of the urethra and bladder sphincter and promote urination. 4) Sound stimulation of running water enhances the function of urination reflex. 5) Oral Chinese medicine diuretic agents such as Paishi Granules or Lysimachia Granules. 6) Acupuncture points: Qihai, Zhongji, Sanyinjiao, intermittent acupuncture for 15 minutes. 7) Intramuscular injection of neostigmine 0.5-1.0mg, but patients with tracheitis, intestinal obstruction, and prostate hypertrophy are contraindicated. 8) All of the above measures are ineffective, and if the bladder is full, catheterization should be used.

    4. Reasonable dietary arrangements. 1) On the day of the operation, a semi-liquid diet with less residue should be given, and milk and other foods that produce more gas and are difficult to digest and absorb should be given. 2) If you have a good appetite, you can eat normally the next day. A normal diet can supplement enough nutrition, enhance physical fitness, promote wound healing, and restore normal gastrointestinal motility as soon as possible. 3) After the first bowel movement, the diet should be adjusted according to the bowel situation. If the stool is not dry or diarrhea, then eat regularly; if the stool is dry and hard to discharge, you should increase the fiber content and drink more water to promote bowel; if the stool is loose or diarrhea, give it semi-liquid easy Digest the diet. 4) After the operation, you should avoid eating spicy foods that stimulate fatness, but one week after the anal fistula operation, you should eat more flesh and blood products such as pigeons, fish and other animal meat and aquatic products with high protein content. You can also supplement them appropriately. It is mainly a nutrient that nourishes blood and qi, and promotes the growth of wound granulation.

    5. Stool conditioning. 1) To prevent postoperative bleeding, in principle, control bowel movements within 24 hours after surgery. Pain and bleeding during defecation are normal conditions, and it may last for 7-10 days. The symptoms will not be relieved until the ligature is off. 2) Due to the control of the stool one or two days ago, the stool became dry and clumpy during the first defecation, the anal pain was severe and unbearable, the bleeding was more, or it was dripping or spraying, which easily caused the patient to panic. At this time, the patient should first stay calm and stand up immediately. If the stool does not ooze blood from the anus, it means that it is normal bleeding and no special treatment is needed. If the stool continues to ooze blood after the stool is pressed, it needs to be handled by a physician. Under normal circumstances, on the second day after the operation, you will resume your normal diet, eat more vegetables, fruits and vegetables; start to take laxatives 24 hours after the operation; This treatment can make the first bowel movement smooth and relieve symptoms such as pain and bleeding. 3) After the operation, the stool is thin and the frequency increases more than 3 times per day, which also affects the healing of the wound and increases anal pain and other discomforts. At this time, the patient should take the following measures: stop taking laxatives; change to a semi-liquid diet and drink plenty of water; appropriately take antidiarrheal drugs to shape the stool and discharge effortlessly.

    6. Sit in the anus after defecation. The sitz bath mainly plays a role in cleaning the anus and promoting local blood circulation in anal wounds. Clinically, warm salt water (half a basin of hot water plus a large scoop of table salt), Chinese herbal decoction or potassium permanganate solution (1:5000) are often used. After defecation, first smoke with hot air. When the temperature of the medicine drops and it is not hot, then soak the anus in the liquid medicine for about 15 minutes each time.

    7. Change the dressing of the anus after defecation. Since most of the wounds in the anus are open, that is, they are not sutured, the dressing change is different from that in other places. Dressing changes are usually performed after stool, and after anal sitz bath, once a day, do not change the dressing too frequently, too frequently will affect the growth of granulation.

    8. Regularly review the wound situation. It takes three to four weeks for the anal wound to heal completely. The first week is the exudation period, and the dressing is easily contaminated by blood and water; the first week is the granulation period, the secretion is reduced, and the wound becomes shallow, then the dressing is relatively clean; the third week is the repair period, and the wound is gradually healed. For anal fistula wounds, the healing time will be delayed. It is generally reviewed once a week, and if the wound is found abnormal in time, it can be dealt with in time.

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