Varicose external hemorrhoids are soft masses formed on the anal rim due to blood stasis and varicose in the external hemorrhoidal venous plexus. They are mostly found in the anal canal or under the skin of the anal rim in the left middle, right front and right back of the anus. The bumps are oval or ring-shaped. It is irregular in shape and soft in texture. The swelling gradually enlarges when struggling hard during defecation. It is blue-purple, and gradually shrinks after going to the toilet. Generally, there is no pain, or there is only a feeling of swelling of foreign bodies. This disease often coexists with hemorrhoids in the second and third stages.
It is mostly because of repeated prolapse of hemorrhoids in the second and third phases, or increased abdominal pressure after pregnancy by the parturient, which results in the obstruction of superficial vein and subcutaneous lymphatic drainage, causing the expansion and varicose of the external hemorrhoidal venous plexus below the anal canal.
The onset is slow. At first, I only feel discomfort when the anus is swollen, but usually does not show up. When the abdominal pressure is increased by defecation and squatting, there are irregular or oval lumps on the anal margin, covered with skin and dark purple. After going to the toilet, squatting for a long time or when internal hemorrhoids are sucked, there is a feeling of bulging or foreign body in the anus, which cannot disappear immediately. Generally, there is no pain, no bleeding, and internal hemorrhoids. If there is inflammation, symptoms such as anal swelling and pain will appear
Physical examination: It can be seen that there are round, oval or long lumps on the skin of the anal margin, with a bluish-purple and shiny surface. When squatting for a long time or attracting internal hemorrhoids, the lumps enlarge, and varicose veins can be seen.
1. Have long-term constipation or squatting in the toilet for too long before the onset.
2. Internal hemorrhoids can coexist at the same time.
3. Generally, there is no conscious symptom. Only when the bowel movement is too long, the anus will feel swollen with a foreign body, the swelling is obvious, and it will gradually shrink after the bowel movement.
4. There are irregular or oval lumps on the anal margin, covered with skin, dark purple, generally painless and no bleeding.
1. Thrombotic external hemorrhoids
The swelling occurred suddenly, the pain was severe, the color was dark purple, the tenderness was hard, and the ulceration showed congestion and overflow.
2. Perirectal abscess
Perianal swelling and pain, obvious tenderness, fluctuating sensation during pus formation, ulceration and discharge.
3. Connective tissue external hemorrhoids
The skin tag gradually increased, the anus and abdominal pressure increased, and the hemorrhoids remained unchanged and no tenderness.
Treatment is not necessary for mild cases, and for heavier bowel movements, astringent ointment is applied locally to relieve symptoms. After non-surgical treatment fails, varicose external hemorrhoids can be treated with dissection. Method of operation. The patient lies in the lithotomy position or on his side, routinely disinfected, injected 0.75% lidocaine, local anesthesia, lifted the external hemorrhoids with mosquito forceps, made a radial fusiform incision around the hemorrhoid root with surgical scissors, and sharply separated the subcutaneous varicose The venous plexus to the anal margin is removed together with the skin and subcutaneous tissue. After the operation, the wound is covered with petroleum jelly gauze and pressure-wrapped; control bowel movement for 1 to 2 days, after the defecation, use 0.2g/L potassium permanganate to sit in a bath, wipe dry, and apply oil gauze until healed.
Department of Anorectal, Tongchuan District Hospital of Traditional Chinese Medicine, Dazhou City