2020年12月22日星期二

hemorrhoids and anal fissures,Nasty anal bulge

    In the anorectal department, when hearing patients describe symptoms, I can often hear, "Doctor, my anus falls in panic, it's uncomfortable, and sometimes it's uncomfortable." What is the feeling of anal bulge, and what kind of disease is caused by it? Generally speaking, the male prostate is adjacent to the rectum and anus. Prostatitis, prostatic hypertrophy, prostate nodules, etc. will all cause certain anal irritation; women will also experience retroverted uterus, uterine fibroids, pelvic inflammatory disease, and endometriosis. There are varying degrees of anorectal swelling.

    Different from anal pain, local fullness and fall in the mild cases, tenso-heavy in the severe cases, frequent squatting in the toilet, and heavy falls after defecation, which is very painful and clinically not uncommon. From my experience, sag is related to many perianal and rectal diseases, such as inflammatory irritation, swelling irritation, increased anorectal pressure, female gynecological diseases, male prostate diseases, etc., which can cause different degrees of sag, which requires careful clinical identification.

    Inflammation of internal hemorrhoids

    Due to dry stool or other reasons, the internal hemorrhoids surface mucosal erosion, edema, bleeding, and massive thrombosis under the mucosa, which can protrude outside the anus in severe cases. Patients often have a strong sense of anal drop, and patients with incarcerated hemorrhoids also experience severe pain.

    Rectal and anal sinus inflammation

    If chronic colitis affects the rectum, anal fall sensation will generally have a longer course, recurring attacks, and varying degrees of disease.

    Internal rectal prolapse

    It can also be called "prolapse of the anus", which refers to the prolapse of the tissue inside the anus outside the anus. The rectal mucosa is loose and accumulated in the rectum, but has not yet taken off outside the anus, which can cause a feeling of bulging and incomplete defecation.

    Intrarectal prolapse refers to the full-thickness or simple mucosal layer of the proximal rectal wall folded into the distal intestinal cavity or anal canal during defecation, does not extend beyond the outer edge of the anus, and persists after the excrement of fecal mass.

    Of course there are other reasons

    ①A variety of inflammatory irritation: such as bacillary dysentery, various proctitis, early rectal submucosal abscess, etc. lead to increased rectal pressure; perianal diseases such as anal sinusitis, anal papillitis (that is, anal papillary hypertrophy and edema), external hemorrhoid edema and various Increasing the pressure of the anal canal caused by wound stimulation after various perianal diseases can all cause different degrees of anal drop.

    ② Tumor irritation: For example, rectal cancer, prostate cancer, rectal polyps, including rectal villous adenoma, pressure stimulates baroreceptors at the end of the rectum, resulting in frequent bowel movements.

    ③Intra-anal stagnation and compression: For patients with long-term constipation or fecal impaction, the feces cannot be smoothly resolved because the stool stimulates the anorectal baroreceptors.

    ④Stimulation of various prolapsed diseases: such as repeated prolapse of internal hemorrhoids, internal hemorrhoids incarceration (congestion caused by the inability to absorb after prolapse), rectal prolapse and other prolapsed objects repeatedly stimulate the anal canal and the end of the rectum.

    ⑤ Diseases of adjacent organs of the rectum: The prostate is adjacent to the rectum and anus in men. Prostatitis, prostatic hypertrophy, prostate nodules, etc. will cause certain anal irritation; women with retroverted uterus, uterine fibroids, pelvic inflammatory disease, endometriosis, etc. There will also be varying degrees of anorectal swelling.

    In addition, some patients may be suffering from very mild diseases, but they are paying attention to their condition all the time every day. They are even terrified and have difficulty falling asleep. Eventually they develop anal neurosis and cause abnormal anal bulging. At this time, some anti-anxiety drugs can be used. Of course, it must be guided by a professional doctor.

    Anorectal swelling can be preliminarily distinguished from the duration and degree of swelling. Such as internal hemorrhoids incarcerated, rectal tumors, anal foreign bodies, the swelling is continuous and has nothing to do with defecation. If the condition is light, the swelling will be light, and vice versa; if the internal hemorrhoids prolapse, rectal prolapse, the swelling will increase after the swelling, when the swelling is absorbed The swelling in the anus is reduced; bacillary dysentery and proctitis are accompanied by significant increase in stools, irregular stools, or even pus and blood in the stool; deep perianal abscesses do not compress anal nerves, so anal pain is not obvious. However, there are often high fever and chills with swelling, and even difficulty in urination and unresolved stools; swelling after ligation of internal hemorrhoids, injection of internal hemorrhoids, or other perianal surgery has a significant history of surgery, that is, caused by the stimulation of the wound after the operation. As the wound grows or the ligature falls off, the swelling will gradually decrease. If women have significant premenstrual bulging, they should consider the possibility of endometriosis, because the displaced endometrium is often located at the lowest point of the uterus and rectum (the place called Douglas’s fossa in medicine). When menstruation is coming, there is obvious congestion in the area leading to bulging; if men with anal bulging accompanied by obvious groin soreness and increased nocturia, attention should be paid to exclude prostate disease.

    In short, once anorectal swelling occurs for a period of time, it is recommended that you do not make your own claim, let alone ignore it. You should actively look for the cause, investigate the condition, and prevent the disease first.

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