2020年12月15日星期二

hemorrhoids and anal fissures,"Prolapse of the anus" to explain the doubt

    In the outpatient work, it is common to see patients with "prolapse" as the main complaint. The original intention of the patient is to defecate, after defecation, increased abdominal pressure (such as coughing, holding breath, etc.), and prolapse of anal mass when walking or standing. In fact, it is a collective term for all diseases that have a prolapsed anus. There are many diseases with "prolapse", which are described as follows:

    (1) Rectal prolapse: whether it is rectal mucosal prolapse or full-thickness rectal prolapse, it can be prolapsed during defecation, and it can be absorbed after contraction, and some need to be backed by hand, often contaminated underwear due to mucus flowing out, Accompanied by perianal itching. When the mucosa is damaged, ulcers and bleeding can occur. The patient is forced to squat, and the digital examination of mucosal prolapse is only two layers of folded mucosa. Complete prolapse is a full-thickness intestinal wall turned out, the mucosa is in concentric ring folds, and the mass is folded in layers, like an inverted pagoda.

    (2) Mixed hemorrhoids and internal hemorrhoid prolapse: The internal hemorrhoids prolapse out of the anus during the defecation, and the hemorrhoids are returned by themselves after the defecation are stage II hemorrhoids; the hemorrhoids cannot be returned after the defecation and the hemorrhoids need manual reduction are the stage III hemorrhoids. The hemorrhoids are purplish red or bright red, resembling a strawberry, and the mucosa is thin and easy to bleed.

    (3) Rectal polyps: Polyps at the lower part of the rectum can protrude out of the anus during defecation and can be absorbed by themselves. The surface of the polyps is mucous membrane. When the mucosa becomes inflamed, it is strawberry-like. The prolapsed polyp has a pedicle and is often easy to bleed.

    (4) Anal papilla hypertrophy: Except for the small triangular and rice-grain hypertrophic anal papilla, the larger anal papilla can protrude out of the anus during defecation, and some can be absorbed by itself, and some need to be restored by hand. There is anal discomfort, no tenderness, and little bleeding. It can be one or several.

    (5) Tumors: Rectal adenomas, villous or papillary adenomas, melanomas, low rectal malignancies, etc. can prolapse outside the anus with feces, accompanied by blood in the stool and pus and blood in the stool. Anal cancer can be painful and bleeding, and the tumor is cauliflower-like, often outside the anus.

    (6) External hemorrhoids: often due to dry stools, swelling and obvious pain on the anal margin after defecating force, local round tumors with obvious tenderness, purple-blue nodules under the skin, mostly thrombotic external hemorrhoids ; Repeated minor injuries and infections of the anal skin can make the skin red, swollen, hot, painful, and skin folds swollen to form inflammatory external hemorrhoids; after the inflammation subsides, the skin tags are left behind, which are connective tissue external hemorrhoids, and only the anus after the stool Discomfort, difficult to clean or itching and other symptoms.

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