Case introduction: Ms. Li, female, 44 years old. During the outpatient visit, she complained that she often felt a lump in the anus during defecation, which can be taken back with her hands. This symptom has been around for more than a year. Hemorrhoids were considered to be hemorrhoids in many outpatient clinics, and anti-inflammatory treatment was given, but the symptoms sometimes disappeared. Recently, it was found that the number of prolapses increased. The doctor performed a colonoscopy and found that a polyp-like material was found 8cm from the anus. The pathological biopsy showed a "villous adenoma", which was then treated by endoscopic resection.
So what are the diseases of anal prolapse?
The anus is tightly closed due to the contraction of the internal and external sphincter muscles, and the perianal skin shows radial wrinkles. Prolapse of anus without mass is defined as a protruding mass on the edge of the anus or prolapse of a mass in the anal canal and rectum outside the anus. It is collectively referred to as prolapse in Chinese medicine. Clinically based on the relationship between tumor prolapse and defecation, if it prolapses during defecation, it can be returned to the anus by itself after defecation; some cannot be received after defecation or often outside the anus. Common diseases include:
1. Internal hemorrhoids: The internal hemorrhoids protrude outside the anus during the defecation, and the hemorrhoids after the defecation return spontaneously are stage II hemorrhoids; the hemorrhoids cannot be recovered after the defecation and need manual reduction is the stage III hemorrhoids. The hemorrhoids are purplish red or bright red, resembling a strawberry, and the mucosa is thin and easy to bleed.
2. External hemorrhoids: often due to dry stools, masses on the anal margin after defecation force, obvious pain, local round masses, obvious tenderness, subcutaneous purple-blue nodules, multiple thrombotic external hemorrhoids; anus Repeated minor skin injuries and infections can make the skin red, swollen, hot and painful, skin folds and swelling to form inflammatory external hemorrhoids; after the inflammation subsides, the skin tags are left behind, which are knotted tissue external hemorrhoids. Only the anus is uncomfortable after defecation and difficult to clean. Or symptoms such as itching.
3. Anal papilla hypertrophy: Except for the small triangular and rice-shaped 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 hand rest to restore the position, clinically only the anus Discomfort, no tenderness, seldom bleeding, can be one or several.
4. Rectal polyps: Polyps in 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 mucosa. When the mucosa becomes inflamed, it appears as a strawberry. The prolapsed polyp has a pedicle and is often easy to bleed.
5. 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. It is often contaminated by the outflow of mucus. There is perianal itching. When the mucosa is damaged, ulcers and bleeding can occur. The patient was forced to squat, the mucosa prolapsed, and there was a radial groove outward from the center of the tumor. There were only two layers of folded mucosa on the digital examination. Complete prolapse is the full-thickness intestinal wall turned out, the mucosa presents concentric annular folds, and the mass is folded in layers, like an inverted pagoda.
6. Tumors: rectal adenomas, villous or papillary adenomas, melanomas, low rectal cancers, etc. can protrude outside the anus during defecation, 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.
It can be seen that if there is a prolapse outside the anus, you should go to the hospital in time and do corresponding examinations to confirm the diagnosis as soon as possible and get timely treatment.