2020年12月17日星期四

what does a hemorrhoids look like,A must-read article for perianal discomfort---lumps, pain, blood in the stool and itching

    Common symptoms of anal discomfort include anal lumps, pain, bloody stools, and anal itching. In clinical practice, the same disease can have different symptoms, and the same symptoms are often not the same disease. Patients must not simply "check in" to avoid aggravating the condition and delay the opportunity for treatment.

    Common symptoms and differential diagnosis of anal diseases

    symptom

    Differential diagnosis

    pain

    External hemorrhoids, anal fissure, abscess, anal fistula, anal spasm, abscess, etc.

    Blood in stool

    Internal or external hemorrhoids, anal fissure, anal fistula, anal papilla hypertrophy, colorectal cancer, ulcerative colitis, Crohn's disease, etc.

    Anal itching

    Internal hemorrhoid prolapse, anal fistula, anal incontinence, anal pruritus, anal nipple, dermatitis, etc.

    Perianal mass

    Thrombotic hemorrhoids and internal hemorrhoids prolapse, perianal abscess, anal cancer, polyps or anal papilla prolapse, rectal prolapse, etc.

    1. Hemorrhoids

    As the saying goes, "ten people have nine hemorrhoids", "ten men have nine hemorrhoids", and "ten women have ten hemorrhoids."

    Hemorrhoids are a normal structure in the anal canal anatomy. The "hemorrhoids" or "hemorrhoids" mentioned by patients refer to a clinical symptom caused by the anal canal vascular mass. Hemorrhoids are classified into internal hemorrhoids, external hemorrhoids and mixed hemorrhoids according to their different locations. Stages of internal hemorrhoids: Degree I, internal hemorrhoids are located in the anal canal and do not prolapse; Degree II, internal hemorrhoids prolapse from the anus during defecation, and can be repaid by itself; Degree III, internal hemorrhoids prolapse and need to be assisted by hand; Degree IV, internal hemorrhoids prolapse, Unable to pay. The causes of hemorrhoids include increased intra-abdominal pressure (such as pregnancy, chronic cough), unreasonable diet (such as drinking, spicy food), poor toilet habits (such as prolonged squatting in the toilet), and constipation. Common clinical symptoms include blood in the stool, pain, itching, burning sensation, prolapsed mass, swelling, mucus, and perianal uncleanness.

    The purpose of hemorrhoid treatment is to control the clinical symptoms rather than completely remove the hemorrhoid tissue. Patients should be told that hemorrhoid tissue is part of the normal anatomy, and it is not necessary to remove all hemorrhoid tissue. Treatment methods mainly include drug treatment (various suppositories and ointments, such as Mayinglong hemorrhoid ointment, etc.), surgical treatment (external stripping and internal ligation, injection sclerotherapy, apron ligation, infrared coagulation, PPH, etc.). Regardless of the treatment method, you must first change your lifestyle, avoid spicy foods, and develop a good habit of regular bowel movements.

    Second, anal fissure

    Anal fissure is a linear or elliptical tear from the end of the anal canal to the tooth line, which occurs in young adults. 75% of anal fissures occur at the posterior midline, more than 25% of women and 8% of anal fissures occur at the anterior midline. When an anal fissure occurs in an atypical location or multiple fissures are found, it should be checked for other potentially complex diseases such as Crohn's disease, tuberculosis, syphilis, AIDS or anal cancer. The common causes of anal fissure are mainly anal canal damage caused by frequent dry and loose stools. The most common symptoms are painful bowel movements and bloody stools.

    Fresh anal fissures can be healed by non-surgical treatments, such as local hot baths and the use of hemorrhoid suppositories. Old anal fissures can be removed surgically. After the operation, keep the bowel movement unobstructed and take a bath in warm water until it is completely healed.

    3. Perianal abscess and anal fistula

    Perianal abscess and anal fistula represent different processes of the same disease. Perianal abscess represents an acute inflammatory phase, while anal fistula represents a chronic process. Anal fistula consists of an external mouth, a fistula, and an internal mouth. 90% of perianal abscesses are caused by crypt gland infection. Predisposing factors include diarrhea and damage to hard stools. The typical symptoms of perianal abscess are anal pain, swelling and fever. Severe rectal pain with dysuria and urinary retention should consider intersphincter abscess or supralevator anus abscess.

    Most of them start with abscesses, and a few start with anal fistulas. Once diagnosed, prompt surgery is required. The basic method of treating perianal abscess is incision and drainage. It should be noted that the application of antibiotics for conservative treatment is often ineffective and can make the disease progress, leading to more complicated abscess formation, and may damage the sphincter mechanism. In rare cases, delays in diagnosis and treatment of peri-anorectal abscesses can lead to fatal necrotic infections. There are many spaces around the anorectum. Delayed surgery often complicates abscesses and fistulas, prolongs postoperative recovery time and increases postoperative recurrence rate. The principle of anal fistula surgery is to eliminate the fistula, prevent recurrence and protect the sphincter function. It should be noted that perianal abscesses and anal fistulas are easy to recur.

    Fourth, anal itching

    Perineal and anal diseases are usually considered difficult things to tell, so that some patients are ashamed to go to the hospital. Most people think that a slight itching in the anus is not important, but if the itching is severe and does not heal for a long time, it will become pruritus. It is a common localized neurological dysfunction skin disease, generally confined to the anus, and some can spread to the perineum, vulva or back of the scrotum. Severe anal pruritus brings great psychological and physical pain to the patient.

    Anal itching is divided into two types: primary and secondary. Primary anal itching is spontaneous and has no clear cause, while secondary anal itching is anal itching caused by a certain disease. Since there are many causes of anal itching, it is of great significance to consider all diseases related to anal itching.

    5. Hematochezia and colorectal tumors

    1. Since hemorrhoids are very common, bloody stools are often considered bleeding from hemorrhoids, but colorectal cancer can also be bloody stools. Therefore, blood in the stool cannot be simply regarded as bleeding from hemorrhoids. Unless the clinical symptoms of young patients are consistent with hemorrhoids, the symptoms of blood in the stool disappear quickly after treatment.

    2. If internal hemorrhoids are found through inspection, it is not rash to conclude that hemorrhoids are bleeding, because hemorrhoids and rectal cancer may exist at the same time.

    3. Therefore, colonoscopy is best for blood stools, and anoscopy or digital rectal examination can only see or touch the length of the index finger. Especially for patients with blood in the stool around the age of 40 who have a family history of colorectal disease, or the clinical symptoms do not match the physical examination, a full colonoscopy should be performed.

    4. In 2014, China formulated the "Consensus on Screening, Diagnosis and Treatment of Early Colorectal Cancer and Precancerous Lesion in China", which conducts risk assessment for all adults, among which one of the following is regarded as a high-risk group: ①Stool occult blood is positive. ②First-degree relatives have a history of colorectal cancer. ③Past history of intestinal adenoma. ④I have a history of cancer. ⑤ Changes in bowel habits. ⑥ Those who meet any of the following items: chronic diarrhea, chronic constipation, mucus blood in the stool, history of chronic appendicitis or appendectomy, history of chronic cholecystitis or cholecystectomy, long-term mental depression, and alarm signal. For those with unknown family history, consider screening for colorectal cancer at the age of 40, while those at general risk start at the age of 50, and screening ends at the age of 75.

    6. Life guidance for perianal diseases

    1. Eat a light diet and drink more water; eat less spicy, fried, spirits and other indigestible and irritating foods, and eat more fruits, vegetables and high-fiber foods.

    2. Develop good bowel habits, defecate regularly every day, each time should not be too long, about 5 minutes is appropriate.

    3. Sit bath with warm water after going to bed and before going to bed to keep the anus clean, but it should be noted that the water temperature should not be too high, which may easily cause anal itching.

    4. Sit bath is a good way to treat perianal benign diseases. When hemorrhoids are particularly itchy, put 20 peppercorns into the pot, boil, add a spoonful of salt, and sit in warm water for 5-15 minutes. Itching and swelling.

    5. A squat-free bidet is recommended, which can be used on the toilet (online shopping name is no-squat healthy bidet).

    Seven, common positions for anal examination

    Common examination methods of the anus include digital rectal examination and anoscopy

    Commonly used examination positions are chest-knee position and lateral position

    Chest and knee position

    Lateral position

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