2021年2月3日星期三

what does a hemorrhoids look like,Questions and answers in the QQ group by Zheng Lihua, director of the Anorectal Department of China-Japan Friendship Hospital

    The text version is in the form of one question and one answer, all based on Director Zheng’s oral records. It is the authoritative answer to anorectal knowledge. Please study carefully. These questions are also the most frequently asked by administrators every day, so you will benefit a lot after reading them carefully.

    In the future, the group will regularly invite Director Zheng to answer questions for everyone, and the time will be notified in advance in the group announcement. Because Director Zheng is very busy at work, please don't disturb Director Zheng at ordinary times, and speak freely when you answer questions. Thank you for your participation and cooperation.

    The following questions and answers are highlights of this Q&A.

    Note: Q is the question, A is the answer. The content in brackets is the group leader's comment.

    Q1: Is it necessary to ban alcohol for life including pepper after anal fistula?

    A: I don’t think it’s necessary to ban it for the whole life, but it should be in moderation, not long-term, large amounts of drinking or eating.

    Q2: How to prevent the recurrence of anal fistula?

    A: Generally speaking, if the anal fistula is cured in one operation, there is no problem of recurrence. However, a fistula may occur again. Because the anal fistula is caused by the infection of the anal crypts, there are about six or seven anal crypts in a circle. The infection at your location is cured, and it may recur in other locations. Therefore, it is necessary to prevent the recurrence of anal fistula To avoid infection, that is to say not to decrease the resistance, but to increase the resistance. To increase resistance is generally to eat less chili, drink less and stay up late. These are all causes of perianal abscess and anal fistula. Try to avoid these incentives to prevent it from happening again.

    Q3: After four months of anal fistula surgery, there are still wounds and bleeding. Is it normal?

    A: I think this is an anomaly. Because four months is already a long time, I should go to the hospital to check to see if the dressing change is not in place in the later period. There is no false healing? There is a problem with always squeezing out blood and pus. In addition, is it possible that there are other fistulas that have not been cleaned, and the necrotic tissues have not been cleaned. These all need to be checked.

    Q4: Is it normal for some fishy fluid to flow out after the operation? How many times do I need to clean the wound every day?

    A: This is actually normal. Because we have to ligate during the operation. During the ligation, he has a process of shedding the necrotic tissue. The smell of the necrotic tissue is very fishy, ​​so if it is within two weeks

    Don't worry if this fishy liquid comes out. Another is the frequency of wound cleaning. I think it is enough to clean the wound once a day, and it is easy to affect the growth of granulation without multiple cleaning.

    Q5: One month after the operation, there is still some pain, is it normal? What else should I pay attention to when eating?

    A: If there is no bleeding, it should be normal, because the scar has not transformed one month after the operation. A scar is a relatively hard tissue that has not yet fully merged with other tissues. Usually it takes about half a year for the scar to soften, and after fusion with other tissues, there will be no needle-like pain! Don't eat too much chili and don't drink too much. Just eat whatever else you need, no problem.

    Q6: Five years after perianal abscess incision, there is no abdominal pain, but enteritis. Is it possible that it is Crohn's disease? Can anal fistula be operated?

    A: This requires colonoscopy to confirm whether there is Crohn's disease. If you have Crohn's disease, anal fistula cannot be treated surgically. If there is no problem with the colon, just a chronic colitis, anal fistula can be treated surgically.

    Q7: One month after the operation of the circular mixed hemorrhoids, there are still some pain and blood in the stool. Is it normal?

    A: I think this problem is not big. Because the recovery of circular mixed hemorrhoids is relatively slow, especially when it comes to the anal canal, it grows slowly. You can try to apply the ointment to the inside of the anus instead of just applying it to the outside. Sometimes it is often caused by a little wound in the anal canal.

    Q8: How long is it safe to get pregnant after anorectal surgery?

    A: Generally, if patients undergoing surgery in China and Japan want to become pregnant, we generally recommend two months later. Because the anesthetics used for surgery are generally metabolized within a few hours, the antibiotics are also metabolized within a week. But to be safe, we still recommend getting pregnant after two months.

    Q9: How to deal with the problem of incomplete defecation and prolapse of the mucous membrane?

    A: Because the feeling of incomplete defecation and anal drop are often not caused by hemorrhoids. It is usually caused by anal sinusitis or prolapse of the rectal mucosa. Whether or not surgery is required, this needs to be checked to determine. If it is caused by prolapse of the rectal mucosa, surgery can be done. You can do a band ligation to fix the rectal mucosa on the intestinal wall for a long time. This is fine. If it is anal sinusitis, all you need to do is to reduce the inflammation, and surgery is meaningless. So, you should check the diagnosis first to determine the next treatment plan.

    Q10: Is it normal to have secretions after anal fistula? Is it safe to do IVF for three months after surgery?

    A: Some secretions after anal fistula surgery are normal. Scars after anal fistula surgery are larger and harder, while hemorrhoids are generally smaller after surgery. When the scar is hard, it does not contract very tightly with other tissues in the anus, so some intestinal fluid will Leak out. There is no problem with IVF for three months after surgery. (Note: Q8 above has about the safe pregnancy time after surgery, please refer to)

    Q11: Regarding the problem of anal fistula in young children, someone reported that his child had an anal fistula at two years and four months. Does it require immediate treatment?

    Q12: A patient in Anhui asked a question and sent a picture. She had an incision and drainage of the perianal abscess. Does she need to continue surgical treatment?

    A: This kind of perianal abscess incision and drainage should be without incision of the anus and no treatment of the internal mouth. I think this anal fistula should still be removed, otherwise it will repeatedly swell and discharge pus repeatedly.

    Q13: Perianal abscess ruptures spontaneously, can it be treated conservatively? Do I still need surgery?

    A: In this case, a radical operation must be done, otherwise an anal fistula will form. So surgery should be done as soon as possible, conservative treatment is meaningless.

    Q14: Do I still need surgery after drainage of perianal abscess?

    A: Since it is a drainage operation, there must be no radical cure. A radical operation is needed. According to the patient's description, his wound is small on the outside and large on the inside. This is still a problem (normal wounds are wedge-shaped with large outside and small inside). The picture is not very clear, I can't see if the anus is cut. So. This has something to do with the heat and humidity in the body, but it is not a decisive factor either. It's not that you can heal on your own without damp heat. As long as the internal mouth is not treated, it will not last, and a radical resection is definitely needed. It must be noted that a perianal abscess should not only be drained, but a radical operation must be done (a hospital with more advanced technology can avoid the pain of two operations and a radical treatment. But if drainage has been done, it must be done Only a radical operation can be recovered).

    Q15: Should anal fistula be operated as soon as possible?

    A: I think anal fistula needs to be operated as soon as possible. Because if you don’t have an operation, the anal fistula may be infected at any time, and every time you get an infection, there may be one more fistula, so the operation will become complicated and easy to miss. If it is omitted, it may recur. So if you have anal fistula, you should do it as soon as possible. When you have time for surgery, do it as soon as possible.

    Q16: During the operation of the perianal abscess, the internal mouth was not found, so no radical resection was performed, only drainage was performed. Do I need another operation?

    A: Generally, 95% of these cases will cause anal fistula. Radical anal fistula resection should be done again. It will be easier to find anal fistula after the stroke (Q12-14 also answered similar questions).

    Q17: There was a question from a patient from Erlong Road. He had a sudden heavy bleeding 13 days after the operation, and he was treated. What causes bleeding? What should be paid attention to after treatment?

    A: I don't know whether Erlong Road does PPH or external stripping and internal binding. If it is stripped outside and tied inside, it may be bleeding caused by disconnection. If it is PPH, it may be bleeding caused by the fall of the nail. It should be noted that even after being discharged from the hospital, try to minimize activities and take more rest. Generally, after sewing again in this situation, it is safe to rest for two weeks from the start of sewing.

    Q18: Is it normal that the electrosurgical incision has not grown for 17 days after mixed hemorrhoid surgery?

    A: This time is normal. Because the incision of the electric knife is a little slower, don't worry about this. I see the picture you sent. Your incision has turned white, indicating that it has started to crawl, so it will be well soon, maybe in a week to 10 days (it will almost heal), and now you should feel It's itchy (the performance of growing flesh).

    Q19: There was a patient who had an operation on April 25. The wound has not grown after two months, some feces have leaked out, and there will be some small blood clots. Is it normal?

    A: It is said that this time should not bleed. It is possible to save a bit of stool by yourself. Because sometimes the long-acting anesthetics used by some doctors may not have the effect of the anesthetic for too long (the long-acting anesthetic temporarily affects the contraction function of the sphincter muscle, and it is normal for the anus to be tightly closed and a small amount of stool leakage). But if there is a blood clot, you should come to the hospital to check it early to see if there is any problem on it.

    Q20: After giving birth to a child, hemorrhoids are very serious. They must come out every time (stool) and need to be sent back by hand. Does this situation require surgery?

    A: Generally, this situation should belong to the third stage of mixed hemorrhoids. I think it is necessary to have surgery. You should consider finding time to do it. Because once there is a prolapse, we recommend that you have an operation. Otherwise, the more and more hemorrhoids will be removed in the future, and finally a ring-shaped mixed hemorrhoid will be formed. The surgical treatment may cause greater damage and greater pain.

    Q21: There is no secretion after drainage of perianal abscess, how to confirm that there is a fistula?

    A: Generally 95% of perianal abscesses will form a fistula after drainage. I definitely cannot confirm it by myself. You should ask the doctor to confirm it and perform the operation as soon as possible (refer to the previous questions Q12-14 and Q16).

    Q22: What is the best treatment for perianal abscess?

    A: Perianal abscess, our Chinese and Japanese techniques both do a radical cure. Generally, it will not be cut first, waiting for the formation of a fistula before treatment. In this case, one is that the treatment is longer, and the other is that the pain is greater, and the effect is not very good. So we all have a radical cure, and it is best for everyone to do a radical cure.

    Q23: A patient sent a picture. Twenty days after the anal fistula, there is discharge. Is it normal?

    A: The wound in the picture is quite big, so some brown sticky secretions are not a big problem. The secretion will definitely last a long time, because your wound is still big. Take your time and grow it slowly. Your wound has started to turn white (it means it has started to crawl and is developing in the direction of healing. See Q18 for similar questions about wound color and growth stage).

    Q24: The perianal abscess has been completely healed after a radical operation for three months? Is it normal for some liquid things to flow out?

    A: This situation should be completely healed. It is normal for some liquid things to flow out, because he has a scar. As I said before, the scar will form a small groove before it softens, and it is normal for some secretions to flow out.

    Q25: Is it normal that the anal fistula has not fully recovered after one month? Can you exercise normally and go to work normally?

    A: Anal fistula is normal for one month. Because some people may grow fast for 20 days, and grow slowly may take a month. If there are no symptoms, just let it grow by itself. It does not affect work and normal activities. Just be careful not to do strenuous exercise.

    Q26: Surgery on June 7 and discharge from hospital on June 15. How long do I need to hold a bath? When can I travel and exercise?

    A: How long it takes to sit in the bath varies from person to person. Normally, one week is enough. If you have a large anal fistula or abscess, you may have to sit for three to four weeks! In addition, when to travel for fitness, this may be a month later, and you have to fully recover before doing vigorous exercise.

    Q27: Does anal fissure have recurring episodes, do I need examination and surgical treatment?

    A: I think this question is a good question. Many patients have this question. If the anal fissure recurs, you should go to the hospital to check it. So what are the indications for anal fissure surgery? Just look at whether there is stenosis in the anus, which means whether there is spasm of the sphincter. If there is sphincter spasm, I also recommend surgery earlier. Because of this situation, it is very difficult to correct. His cracks are long and unreal, and they are all false and long (that's why they recur). So I think this situation should still be checked by a doctor in the hospital.

    Q28: After drainage of perianal abscess, no fistula was found by B-ultrasound. Now how to do?

    A: In this case, you can observe it first, and then do a radical resection of perianal abscess next time if it becomes swollen again, without waiting for his fistula to form. It is estimated that you have to commit this again (the previous director explained that 95% of the fistulas will form after drainage).

    Q29: It has been more than half a year after the anal fistula operation, and some feces overflowed. Is it normal?

    A: This situation may sometimes be because your anal fistula or perianal abscess has a relatively large wound, and the scar formed is relatively deep. At this time, a small groove will form at the scar, and sometimes the intestinal juice or feces will be small from the scar. Overflowing from the ditch, this is also normal. As long as there is no swelling and pain, no bleeding. This situation will gradually get better, as the scar softens, it will get better. This is a common symptom after anal fistula and abscess surgery.

    Q30: After anal fistula, there is a bit of anal fissure and a bit of sentinel hemorrhoids, do I need surgery?

    A: I saw your picture. I think your hemorrhoids are very small, so you don't need surgery for the time being. Let's observe and observe. It is not necessary (now surgery).

    Q31: What should I pay attention to before and after the traditional surgery for hemorrhoids?

    A: I think there should be no problem as long as the operation is completed. The main thing is to take a good rest after the operation, don't be tired, don't squat for a long time, this is the situation.

    Q32: There are many small cracks in anal fissure, how to treat the best effect?

    A: This kind of situation should be more itchy. Generally, we take injections for better treatment. You can also try using traditional Chinese medicine in a sitz bath, but the effect is slower and the effect is not so good.

    Q33: How should I treat the two anal fistulas at the three-point position and the root of the scrotum?

    A: I think you should have an operation as soon as possible, and an operation as soon as possible (operation as soon as possible! The important things are said three times)!

    Q34: Does the complex anal fistula grow well? How to prevent recurrence?

    A: You can't just look at whether the inside grows well, does the outside grow well? It is healed if it grows up inside and out. To prevent recurrence, I have already talked about it, try not to stay up late, eat less peppers and drink less, to enhance resistance.

    Q35: Fifty days after ligation of anal fistula and hemorrhoids, there are still secretions and the pain is obvious. Is it normal?

    A: I think this is abnormal and should be checked in the hospital as soon as possible. There should be no more pain in fifty days.

    Q36: Thirty days after the operation of circular mixed hemorrhoids, the stool is not very good. Sometimes it is hard and sometimes about five or six times a day. Is it normal? Can anal stenosis be diagnosed? What should I pay attention to after eating?

    A: This is abnormal. It should be a bowel movement once or twice a day, and the stool should be formed and soft. If the bowel movement is not good, you should adjust your bowel movement. At this time, it cannot be easily diagnosed as anal stenosis. This requires a doctor to check to see if the anus is narrowed. Normal postoperative fasting is mainly pepper and wine. Others depend on the condition of the stool. If the stool is dry and hard, eat more crude fiber such as fruits. If the stool is good, then eat anything. Fried food There is no problem.

    Q37: I just finished the anal fistula operation. The doctor said that there are fistulas on both sides and it needs to be done twice. Why?

    A: Because if the fistula on both sides is deep, you may need to do it twice, but generally you can do it once. Now that you have done it once, don't worry or regret, just stick to the treatment.

    Q38: For patients with high anal fistulas, surgery is required. The doctor says to remove a quarter of the buttocks. What should I do?

    A: I don't think this is necessary. I think your fistula does not seem to be very high, it should not be too complicated. Generally, the wound here is very small, and it has little effect on the shape of the anus, and basically does not affect the function. No need to cut so much. Our current technology is minimally invasive (please note that the minimally invasive method mentioned here is the real minimally invasive. The director is referring to the treatment of anorectal diseases with the smallest possible wound. The method is still traditional surgery, but the technology and techniques are advanced. The trauma is small, this is true minimally invasive! Remember, pph, HCPT, Cook gun, laser, electric knife, etc. are some fake minimally invasive that cheat money under the banner of "minimally invasive", and you must not do it! ), the wound is small.

    Q39: After anal fistula, the thread was tightened once, the thread was removed once, and the thread was hooked up again. The thread has not fallen off. Do you still need to tighten the thread?

    A: At this time, the outer mouth should be fully grown. There should be no need to tighten the thread. When the thread is loose at the end, it can be grown directly after removing it. Don’t worry.

    Q40: Is it normal to occasionally experience anal hotness and discomfort two years after surgery? What should be done?

    A: I don't think you need to worry too much, it shouldn't be a big problem. As long as there are no swellings, indurations and secretions, etc., it does not matter if there are occasional minor discomforts. You can take a sitz bath with warm water and take a little rest. I don’t think the problem is big.

    Q41: Two months after the operation of the perianal abscess, a little stool overflow from the anus, is it normal? Will this symptom disappear?

    A: I have said this before. This is all right. When your scar gradually softens and the anus is closed, these symptoms will disappear slowly, usually after half a year.

    Q42: How long does it take for mixed hemorrhoids and anal papilloma to be painless after surgery?

    A: This question is very good. In general, we do operations in China and Japan generally one week to ten days after the operation. Some people have obvious pain relief after a week; some people have obvious pain relief after ten days. This is more regular. After ten days, he will not feel pain if he doesn't defecate in general. The pain is normal.

    Q43: Can you reduce the frequency of bowel movements in order to avoid pain after surgery?

    A: In general, it is normal for us to have a bowel movement once a day. Don't eat less and delay bowel movement on purpose. I think that if delayed stool cannot be eliminated by time, it will cause dry stool, then you will be more painful when shooting. Therefore, it is better to maintain the habit of bowel movement once a day and do not deliberately change your bowel habit.

    Q44: The above-mentioned anal fistula needs two surgeries to ask questions. Will a new fistula grow again during the second operation after the first operation?

    A: Generally, the interval between two operations is not too long, and other fistulas will not grow so quickly, so don't worry too much.

    Q45: How long does an anal fistula usually form after an abscess is ruptured?

    A: It usually forms two to three months after the collapse, and usually does not form so quickly within a week. Don't worry too much.

    Q46: Guilin's patient hospital diagnosed stage III hemorrhoids. What are the diagnostic criteria for stage III hemorrhoids?

    A: Third-stage hemorrhoids are generally not just bleeding. There should be prolapse and it needs to be repaid by hand to be considered as the third stage hemorrhoids. I don't think any of your symptoms say that you have prolapsed symptoms, so it is impossible to diagnose stage III hemorrhoids. There is no need for PPH. If you don't even get out, PPH doesn't need to be done at all. And even if there is prolapse, we also advocate the use of external stripping and internal ligation instead of PPH! (PPH has poor treatment effect, slow postoperative recovery, and high complication rate. It is a technology that has been eliminated. Many hospitals use this method to cheat money under the banner of fake and minimally invasive. Please be careful not to be fooled).

    Q47: Will pregnant women with hemorrhoids affect normal delivery?

    A: I saw the picture you sent. Your hemorrhoids are not very big. I think you can give birth smoothly, and it won't affect you too much.

    Q48: Two weeks after the operation, there are not many secretions. Do I need to wash it many times a day? To what extent can the wound be cleaned up?

    A: This is also a question that many postoperative patients love to ask. Let me explain to everyone here that our wound is a three-type wound, not a sterile window. There is no need to clean the wound so cleanly. Our Chinese medicine doctor also pays attention to the growth of flesh with little pus, and the wound with a little secretion may grow faster. So don't deliberately pursue cleaning so clean. The main thing is to clean the stool, or the feeling of stool being caught in the wound is quite uncomfortable. And there is no need to put Ai Kexin dressing inside every day, it is really unnecessary to put it every day, and it is quite painful to listen to the patient's reaction (Sai ​​Ai Kexin dressing), it is not necessary.

    Q49: How should a 14-year-old patient be diagnosed and treated if Crohn's disease is suspected?

    A: I think Crohn's disease still needs to be diagnosed by colonoscopy. Only anal fistula cannot be diagnosed. Although Crohn's disease is a bit different from ordinary anal fistula, it still needs to be confirmed by colonoscopy. If colonoscopy cannot confirm Crohn's disease, it should not be. In this case, anal fistula still needs surgery. If colonoscopy is diagnosed as Crohn's disease, then anal fistula does not require surgery.

    Q50: How long is the pain in patients after hemorrhoid surgery normal? How long will the pain disappear? How long does the wound last?

    A: Patients after hemorrhoid surgery usually have pain, which usually lasts for 7-10 days. After 7-10 days, the pain will be very light if there is no bowel movement. There will also be some falling sensation, usually within two weeks. The wound growth cycle of hemorrhoid patients is generally 20 days to 30 days, so it is normal within a month, so don’t worry. Because according to the size of your hemorrhoids, the number of wounds, and the strength of your body, the opposite sex is very strong. Everyone shouldn’t compare, say how he grew up in more than ten days and I didn’t grow up in twenty days. This is not necessary. This is all normal. Don’t worry. Some anal swelling, pain, and irritation are also normal, so don't worry.

    Q51: 9 months after the operation, there are still swelling and falling feeling in the anus. Is it normal? What should be done?

    A: Generally, there is a feeling of falling or inflammation of the anal sinus, which has little to do with the operation, because the wound has completely healed in nine months. At this time, you can try a little Anus Thai suppository, pay attention to rest, increase sleep, and enhance resistance, so as to avoid the occurrence of anal sinusitis. Because once anal sinusitis occurs, it is still very troublesome, and it is prone to chronic and repeated attacks.

    A letter from Director Zheng to the national patient group and China-Japan patient group:

    I am particularly grateful to these two QQ groups, thanks to this platform, and thanks to so many administrators for their silent dedication, three years of hard work and perseverance without any remuneration. Your actions touched me in particular, moved our anorectal department, and moved our China-Japan Hospital. We will keep in mind your dedication to us and the dedication to these patients, and we will thank you with a grateful heart. I may not have had the opportunity to express my love for you, my respect and respect for you before, and I hope that through the opportunity of this event, I would like to express my deep gratitude to you, thank you!

    June 18, 2016

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