external hemorrhoids
Introduction
Introduction to foreigners The external hemorrhoid is located below the tooth line. It is a mass formed by inflammation of the external varicose veins or anal folds, hypertrophy, connective tissue hyperplasia or thrombosis. The outer surface of the external hemorrhoids is covered with skin. It can be seen and cannot be delivered into the anus. Bleeding, with pain and foreign body sensation as the main symptoms. Clinically often divided into connective tissue external hemorrhoids, varicose external hemorrhoids, inflammatory external hemorrhoids and thrombosis. The external hemorrhoids that cannot be self-healed should be promptly examined and treated in a professional hospital. basic knowledge The proportion of illness: 0.15% Susceptible people: no special people Mode of infection: non-infectious Complications: anal pruritus, perianal eczema, anal fissure
Cause
External cause
Anatomical reasons (15%):
When the person is standing or sitting, the anorectal rectum is located in the lower part. Due to the gravity and the pressure of the organ, the vein is upwardly obstructed by the vein. The rectal vein and its branches lack the venous valve, the blood is not easy to reflow, and it is easy to accumulate. Passing through the muscle layer at different heights, it is easy to be pressed by the fecal mass, affecting blood return, and the vein passes through the loose tissue of the submucosa, and there is no stent fixation around it, which is easy to expand and flex.
Professional relationship (16%):
People standing or sedentary for a long time, long-term weight-bearing long-distance, affecting venous return, slow blood flow in the pelvic cavity and congestion of abdominal organs, causing excessive filling of the iliac vein, decreased tension of the vein wall, easy blood vessel expansion, and lack of exercise. Reduced bowel movements, slow stools, or habitual constipation can compress and stimulate the veins, causing local congestion and blood reflux disorders, causing increased pressure in the iliac vein and reduced resistance to the vein wall.
Local irritation and dietary disparity and genetic relationship (20%):
The vein wall is congenitally weak, the resistance is reduced, and the intravascular pressure cannot be tolerated, so it gradually expands. Cold in the anus, heat, constipation, diarrhea, excessive drinking and eating spicy food can stimulate the anus and rectum, make the iliac venous plexus congestion, affect the venous blood return, so that the resistance of the vein wall decreases.
Increased anal venous pressure (23%):
Due to cirrhosis, liver congestion and incomplete cardiac function compensation, the anal canal can be hyperemia, and the pressure is increased, which affects the blood flow of the rectal vein.
Increased intra-abdominal pressure and anal infection (10%):
Intra-abdominal tumors, uterine tumors, ovarian tumors, prostatic hypertrophy, pregnancy, over-feeding or squatting for a long time can increase the intra-abdominal pressure and prevent the blood from flowing back. The iliac veins are inflamed by acute and chronic infections. The elastic tissue of the vein wall gradually becomes fibrotic and weakens, and the resistance is insufficient. The varicose veins are enlarged, and other causes cause the varicose veins to gradually increase and generate sputum.
Prevention
External mole prevention
1. Strengthen exercise and enhance the body's ability to resist disease.
2, prevent constipation:
(1) Reasonable blending diet: Eat more vegetables, fruits and cellulose, eat less spicy food.
(2) Develop the habit of regular bowel movements: avoid excessively long squatting.
(3) Choose the correct way to treat constipation: If you have intractable constipation, you must be treated correctly under the guidance of a specialist.
3, pay attention to pregnancy care.
4. Keep the anus clean.
5, other: increased abdominal pressure can cause hemorrhoids, such as portal hypertension caused by cirrhosis, anal rectal vasodilation caused by hemorrhoids, this time should first treat primary lesions such as cirrhosis.
Complication
External hemorrhoid complications Complications anal pruritus, perianal eczema, anal fissure
1, long-term blood in the stool will lead to anemia.
2, sputum nucleus out of the anus, increased secretions, induced anal pruritus or anal eczema, female patients can also lead to gynecological diseases.
3, due to pain, pain, inconvenience, vicious circle, can eventually lead to liver, kidney disease, anal fissure, large intestine tumors and so on.
Symptom
External hemorrhoids symptoms Common symptoms Connective tissue external hemorrhoids Anal itching Anal bulge Urinary is not easy to empty sputum anal pain
First, the symptoms: external hemorrhoids usually have no special symptoms, thrombosis and inflammation may have swelling, pain.
Second, classification: swelling and pain during the attack, the clinical is divided into four types:
Connective tissue external hemorrhoids: connective tissue nephew, also known as skin or skin. basically connective tissue changes, no obvious varicose veins, very few blood vessels, wide at the bottom, long brown, brownish black, prominent and easy to see, size and shape, sometimes only one, in the back of the anus or in the front Sometimes several around the anus.
Venous varicose external hemorrhoids: varicose external hemorrhoids are external venous plexus varices below the dentate line, forming a round, elliptical or prismatic soft mass at the anal margin. If there is edema, the shape becomes larger. When the bowel movement is increased, the symptoms can be alleviated to a different extent after returning to the normal position.
Inflammatory external hemorrhoids: Inflammatory external hemorrhoids are caused by inflammation on the basis of connective tissue spasm and varicose external hemorrhoids, and can also be seen in the acute inflammatory phase of thrombotic external hemorrhoids. Often caused by anal skin damage and infection. The anal edge of the skin wrinkles the wall as a blister. The swelling is painful.
Thrombotic external hemorrhoids: often due to overeating spicy food, stools to the toilet, the perianal subcutaneous vein rupture, blood stasis under the skin. It is characterized by sudden onset, local swelling and severe pain.
Examine
External inspection
The external hemorrhoid is located below the tooth line, with pain and mass as the main symptoms. There are skins of different sizes and shapes around the anus.
The digital examination of the anus can touch the nodules.
Anal microscopy can see the location, size, shape, etc. of the sputum, which is the basic method of diagnosis.
Preoperative examination items: urine routine, stool routine, biochemical examination, hemoglobin, white blood cell count and classification, erythrocyte sedimentation rate, platelet count and clotting time.
Diagnosis
External diagnosis and identification
Differential diagnosis
1. The disease is generally differentiated from the internal hemorrhoids. The surface of the internal hemorrhoids is covered by mucous membranes. It is located above the tooth line and is formed by the internal iliac vein plexus. It is usually found in the left middle, right front and right rear. There is often a history of blood in the stool and prolapse.
2. Identification with rectal cancer. Rectal cancer refers to cancer between the dentate line and the rectosigmoid junction, and is one of the most common malignant tumors in the digestive tract. Rectal cancer has a low position and is easily diagnosed by rectal examination and sigmoidoscopy. However, due to its location in the pelvic cavity, the anatomical relationship is complicated, the operation is not easy, and the recurrence rate is high. The middle and lower rectal cancer is close to the anal sphincter. It is difficult to keep the anus and its function during surgery. It is also a difficult problem in surgery. The median age of onset of rectal cancer in China is around 45 years old.
