anorectal disease
Introduction
Introduction to anorectal diseases Anorectal diseases are common and frequently-occurring diseases that are unique to humans. Broadly speaking: all kinds of diseases that occur in the anus and large intestine are called anorectal diseases, and there are more than 100 common diseases. In a narrow sense: there are more than 30 kinds of diseases that occur in the anus and rectum, such as: internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, anal fissure, anal fistula, perianal abscess, anal skin disease, anal sinusitis, proctitis , rectal ulcer, export constipation, rectal prolapse, rectocele, rectal mucosal prolapse, anorectal stenosis, anal incontinence, anal canal cancer, rectal cancer, anal papilloma, rectal polyp, anorectal tuberculosis, anal neurosis , condyloma acuminata, anorectal congenital malformation, anorectal trauma and so on. basic knowledge The proportion of sickness: 0.01% Susceptible people: people with bad habits during bowel movements, people who have long standing, sedentary and constipation for a long time, pregnant women, people who have no regular life Mode of infection: non-infectious Complications: anal incontinence, edema, rectal cancer
Cause
Causes of anorectal diseases
Internal cause:
1. Normal human anatomical factors are particularly prone to sputum formation.
2, physiological factors: colon, rectum is an important organ for transporting food residues, and after the food is decomposed and absorbed by the body, the residue often contains a lot of harmful substances, which are retained in the colorectal for a long time and can induce tumors.
3, genetic factors: due to genetic defects, can produce multiple colon polyps, pj syndrome (melanoma-colony polyposis) and other hereditary anorectal diseases.
4. Congenital diseases.
External cause:
1, bad bowel habits: when going to the toilet, reading and reading newspapers, causing squatting and prolonged defecation time, easy to cause blood stasis in the rectum and induce disease. Smoking can buffer the bowel movements of the brain when going to the toilet, which can easily cause constipation. Excessive force during defecation, some people feel strong regardless of bowel movements, blindly and violently earned, can only make the rectum anus and pelvic floor muscles increase unnecessary burden and local blood stasis, leading to disease occurrence and development.
2, abnormal bowel movements: diarrhea and constipation are important factors in the anorectal disease. Constipation is the biggest bane. Long-term retention of toxic substances in the rectum not only induces rectal cancer, but also accumulates feces and affects blood circulation. Applying force to solve the dry fecal block will inevitably cause the anus to bear a lot of pressure, resulting in a series of pathological changes such as blood stasis, swelling, and cracks. Diarrhea is often a clinical manifestation of colonic disease, diarrhea can also increase the chance of local infection of the anus, resulting in anal sinusitis, inflammatory external hemorrhoids, perianal abscess and other diseases.
3, dietary factors: in daily life, eating patterns or diet varieties are inevitably changed, it is very natural. Such as the quality of food, the change of vegetable types and the increase or decrease of the amount of protein, fat, starch, cellulose, etc., the moisture intake, can directly affect the fecal composition, causing anorectal disease. People who drink alcohol for a long time or who like spicy food can stimulate the digestive tract mucosa due to alcohol and spicy substances, causing blood vessels to dilate, colonic dysfunction, and the incidence of anorectal diseases is significantly increased. According to the national census data, the incidence rate of those who like spicy food is 61.6%, and the incidence rate of those who drink alcohol is 64.6%, which is significantly higher than the total incidence rate.
4, occupational factors: long standing or sedentary. Due to the erect or sitting posture, the anus rectum is in the lower part of the body, and the venous venous return is not smooth.
5, chronic diseases: such as long-term malnutrition, physical weakness, causing anal sphincter relaxation weakness. Long-term suffering from chronic bronchitis, emphysema, abdominal pressure caused by cough and asthma, pelvic blood stasis. Chronic hepatitis, cirrhosis, diarrhea, colitis, etc. are all causes of anorectal disease. Therefore, in the prevention, we should pay attention to the general condition of the patient and take reasonable and effective preventive measures.
Prevention
Anorectal disease prevention
1. Eat low-fiber foods. Such as potatoes, pasta, beans and vegetables such as cabbage, cauliflower, onions, etc., they are easy to produce gas inside the stomach, leading to the occurrence of bloating.
2, do not eat foods that are not easy to digest. Stir-fried beans, hard pancakes and other hard foods are not easy to digest, so the time spent in the stomach will be longer, resulting in more gas and cause abdominal distension.
3. Change the habit of gorging. Eating too fast or eating and eating bad habits, it is easy to swallow a lot of air; in addition, the usual straw drink will also make a lot of air into the stomach, causing abdominal distension.
4. Overcome bad feelings. Unpleasant emotions such as anxiety, anxiety, sadness, depression, depression, etc. may also weaken the digestive function, or stimulate the stomach to cause excessive stomach acid. As a result, the gas in the stomach may be excessive, causing the abdominal distension to increase.
5, pay attention to exercise. It is necessary to stick to an appropriate amount of exercise for about 1 hour every day, which not only helps to overcome bad emotions, but also helps the digestive system maintain normal functions.
6. Moderately supplement fiber food. High-fiber foods do not only cause bloating. Sometimes, on the contrary, after eating high-fat foods, sometimes it will reduce the bloating. The reason is that high-fat foods are difficult to digest and absorb, so staying in the stomach often takes a long time, and once a fiber is added, the blocked digestive system is likely to be quickly cleared.
Complication
Anorectal disease complications Complications anal incontinence edema rectal cancer
Common complications after anorectal surgery include urinary retention, bleeding, pain, edema, infection, constipation, fever, tetanus, slow wound healing, anorectal stricture, and anal incontinence.
Symptom
Anorectal disease symptoms Common symptoms Anal pain Anal swell constipation Blood mucus will anal Eczema Itching abdomen full anal valgus fever with chills nausea and vomiting
Symptoms of anorectal diseases include: anal and abdominal pain, blood in the stool, constipation, anal dissociation, anal mucus or blood, anal mass, anorectal foreign body sensation, diarrhea, mucus and blood, difficulty in defecation, change in stool shape, evil Cold fever, full belly, nausea and vomiting, abdominal mass, anemia, etc.
Common symptoms include:
1, hemorrhoids:
Acne is a soft vein formed by the expansion and flexion of the submucosal and subcutaneous venous plexus of the rectum at the end of the rectum. It is more common in people who are often standing and sedentary. Acne, including internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids, is a chronic disease of one or more soft venous masses formed by the varicose veins of the anorectal base and the anal mucosa. Usually, when the defecation continues to exert force, the pressure in the vein is repeatedly increased and the vein is swollen. During pregnancy, acne is often impeded by the pelvic veins, and many obese people suffer from acne. If you have acne, the swollen vein wall in the anus becomes very thin, so it is very easy to break during defecation. The internal hemorrhoid is the sputum that grows at the beginning of the anal canal. If the swelled vein is located lower, almost on the anal canal, the varicose vein is called the external iliac crest. The external hemorrhoids sometimes come out or emerge from the anal canal, but this happens only during defecation, and it will retract to its original position after defecation. Thrombosis can occur regardless of guilt or external hemorrhoids. When a thrombus occurs, the blood in the sputum condenses into a mass, causing pain.
2, anal fissure:
The anal fissure is a small ulcer in the whole layer of the anal canal below the dentate line. Its direction is parallel to the longitudinal axis of the anal canal. It is about 0.5-1.0 cm long and has a fusiform or elliptical shape. It is difficult to heal and is an anal canal for young and middle-aged people. Common causes of severe pain. The superficial laceration of the anal canal can not be regarded as an anal fissure because it can heal quickly and is often asymptomatic. Anal fissure occurs in the middle of the anal canal. If there is an anal fissure on the side of the anal canal, or there are multiple clefts, it should be thought that it may be an early manifestation of intestinal inflammatory disease.
3, anal fistula:
Anorectal fistula mainly invades the anal canal and rarely involves the rectum. It is often called anal fistula. It is a granulomatous duct that communicates with the skin of the perineal area. The inner mouth is located near the tooth line, and the outer mouth is located at the perianal and skin. The entire wall of the fistula is composed of thickened fibrous tissue, and a layer of granulation tissue is placed inside, which is not cured for a long time. The incidence rate is second only to sputum, more common in male young adults, and may be related to the secretion of sebaceous glands in one of the male sex hormone target organs.
4, perianal abscess:
Subcutaneous abscess around the anus is most common, mostly caused by anal gland infection through the lower part of the external sphincter skin outward or directly outward, often located in the lower part of the skin around the anus, generally not large, the main symptoms are persistent perianal severe pain, pressure Or increased cough, inconvenient walking, restlessness, systemic infection symptoms are not obvious, local examination: the skin around the anus is obviously red and swollen, with induration and tenderness, may have a sense of volatility, if necessary, puncture confirmed, if not cut in time It often breaks down on its own and forms a low anal fistula. The infection can also penetrate the perianal fascia upwards and spread to the ischial rectal fossa. Sometimes it is misdiagnosed as a thrombotic external hemorrhoid in the early stage, but the latter has a clear boundary and no inflammatory reaction around the skin.
Examine
Anorectal disease examination
1. Anal inspection: gently separate the patient's buttocks with both hands and observe the anus and surrounding exudates, external hemorrhoids, fistula, abscess, anal fissure, etc.
2, rectal examination: also known as anal finger examination. The examiner puts on the glove on the right hand or puts on the fingertip on the right index finger, applies the lubricant, and puts the front end of the right index finger on the anus. After the patient adapts, gently insert it into the anus. First test the tightness of the anal sphincter and then the anal canal. The rectum is examined in turn, and attention should be paid to the presence or absence of tenderness, swelling, undulation, and stenosis around the intestinal wall. On the anterior wall of the rectum, the male can lick the prostate, and the woman can touch the cervix. When the finger is pulled out, observe whether there is blood or mucus on the glove.
3, anoscope examination: anal mirror oil, slowly inserted into the anus, pull out the core, good light, from deep to shallow to observe the color of the rectal mucosa, rectal flap, with or without ulcers, polyps, tumors, foreign bodies, etc., will be anoscope Slowly quit outward, and observe the presence or absence of lesions near the rectum and the tooth line, such as the internal mouth and sputum.
Diagnosis
Diagnostic identification of anorectal diseases
Differential diagnosis of anorectal diseases:
1, anal fissure: anal fissure bleeding for the stool with blood or blood after the stool, often a few drops of blood, no blood. The main symptom is severe pain in the anus after defecation or defecation. The examination shows that there is a longitudinal cleft in the middle of the anal canal (a few in the middle of the anterior middle), and the pain is obvious, which is sphincter pain.
2, rectal cancer: mostly for stool with pus or mucus blood, accompanied by increased frequency of stool, urgency and thick feeling, stool deformation, rectal examination and endoscopy can be found in the mass, and the surrounding infiltration, further biopsy Determine the diagnosis.
3, rectal polyps: rectal polyps can have stool with blood, low polyps with pedicles can be taken out of the anus, the disease is more common in children, stool with blood often mixed with mucus. The polyps that are taken out are round, fleshy red, hard, and highly active, and are easy to identify with cockroaches.
4, ulcerative proctitis: mostly pus and blood, accompanied by increased frequency of stool, loose stools, often accompanied by lower abdominal pain, endoscopy can be seen in the rectal mucosa flaky or diffuse congestion, erosion, small ulcers, mucosal fragility, easy bleeding.
5, rectal hemangioma: mostly sudden large amount of blood, often mixed with blood clots, less blood in the stool, more common 1-2 years of attack, endoscopy can be seen in the rectal mucosa with a flat soft sponge-like tumor.
6, rectal prolapse: can be divided into rectal mucosal prolapse and rectal full-thickness prolapse. The mass of the mucous membrane prolapse is shorter, more than 2-3 cm, round, red, smooth surface, radial folds, soft, and can be retracted after defecation; the whole layer of prolapsed mass is longer, up to 10 More than a centimeter. It is pagoda-like or cylindrical. The surface of the ring can be seen with ring-shaped mucosal folds, and the sphincter is weak.
