fistula
Introduction
Introduction to acne Acne is also known as "ten people and nine sputum", an anorectal disease, clinical manifestations of blood in the stool, prolapse, pain, swelling and so on. There are many reasons for the occurrence of hemorrhoids. Sedentary, long standing, tired, etc. make the human body in a fixed position for a long time, which affects blood circulation, makes the blood flow in the pelvic cavity slow and the internal organs are congested, causing excessive filling and varicose veins. The bulge and the venous wall tension are reduced, causing hemorrhoids. Acne includes two major categories of hemorrhoids and fistulas. Common anal fissures, anal papilloma, rectal prolapse, rectocele, rectal polyps, and anal eczema. basic knowledge Sickness ratio: 5% Susceptible people: no specific population Mode of infection: non-infectious Complications: rectal cancer anemia
Cause
Causes of acne
There are many causes of the disease. Sedentary, long standing, tired, etc. make the human body in a fixed position for a long time, thus affecting blood circulation, making the blood flow in the pelvic cavity slow and the internal organs are congested, causing excessive filling, varicose and bulging of the axillary vein. Hemorrhoids caused by decreased vein wall tension is one of the important causes of the disease. If the exercise is insufficient, the intestinal peristalsis is slowed down, the stool is slow or due to habitual constipation, thereby compressing the vein, causing local congestion and blood reflux disorder, causing an increase in the internal pressure of the iliac vein, reducing the resistance of the vein wall, and also causing the incidence of acne. Increase. According to the analysis of clinical observations and statistical census results, the prevalence rates among different occupational patients are significantly different. The prevalence of clinical cadres, car drivers, sales clerk and teachers is significantly higher.
Prevention
Acne prevention
take more exercise:
Frequent participation in a variety of sports activities such as radio gymnastics, tai chi, qigong, etc., can enhance the body's disease resistance, reduce the possibility of disease, and also have a certain preventive effect on hemorrhoids. This is because physical exercise is beneficial to blood circulation, can reconcile human blood, promote gastrointestinal motility, improve pelvic congestion, prevent constipation and prevent hemorrhoids. On the other hand, self-massage can be used to improve the local blood circulation of the anus. There are two methods: one is to self-massage the long strong point of the tailbone before going to sleep, each time about 5 minutes, can clear the meridians and improve the anus blood circulation; the other method is to use the idea to consciously contract the anus 1 time in the morning and evening, 30 times each time, this is a method of internal massage, which has the effect of transporting blood stasis, exercising anal sphincter, and lifting the gas. Regular use can improve the venous return, which has a certain effect on the prevention and self-treatment of acne.
Prevent constipation:
Normal people have 1 bowel movement every day, and there are different habits of bowel movement in the morning, middle and evening. The normal discharge of the stool is to form a soft stool, not dry or not, and does not feel difficulty in defecation during defecation, and then has a relaxed and comfortable feeling, which indicates that the gastrointestinal function is good. If the constipation is hard, not only is it difficult to defecate, but also because of the accumulation of feces in the intestine, the pressure in the anorectal blood vessels is increased, and the blood flow back is blocked, causing acne varicose veins to form acne. To prevent constipation, the following points should be noted:
1 Reasonably mix the diet. It can increase appetite, correct constipation and improve gastrointestinal function, and can also develop the habit of regular bowel movements. In daily diet, vegetables, fruits, beans and other diets containing more vitamins and cellulose may be used, and less spicy foods such as pepper, mustard and ginger may be used.
2 develop the habit of regular bowel movements. There are usually no feces in the rectum of healthy people. The upright reflex caused by getting up in the morning, the stomach and colon reflex caused by breakfast, the colon can produce a strong "group peristalsis", pushing the feces into the rectum, and the feces in the rectum accumulate to a certain amount. Produce a sense of convenience. Therefore, it is best to develop the habit of regular bowel movement every morning, which plays a very important role in preventing the occurrence of hemorrhoids. Some people think that drinking 1 cup of cold boiled water in the morning can stimulate gastrointestinal exercise and prevent constipation. In addition, a variety of sports activities such as running, doing exercises, and Tai Chi can prevent constipation in the morning. Don't hold back if you have a bowel movement, because you can cause habitual constipation. When you have a long time in defecation, or read a newspaper, or use excessive force, these are bad bowel habits and should be corrected.
Complication
Acne complications Complications Rectal cancer anemia
1. Anemia: Hemorrhoids can cause hemorrhagic pelvic blood, patients with dizziness, fatigue, weakness, poor energy, poor appetite, dry stools, etc. are common symptoms of anemia, hemoglobin is often significantly reduced.
2. Thrombophlebitis: When the iliac plexus is dilated and the reflux is blocked, a thrombus can form. The patient feels local pain, and the pain is aggravated during defecation, walking, sitting and the like.
3. Necrosis: The nucleus is incarcerated outside the anus. Due to a series of pathological changes, the accumulation of local metabolites further aggravates the local anal edema and aggravates the incarceration of the nucleus. This is a vicious circle, so the incarceration of the internal hemorrhoids will inevitably appear necrosis at this time. Necrosis is often confined to the mucosal part of the nucleus but also invades other parts of the body. It has been reported in foreign countries that the thrombus up-diffusion necrotic area in the nucleus extends to the rectal wall and causes severe sepsis in the pelvic cavity. Rare but must be highly valued by clinicians.
4. Infection: After the incarceration of the nucleus, there are many patients with different degrees of infection. After the urgency, the pain of the anus is obviously obvious. At this time, the infection is mostly confined to the anus. If the strong reduction is easy, the infection may spread to cause submucosal perianal or sciatic rectal abscess. Exfoliated emboli with antibiotics along the vein plus improper use or no antibiotics can form portal bacteremia or sepsis can also form liver abscess. Foreign reports have been reported due to sacral incarceration with fatal portal vein septicemia.
Symptom
Acne symptoms common symptoms constipation bloody anal fissure ulcer
The main symptoms
(1) Blood in the stool
It is characterized by painlessness, intermittentness, and bright red blood after the stool. It is also a common symptom of guinea or mixed sputum. The blood in the stool is often caused by the faeces rubbing the mucous membranes or expelling the feces, causing rupture of the dilated blood vessels. Most of the light is blood on the stool or on the toilet paper, followed by blood drops, and the heavy one is spray-like bleeding. The blood in the stool can often stop itself after a few days. This is important for diagnosis. Constipation, dry stools, alcohol and food irritating foods are all causes of bleeding. If long-term repeated bleeding, anemia can occur, clinical is not uncommon, should be differentiated from bleeding disorders.
(2) block prolapse
Often late symptoms, more prolapsed after blood in the stool, due to the enlargement of the late corpus callosum, gradually separated from the muscle layer, was pushed out of the anus when defecation. The lighter only prolapses when the stool is in the stool, and then he can recover it by himself. The severe one needs to be pushed back by hand. The more serious one is to take out the anus outside with a little abdominal pressure, such as coughing, walking and other abdominal pressure slightly increase, the block is Can escape, reply difficult, and can not participate in labor. A small number of patients complained of prolapse is the first symptom.
(three) pain
Simple internal hemorrhoids have no pain, and a few have a feeling of bulging. When the internal hemorrhoids or mixed hemorrhoids are incarcerated, and there is edema, infection, and necrosis, there are different degrees of pain.
(four) itching
Late sputum, palate prolapse and anal sphincter relaxation, often secreted and discharged, due to secretion stimulation, itching often around the anus, and even skin eczema, the patient is extremely uncomfortable.
Type
Guilt
According to the location of internal hemorrhoids, the primary internal hemorrhoids (mother-infested) and secondary internal hemorrhoids (sub-sputum) are related to the branch of the blood vessels. The main terminal branches of the superior rectal artery are distributed in the right front, right posterior and left lateral rectal. Inside, the three parallel superior rectal veins are flexed, called the internal iliac vein plexus, such as the right anterior, right posterior and left anterior medial iliac venous plexus dilatation, distortion and congestion, which becomes primary guilt, secondary guilt may have 1 to 4, often connected with the right posterior and the left middle of the female sputum (because the vein is branching again), and the veins in the right anterior sac are no longer branched, so often occur in a single occurrence, without the sputum, but the sputum and There are also variations in the position of the scorpion, some are isolated, and some are connected together. If the mother and the scorpion are all out of the anus, they are plum-shaped, called the ring sputum. If the sacral edema cannot be returned, it is called Incarcerated internal hemorrhoids, if there is blood circulation disorder, called strangulated guilt.
(1) Symptoms and signs:
1 blood in the stool: painless, intermittent, there are bright red blood after the stool is its characteristics, but also common symptoms of guinea or mixed sputum early, blood in the stool due to feces rubbing the mucous membrane or dying excessive force, causing rupture of blood vessels, Most of the light is blood on the stool or on the toilet paper, and then the blood is dropped. The heavy one is spray-like hemorrhage. The blood can be stopped spontaneously after a few days. This is important for diagnosis. Constipation, dry stool, drinking and eating irritating food. Etc. is the cause of bleeding, if long-term repeated bleeding, anemia can occur, clinical is not uncommon, should be differentiated from bleeding disorders.
2 sacral prolapse: often late symptoms, more prolapsed after blood in the stool, due to the increase of the late corpus callosum, gradually separated from the muscle layer, when the feces are pushed out of the anus, the light only prolapse when the stool, After the stool, you can reply by yourself. If you are serious, you need to push it back by hand. The more serious one is to take out the anus outside with a little abdominal pressure, so that when the abdominal pressure is increased, the sputum can be pulled out, the recovery is difficult, and the labor cannot be participated. There are a few patients who complain that prolapse is the first symptom.
3 pain: simple internal hemorrhoids without pain, a few have a sense of bulging, when the internal hemorrhoids or mixed hemorrhoids get rid of incarceration, edema, infection, necrosis, there are different degrees of pain.
4 Itching: late internal hemorrhoids, prolapse of the ankle and relaxation of the anal sphincter, often secreted and discharged, due to secretion stimulation, there is often itching discomfort around the anus, and even skin eczema, the patient is extremely uncomfortable.
(2) Clinical stage or division: According to the degree of internal hemorrhoids, the staging of internal hemorrhoids at home and abroad is not completely unified, and the representative ones are as follows:
Miles (1919) 3 degree classification:
I degree: also known as early internal hemorrhoids, bleeding during defecation, no prolapse, no pain.
II degree: also known as the middle period of sputum, when the bowel movements occur in the sputum, you can naturally return.
III degree: also known as late internal hemorrhoids, the internal hemorrhoids easily escape from the anus, need to be returned by hand.
2. Foreigner
External hemorrhoids are more common with thrombosis and connective tissue.
(1) thrombotic external hemorrhoids: is the most common type of external hemorrhoids, often due to constipation, defecation, cough, excessive force or continuous vigorous exercise, the anal canal vein rupture, blood forms a round or oval blood clot under the anal margin However, it can also be a spontaneous rupture without cause. The size of the blood clot can range from a few millimeters to a few centimeters. The main clinical manifestations: a swollen mass on the anal edge of the patient's sensation. The blood clot separates the anal skin from the subcutaneous tissue, causing severe pain and walking. Inconvenience, restlessness, pain is the most severe at 48h after the onset, the pain is relieved after a few days, the mass becomes soft, and gradually dissipates. Check: A dark purple round induration can be seen on the surface of the anal edge in the early stage. The boundary is clear, hard, tenderness is obvious, and the blood clot can be The rupture is self-discharged, and the wound heals itself or forms an abscess and anal fistula.
(2) connective tissue external hemorrhoids: referred to as skins, size and shape, can be single or multiple, often thrombotic external hemorrhoids or anal surgery sequelae, no obvious symptoms, occasional itching, small falls and foreign body sensation, if there is inflammation It feels pain.
(3) varicose external hemorrhoids: a soft mass formed by subcutaneous varicose veins of the anus, generally anal swelling and discomfort, slow development, if there are complications, pain, bleeding, examination, see a lump at the anus, soft, There is a varicose vein under the skin.
(4) Inflammatory external hemorrhoids: inflammation and edema of the anal skin folds. The disease manifests as local redness, pain, tenderness during examination, local congestion and edema, and a small amount of secretions.
3. Mixing
It is the anal pad hypertrophy in the same temporal region of the dentate line, which is consistent with each other. The sphincter sulcus disappears, and the upper and lower sulcus are connected into one whole. The clinical manifestations are characterized by internal hemorrhoids and external hemorrhoids. Some are in the right front, right rear or left middle. Some are ring-shaped, forming a ring-shaped mixed enthalpy.
The diagnosis of internal hemorrhoids is mainly based on anorectal rectal examination. First, the anus is inspected. The anus is retracted to both sides with both hands. Except for the period of 1 period, the other 3 periods can be seen under the anus examination. The sag, it is best to observe immediately after the bowel movement, which can clearly see the size, number and location of the sputum, especially for the diagnosis of ring sputum, more meaningful, rectal examination can rule out other in the rectum Lesions, especially except rectal cancer and polyps.
Examine
Hemorrhoids examination
1. Rectal examination:
When there is no thrombus formation or fibrosis in the internal hemorrhoids, it is not easy to be erupted. The larger internal hemorrhoid can touch the longitudinal wrinkles and the bulging nodules above the dentate line. The external thrombus can touch the oval thrombus in the center of the corpus callosum. It can be active and tender. In addition, through rectal examination, you can find out whether there are other lesions in the rectum, especially excluding rectal cancer and polyps.
2. Anoscope examination:
First observe the rectal mucosa with or without congestion, edema, ulcers, lumps, etc., after excluding other rectal diseases, then observe the presence or absence of sputum on the dentate line, if any, then the internal hemorrhoids protrude into the anoscope, showing a dark red nodule, this Attention should be paid to its location, size, number and shape. The primary internal hemorrhoid usually has a right front, a right rear and a left middle. The position of the secondary internal hemorrhoid often varies. In the past, the primary internal hemorrhoids were thought to occur in the right front, right rear, left middle. The main branch of the superior rectal artery is related to the right front of the rectum, the right posterior and the left middle. Modern research suggests that the anal cushion is divided into three blocks with a "Y"-shaped fissure, which is located in the right front, right rear and left outer.
3. Aspirator check:
In the middle and late stage, there is a history of sputum removal. The axillary device can be used to attract the corpus callosum to the anus for observation, or the patient should not be reset after the bowel movement.
Diagnosis
Hemorrhoid diagnosis
diagnosis
According to the typical symptoms and examination of sputum, the diagnosis is generally no difficulty.
According to medical history and anal physical examination, anorectal digital examination and anal examination, the diagnosis was made with reference to the classification of sputum.
If there is a slight suspiciousness, further examination should be carried out to exclude the knot, rectum, anal canal, malignant tumor and inflammatory disease.
Need to be identified with the following diseases:
1. Rectal cancer: clinically, the lower rectal cancer is misdiagnosed as sputum, delay treatment, the main reason for misdiagnosis is the diagnosis of symptoms only, without digital rectal examination and anal microscopy, so the above two must be done in the diagnosis of sputum Examination, rectal cancer can be found in the rectal examination, the surface is ulcerated, the surface of the intestine is often narrow, and the fingertips are often stained with blood. It is important to note that the internal hemorrhoids and the ringworm can coexist with rectal cancer. You must not see a guilty or ring-shaped sputum, and you should be treated with sputum for the diagnosis of sputum, until the patient's symptoms are aggravated before the rectal examination or other examination to confirm the diagnosis. This misdiagnosis, miserable experience and painful experience It is not uncommon in clinical practice and deserves attention.
2, rectal polyps: low pedicled rectal polyps, sometimes out of the anus is sometimes misdiagnosed as sputum prolapse, but polyps are more common in children, round, substantial, pedicle, can be active.
3, anorectal rectal prolapse: sometimes misdiagnosed as a ring sputum, but the rectal prolapsed mucosa is ring-shaped, smooth surface, sphincter relaxation during rectal examination; the mucosa of the ring-shaped sputum is plum-petal, sphincter does not relax.
