What Is Metrorrhagia?

Hemorrhoids (commonly known as hemorrhoids) is a common disease located in the anus area and can develop at any age, but the incidence gradually increases with age. Hemorrhoids are the most common anorectal disease in China.

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2017-12-12 23:12 Ten people have nine hemorrhoids, many are things you don't know 2017-12-12 23:12

Speaking of hemorrhoids, it is really a common disease with frequent outbreaks. As the saying goes, ten people have nine hemorrhoids. Once attacked, it is difficult to describe how to sleep and eat. ... more

Basic Information

nickname: Hemorrhoids
English name: hemorrhoid
Visiting department: surgical

Common locations: anus
Common causes: Mostly caused by varicose veins and anal pads
Common symptoms: Blood after intermittent defecation, pain during incarceration

Causes of hemorrhoids

There are two main theories about the cause of hemorrhoids. The first is the varicose vein theory. Hemorrhoids are thought to be venous clusters formed by congestion, dilation and flexion of the venous plexus in the submucosa of the lower rectum and under the skin of the anal canal. However, the widely accepted theory is Thomson's theory of anal pad downshifting, which believes that hemorrhoids were originally a normal anatomical structure of the anal canal, that is, vascular pads, which are tooth-shaped lines and 1.5 cm or more of a circular sponge-like tissue band. Hemorrhoids can only be called when there is abnormality in the anal pad tissue and there are symptoms. Treatment is needed. The purpose of treatment is to relieve the symptoms, not to eliminate the hemorrhoids. There are many predisposing factors for hemorrhoids, among which constipation, long-term drinking, eating a lot of irritating food and sedentary are the main causes.

Hemorrhoid classification

Hemorrhoids are divided into internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids according to the site of occurrence. At the junction of the anal canal skin and the rectal mucosa, there is a jagged visible line called the anal canal dentate line. Above the dentate line are internal hemorrhoids, supporting structures of the anal cushion, venous plexus, and arteriovenous anastomotic branches undergo pathological changes or displacements, covering the rectal mucosa. Due to the contraction of the internal sphincter, the anal cushion is divided into the left side by the Y-shaped groove, Right anterior, right posterior, three internal hemorrhoids are common on the left, right anterior, and right posterior; external hemorrhoids below the dentate line, covering the anal canal mucosa, can be divided into connective tissue external hemorrhoids, varicose external hemorrhoids, and thrombi External hemorrhoids; mixed hemorrhoids with internal and external hemorrhoids are mixed hemorrhoids, where internal hemorrhoids are fused with the corresponding external hemorrhoids through the venous plexus, that is, the anastomosis of the superior and inferior venous plexus. The sphincter is incarcerated to form an incarcerated hemorrhoid.

Clinical manifestations of hemorrhoids

1. Mainly manifested as blood in the stool. The nature of blood in the stool can be painless, intermittent, fresh blood in the stool, blood dripping in the stool or blood on the toilet paper, and it becomes worse after constipation, drinking, or eating irritating food.

2. Simple internal hemorrhoids have no pain, they only swell, they can bleed, they develop to prolapse, and they only occur when they are combined with thrombosis, incarceration, and infection.

3. Internal hemorrhoids are divided into 4 degrees. Degree of bleeding during defecation, bleeding can be stopped after defecation, hemorrhoids do not prolapse from the anus; Degree of bleeding often occur ; defecation during the defecation, automatic resuscitation after defecation; Degree of hemorrhoids need hand assistance to replenish ; Degree of hemorrhoids long It can not be accepted outside the anus. Among them, internal hemorrhoids above degree often form mixed hemorrhoids. The symptoms of internal hemorrhoids and external hemorrhoids coexist, and pain and discomfort can occur. Itching is often caused by viscous secretions when hemorrhoids come out . After more than three degrees into mixed hemorrhoids.

4. External hemorrhoids usually have no special symptoms, and there may be swelling and pain when thrombosis and inflammation occur.

Hemorrhoid Examination

Anal inspection

Except for internal hemorrhoids of degree I, the prolapse degree can be observed in the squatting position.

2. Digital rectal examination

It is not significant for internal hemorrhoids, but you can know whether there are other lesions in the rectum.

3. Anal mirror

Understand the situation in the rectum and anal canal.

Differential diagnosis of hemorrhoids

Rectal cancer

The main symptoms are changes in bowel habits, rectal irritation symptoms, cauliflower-like masses on digital diagnosis, and colonoscopy and biopsy pathology.

2. Rectal polyps

More common in children, mostly low-pedicled polyps, round, solid, and good mobility.

3. Rectal prolapse

The mucosa is ring-shaped, the surface is smooth, and the sphincter is relaxed.

Hemorrhoid treatment

Non-surgical treatment

Asymptomatic hemorrhoids do not require treatment; symptomatic hemorrhoids do not require radical cure; non-surgical treatment is the main treatment.

(1) General treatment Applicable to most hemorrhoids, including the early stages of thrombotic and incarcerated hemorrhoids. Pay attention to diet, avoid alcohol and spicy food, increase fibrous food, eat more fruits and vegetables, drink more water, change bad bowel habits, keep stools open, take laxatives when necessary, and clean the anus afterwards. For prolapsed hemorrhoids, take care to gently support the hemorrhoids with your hands to prevent them from coming out. Avoid sitting for a long time, take appropriate exercise, warm water (possibly containing potassium permanganate) sitting bath, etc. before going to bed.

(2) Topical treatment has been widely used. The drugs include suppositories, ointments and lotions, and most of them contain traditional Chinese medicine ingredients.

(3) Oral drug treatment Drugs for varicose veins are generally used.

(4) Injection therapy has better effect on and degree hemorrhoidal internal hemorrhoids; sclerosing agent is injected around the submucosal venous plexus to cause inflammation and fibrosis, thereby compressing varicose veins; repeating treatment after 1 month, Avoid injecting hardener into the mucosal layer and causing necrosis.

(5) Physical therapy Laser therapy, cryotherapy, direct current therapy and copper ion electrochemical therapy, microwave thermocoagulation therapy, and infrared coagulation therapy are rarely used.

(6) Rubber band ligation The ligature root is blocked to block the blood supply so that the hemorrhoids fall off and become necrotic. It is suitable for II and III internal hemorrhoids. It is more suitable for huge internal hemorrhoids and fibrotic internal hemorrhoids.

2. Surgical treatment

(1) Indications for surgery Ineffective conservative treatment, severe hemorrhoid prolapse, poor treatment of large fibrotic internal hemorrhoids, injection, etc., combined with anal fissure, anal fistula, etc .;

(2) Surgery principle The prolapsed anal cushion is reset through surgery, and the structure of the anal cushion is retained as much as possible, so as to affect the ability of fine stool control as little as possible after the operation;

(3) Preparation before surgery When there is an ulcer or infection on the surface of internal hemorrhoids, laxative, warm and hot sitz bath conservative treatment should be performed first, and surgery should be performed after the ulcer heals;

(4) Surgery method Thrombosis external hemorrhoid dissection is suitable for those who do not have pain relief or shrinkage after conservative treatment of thrombotic external hemorrhoids. Traditional hemorrhoidectomy, that is, external peeling and internal ligation. The classic operation method of hemorrhoid circumcision (Whitehead surgery) textbooks, which easily lead to anal stenosis, is rarely used in clinical practice. PPH operation Stapler hemorrhoidal superior rectal mucosa ring incision and staple operation. It was created by Italian Longo doctor and started to be popularized in 1998. It is mainly suitable for prolapse type III-IV degree mixed hemorrhoids, ring hemorrhoids, and some degree II internal hemorrhoids with severe bleeding. The mechanism of PPH in treating prolapsed hemorrhoids: circular resection of the lower 2 ~ 3 cm mucosa and submucosal tissue of the rectum to restore the normal anatomical structure, that is, the return of the anal cushion; removal of the submucosal tissue blocks the blood from the upper hemorrhoid artery to the hemorrhoidal area Supply, atrophy of hemorrhoids after surgery. Compared with traditional hemorrhoidectomy, PPH surgery has shorter operation time, less postoperative pain, faster recovery, and fewer complications, but the price of the equipment is more expensive.

(5) Postoperative management Observe whether complications occur, pay attention to diet, and maintain smooth stool.