1.What are the common anal bleeding diseases? How to distinguish?
Lower gastrointestinal bleeding is clinically subdivided into six categories, namely inflammatory, mechanical, vascular, neoplastic, and systemic. Most of the lower gastrointestinal bleeding comes from the colon and rectum, and a few from the small intestine. The characteristics of their common diseases are briefly described as follows.
(1) Colon and rectal polyps or colonic polyposis: intestinal polyps mostly occur in the rectum and sigmoid colon, mostly single, and a few are multiple. Their main symptom is blood in the stool. Blood in stool is characterized by intermittent, bright red color, generally small amount, not mixed with feces. Children with blood in the stool, but the number and nature of the stool is basically normal, most of them are rectal polyps. Colon polyps are mostly seen in young adults, whose clinical features are diarrhea, fresh blood and mucus in the stool, and can cause anemia due to repeated bleeding.
(2) Colonic hemangioma: The main symptom is intestinal bleeding or intestinal obstruction. It may manifest as acute hemorrhage, and anemia due to long-term small amount of blood loss is common. The hemangioma can be capillary hemangioma or cavernous hemangioma, or both. Enteroscopy reveals large extended veins under the mucosa.
(3) Amoebic colitis: Patients have blood in the stool as the main symptom, the stool is saucy red, mucousy, with foul odor, the right lower abdomen often has pressure pain, and the urgency is less than that of bacillary dysentery.
(4) Rectal and colon cancer: rectal cancer blood in stool, bright red or dark red in early stage, not much, intermittent, often with alternating history of constipation and diarrhea; late stage stool often mixed with foul-smelling mucus at the same time. Left-sided colon cancer is similar to rectal cancer, but is prone to intestinal obstruction. Right-sided colon cancer is mainly characterized by tarry stools, and the stool occult blood test is often positive, accompanied by indigestion, anemia and right lower abdominal masses and other signs.
(5) Colonic diverticulitis: mostly located in the sigmoid colon, with habitual constipation. Uncomplicated diverticula are asymptomatic; if the diverticula are inflamed, there may be mucus and blood stools, abdominal pain, fever and other symptoms.
(6) Ulcerative colitis or other inflammatory diseases: large amount of blood in the stool is rare, often mucus blood stool, with a history of diarrhea, abdominal pain, mostly accompanied by lower abdominal pain, colonoscopy and barium enema angiography can be clearly diagnosed.
(7) Internal hemorrhoids: The first and second stage internal hemorrhoids are mostly blood in the stool, blood in the stool usually occurs during defecation, sometimes dripping, shooting blood, or only blood on the hand paper, blood and stool do not mix, bright red color. Stage III internal hemorrhoids are often accompanied by symptoms of hemorrhoid prolapse. The hemorrhoids bleed in small amounts, usually without urgency and pain, and often with constipation.
(8) Intestinal entrapment: often mucus and blood stool, jam-like, more common in children, accompanied by abdominal pain, abdomen can be found in the lump of entrapment, easy to cause intestinal obstruction.
(9) Meniere’s diverticulum: also known as terminal ileal diverticulum, is a congenital disease, characterized by sudden blood in the stool, without abdominal pain or other symptoms, can be relieved by supportive therapy, but can soon bleed again. Bloody stools are often dark red with blood clots and cause shock and anemia when there is a lot of bleeding. This disease should be thought of in pediatric patients with unexplained lower gastrointestinal bleeding. ÷
(10) Small intestinal tumors: benign tumors are rare, usually without systemic symptoms and less bleeding. If the tumor is enlarged, it may cause black or red blood in the stool symptoms, often accompanied by abdominal distension, abdominal pain, loss of appetite, abdominal mass and other symptoms.
(11) Anal fissure: bleeding during defecation, accompanied by anal pain, small amount of bleeding, bright red color, history of constipation, more common in young people, local examination can be seen in the anal canal fissure, mostly in the posterior median or anterior median.
(12) Radiation proctitis: blood in the stool, urgency, mixed blood and mucus, more frequent bowel movements, and experience of radiotherapy.
2.What are the causes of anal prolapse? How to distinguish?
Anal prolapse is generally divided into 2 types: one is frequent prolapse, such as third-stage internal hemorrhoids, complete rectal prolapse, anal canal exstrophy, thrombosed hemorrhoids, and external hemorrhoid skin flaps. The other type is the prolapsed material during defecation, which can be incorporated into the anus by itself after defecation, such as stage II internal hemorrhoids, lower rectal polyps, anal papillary hypertrophy, rectal mucosal prolapse, etc.
It is not difficult to identify them based on the relationship between prolapse and defecation, the shape and color of the prolapsed material and other clinical symptoms.
Internal hemorrhoids of grade II and III, prolapsed during defecation, some of them can be retracted by themselves, sometimes they cannot be retracted by themselves and need to be repositioned manually, often accompanied by symptoms of blood in the stool. The shape is strawberry-shaped.
Anal fissure: Painful and bleeding during defecation, the prolapsed material at the anal canal cannot be retracted into the anal canal, and it is a skin-like material growing at the bottom of the fissure.
Rectal prolapse: prolapse during defecation, contraction after defecation can be self-retracted, the surface of the prolapse is also mucous membrane, but the prolapse is larger than hemorrhoids, and there is a circular mucous membrane groove, while hemorrhoids are radial mucous membrane groove.
Anal canal ectropion: occurs during defecation and is covered by skin tissue, often accompanied by hemorrhoids and rectal prolapse.
Anal papillomegaly: prolapses during defecation, partially retracting on its own, partially requiring manual pushing to reset. The surface of the prolapse is a heterogeneous anal canal epithelium with a tip, white in color, rarely bleeding, but with anal discomfort and no pressure pain. It can be one or several.
Rectal polyp: it prolapses during defecation and can be retracted by itself, the surface is mucous membrane, strawberry-shaped when the mucous membrane is inflamed, some have a tip, some have no tip, often accompanied by bleeding symptoms.
Thrombosed external hemorrhoid: a sudden swelling located in the anal canal with obvious pain. If you press the external hemorrhoid, there are hard nodes under the skin with purple color.
3.Is something coming out of the anus when defecating a hemorrhoid?
It is a common symptom of anal disease, and can be seen in a variety of anal diseases, including anal papilloma, rectal polyps, and rectal prolapse. When the internal hemorrhoid prolapses, you can see the obvious nucleus of the hemorrhoid with smooth, light pink surface and visible varicose blood vessel plexus, which is close to the anus, and most of them can be returned by themselves. Anal papillomas are formed when the anal papillae are repeatedly stimulated by chronic inflammation and the fibrous tissue proliferates. The prolapse is mostly irregularly shaped, with skin on the surface, grayish-white, with a slender tip, and in some cases, without.
Rectal polyps are new organisms that occur on the rectal mucosa. Polyps with tissues closer to the anus or larger polyps can be prolapsed during defecation, and the surface of the prolapsed material is congested with blood, some of which can be seen as villi-like protrusions, which can bleed when lightly touched and can be returned by themselves after defecation. Rectal prolapse includes rectal mucosal prolapse and total prolapse, mucosal prolapse is caused by mucosal relaxation, while total prolapse is formed by the relaxation of the tissue supporting and fixing the rectum, which can not fix the rectum, the rectal mucosa prolapses outside the anus in a hemispherical shape, the surface is mucous membrane, there are many radial folds, the prolapse of total rectal prolapse is larger, columnar or horn-shaped, the length varies from a few centimeters to a dozen centimeters, the touch is tough and It is tough and elastic to the touch.
The prolapse of the above diseases is clearly distinguishable from the prolapse of the nucleus pulposus, which is easy to distinguish.