A. What is “hemorrhoid”
Hemorrhoids are generally considered to be a mass formed by pathological hypertrophy and displacement of the anal cushion and stagnation of blood flow in the perianal subcutaneous vascular plexus. Hemorrhoids are one of the most common and frequent anal diseases, with a prevalence rate of 49.14%, according to the epidemiological survey results released by the Chinese Society of Traditional Chinese Medicine, Anorectal Branch in 2015.
What factors are associated with hemorrhoids?
The cause of hemorrhoids is not fully understood in modern medicine, but is currently considered to be mainly related to the following factors.
1.Anatomical factors
(1) Anal cushion subluxation theory: It is believed that hemorrhoids are originally normal anatomical structures in the anal canal area, namely the vascular cushion, which is a ring of sponge-like tissue 1.5cm above the dentate line. Only when the anal cushion tissue is abnormal and combined with symptoms, it can be called hemorrhoid.
(2) varicose veins theory: it is believed that hemorrhoids are venous masses formed by stasis, dilation and flexion of the venous plexus under the mucosa of the lower rectum and the skin of the anal canal.
2.Constipation factors and bad bowel movements
Such as long time to go to the toilet. When constipation dry hard stool compression rectal wall, blocking the venous reflux on the hemorrhoids, while the increase in abdominal pressure so that the anal cushion down or out. Resulting in the occurrence of hemorrhoids.
3.Eating habits
Long-term spicy and stimulating diet, drinking alcohol. If there is little cereal, lack of crude fiber, small amount of hard stool, longer stay in the intestine, dry hard stool on the rectum pot belly pressure greatly increased, and therefore easy to produce hemorrhoids.
4, genetic factors
There is no conclusive evidence of the relationship between hemorrhoids and heredity, and the familial phenomenon may be the result of the fact that the living conditions and habits of these family members are relatively similar.
5, pregnancy and childbirth factors
Uterine compression, increased abdominal pressure, pelvic floor drop, abnormal sphincter function due to nerve pulling, etc.
6, disease factors
Some factors that increase abdominal pressure, such as intra-abdominal tumors, portal hypertension, long-term cough, easy to cause increased abdominal pressure, hemorrhoidal vein pressure and varicose, leading to the occurrence or aggravation of hemorrhoid disease.
7.Occupational factors
The onset of hemorrhoids is related to certain occupations, with a high incidence in those who stand or squat for long periods of time.
8.Age factor
Children and teenagers rarely suffer from hemorrhoids. After adulthood, hemorrhoids are easy to develop, and the older the age, the higher the incidence. From the range of known etiological doctrines, the occurrence of hemorrhoids is related to many factors and must be studied from multiple aspects to make a more complete explanation.
What are the clinical manifestations of hemorrhoids?
1. Blood in the stool
This is the most important symptom of internal hemorrhoids. In the early stage of internal hemorrhoids, fresh blood in the stool is the main problem; in the late stage of internal hemorrhoids, the blood in the stool is reduced because of the severe fibrosis of the mucosal surface of hemorrhoids.
2.Prolapse
Prolapse is the main symptom of the development of internal hemorrhoids to the middle and late stage, the middle stage hemorrhoids are prolapsed during the stool and can be retracted by themselves after the stool, while the stage III internal hemorrhoids can be retracted only after a few moments of hand support or bed rest. In some cases, the hemorrhoid can be prolapsed even during normal activities, after standing for a long time, during exertion, or when coughing, and some patients cannot be held back in the anus by hand after the hemorrhoid is prolapsed, which becomes an embedded internal hemorrhoid, or the internal hemorrhoid is not fully retracted in a continuous semi-prolapsed state.
3.Anal swelling
All internal hemorrhoids above stage II can have different degrees of anal swelling. It is lighter in stage II and heavier in stage III. It is especially worse after exertion, after standing for a long time or after lunch. The cause of anal swelling may be due to the stimulation of the rectal mucosa by the enlarged nucleus or the inflammation of the mucosal surface of the hemorrhoid.
4.Pain
Internal hemorrhoids alone are not painful, but can cause more intense pain if they are embedded or infected, thrombosed, or ulcerated. When the hemorrhoid is embedded, the patient has more pain in the anus, and the defecation and vectoring are obstructed, and some of them also reflexively cause difficulty in urination, and it can last for 7 to 10 days.
5.Mucus flow, anal dampness or itching
The secretion in the intestinal cavity often flows out from the anus due to the relaxation of the anal sphincter muscle, especially after standing for a long time or after exertion. When the internal hemorrhoid prolapses, the secretion flows directly into the perianal area. The mucus may cause dampness or itching in the anal area after the discharge.
4.What examination is needed
The examination includes two categories: general examination of the whole body and local specialized examination of the anus. The local specialized examination mainly includes visual examination, finger diagnosis and anoscopy.
1.Visual examination
Generally adopt the lateral lying position. Observe the location, shape, size and nature of the mass inside and outside the anus, the color and flatness of the surface of the hemorrhoid nucleus, the presence of ulceration and bleeding points, the change of the size of the hemorrhoid nucleus and its relationship with the body position, the presence of blood and blood color in the anus, whether the anus is moist or whether there is secretion, and whether there are changes in the perianal skin. When there is a mass prolapse, we should pay attention to the location of the mass, the size and shape of the mass, the color of the surface mucosa, the presence of ulcers, necrosis, bleeding spots, the fibrosis of the mucosal surface, and whether the prolapse can be retracted by itself. In order to observe the prolapse situation, sometimes it is necessary to use squatting position to observe.
2.Finger diagnosis
Finger palpation mainly examines the texture of the mass inside and outside the anus, the presence of hard nodules, pain to palpation, surface temperature, the anal sphincter and the inter-sphincter sulcus, and also pays attention to whether there is any abnormality in the rectal ring of the anal canal, whether there is hypertrophy of the mucosa above the dentate line, and whether there is any injection of hard nodules, etc.
3.Anoscopic examination
Observe whether the anoscope is inserted smoothly, the size, location, shape, surface mucosal color, erosion, bleeding and fibrosis of the masses above and below the dentate line, the interrelationship of the masses above and below the dentate line, whether there is accumulated blood and mucus in the intestinal cavity and its color, quality and quantity, whether the rectal mucosa is loose and overlapping, and whether the dentate line sulcus exists, etc.
V. How to treat
The choice of hemorrhoid treatment method should first be conservative therapy such as internal and external drugs, and then consider surgical therapy if the effect is not satisfactory.
1, conservative treatment of Western medicine symptomatic treatment is mainly for the clinical symptoms of various types of hemorrhoid disease. Select effective hemostatic drugs, painkillers, antibiotics, anti-phlebitis agents, etc., such as anemia can also be given iron, if necessary, blood transfusion to correct severe anemia. Topical drugs: various ointments, fumigants, suppositories. According to different clinical manifestations, select the dose.
2.Surgical treatment
(1) External hemorrhoid stripping internal hemorrhoid ligation method Willow-shaped excision stripping external hemorrhoid subcutaneous venous plexus to the dentate line, near the dentate line incision inward, clamp the base of internal hemorrhoids to be ligated or sutured. Indications: Mixed hemorrhoids of all stages.
(2) Injection therapy Injecting sclerosing agent into the nucleus of internal hemorrhoids, indications: stage I and II internal hemorrhoids, mixed hemorrhoids.
(3) Ligation therapy Using medical silk thread, simple ligation or suture at the base of the internal hemorrhoid to block the blood supply of the hemorrhoid, causing ischemia and necrosis of the hemorrhoid tissue to fall off, so as to achieve the purpose of treatment. Indications: II and III internal hemorrhoids.
(4) Rubber ring ligation therapy The rubber ring used for ligation is a special rubber ring, which is laced on the root of internal hemorrhoid and tightened by its natural elasticity, causing ischemia and necrosis of hemorrhoid to fall off. Indications: II and III internal hemorrhoids.
(5) PPH surgery, i.e. anastomotic rectal mucosal circumcision, indications: internal rectal mucosal prolapse, Ⅱ and Ⅲ internal hemorrhoids.
(6)Others
There are also cryotherapy, laser therapy, infrared coagulation therapy, classical surgery (Milligan-Morgan procedure open hemorrhoidectomy, Whitehead hemorrhoid circumcision), etc.
VI. What is the prognosis of “hemorrhoids”?
Most patients can be relieved by conservative treatment and can be cured by surgical treatment. Some patients can regrow hemorrhoids due to bad habits and other triggers, and need to be treated again.
Seven, how to prevent “hemorrhoids”
1. Develop good bowel habits and hygiene habits
The best time to defecate is in the morning and after breakfast, the cardia-rectal reflex can help the smooth discharge of feces, while avoiding too long squatting toilets, correcting the bad habits of squatting for a long time reading books, reading cell phones, reading newspapers or smoking. And pay attention to the cleanliness and hygiene around the anus.
2.Healthy diet
Avoid alcohol and spicy foods, and eat more fiber-rich foods every day, such as fresh fruits, vegetables and coarse grains. You can eat honey, black sesame and other foods with moistening effect in moderation, and drink more water.
3.Warm water sitz bath
Every day you can soak your buttocks in warm water for about 15 minutes to help promote blood circulation in the affected area.
4.Anal health exercises
Lift and contract the anus with force, maintain the upper mentioned contracted state to their limits, and then slowly and slowly relax the anus, so that a collection and release is once. It is recommended that each group do 20 to 30 times the collection and release action, do 3 groups per day. The point is to lift the contraction quickly and forcefully, and slowly when relaxing.