Hemorrhoids

Introduction to nucleus The nucleus 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 human 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. basic knowledge The proportion of illness: 5% (more common in men, especially those who smoke and drink) Susceptible people: no specific population Mode of infection: non-infectious Complications: anemia, internal hemorrhoids, rectal cancer, phlebitis

Cause of nucleus

The anal cushion moves down (18%):

is the result of partial mucosal and submucosal tissue migration due to degeneration of the anal canal support tissue. The mucosal sliding theory was first proposed, and Parks and Thomson further developed this, and proposed an anal canal submucosal mat theory and anal cushion ( Anal cushion is composed of dilated veins, smooth muscles, collagen fibers and elastic connective tissue. It can adapt the anal canal mucosa to changes in the size of the intestine, and plays an important role in assisting in closing the anus and maintaining the anus. The connective tissue is regressed. Sexual change, excessive force during defecation can make the anal cushion move down and cause symptoms of sputum. Once the anal cushion sag, it will inevitably lead to obstruction of iliac veins, congestion and edema of the sacral block, and the degree of congestion of the anal cushion besides the pressure of the anal canal such as constipation, pregnancy In addition to the influence of factors, it is also related to hormones, biochemical factors and emotions.

Angiogenesis (15%):

The submucosal tissue is thick, Bourgery compares it to the "erectile web", which Henrich (1980) calls the rectal corpus cavernosum, which consists of a large number of blood vessels, smooth muscles, elastic fibers and connective tissue. Like a circular air cushion, when the sphincter contracts, it helps to close the anus. When the blood vessels proliferate and expand and become abnormally hypertrophy, it can form sputum, but from the histomorphology, there is still insufficient evidence for angiogenesis.

Anal stenosis (20%):

The theory of anal canal stenosis was proposed by Brnes, Mile, Slack, etc. They believed that the sphincter could not be fully relaxed, and the defecation was promoted by increasing the abdominal pressure, which caused the iliac vein to be congested and then caused internal hemorrhoids, and increased the shearing force on the anal cushion. Downward, the theoretical basis of anal sphincter therapy is the theory of anal stenosis. Although it has achieved certain clinical effects, this theory does not explain all the problems that occur.

Vascular lesions (12%):

It is known that venous dilatation and venous return are obstructed as the cause of sputum formation. Therefore, various factors that increase venous pressure, such as increased intra-abdominal pressure, and factors that damage the standing position or vessel wall are related to the occurrence of sputum.

Nucleus prevention

Reasonable diet

Maintaining the law of life and conditioning the diet is an important measure to prevent phlegm. In the daily diet, a certain amount of "food fiber" food and moderately irritating food should be maintained. The main components of dietary fiber are cellulose, hemicellulose, pectin. And lignin, etc., these substances are not affected by digestion when passing through the intestines. After absorbing a large amount of water, it is easy to discharge the formed stools quickly, which shortens the time for the stool to stay in the intestines, thus playing a protective intestine. The role of the function of the road, the currently marketed oatmeal and "black bread", taking 10 ~ 15g before each meal, is effective in preventing sputum and intestinal cancer, vegetables, fruits and beans also contain a certain amount of fiber , but some can be digested and absorbed in the intestines, can not play a significant protective effect like dietary fiber, so can not replace food fiber, properly control spicy spicy food or condiments, such as wine, pepper, mustard, curry, etc., due to a large number Ingestion of these foods can inhibit bowel movements, leading to dry stools, and directly stimulate the intestinal tract, so that it is in a contracted state, often induced sputum prolapse, suppository And caulking, wine and alcoholic beverages can quickly and directly affect the tension and blood supply of the anal sphincter. It is also a common cause of sputum prolapse, embolism and incarceration. It should be properly controlled in the diet, especially with sacral prolapse. More attention should be paid.

2. Establishment of good bowel habits

This is the main measure to prevent the occurrence and development of sputum. It is best to use the "stand-up reflex" and "stomach colon reflex" to cause defecation after getting up in the morning or after breakfast. It is easy to defecate. In addition, do not read the book during defecation. At the same time, try to shorten the time of defecation, especially if the time is not too long.

3. Anal movement

4. Proper physical exercise

Attention to strengthen physical exercise, especially for sedentary, Jiuli workers should participate in some sports activities, such as labor, Tai Chi and Qigong, which can offset the disadvantages of position and prevent the occurrence and development of cockroaches. It is positive.

5. Pay attention to the cleaning of the anus

It is best to wash with warm water after each bowel movement. Do not wipe with hard paper to prevent trauma. It is meaningful to prevent the occurrence and development of sputum.

Nucleus nucleus complications Complications anemia, rectal cancer, phlebitis

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.

Symptoms of sputum nucleus Common symptoms Constipation inflammation, congestion, blood intestines, peristalsis, slowing anal pain

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.

Helium check

an examination

1. Rectal examination: When there is no thrombosis 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 eggs in the center of the corpus callosum. Round thrombus, hard, active, tenderness, in addition to rectal examination to understand whether there are other lesions in the rectum, especially except rectal cancer and polyps.

2. Anal microscopy: 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. Dark red nodules, at this time should pay attention to its location, size, number and shape, the primary internal hemorrhoids generally have right front, right rear and left middle, the position of secondary internal hemorrhoids often varies, in the past, the primary internal hemorrhoids occurred in the right front Right, the left middle and the main branch of the superior rectum, 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 pieces with a "Y"-shaped fissure, located at the right front, right rear and The reason for the left outside.

3. The aspirator is inspected for the middle and the late stage has a history of sputum removal. The axillary device can be used to attract the corpus callosum to the outside of the anus, or the patient should not be reset after the bowel movement.

Hemodialysis diagnosis

According to the typical symptoms and examinations of the 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 often misdiagnosed lower rectal cancer as sputum, delay treatment, the main reason for misdiagnosis is the diagnosis of symptoms only, without digital rectal examination and anal microscopy, so the two kinds of examinations must be done in the diagnosis of sputum 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 should never 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, the miserable experience of mistreatment, It is not uncommon in clinical practice and deserves attention.

2, rectal polyps with pedicled rectal polyps, sometimes out of the anus is sometimes misdiagnosed as sputum prolapse, but polyps are more common in children, round, substantial, pedicle, and active.

3, anorectal rectal prolapse is sometimes misdiagnosed as a ring sputum, but the rectal prolapsed mucosa is ring-shaped, the surface is smooth, the sphincter relaxation during rectal examination; the mucosa of the ring-shaped sputum is plum-petal, the sphincter does not relax.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.