• Chapter Two

    3 typical anal canal diseases such as hemorrhoids

    Anal canal disease is a highly prevalent disease and is a general term for many diseases, not just one.
    The anal canal is an organ approximately 3 cm in length, and the symptoms of anal canal disease vary depending on the location of the disease and the corresponding treatment. The structure of the anal canal is determined by the way it is formed.The anal canal is formed by the fusion of the endoderm and ectoderm of the primitive rectum, and its articulation is marked with a serrated pattern, hence the name dentate line. The dentate line is the boundary between the mucosal tissue of the rectum and the skin of the anal canal.
    The dentate line is the boundary between the rectal mucosa and the skin of the anal canal.

    The 3 typical anal canal diseases are hemorrhoids, anal fissures and anal impotence. According to statistics, among these 3 types of anal canal diseases
    The incidence of hemorrhoids is relatively high among both men and women, with an incidence rate of about 60%, followed by anal impotence and anal fissure. The incidence of anal impotence is about 13% in men and 8% in anal fissures; the incidence of anal fissures is about 15% in women and about 3% in anal impotence.
    When constipation occurs, if you strain for a long time, it can cause bruising at the anal pad, and in severe cases blood vessels break The fissures can bleed and the connective tissue can proliferate, resulting in hemorrhoids.

    Hemorrhoids are generally classified as internal hemorrhoids. External hemorrhoids, mixed hemorrhoids

    Hemorrhoids are soft swellings that protrude from the inside and outside of the anus and are formed by stagnant, varicose veins in the anal canal.
    Depending on the location of the hemorrhoid, they are generally classified as internal, external, or mixed hemorrhoids, with the main focus here being internal and external hemorrhoids.
    The rich venous plexus in the lower rectum and anal canal forms the anal cushion tissue that prevents leakage of stool and waste gas. If you strain too hard during constipation, you can increase the burden on the anal canal, rupture or cause bruising, which can cause the connective tissue around the blood vessels to proliferate. This protruding soft swelling is called a hemorrhoid.
    We usually refer to hemorrhoids that occur above the dentate line as internal hemorrhoids and hemorrhoids as external hemorrhoids. The mechanism of occurrence of internal and external hemorrhoids is different.
    It is important to note that during the second trimester of pregnancy, internal hemorrhoids can easily form or worsen the symptoms of hemorrhoids because of the pressure of the enlarged uterus on the pelvic veins
    If the hemorrhoids are left unattended, the symptoms can become more and more severe, eventually leading to "prolapse" in which the rectal mucosa comes out of the anus during defecation

    Symptoms of internal hemorrhoids

    Internal hemorrhoids are soft venous masses formed by enlarged varicose and engorged veins above the dentate line. They are usually not painful because they are autonomously innervated. Many people do not realize they have internal hemorrhoids until they bleed or the hemorrhoid nucleus comes out of the anus. Many people do not realize they have internal hemorrhoids until after they bleed or the hemorrhoids prolapse from the anus.

    Internal vs. external hemorrhoids

    The enlarged varicose veins are usually caused by excessive straining during defecation, and under strong abdominal pressure, the elasticity of the venous plexus gradually decreases, and eventually the plexus and surrounding tissues will prolapse out of the anus during defecation.
    In addition, internal hemorrhoids act as a sponge to store blood. As the degree of stasis changes, so does the size of the "sponge," or nucleus, which stores the blood.
    Depending on the severity of the symptoms, internal hemorrhoids can be divided into four stages, from stage I to stage IV.

    Stage I Bleeding during defecation but the hemorrhoid nucleus does not protrude from the anus
    The connective tissue of internal hemorrhoids remains largely intact, but blood is trapped in the nucleus, causing the mucous membrane to become congested and swollen. If you push too hard during defecation, the nail of the hemorrhoid rubs against the dry stool, causing the mucosa of the nail to rupture and bleed.
    In mild cases, the bleeding may be seen as blood in the stool or dripping blood during defecation, or in severe cases, as In severe cases, the bleeding may be in the form of spraying. The bleeding usually stops at the end of the bowel movement.
    Stage II The hemorrhoid nucleus prolapses out of the anus during defecation, and then retracts on its own after defecation
    The internal hemorrhoid gradually increases in size and prolapses out of the anus during defecation. The repeated prolapse of the hemorrhoid nucleus causes the mucous membrane of the internal hemorrhoid to gradually thicken and the connective tissue to grow, so it is less likely to rupture and bleed, so the amount of bleeding is less than that of stage I internal hemorrhoids. After defecation, the prolapsed hemorrhoids can be returned on their own.
    Stage III The nucleus of the hemorrhoid prolapses during defecation and cannot be retracted by itself, so you need to press it by hand to make it retract.
    The nucleus of internal hemorrhoids gradually increases in size and cannot be retracted without finger pressure after prolapse. If you do not use the correct method, some of the hemorrhoid nucleus may remain outside the body, causing bruising and pain in the nucleus and bleeding if it is pressed. In addition to bowel movements, playing golf or holding heavy objects may cause the hemorrhoid to come out of the body.

    Stage IV hemorrhoids prolapse and cannot be retracted
    At this stage, the nucleus will come out again even if you press it with your hand. In other words, the hemorrhoid nucleus is always in a state of prolapse. Sometimes only one hemorrhoid is prolapsed, sometimes three or four hemorrhoids are prolapsed at the same time.
    In addition, the hemorrhoid nucleus may prolapse together with the rectal mucosa, causing the skin around the anus to become contaminated with stool, leading to ulcers or itching.
    For stage I and II internal hemorrhoids, they can be cured with lifestyle changes and proper treatment, and surgery is not necessary. However, if the condition has reached stage M, surgery may be necessary. In our hospital, the rate of surgery for internal hemorrhoids is 13%.
    In addition, some of the hemorrhoids that cannot be returned by hand pressure are called "embedded hemorrhoids". This type of internal hemorrhoid that has prolapsed from the anus is held by the sphincter, causing bruising and is accompanied by symptoms such as hardening of the hemorrhoid and pain.
    The prolapsed hemorrhoid is held in place by the anal sphincter, causing arterial blood with higher pressure to flow into the hemorrhoid, while venous blood with lower pressure is blocked, and eventually the arterial blood vessels are also pressed shut, resulting in bruising. After the blood flow inside the hemorrhoid nucleus is almost completely stopped, the nucleus swells rapidly and has a purple-black surface.

    When the hemorrhoid nucleus comes out of the anus, the epithelial tissue of the anal canal, which is more sensitive to pain, sometimes comes out with it.
    When internal hemorrhoids develop, they are usually painless. However, in the case of an embedded hemorrhoid, there is swelling of the affected area In the case of an embedded hemorrhoid, however, the affected area will swell and become severely painful. If the surface of the hemorrhoid ruptures, it can bleed profusely and sometimes requires surgery.
    It is important to find out if you have internal hemorrhoids as soon as possible if you have any of the following symptoms: - Lately, you have been taking longer to go to the bathroom.
    -There is no pain during defecation, but there is blood in the stool.
    -A certain amount of blood on the surface of the stool -An unusual sensation during defecation, with the nucleus of the hemorrhoid coming out of the body.
    -There is a sensation of swelling and retention of stool in the anus, but no pain. If you have the following symptoms, you should be alert for embedded hemorrhoids.
    -Low bleeding during defecation with severe pain.
    -Bleeding from the anus with or without defecation and painful.
    -The nucleus of the hemorrhoid is prolapsing from the anus and there is severe pain in the mouth.

    Symptoms of external hemorrhoids

    Constipation, where you have to strain to pass dry stools, causes bulging tissue on the surface of the anal canal below the dentate line.
    External hemorrhoids may cause intense pain around the anus when lifting heavy objects or playing golf.
    External hemorrhoids are the result of pathological varicose veins, thrombotic stasis, or recurrent inflammation of the venous plexus below the dentate line.
    Because external hemorrhoids occur in the skin of the anal canal below the dentate line and are innervated by the same somatic nerves as the skin, they often produce a strong painful sensation.
    If the hemorrhoid nucleus is compressed by the anal sphincter, the pain will be more intense.

    By eating more foods rich in dietary fiber, you can soften the stool and make bowel movements smooth. Take anti
    The pain caused by external hemorrhoids will be relieved by taking anti-inflammatory and analgesic drugs for 5-7 days, and the swelling of the hemorrhoid nucleus caused by inflammation will disappear after 1 month.
    The number of cases requiring surgery for external hemorrhoids is very small (in our hospital, the rate of surgery for external hemorrhoids is only 1.5%).
    In our hospital, the rate of surgery for external hemorrhoids is only 1.5%) o For thrombosed external hemorrhoids with severe pain and hard masses that do not go away, surgical removal of the thrombus can be used.
    The thrombus can be removed surgically

    Factors triggering hemorrhoids

    The following factors can trigger hemorrhoids and make them worse.
    Constipation can lead to excessive straining during defecation, which increases abdominal pressure and obstructs blood circulation in the inferior vena cava, This causes stasis in the venous plexus of the anal cushion, resulting in rapid swelling and thickening of the blood vessels, and the proliferation of connective tissue around the anal canal, eventually forming a hemorrhoid nucleus.
    In addition, when dry stool passes through the anal canal, it can scratch the anal canal and cause inflammation, which can lead to the formation of hemorrhoids. nucleus. If you do not have a bowel movement for several days, the stool that remains in the rectum and anal canal for a long time can irritate the mucous membrane of the rectum and the skin of the anal canal and cause inflammation, which can lead to hemorrhoids.
    Most people who take a long time to go to the toilet have symptoms of constipation, and some people take 20 to 3 minutes to defecate once. minutes. Longer bowel movements can raise abdominal pressure and cause stasis in the venous plexus, which can easily lead to hemorrhoids.

    Maintaining the same posture for a long time

    Sitting or standing in the same position for long periods of time can cause stasis in the venous plexus under the skin of the anal canal, which can lead to hemorrhoids. This is why coach drivers, pilots, and typists are prone to hemorrhoids.
    In addition, bicycling, horse racing, weight lifting and trumpet playing, which require high abdominal pressure, can also increase the pressure on the anal canal.

    Pregnancy, childbirth

    Blood stasis, excessive force during childbirth can also induce diseases such as hemorrhoids

    During pregnancy, the enlarged uterus compresses the surrounding blood vessels and can cause veins under the skin of the anal canal

    Excessive intake of spicy seasonings, alcohol, etc.

    Most of the chili peppers in spicy seasonings are not absorbed by the body and are excreted in the stool. Therefore, the residual chili pepper can irritate the anal canal and cause inflammation during bowel movements.
    Alcohol is also a trigger for inflammation of the anal canal, and large amounts of alcohol intake may cause diarrhea and further worsen hemorrhoids.

    Measures to be taken after the appearance of hemorrhoids

    If you have internal hemorrhoids, they usually do not continue to bleed after the bowel movement is over. After using the toilet, you can sit on a comfortable cushion or sponge, or you can elevate your buttocks or lie still to recuperate. You can also use a skimmed cotton ball to plug the anus to enhance the hemostatic effect.
    In addition, in order not to increase the burden on the anal canal, eat as much food as possible that can soften the stool and prevent To prevent constipation
    To eliminate bruising and keep the anus clean, it is recommended that you take frequent baths or sitz baths. You can also apply ointment to the affected area under the guidance of your doctor to enhance the treatment effect.
    Poor circulation in the venous plexus under the skin of the anal canal is the main cause of external hemorrhoids, so it is important to improve blood circulation to treat them. You can improve blood circulation by taking a bath or sitz bath, or you can warm your buttocks with a warm water bag.
    For severe pain, you can take common painkillers. In addition, you can apply ointment to the affected area to relieve the pain caused by friction when walking. Although baths and sitz baths can improve the condition, for patients who have started to develop pus, promoting blood circulation in the buttocks can increase the pain and warm stimulation should be avoided.