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Yu Xu Chao
Colorectal Surgery
About me
Chief physician, master's degree graduate, engaged in colorectal surgery for six years, proficient in using integrated traditional Chinese and Western medicine to treat colorectal diseases.
Proficient in diseases
Has rich clinical experience in anal diseases, specializes in using a combination of Chinese and Western medicine methods to treat internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, anal fissures, anal fistulas, perianal abscesses, rectal prolapse, anal stenosis, constipation, inflammatory bowel disease, colorectal tumors, etc.
Voices
Is the pain and swelling of hemorrhoids external or internal?
This situation might involve both internal and external hemorrhoids, which is referred to as mixed hemorrhoids. Internal hemorrhoids might also prolapse, leading to inflammatory edema and causing anal swelling and pain. External hemorrhoids can also present with inflammatory edema and thrombosis, leading to anal swelling and pain. Hence, in clinical practice, this situation is often considered as mixed hemorrhoids. Mixed hemorrhoids mainly occur at the same point in the anal canal, both above and below the dentate line, and symptoms of both internal and external hemorrhoids are present. Clinically, if the patient is unwilling to undergo surgery, conservative treatment with medication can be considered initially, such as oral administration of Diosmin tablets, followed by the use of an anal wash or a sitz bath with potassium permanganate solution after defecation, and then application of Dihuang ointment externally to alleviate discomfort. However, if the inflammatory edema does not subside and anal swelling and pain are significant, it is advised to consider surgical intervention early to prevent necrosis due to prolapsed hemorrhoids. (Please follow medical advice when using medications.)
How to eliminate external hemorrhoids without a core?
Conservative medication treatment for external hemorrhoidal nodules can only reduce their size, but cannot completely eliminate them. For instance, if an external hemorrhoidal nodule develops inflammatory edema, one can take oral Diltiazem tablets, combined with anal wash or potassium permanganate solution for local sitz baths, and apply Golden Ointment externally, which can achieve good anti-swelling effects. However, if the external hemorrhoidal nodule is significantly enlarged, or even forms a thrombus causing pain and swelling in the anus, simply using medication cannot effectively improve the symptoms. In such cases, surgical intervention is required to eliminate the nodule, such as external hemorrhoidectomy. Post-surgery, dressing changes such as Mupirocin ointment, red oil gauze strips, Golden Ointment, and other medications are recommended. Furthermore, the patient should maintain good bowel habits, avoiding prolonged toilet time or excessive straining.
How long will it take for internal hemorrhoids to become necrotic if they prolapse?
The duration before prolapsed internal hemorrhoids become necrotic is directly related to the severity of the prolapse. If the prolapsed internal hemorrhoids are minimal and there are no significant inflammatory infections or thrombosis, necrosis is generally unlikely to occur in such cases. However, it might lead to an increase in secretions in the anal area, causing pain and discomfort. In this scenario, it is advisable to immediately reduce the prolapse manually, along with using medications to reduce swelling, to help retract the hemorrhoids back inside the anus. However, if the prolapsed internal hemorrhoids are large and there is edema due to entrapment, and local thrombosis has occurred, then necrosis might develop within three to five days. In such cases, it is recommended that the patient promptly visits the proctology department of a hospital to undergo internal hemorrhoid surgery, such as hemorrhoidal banding, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Hemorrhoidal Dearterialization). Post-surgery, it is essential to keep changing dressings to avoid infection and bleeding from the surgical wound.
Can external hemorrhoids be pinched?
In clinical practice, external hemorrhoids can be classified into skin tag hemorrhoids, varicose vein hemorrhoids, thrombosed hemorrhoids, and inflammatory hemorrhoids. Among these, skin tag hemorrhoids can be pinched, but do not exert excessive force to avoid skin damage and causing anal pain. On the other hand, varicose vein hemorrhoids, thrombosed hemorrhoids, and inflammatory hemorrhoids should not be pinched, as pinching may easily cause subcutaneous vein damage, exacerbate thrombosis, and lead to anal distension and pain. External hemorrhoids can be gently massaged and rubbed, but should not be pinched forcefully. Moreover, clinically, treatments for external hemorrhoids often involve the use of anal washes or potassium permanganate solution for sits baths, and it is recommended to take a sitz bath for five to ten minutes after defecation to help reduce external hemorrhoids and prevent their enlargement. Maintaining good bowel habits is essential, avoiding prolonged defecation and excessive straining. After defecation, it is advisable to perform more anal lift exercises to strengthen the anal sphincter muscles.
How to treat anal fissure bleeding
For early anal fissure bleeding, the first step is to soften the stool by eating more foods high in rough fiber to maintain smooth bowel movements as much as possible. This prevents hard and dry stools from irritating the fissure, causing bleeding or worsening pain. Additionally, after defecating, it is necessary to take a sitz bath using warm saltwater or an anal cleansing solution. It is generally recommended to sitz bath for five to six minutes, which can have anti-inflammatory and hemostatic effects. After the sitz bath, apply Dragon Ball ointment or nitroglycerin ointment locally to promote ulcer healing. Typically, symptoms can significantly improve within seven to ten days of medication. However, if the patient has chronic anal fissure with prolonged pain after each bowel movement, surgical treatment is needed due to fibrous scar formation in the internal anal sphincter. In such cases, an anal fissure excision surgery might be undertaken, followed by dressing changes using medications like red oil ointment gauze or golden ointment. (Please follow medical advice regarding medication.)
Hemorrhoids are divided into several degrees.
In clinical practice, external hemorrhoids are not classified by degrees but mainly into skin tag hemorrhoids, varicose vein hemorrhoids, inflammatory hemorrhoids, and thrombosed hemorrhoids. Skin tag hemorrhoids and varicose vein hemorrhoids typically cause sensations of foreign bodies in the anus and feelings of anal prolapse, etc., and conservative medication treatment is generally chosen for these. However, thrombosed hemorrhoids or inflammatory hemorrhoids can cause significant anal swelling and pain, severely impacting the patient's normal life. For these two types of external hemorrhoids, it is recommended to promptly undergo hemorrhoidectomy, followed by medication treatment to promote healing of the surgical site. Because the surgical site for hemorrhoid operations is located at the anus, it is susceptible to contamination from feces and other secretions, which can easily lead to local infections, bleeding, and swelling. Therefore, it is essential to persist in changing dressings and to maintain smooth bowel movements.
What is the most effective treatment for internal hemorrhoids bleeding?
The most effective treatment method for internal hemorrhoid bleeding primarily depends on the severity of the bleeding. If it is only early-stage internal hemorrhoid bleeding, the most effective method is to choose hemorrhoid suppositories or ointments for anal administration, which can quickly stop the bleeding. At the same time, patients should pay attention to their diet and avoid spicy, irritating and dry foods as much as possible, which can also alleviate the bleeding of internal hemorrhoids. However, if the internal hemorrhoid bleeding is frequent and the amount of bleeding is substantial, then the most effective treatment method is to go to the hospital's colorectal surgery department for surgical treatment. The surgical treatments can include sclerotherapy injections, PPH or TST, and internal hemorrhoid banding, etc. Consistently changing dressings after surgery can effectively improve and control internal hemorrhoid bleeding.
Are there any effects if internal hemorrhoids are constantly prolapsed?
Internal hemorrhoids that protrude permanently can easily lead to incarceration, causing inflammatory edema. Constant friction over a long period can also cause the surface of the hemorrhoids to break and bleed. Additionally, contamination and waste matter may infect the hemorrhoids. Due to the prolonged protrusion outside the anus, the local circulation can become obstructed, leading to swelling and even inducing local thrombosis, which causes pain in the anus. Therefore, it is not possible to reinsert the prolapsed internal hemorrhoids back into the anus. In such cases, it is advisable to seek prompt medical treatment at a hospital's colorectal surgery department. Surgical options like hemorrhoid banding, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Hemorrhoidal Dearterialization) are recommended. Post-surgery care should include the use of anal cleansers, red oil gauze strips, and golden ointment for dressing changes. Additionally, it is crucial to maintain smooth bowel movements.
Do minor external hemorrhoids itch?
Mild external hemorrhoids can also cause localized itching in the anal area, but the itching is not pronounced. This is because the external hemorrhoids themselves stimulate the perianal skin, causing mild itching and a sensation of a foreign body in the anus. Moreover, external hemorrhoids can lead to increased secretions around the anus, further irritating the perianal skin and, in severe cases, causing anal eczema. Thus, in most cases, mild external hemorrhoids can cause itching, although it is not intense. For such situations, it is primarily important for patients to keep the perianal area dry and hygienic, wear loose, breathable cotton underwear, and avoid friction against the hemorrhoids. For mild itching, topical treatments such as calamine lotion can be used, along with keeping the perianal area dry. Additionally, a light diet should be maintained.
Can internal hemorrhoids with prolapsed thrombus shrink?
If internal hemorrhoids prolapse and form thrombosis, it indicates poor local blood circulation in the internal hemorrhoids and damage to the hemorrhoidal veins, leading to thrombosis. Such thrombosis will not shrink and will cause a significant foreign body sensation in the anus and anal distension pain. For cases where internal hemorrhoids prolapse and form thrombosis, it is crucial to go to the hospital's colorectal surgery department for timely surgical treatment. Surgical options include internal hemorrhoidal banding, internal hemorrhoidectomy, or TST. Postoperatively, patients should use anal cleansers and medications like golden ointment and red oil ointment gauze for dressing changes to promote wound healing. Furthermore, patients should be cautious with their diet, avoiding spicy, stimulating, and dry foods to prevent irritation to the wound, which could lead to infection, inflammation, or swelling, and thus significant pain. Additionally, patients should maintain hygiene around the anal area and wear loose, breathable cotton underwear.