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Chen Tian Jing
Colorectal Surgery
About me
Master's degree, specializing in research and treatment of colorectal surgery.
Proficient in diseases
Mixed hemorrhoids, internal hemorrhoids, external hemorrhoids, anal papillitis, perianal abscess, anal fistula, anal sinusitis, anal fissure, perianal abscess, pruritus ani.
Voices
Will internal hemorrhoids falling out be painful?
If internal hemorrhoids can retract back into the anus on their own after prolapse, they generally do not cause severe pain. However, if the prolapse lasts for a long time or occurs repeatedly, and if the mucous membrane of the hemorrhoid core ruptures and bleeds due to friction from walking or exercising, this can lead to pain due to the localized prolapse. It may even lead to congestion and swelling of the local hemorrhoid core after prolapse, thereby causing inflammatory edematous hemorrhoids, further intensifying the pain. Therefore, to avoid pain from internal hemorrhoids, or for those that prolapse and cannot retract back, it is advisable to actively use medications for treatment at the early stages of prolapse. For recurrent cases, direct internal hemorrhoid ligation surgery can also be performed.
The difference between perianal abscess and hemorrhoids
Perianal abscess and hemorrhoids are two different types of common anorectal diseases. When a perianal abscess occurs, the onset is generally sudden and there is severe pain in the anal area. Under the skin of the anal area or inside the anal canal, a submucosal abscess forms, encapsulating pus. Surgical treatment is required as soon as possible to prevent further spread of the abscess cavity. Hemorrhoids, on the other hand, are caused by the long-term and repeated accumulation of local tissues in the anal area, leading to the formation of blood clots or varicose vein masses. These generally occur near or around the dentate line, and may also be accompanied by skin tags of external hemorrhoids.
What should I do if my anal fissure doesn't heal?
If an anal fissure consistently fails to heal proactively, it may be due to the repeated expansion of the fissure, or recurrent instances of dry stools and bleeding, leading to ulcerative, infectious changes at the local fissure. This can progress into a chronic anal fissure. Chronic anal fissures have larger local wound surfaces, and the patient may also experience excessive tightness in the anal canal. The local fissure, wrapped within the tightened anal canal, does not drain well, making self-healing impossible. To treat chronic anal fissures, or recurrent fissures, it is recommended to perform a lateral internal sphincterotomy and further debride the local fissure to ensure complete healing of the anal fissure.
Is surgery necessary for thrombosed external hemorrhoids?
Thrombotic external hemorrhoids do not necessarily require surgery during the acute phase of an attack. If the thrombotic external hemorrhoids are mild, Chinese herbal medicine can be used for local topical application to relieve symptoms. Early-stage or mild thrombotic external hemorrhoids may only form small thrombi, and the pain experienced by the patient is not very intense. Therefore, one can opt to use Chinese herbal washes for hot compresses and fumigation, along with the application of hemorrhoid cream to alleviate symptoms. However, it is only recommended to perform excision surgery for thrombotic external hemorrhoids if they are acutely recurring over a long period or repeatedly, severely affecting the patient's life. (Please use medication under the guidance of a professional physician and avoid self-medication.)
Does a second surgery for a perianal abscess hurt?
When it comes to a second surgery for a perianal abscess, it is generally recommended to proceed directly with spinal anesthesia. Simple local anesthesia might be more painful for the patient, as spinal anesthesia does not cause pain sensations. If there is pain after the surgery, one can opt for oral painkillers or a combination of pain relief pump treatments. Alternatively, pain relief gel can be applied to the wound to alleviate pain before each dressing change. Therefore, after the onset of a perianal abscess, whether it is the first or second surgery, it is essential to operate as soon as possible, and to disinfect and change dressings postoperatively to prevent pseudo-healing or secondary recurrent infections. To relieve pain, painkillers can be chosen. Before or after each bowel movement, one may use clean water for local cleansing to soothe the sphincter and prevent fecal residue.
How to deal with a ruptured perianal abscess?
Perianal abscesses that recur or occur acutely may locally form an abscess or pus pocket. If the abscess or pus ruptures, secretions will flow out of the abscess cavity around the anus, further leading to the formation of an anal fistula. After the perianal abscess ruptures, it is necessary to promptly perform local debridement, mainly to thoroughly remove the pus from the abscess cavity and to further disinfect the area. After a typical anal fistula forms, surgical treatment involving a fistulotomy with seton placement is required. The principle of the surgery is to completely remove the local infection while preserving the function of the anal sphincter muscles. Subsequent dressing changes and application of ointments or growth factor gels are necessary to promote normal growth of the granulation tissue.
Why does a perianal abscess recur?
Perianal abscess is an infectious disease of the local skin and tissues around the anus caused by an infection in the anal crypts. If a perianal abscess is not treated with a definitive one-time surgical intervention, it is very likely to recur, or after rupture of the abscess, to form an anal fistula with long-term intermittent discharge of pus from an external opening. Therefore, during the acute phase of a perianal abscess, once a distinct abscess cavity and pus formation occurs, it is necessary to promptly perform a one-time definitive surgical treatment of the perianal abscess, rather than choosing conservative medication treatment or simple incision and drainage. The above treatments only temporarily alleviate symptoms of a perianal abscess; only a one-time definitive surgery that completely cleans the local wound can result in the complete healing of the perianal abscess.
Can a colonoscopy be performed with an anal fissure?
Patients with anal fissures are advised not to undergo colonoscopy, primarily because the procedure involves inserting the colonoscope through the anus, and anal fissures typically occur within the local sphincter muscles. The passage, or repeated movement, of the probe can cause local fissures to experience painful stimulation, or even worsen the symptoms of the fissures, increasing the likelihood of pain and bleeding for the patient afterwards. Therefore, if patients with anal fissures wish to undergo colonoscopy, they should first receive appropriate medical treatment and wait for the local fissures to heal or be completely cured before undergoing the procedure. If a colonoscopy is necessary, a lubricant can also be applied to the anal region to reduce the irritation of the colonoscope on local fissures.
What anti-inflammatory medication should be taken for a perianal abscess?
If the perianal abscess is in the acute phase, one can opt for oral medication that clears heat, cools the blood, reduces swelling, and relieves pain, specifically designed for hemorrhoids, and it can be combined with oral antibiotics for anti-inflammatory treatment. However, treating a perianal abscess with oral medication alone can only alleviate symptoms or prevent the pus cavity from spreading too quickly, and does not provide a radical cure. The definitive treatment for a perianal abscess primarily involves surgery. The surgical method generally used is a one-time radical surgery for perianal abscesses, as the abscess forms a pus cavity and pus under the skin around the anus. Therefore, the surgery initially requires draining of the local pus, followed by thorough debridement of the walls of the pus cavity to allow fresh granulation tissue to regrow, filling the wound and facilitating the recovery of the local wound. (Note: This answer is for reference only. Please consult a doctor and follow the guidance of a professional physician before using any medication. Do not self-medicate.)
Hemorrhoids bleeding and rectal cancer bleeding
Hemorrhoids or colorectal cancer can both cause local bleeding in the anal area, but there are clear differences between hemorrhoidal bleeding and colorectal cancer bleeding in clinical practice. Hemorrhoidal bleeding is mostly bright red and does not mix with the stool; it is separate bleeding. It may manifest as blood on the finger, or as dripping or spurting blood. Colorectal cancer bleeding, on the other hand, is generally dark red and mixes with the stool, sometimes accompanied by pus and blood. Bleeding from colorectal cancer mainly occurs in the late stages of the disease, usually caused by local mucosal ulceration or tumor rupture. During hemorrhoidal bleeding, an anal scope examination can reveal clear bleeding points above and below the dentate line, while bleeding from colorectal cancer requires examination with an electronic colonoscope to observe the local tumor area, which may show mucosal damage or ulcers.