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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
What is the best treatment for anal fistula?
The primary treatment method for anal fistulas is surgery, which mainly involves the use of a local seton thread. This method allows the surgeons to excise or remove the affected area of the anal fistula while preserving the normal contractile function of the local anal sphincter. This precaution helps prevent excessive removal that could lead to sphincter relaxation or excessive loosening of the anus. As the local sphincter naturally repairs itself and the seton falls out post-surgery, it ensures the proper healing of the local wound. Postoperative care for anal fistula surgery also involves proper drainage and disinfection of the local wound. Daily application of oil gauze and changing of anti-inflammatory medications on the local wound are recommended. This helps in reducing inflammation and facilitating drainage, thereby preventing the occurrence of local pseudohealing.
What department should I go to for anal fistula?
If you suspect you have an anal fistula, it is recommended to register with a proctology department for examination and treatment. The examination of an anal fistula mainly involves digital rectal examination, local perianal ultrasound, and probing with a probe. Typically, an anal fistula will have an external opening in the local anal area, and when the doctor touches near the dentate line of the anal canal with their index finger, an internal opening will be found in the anal crypt. Pressing on the local internal opening will cause secretions to flow out from it. Anal fistulas are relatively easy to diagnose, but further examinations such as perianal ultrasound and pelvic MRI are needed to clarify the direction of the fistula tract and the extent of the lesion. The treatment of an anal fistula primarily involves surgery, using techniques such as fistulotomy with seton placement to remove the local infection.
Initial symptoms of perianal abscess
The primary cause of perianal abscesses is recurrent infections at the anal crypts, also known as repeated episodes of cryptitis. Generally, when cryptitis recurs and forms a local infection foci, early symptoms of a perianal abscess include pain in the anus and anal canal, accompanied by pus discharge from the anal canal. When the condition progresses to a certain extent, there will be hard pus pockets or pus formation. Once the infection within the pus pocket completely turns into pus, the patient will experience intense pain, manifesting as throbbing pain. Therefore, to alleviate the pain, it is necessary to promptly incise and drain the pus and further remove the local infection foci completely.
Will fecal incontinence heal on its own?
The causes of fecal incontinence in the anal region are primarily considered to be due to local organic lesions, or disturbances in nerve control, which can also lead to incontinence. If fecal incontinence is caused by either of these two reasons, it generally will not heal on its own. Severe diarrhea or acute intestinal infections can also cause fecal incontinence due to an increased frequency of bowel movements and acute inflammatory edema of the local intestinal mucosa. This can be alleviated by taking oral anti-inflammatory and anti-diarrheal medications. If the incontinence is caused by excessive relaxation of the anal sphincter, surgical treatment can be considered. If it is due to other neurogenic changes, active treatment of the primary disease is needed.
Can internal hemorrhoids heal by themselves?
The vast majority of internal hemorrhoid bleeding is not self-healing. Only a small amount of mucosal bleeding or if the patient actively takes care of themselves after bleeding, there might be a tendency to self-heal. Internal hemorrhoid bleeding is mainly caused by excessive local congestion pressure or hard stools piercing the local mucosal skin, leading to bleeding, generally related to poor dietary habits and defecation habits of the patient. Therefore, to achieve self-healing from internal hemorrhoid bleeding, the patient firstly needs to adjust their diet and defecation habits to avoid repeated occurrences of bleeding during bowel movements. If the bleeding is significant or lasts for a long time and cannot heal on its own, it is recommended that the patient seek treatment as soon as possible to avoid long-term internal hemorrhoid bleeding which could lead to anemia.
Thrombotic external hemorrhoid compression treatment
Treatment options for thrombosed external hemorrhoids include topical medications, compression therapy, or direct surgical excision. The choice of treatment depends on the severity of the clinical condition. For mild thrombosis, a traditional Chinese medicine wash with blood-activating and stasis-dissolving effects can be used for local hot compresses to promote the absorption and reduction of the thrombus. If the thrombus enlarges, professional proctological techniques can also be used to crush the thrombus locally, but it is important to maintain cleanliness and hygiene of the local mucosa to avoid infection. If the condition of thrombosed external hemorrhoids worsens, or if the patient experiences severe pain, surgical excision treatment can also be directly performed.
Postoperative Precautions for Perianal Abscess Surgery
After surgery for a perianal abscess, it is important to focus on the diet, primarily a liquid diet, since normal defecation is not advised in the early postoperative period or if the stool is too dry to avoid irritating the wound with feces, causing pain or even symptoms of infection. Therefore, the postoperative diet should primarily consist of a light, liquid diet. Postoperatively, since there will be local sutures and ligatures tied at the wound site, it is not recommended to engage in excessive exercise and activity within two weeks. The recovery of the local wound after surgery requires proper dressing changes. Postoperative dressing changes involve daily cleaning and disinfection of the local wound, ensuring smooth drainage, and using gauze packing to pressurize and drain the wound.
The early symptoms of internal hemorrhoids are
If early symptoms of internal hemorrhoids appear, the main manifestations are local mucosal protrusion or sub-mucosal congestion and edema. Patients may experience varying degrees of anal pain and might even experience minor bleeding during bowel movements due to irritation from hard, dry stools. The bleeding is usually bright red. After taking oral and topical medications, early-stage internal hemorrhoids can be cured and relieved. However, to prevent recurrent attacks of internal hemorrhoids or worsening of the condition, it is advised that patients maintain good bowel movements to avoid overly dry stools, keep bowel movement time under ten minutes, and avoid consuming spicy and irritating foods as much as possible.
When will the anal fistula seton fall off?
After the diagnosis of an anal fistula, it is necessary to perform surgery on the anal fistula as soon as possible. The main surgical method for anal fistula is the fistulotomy with seton placement, which uses an elastic band to indirectly cut the local sphincter. The time for the elastic band to fall off mainly depends on the amount of sphincter involved and the depth of the anal fistula location. If it is a simple anal fistula, the band typically falls off about a week after placement. For high, complex fistulas, or if multiple elastic bands are used, the time may extend to ten or even twelve days. If the band does not fall off after the surgery, and the local sphincter has regenerated, a professional colorectal surgeon can cut the band. However, it is important to ensure that the local sphincter is not damaged before proceeding.
Is anal fistula serious?
To determine whether an anal fistula is severe, it mainly requires a digital rectal examination and probe inspection, and if necessary, supplemented with perianal ultrasound and pelvic MRI. If it is a low-lying single fistula tract, it generally is not severe and considered a low-type fistula. If the internal opening of the fistula is positioned high, or if there are multiple branches of the tract, the condition is generally more severe, classified as a high, complex fistula. Typically, the local infection will spread across the sphincter muscles, and some even reach the ischioanal fossa. Whether it is a simple low fistula or a high, complex fistula, once discovered, it requires prompt surgical treatment with fistulotomy and seton placement.