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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 should I do if the perianal abscess bursts?
Since a perianal abscess is an acute symptom of a local skin infection around the anus, during the acute phase of a perianal abscess, an abscess cavity and pus formation generally occur within about a week. As the disease worsens and progresses, the perianal abscess will rupture about a week later. If the perianal abscess ruptures, it may have already formed an anal fistula. A perianal abscess and an anal fistula represent two different stages of the disease, and both require surgical treatment. The main surgical treatment for anal fistulas is fistulotomy with seton placement, and care must be taken to drain and disinfect the local wound post-surgery to prevent pseudohealing of the wound.
How to operate on a perianal abscess
The surgical methods for perianal abscess vary depending on the location of the lesion. If it is a simple ischiorectal fossa subcutaneous abscess, a one-time incision and drainage surgery is generally used. The local wound is debrided and necrotic tissue is removed. After trimming the wound, it is important to maintain clear drainage of the local wound. Local application of gauze strips for compression and drainage treatment can be used. If the abscess is in the ischioanal fossa or the pelvirectal space, considering that the location of the lesion is deep, a one-time incision and seton drainage radical surgery may be required for the perianal abscess. Post-surgery, thorough disinfection and drainage of the local wound are also necessary.
Should surgery be performed if there are no symptoms of anal fistula?
If an anal fistula is in its acute phase, the main clinical symptoms are intermittent discharge of pus from the external opening, or pain and itching. If there are no symptoms, and only the external and internal openings along with the fistula tract exist, surgery is still required because the absence of symptoms temporarily does not guarantee that an acute episode will not occur later. During an acute episode, there will be local tissue and skin inflammation, redness, heat, and severe pain. If an anal fistula is not surgically treated for a long time, it may lead to an increase in the number of branches of the fistula or thickening of the fistula wall, and it may even spread to the pelvic cavity. Therefore, once an anal fistula is discovered, it is necessary to perform surgery as soon as possible. Early treatment has significant benefits for wound recovery and the difficulty of the operation.
What to do about the false healing of anal fistula?
If a false healing of the wound occurs after local surgical excision of an anal fistula, it is mainly due to improper dressing changes by the patient and a lack of timely observation of the local wound. It is recommended to open the superficially healed wound to allow it to regrow. In particular, the patient needs to change the dressing and observe the wound daily to prevent the situation where the internal part of the wound has not healed, but the external opening appears healed. During dressing changes, hemorrhoid creams and other drugs that promote mucosal healing can also be applied locally and inside the anal canal to further promote the healing of the internal opening. Only when the internal opening has fully grown should treatment that promotes healing of the external opening be applied. (Please use medication under the guidance of a professional physician, and do not self-medicate.)
Can anal fistulas be left untreated indefinitely?
If a patient is diagnosed with an anal fistula, it must not be left untreated. If an anal fistula is not actively treated over a long period, it can easily lead to thickening of the fistula tract or an increase in branching. Moreover, after long-term repeated inflammatory stimulation, some fistula tracts are prone to malignant transformations. Therefore, it is recommended that patients with anal fistulas seek symptomatic treatment as soon as they are diagnosed. The primary method of treating anal fistulas is surgical. The main surgical approach for an anal fistula is fistulotomy with seton placement, which involves removing the local fistula tract wall while preserving the function of the patient's sphincter muscle. After the surgery, patients need to follow a light diet to avoid an increase in local secretions, which can lead to inflammatory stimulation and even the recurrence of the anal fistula.
Rectal prolapse symptoms
The symptoms of rectal prolapse mainly refer to local mucosal relaxation in the anal canal, which leads to the prolapse of the internal mucosa outside the anus, or excessive relaxation of the mucosa that accumulates at the anus, forming an internal mucosal prolapse of the rectum. Rectal prolapse may also manifest as local bloating, pain, and a feeling of falling in the patient. Due to repeated prolapses, it may also cause difficulties in defecation due to mucosal accumulation at the anus, or form outlet obstructive constipation. Therefore, whether it is internal mucosal prolapse of the rectum or prolapse that leads to rectal prolapse, it is advisable for patients to undergo surgical treatment as soon as possible to avoid aggravating the condition and delaying treatment.
Can external hemorrhoids be eliminated?
External hemorrhoids are generally divided into skin tag-type external hemorrhoids, thrombotic external hemorrhoids, and inflammatory edematous external hemorrhoids; each type presents different clinical symptoms. If the condition is skin tag-type external hemorrhoids or connective tissue-type external hemorrhoids, the patient generally does not feel obvious symptoms, but these will not resolve on their own and require surgical removal. If skin tag-type or connective tissue-type external hemorrhoids do not affect the patient's normal life, it is possible to avoid excessive intervention and treatment. However, if it is thrombotic external hemorrhoids or inflammatory edematous external hemorrhoids, since there is significant pain during flare-ups that affects the patient’s normal life, surgical removal and treatment should be performed as soon as possible.
Do anal fistulas need surgery even if there are no symptoms?
After the formation of an anal fistula, it does not always lead to acute episodes over a long period. Acute episodes of an anal fistula, causing infectious symptoms, occur only when there is a severe localized damp-heat condition. Therefore, the symptoms of an anal fistula are intermittent. The absence of symptoms does not mean that the anal fistula is completely cured or will not recur. Therefore, if an anal fistula is diagnosed, it is necessary to undergo surgical treatment as soon as possible to avoid repeated episodes due to lack of active treatment. Long-term repeated episodes of an anal fistula can lead to thickening of the fistula wall and an increase in branching. Even if an anal fistula is not actively treated over many years, it may even induce carcinogenesis in the local fistula wall.
How to improve anal fissure bleeding?
To improve anal fissure and bleeding, the first step is to treat constipation by softening the stool, as most anal fissures are caused by dry stools tearing the local skin and mucous membranes of the anus, leading to bleeding from these tears. For those experiencing pain and bleeding due to anal fissures, it is advisable to apply sesame oil around the anus before each bowel movement to prevent irritations from stool aggravating the fissure, which can cause recurrent pain and bleeding. After defecation, hemorrhoid cream can be applied for hemostatic treatment, and medicinal herbal solutions can be used for local compression and hot compresses to promote the growth and healing of the fissure. (Note: Medications should be used under the guidance of a doctor.)
Do internal hemorrhoids require surgery?
The clinical symptoms of internal hemorrhoids are numerous, and surgery is only recommended if the internal hemorrhoids frequently recur, or if the clinical symptoms are severe. Severe internal hemorrhoids are primarily characterized by substantial rectal bleeding or recurrent prolapses, and due to repeated prolapses, friction on the local mucosa may even cause anal pain. A severe symptom of prolapsed internal hemorrhoids is that after each prolapse, the patient needs to manually reposition them, accompanied by jet-like or dripping fresh red rectal bleeding. Surgical methods for internal hemorrhoids mainly include hemorrhoidectomy with ligation or local injection of sclerosing agents.