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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
Can internal hemorrhoids that protrude outside the anus be cured by taking medicine?
Internal hemorrhoids that prolapse outside the anus cannot be cured by medication alone. This is because when internal hemorrhoids prolapse, it indicates a significant pathological enlargement and downward displacement of the anal cushions, which are structural changes. Merely taking medication will not result in significant improvement; surgery is the primary option at this point. For this condition, surgical options such as PPH (Procedure for Prolapse and Hemorrhoids) or TST (Transanal Hemorrhoidal Dearterialization) can be employed. Consistent postoperative care and dressing changes can facilitate recovery. Because prolapsed internal hemorrhoids are located at the anal opening, if not treated surgically, they can lead to impaired blood flow, which may cause incarceration leading to edema or thrombosis, and even potentially result in infected necrosis. Therefore, early surgical intervention is required for prolapsed internal hemorrhoids. Additionally, patients should regularly perform anal sphincter exercises, avoid straining excessively during bowel movements, and not spend too much time on the toilet.
How long does it take for internal hemorrhoids to reposition after being pushed back in?
This situation mainly depends on how much the internal hemorrhoids have prolapsed and the severity of the prolapse. If the internal hemorrhoids can be pushed back in after prolapsing, it generally takes half an hour to an hour to reposition them. However, if the patient overexerts themselves or strains during coughing or defecation, the internal hemorrhoids may prolapse again. For patients whose internal hemorrhoids repeatedly prolapse, it is advisable to consider surgical treatment as soon as possible. Because repeated prolapse of internal hemorrhoids can lead to further pathological hypertrophy and descent of the anal cushion, in such cases of organic lesions, simple repositioning cannot solve the problem. It may even cause the prolapse to become larger over time and lead to complications like incarcerated edema, resulting in local thrombosis, swelling, and anal pain. Therefore, for patients with repeated prolapse, it is recommended to visit the hospital's colorectal surgery department for surgical treatment as soon as possible, such as internal hemorrhoid ligation, TST, and other surgical methods.
Is it better for the external opening of an anal fistula to be closed or not closed?
In clinical practice, it is generally best not to close the external opening of an anal fistula. Keeping the drainage unobstructed can prevent the infection from worsening or the formation of multiple branches. This is because when the fistula drains properly, the infectious secretions can flow out of the external opening. However, if the external opening does close, the infected tissues and secretions will accumulate within the fistula and then spread to the surrounding areas, forming branches and leading to an increase in the number of branches, thus creating a complex anal fistula and increasing the difficulty of future surgeries. Therefore, it is best not to close the external opening of an anal fistula. Clinically, the treatment for an anal fistula involves fistulectomy, which primarily involves removing the internal opening and the fistula. The external opening also needs to be treated. Postoperatively, medications such as erythromycin ointment gauze strips should be used for dressing changes.
How to quickly reduce hemorrhoid swelling
Inflammatory edema in hemorrhoids can lead to anal distension and pain in patients. Clinically, for the reduction of hemorrhoid swelling, options such as anal cleansing agents or potassium permanganate solutions can be used for sitz baths. The duration of the sitz bath should be controlled between five to six minutes, which can help in reducing swelling and relieving pain. After the sitz bath, applying Golden Ointment externally can also help in reducing swelling and relieving pain. Additionally, patients need to take oral Diosmin tablets to improve local blood circulation and prevent exacerbation of local swelling. Furthermore, patients should ensure smooth bowel movements, avoiding dry and hard stools to prevent irritation of the swollen hemorrhoids, thus worsening anal pain. They should also visit the hospital's proctology department as soon as possible for manual repositioning of the prolapsed hemorrhoids back into the anus. If repositioning is not possible, then surgical intervention, such as hemorrhoidectomy, must be considered promptly.
Can external hemorrhoids use hemorrhoid suppositories?
In clinical practice, hemorrhoidal suppositories can also be used for external hemorrhoids. Since hemorrhoidal suppositories are mainly administered through the rectum to act locally, they have a certain therapeutic effect on external hemorrhoids, especially for varicose external hemorrhoids and inflammatory external hemorrhoids, helping to alleviate local swelling and pain. Additionally, for external hemorrhoids, it is often recommended to use anal cleansers, or to sit in baths with potassium permanganate or other medicated solutions, combined with the external application of hemorrhoidal cream or golden ointment. If symptoms do not show significant improvement after four to five days of medication treatment, it is advisable to visit a hospital's proctology department for external hemorrhoid surgery as soon as possible, to prevent potential thrombosis or necrosis of the external hemorrhoids. Moreover, patients should develop good bowel habits, avoiding prolonged sitting or excessive straining during bowel movements to prevent worsening of external hemorrhoids. (Medication should be used under the guidance of a doctor)
Is a second surgery for an anal fistula more difficult than the first one?
Relative to the initial procedure, a second surgery for anal fistula is more difficult. The main goal of anal fistula surgery is to remove the internal opening and the fistula tract completely to cure the condition. During a second surgery for an anal fistula, due to the previous operation, the internal opening may be unclear, and it can be difficult to distinguish between the fistula and scar tissue. This can lead to incomplete removal by less experienced surgeons, increasing the likelihood of the fistula recurring later. Therefore, for a second surgery on an anal fistula, it is essential to undergo the procedure in a specialized colorectal department at a provincial-level top-rated hospital. It is recommended to have a magnetic resonance imaging (MRI) of the anal region before surgery to ensure precise operation and complete removal of the internal opening and fistula tract. Proper postoperative dressing changes are also crucial to avoid infection and inflammation of the wound, which will help with normal recovery after the surgery.
What are the consequences of not treating anal fistulas?
Since an anal fistula is caused by the infection and inflammation of the anal glands, it connects the rectum or anal canal with the skin around the anus, forming repeated abscesses, pain, and discharge of pus and blood around the anus. If an anal fistula is not treated, more fistula tracts will develop over time, and more of the muscles around the anus will become infected. This can even lead to high, complex anal fistulas, making surgical treatment later on more difficult and could easily lead to anal incontinence. Also, if an anal fistula is left untreated for a long time, there is the possibility of malignant transformation. Therefore, in clinical practice, it is recommended to undertake surgical treatment for anal fistulas as early as possible. The surgery for an anal fistula mainly involves the removal of the internal opening and the fistula tract, which is essential for a complete cure. Postoperatively, it is necessary to persist in changing dressings to avoid infection or pseudohealing at the wound site. Moreover, patients should be mindful of their diet.
Is the recovery from a second anal fistula surgery quick?
Whether the recovery from a second surgery for anal fistula is quick primarily depends on whether the surgical wound is infected and bleeding, and it is also directly related to the patient's own immunity and the size of the wound. Generally, if the wound from the second surgery is relatively small and the patient does not have diabetes, tuberculosis, or inflammatory bowel disease, then the postoperative recovery tends to be quicker. Moreover, the patient should eat foods rich in high-quality protein and persist in changing dressings to avoid infection and bleeding of the wound, which also facilitates recovery after anal fistula surgery. However, if the wound from the anal fistula surgery is larger and the second procedure involves the seton technique, and since the patient's second surgery is for a high complex anal fistula, the recovery time is relatively slower. Additionally, if the patient has diabetes or inflammatory bowel disease, this will directly affect the postoperative recovery.
How to distinguish between anal fissures and hemorrhoids
To distinguish between anal fissures and hemorrhoids, one can first differentiate based on symptoms. Anal fissures primarily cause pain during defecation and minor bleeding, with the pain typically lasting from 20 minutes to half an hour. Patients often have hard stools or constipation. In contrast, hemorrhoids primarily lead to intermittent painless rectal bleeding. The blood is bright red and usually in greater volume, often appearing in a spraying or dripping pattern after defecation. Some patients may also experience prolapsed hemorrhoids, often accompanied by a sensation of heaviness and foreign body in the anus. Further, through a digital rectal examination, an anal fissure can be identified by a palpable ulcer or crack at the posterior or anterior midline of the anus. Hemorrhoids, being soft venous clusters, can also be differentiated through this examination.
If pus is draining from a perianal abscess, does that mean it's getting better?
The discharge of pus from a perianal abscess does not indicate improvement. This situation is due to the spontaneous rupture of the perianal abscess, which can easily lead to the formation of an anal fistula. Since a perianal abscess is caused by an infection of the anal glands and can infect the surrounding tissues, the simple discharge of pus without clearing the internal opening and infected tissues will not resolve the problem. Furthermore, there is a risk of recurrent episodes that may even result in more severe swelling. Therefore, it is necessary to seek early treatment at a hospital's colorectal surgery department for a definitive one-time surgical resolution of the perianal abscess, removing the internal opening and infected tissues. Post-surgery, medications like anal washes and potassium permanganate solutions should be used for dressing changes. Additionally, medications like erythromycin ointment strips and mupirocin ointment can be used to promote healing of the local surgical site. Patients should also maintain perianal hygiene, ensure smooth bowel movements, and avoid dry, hard stools that may irritate and cause pain or bleeding at the wound site.