Hemorrhoids bleeding

　　The causes of hemorrhoidal bleeding are mostly due to increased intra-abdominal pressure, and the stool rubs through the mucosal tissue of the hemorrhoid mass, causing bleeding during defecation or blood on the toilet paper, with a few cases showing喷射状 bleeding.

　　1. Hematochezia caused by hemorrhoids: Due to dry stool and the anal canal being stretched and torn, bleeding is very common in daily life. At the same time, anal fissure is also a common cause of hematochezia, characterized by bright red blood, usually with less bleeding, mainly stained with toilet paper, accompanied by severe anal pain during defecation, with slight pain relief after defecation, and then severe pain again, often lasting for several hours.

　　2. Constipation, alcohol consumption, and spicy food are the main triggers of hemorrhoidal bleeding. Once mixed bleeding occurs, it is necessary to keep the stool soft, inject oil into the anal canal or insert suppositories to protect the damaged mucosa, and the bleeding can usually stop on its own.

　　3. Anal and rectal inflammatory diseases (abscesses, anal sinusitis, ulcerative colitis, dysentery) cause inflammation of the hemorrhoidal veins, making the vessel wall脆化, and secondary expansion and congestion into hemorrhoids.

　　4. In addition to anal and rectal diseases, gastrointestinal diseases, systemic diseases, etc., can also cause the appearance of hematochezia. Some patients, although they have discovered that they have hematochezia, do not pay attention because there is no pain or itching. Experts at Shenzhen Baohui Hospital point out: This is a very wrong and very dangerous view. It is necessary to seek medical attention at a professional hospital as soon as possible when bleeding symptoms are found.

　　5. Elderly and weak individuals may have relaxed and weak anal sphincter muscles or the anal surgery has destroyed the complete structure of the sphincter muscles, causing anal incontinence, prolapse of the anal mucosa, and friction damage leading to hematochezia.

　　6. Patients with hypertension, benign prostatic hyperplasia, asthma, chronic bronchitis, pulmonary heart disease, liver cirrhosis, and obesity are more prone to develop hemorrhoids.

　　7. There are two causes of hemorrhoid postoperative bleeding: primary bleeding and secondary bleeding.

　　Primary hemorrhage: ①During the ligation operation of internal hemorrhoids, the mucosa above the dentate line is resected too much and fails to stop bleeding completely. Due to the rich blood vessels in the mucosa and the fact that internal hemorrhoids themselves are a disease of abnormal vascular hyperplasia, it is easy to cause persistent bleeding; ②During the ligation operation of internal hemorrhoids, due to rough handling during ligation, the hemorrhoid nodule mucosa is torn off and fails to stop bleeding completely. Or the active bleeding point is not treated in time; ③During the ligation operation of internal hemorrhoids, due to the ligation line not being tied tightly, the blood supply of the internal hemorrhoids is not completely blocked, and the residual end of the internal hemorrhoids continues to bleed; ④During the ligation operation of internal hemorrhoids, due to the residual end of the internal hemorrhoids being left too short, the ligation line slips off, causing the wound surface to open and continue to bleed; ⑤On the day of the operation, defecation causes the ligation line to slip off, the wound surface to tear, and the wound surface to bleed continuously; ⑥Wound damage, which often occurs during the necrosis and shedding period of internal hemorrhoids. If the stool is dry and defecation is too forceful, it can cause wound damage and bleeding, or due to the vascular embolism at the base of the hemorrhoid nodule not being firmly established, the root of the ligation line is over-tugged or the residual end of the hemorrhoid nodule is trimmed, causing wound surface bleeding.

　　Secondary hemorrhage: In cases with good blood supply and larger internal hemorrhoids, there are often small arteries above and around the hemorrhoids. When the hemorrhoids fall off, it is easy to damage the small arteries and cause bleeding. When the internal hemorrhoids necrotize and fall off, if excessive force is used during defecation, coughing, carrying heavy objects, etc., which increases friction, the base of the hemorrhoids may become embolized, and the thrombus in the blood vessels may be flushed off, causing the vessels to open and bleed.

　　Complications of hemorrhoidal bleeding

　　1. Necrosis:When the hemorrhoidal core is incarcerated outside the anal canal, due to a series of pathological changes, local metabolic products accumulate, further aggravating local anal edema and exacerbating the incarceration of the hemorrhoidal core. This is a vicious cycle. Occasionally, thrombosis in the hemorrhoidal core may spread upwards, extending the necrotic area to the rectal wall, resulting in severe pelvic sepsis.

　　2. Infection:After the hemorrhoidal core is incarcerated, there is often varying degrees of infection, which leads to mucosal erosion over time, followed by diseases such as perianal abscess and anal fistula. In severe cases, there may be ascending infection, leading to portal vein sepsis or even septicemia.

　　3. Easy to cause colorectal cancer.The following groups of people need to pay attention: ① Men over 35 years old, women over 30 years old; ② with a history of colorectal polyps; ③ obesity; ④ with a history of colorectal cancer or breast cancer; ⑤ with a family history of colorectal cancer and colorectal polyps; ⑥ with a history of chronic colitis; ⑦ with the habit of high-fat, low-fiber diet; ⑧ with a history of cholecystectomy; ⑨ with changes in defecation habits.

　　Symptoms of hemorrhoidal bleeding often occur during defecation or after defecation, with bright red blood, not mixed with feces, dripping down or sometimes喷射出来, the amount of bleeding can be large or small, can stop spontaneously, and some show a certain periodicity. Some patients may have a small mass protruding from the anal canal when straining during defecation, but without anal pain.

　　Symptoms of hemorrhoidal bleeding caused by hemorrhoids: Taking internal hemorrhoids as an example, the main symptom of internal hemorrhoids is bleeding. Early internal hemorrhoid patients often have no obvious pain, only slight itching in the anal area, and a sense of increased secretion. Occasionally, there may be blood on toilet paper after defecation, or drops of blood or shooting blood. In more severe cases, patients often have no obvious pain, only slight itching in the anal area, and a sense of increased secretion. Occasionally, there may be blood on toilet paper after defecation, or drops of blood or shooting blood.

　　Symptoms of hemorrhoidal bleeding caused by anal fissure: The characteristic is bright red blood, usually with less bleeding, mostly stained on toilet paper, accompanied by severe anal pain during defecation, which slightly relieves after defecation, but then starts again with severe pain, often lasting for several hours.

　　What measures can prevent hemorrhoidal bleeding?

　　1. Maintain smooth defecation: Develop the habit of timely defecation every day. Drinking a glass of cool water in the morning can promote defecation. It is not advisable to read newspapers or magazines during defecation, as this may ignore the urge to defecate, leading to constipation over time, forming hard stool lumps that are difficult to pass. Avoid prolonged squatting or sitting, as this can lead to varicose veins in the hemorrhoidal veins and bleeding.

　　2. Pay attention to anal hygiene: Keep the anal area clean, use warm water for cleaning frequently, and change underwear regularly.节制性生活，注意性生活的清洁卫生。If there is a lot of vaginal discharge, it is recommended to clean the anal area with warm water after defecation or before going to bed. Change underwear regularly, and dry the cleaned underwear in the sun.

　　3. Treat the primary disease: It is necessary to treat perianal diseases and systemic diseases in a timely manner to reduce the occurrence of hemorrhoids. Such as enterobiasis, trichomoniasis, perianal eczema, constipation, diarrhea, excessive leukorrhea, hypertension, heart disease, emphysema, diabetes, etc.

　　4. Pay attention to dietary hygiene: In terms of diet, pay attention to the matching of meat and vegetables, and the appropriate proportion of coarse and fine grains. The diet should be light, moisten the intestines and defecate, and prefer fresh vegetables and fruits rich in fiber. Stimulatory foods can stimulate the anal mucosa and skin, causing local congestion and burning pain, which can worsen the occurrence of hemorrhoids and should be avoided. In addition, hemorrhoid patients should also avoid smoking and drinking, and avoid overeating and binge drinking.

　　5. Persistent physical exercise: For those who work for a long time sitting or standing, they should take a 10-15-minute walk after working for 1-2 hours. In daily life, you can choose activities such as running, Tai Chi, fitness exercises, and work-break exercises, which can promote blood circulation and intestinal peristalsis, reduce pelvic congestion, and reduce the occurrence of hemorrhoids.

　　6. Hemorrhoid rupture is prone to inflammation due to fecal contamination, so for those who have already developed hemorrhoid bleeding, it is necessary to strengthen inflammation control. Appropriate proportions of potassium permanganate solution can be used to soak the anus, twice or thrice a day; or the horse chestnut hemorrhoid ointment can be injected into the anal canal, which has the effects of defecation, inflammation control, and hemostasis. In addition, strengthening exercise can promote blood circulation and reduce the pressure on hemorrhoidal veins. Moreover, every day, you can kneel on the bed, take a chest-knee position, and practice anal contraction exercises, which can also have a good effect on reducing hemorrhoid bleeding.

　　Items to be checked for hemorrhoid bleeding

　　1. Hemorrhoids with hematochezia occur during the defecation process or after defecation, with bright red blood that does not mix with stool. The amount of bleeding can be large or small.

　　2. Anal inspection: Gently separate the patient's buttocks with both thumbs and observe whether there are any prolapsed objects, external hemorrhoids, fistulae, abscesses, anal fissures, etc. around the anus.

　　3. Rectal examination: Also known as digital rectal examination. Rectal examination is an indispensable item in the experience of hematochezia. One of the main causes of lower gastrointestinal bleeding is colorectal cancer, of which rectal cancer accounts for 60%, and most of the rectal cancer is located in the lower part of the rectum. About 70% of rectal cancers can be palpated through rectal examination, which is a reliable and simple method for early detection of rectal cancer. If a mass is palpated and the gloves are stained with blood or pus, consider colorectal cancer, polyp disease, and other conditions.

　　4. Anorectal endoscopy: When patients have hematochezia, it is necessary to find the bleeding site. It cannot be determined that it is hemorrhoid bleeding simply by touching the internal hemorrhoids during digital rectal examination because the patient has fresh blood in the stool. Instead, anorectal endoscopy should be performed to determine if there are bleeding points or bleeding tendencies on the hemorrhoidal mucosa.

　　Dietary care for hemorrhoid bleeding patients

　　1. Maintain smooth defecation and develop the habit of defecating every day. Hemorrhoids often bleed due to constipation, which increases abdominal pressure when straining to defecate, causing the vein pressure of the hemorrhoids to increase and break, resulting in bleeding; there are also cases where the stool is dry and hard, and the hemorrhoidal veins are abraded when passing through the anus, causing bleeding. Eating more vegetables and drinking plenty of water can prevent constipation. For those who have already developed constipation, eating more honey or sesame oil can help moisten the intestines and defecate. Defecate regularly, reduce the intake of strong tea, coffee, and alcohol, and eat less spicy and刺激性 food to help reduce hemorrhoid bleeding.

　　2. Preferably consume easily digestible and soft foods.

　　3. Strive for smooth defecation, and consume foods rich in fiber, such as: fresh vegetables, fruits, tremella, kelp, etc.

　　4. Consume foods with laxative effects, such as: pears, bananas, spinach, honey, sesame oil, and other vegetable oils and animal oils.

　　5. Choose foods with a slightly cool nature, such as: cucumbers, bitter melon, winter melon, watermelons, lotus root, bamboo shoots, celery, spinach, lettuce, lotus root, water spinach, eggplant, luffa, mushrooms, duck eggs, and duck meat, to avoid exacerbating internal heat and causing hematochezia.

　　Common methods used in Western medicine to treat hemorrhoids

　　Surgical Method:If hemorrhoids are asymptomatic, no treatment is needed. Just pay attention to diet, keep the bowels smooth, keep the perineum clean, and prevent the occurrence of complications. Treatment is only needed when complications such as bleeding, prolapse, thrombosis, and impaction occur.

　　Other Methods:Including dietary therapy, oral medication, external medication, injection therapy, hemorrhoid therapy, infrared therapy, cryotherapy, laser therapy, etc. Painkillers, anti-inflammatory tablets, and ointments are used for oral or external administration. If the symptoms are severe, surgery may be required. The postoperative pain and the longer hospitalization and healing time brought by traditional surgical therapy often make patients scared; traditional surgical therapy has a certain possibility of recurrence, especially important is that it has cut out the anal pad to some extent, so some patients may have varying degrees of incontinence after surgery.

　　Western Medicine Method:After the patient uses a potassium permanganate hot water bath with a concentration of 1:5000 for 15 minutes after defecation, disinfect the perianal wound with a cotton ball soaked in 0.1% New Jie'er Liquid, inject the herbal ointment for promoting muscle growth and stopping bleeding into the anal cavity with a glycerin syringe, and cover the outside with sterile gauze. Administer 5ml each time, once a day or after each defecation, and continue for 5 days after the hematochezia stops, then change to routine dressing.