Q
If I have hemorrhoids, do I often have a gassy stomach?
A
When hemorrhoids develop, it is difficult to pass a bowel movement due to pain or bleeding, leading to a vicious cycle of worsening constipation again.
Therefore, patients with hemorrhoids often have constipation and irritable bowel disease, which can make your stomach feel bloated or full of gas, frequent belching and farting, and more so-called "gassy symptoms." In other words, hemorrhoids by themselves do not produce gas in the stomach, but they are more likely to occur together. Treating constipation or irritable bowel disease that causes stomach gas together with hemorrhoids can help alleviate these symptoms.
Q
What is the difference between intestinal bleeding and rectal bleeding?
A
Question]
I go to the restroom regularly. I often experience bleeding during defecation, pain in the anus after defecation, and pain in the lower abdomen before going to the restroom. After giving birth, whenever I breastfed, my stomach hurt, so I thought it was uterine contractions and continuously cut down breastfeeding. I thought maybe it was hemorrhoids, so I inquired at the pharmacy, but they said it is not intestinal bleeding or anal bleeding, so can you tell me how to tell them apart?
Answer]
The location and diagnosis of the lesion cannot be determined with certainty from the color and extent of bleeding. However, if the bleeding is bright red on toilet paper, one can assume a lesion near the anus, such as hemorrhoids or fissure, and if the bleeding is blackened, a lesion is possible in the large intestine far from the anus.
Other symptoms often accompany anal or rectal bleeding. If anal bleeding is accompanied by painful tumor lumps and is not related to defecation, thrombotic hemorrhoids may be suspected. Bleeding with pain during defecation may indicate fissure.
Also, if bleeding is accompanied by diarrhea and mucous stool, ulcerative colitis may be suspected. Therefore, it is recommended to first receive an accurate diagnosis from a specialist and appropriate treatment accordingly.
Q
The anus area is very itchy. What could be the causes?
A
Pruritus is an unpleasant skin sensation that causes an unbearable urge to scratch. Pruritus ani is a symptom that causes pruritus when the sensory nerves abundantly present around the anus are stimulated, causing excessive scratching of the skin, which in turn causes skin damage.
[Causes]
1. Secondary pruritus: Refers to a secondary symptom of a specific disease.
(1) Anorectal Disease: Fistula, hemorrhoids, fissure, colitis, tumor, rectal prolapse, etc., which cause pruritus by leaking secretions around the anus, causing inflammation or ulcers
(2) Personal hygiene: Stool contamination around the anus can irritate the skin.
(3) Hypersensitivity reaction: Occurs if you have atopic dermatitis or skin hypersensitivity reaction.
(4) Skin diseases: Cause perianal skin diseases such as psoriasis, lichen planus, lichen simplex, and eczema.
(5) Systemic diseases: Observed with obstructive jaundice, diabetes, leukemia, chronic renal failure, and thyroid dysfunction.
(6) Food: Caused by contamination around the anus due to loose stools after excessive water intake, coffee, milk, cola, chocolate, black tea, beer, tomatoes, citrus fruits, etc.
(7) Gynecological disease: Accompanied by pruritus of the vulva in case of severe leukorrhea or incontinence.
(8) Diarrhea: In severe cases, skin irritation due to moisture, contamination around the anus, and skin damage due to frequent wiping
(9) Mental factors: anxiety, nervousness, tension, stress
(10) Drugs: tetracycline, quinidine, colchicine, etc.
(11) Infectious diseases: Asymmetric pruritus around the anus due to skin damage caused by bacteria, viruses, fungi, and parasites.
2. Idiopathic pruritus: Conditions for which no cause can be found.
A
Question]
My mother has a symptom that her anus falls out even when standing for a while, far beyond the case of hemorrhoids. My mother had the operation about four years ago. It was a type of surgery to tie the outside of the anus with a wire. She expressed too much pain, and the wire had to be untied again. She said these symptoms have continued since she gave birth about 35 years ago. She was in so much pain and recently visited a hospital for surgery. However, the hospital said it was difficult to operate (a form of excising the intestines to raise the anus) because of the high severity. Even if the operation were performed, it would be difficult to pass a bowel movement. So, my mother could not undergo surgery. Can you suggest any treatment or possible surgery for the above symptoms to relieve the pain?
Anwer]
I can suspect your mother's illness is probably a rectal or anal prolapse. Anal prolapse is the prolapse of the entire anal mucosa through the anus, and rectal prolapse is the prolapse of a part of the rectum through the anus. It is difficult to distinguish between these with words alone and can only be known through direct examination.
A significant number of patients complain of fecal incontinence, uncleanness of the perineum, pain around the anus, and in severe cases, the prolapsed intestines even rot. However, most patients are shy and do not visit the hospital very often.
There are various treatment methods, but the best method has not been decided yet, and the surgical success rate is not satisfactory.
It seems your mother received an operation called Tiersch. Because this procedure is simple, it is often used for the elderly with generally poor health conditions, but the operation often fails due to the same problems as your mother. In addition, there are methods such as resecting through the anus, opening the stomach and resecting and fixing the rectum, and fixing the rectum using a cloth. However, since the procedure is decided according to the patient's condition and risk of surgery, it is advisable to visit a hospital and consult with a specialist before deciding on the treatment method.
Q
I was diagnosed with rectal cancer. Is there any way to avoid having an artificial anus?
A
Only 10% undergo colostomy surgery. An artificial anus is a hole made in the abdominal wall to excrete feces outside the body when the anus has to be cut out due to colorectal or rectal cancer. Patients undergoing colorectal cancer surgery often suffer from the fear of having to remove the anus and wear an artificial anus rather than the surgery itself. However, with the development of medical technology, the possibility of salvaging the function of the anus increases, so only about 10% of the patients undergo surgery to create an artificial anus. In order to preserve the function of the anus, there should be a space of 5-6 cm from the anus where the muscles that tighten the anus exist. Therefore, in rectal cancer that is very close to the anus, an artificial anus is unfortunately unavoidable.
Even if you have an artificial anus, if you take good care of it, you can enjoy sports such as swimming and golf and social life, sex life, childbirth, and childcare. In addition, to alleviate the fear of patients who have no choice but to create an artificial anus in this way, Samsung Medical Center arranges an interview with an experienced person who has undergone an artificial anus surgery for mental stability before surgery. Meanwhile, our hospital is the only hospital in Korea where ostomy nurses who have acquired professional nursing qualifications in the United States assist patients in rehabilitation.
A
A hernia is a condition in which internal organs protrude when abdominal pressure rises due to congenital or acquired weakness in the abdominal wall or other areas. Inguinal hernias are the most common and occur 2-3 cm above the thigh and lower abdomen junction. Femoral hernias occur 2-3 cm below the junction of the thigh and abdomen.
Hernias may be asymptomatic, and in most cases, the groin or abdominal wall swells when abdominal pressure is applied, and you may feel heavy pain. For an inguinal hernia, the protruding organs may get caught in the blood circulation and cause tissue necrosis, so prompt surgery is required.
Q
Is it colorectal cancer?
A
Colorectal cancer has no specific symptoms, so regular checkups are essential. If you suddenly change your bowel habits or have blood in your stool, it's a good idea to get tested right away.
Most anal bleeding is due to hemorrhoids. However, there are cases in which it leads to dangerous colon cancer while assuming hemorrhoids, so a quick checkup is required. The incidence of colorectal cancer in Korea is also rising, so it is recommended to be examined when you reach middle age, especially if you enjoy oily food or have constipation.
Eating plenty of fresh vegetables and exercising regularly to have a good bowel movement can prevent cancer.
Q
How is a colonoscopy done?
A
Colonoscopy is the best method for diagnosing colorectal cancer by entering the endoscope and examining the entire interior of the large intestine.
Because the large intestine is bent by almost 90 degrees, it is very uncomfortable during an examination, so a sleep colonoscopy is performed. A colonoscopy always requires a reservation because the stool inside the large intestine must be washed off to observe the intestinal wall. Currently, reservations are delayed by 2-3 weeks at our hospital. When you book a colonoscopy, you will be given medicine to take the day before your appointment to wash your intestines.
You need to follow the instructions carefully and wash your large intestine before coming back for a good test. If a polyp or an abnormal area is found during endoscopy, the polyp is immediately removed, and tissue collection for biopsy is possible. After a colonoscopy, sometimes gas in the abdomen and discomfort can occur, so we will prescribe medicines to help the bowel movement and normalize the intestinal coliform again.
Avoiding greasy and irritating foods for 2-3 days after the endoscopy prevents diarrhea, and having lactic-acid bacteria drinks and fiber helps normalize the intestinal coliform.
Q
What are the symptoms of hemorrhoids?
A
Although the symptoms of hemorrhoids differ from person to person, they can be divided into external hemorrhoids, which are very painful, and internal hemorrhoids, which are not painful but accompanied by heavy bleeding.
ⓛ Something protruded from the anus.
② There is pain.
③ There is bleeding.
④ There is a feeling of residual stool.
⑤ Mucus is smeared.
Q
May I be discharged from the hospital on the same day of operation?
A
In our hospital, patients usually come, undergo a checkup, and make an appointment for surgery. However, for those who do not have time due to work, etc., we provide quick service so that you can come and receive a checkup and perform surgery immediately.
The length of hospitalization treatment varies depending on the degree of surgery, but it is usually about two nights and three days.
Spinal anesthesia is administered during surgery, and it takes about 5 hours for the patient to wake up from anesthesia. After that, you can go about your daily activities, but on the first day, there is a possibility of bleeding and swelling of the wound, so it is recommended to rest.
Q
What is the fistula surgery and recurrence rate?
A
A fistula is a condition that develops from a perianal abscess and has a hole in the side of the anus. There is a convex hole around the anus, and when you touch it, the fistula canal is firmly touched under the skin. Fistula surgery involves finding and making an incision, and if the hole cannot be found, the recurrence rate is high.
Fistula surgery can be very complicated depending on the type of fistula, and it is a disease that tends to recur and has a long treatment period. As the recurrence rate after surgery is high, you need to take care of yourself, and if the symptoms are even a little strange, it is vital to get a checkup and get treatment as soon as possible. After a complicated fistula, it is crucial to treat the sphincter as early as possible because it may be difficult to perform surgery while preserving the sphincter.
Therefore, a patient should not neglect the perianal abscess and should treat it quickly. It is essential to have a consistent lifestyle and a balanced diet to raise the anus cleanliness and immunity.
Q
I suffer from constipation.
A
Constipation includes not only cases of not having a bowel movement every day but also all cases of feeling uncomfortable. Constipation is mainly caused by lifestyle problems rather than anatomical diseases and is more common in women due to hormonal effects.
First of all, the first remedy is to eat breakfast, and it is essential never to hold a bowel movement. If you frequently hold a bowel movement, the ability to perceive pressure in the anus decreases, making it difficult to feel the urge for a bowel movement, resulting in chronic constipation.
Second, you should consume enough water and fiber. You should drink at least eight glasses of water a day and consume at least 40g of fiber per day. If you reduce the amount of food you eat because you are on a diet, you will become constipated. If you have a small amount of stool staying in the large intestine for a long time, the water will be lost, and the stool will become hard. The more you diet, the more non-calorie vegetables you need to eat. If it is difficult to eat many vegetables, there is a dietary fiber that can be prescribed, so take it with a prescription.
Third, exercise. Exercising also promotes the movement of our internal organs. If you cannot correct your lifestyle, you should check your anal function. Rectal constipation can be treated with biofeedback training to control anal pressure.
Q
I have bleeding after hemorrhoid surgery.
A
There is no need to worry about bleeding after hemorrhoid surgery as it lasts about two weeks or sometimes even three weeks.
During the healing process, the wound at the surgical site oozes, the anus relaxes during defecation, the capillary at the end of the wound ruptures with a small amount of bleeding. However, if you have bleeding as much as dripping during a bowel movement, you should go to the hospital as soon as possible to stop the bleeding. In general, there may be puddles of blood during the first few days after surgery. Also, you may see bleeding for up to about two weeks, and there is a case of bleeding increasing after more than one week.
You should take good care of bowel movements with sufficient water and dietary fiber and take a hot sitz bath three times a day to help wound healing.
Q
I have tearing pain and bleeding during bowel movements.
A
This is a symptom that can occur after frequent diarrhea or when it is difficult to pass a bowel movement due to constipation. Most of these symptoms are caused by fissure, which occurs when the anal mucosa is weakened and torn. In the case of an acute fissure, it is necessary to manage bowel movements with sufficient water and fiber intake and allow the wound to heal. The wound becomes fibrous and loses elasticity if the anal mucosa is torn repeatedly, leading to a chronic fissure. As the wound gets more profound, the sphincter is damaged, and fecal incontinence may occur.
It is a preventive measure to avoid diarrhea, and if you are constipated, take sufficient water and fiber and exercise to ensure smooth bowel movements.
Q
The area around the anus is swollen with pain.
A
It is caused by an abscess around the anus. You may feel severe pain and heat, and symptoms such as body aches are sometimes accompanied. A perianal abscess is caused when bacteria enter the dentate gland inside the anus, forming pus in the surrounding tissues. This often progresses to fistulas, so it is recommended to seek treatment as soon as possible.
In most cases, it occurs when the resistance is reduced due to severe diarrhea or overwork. If you try to treat yourself with an ointment or sitz bath, the pus size may grow, damaging the sphincter. Since this may develop into a complicated fistula, you need to see a hospital as soon as possible and treat it with surgical drainage.
Q
I suddenly feel a lump in my anus and I have pain~
A
If the anus suddenly swells and forms a lump with pain, it is usually thrombotic hemorrhoids. Thrombotic hemorrhoids are swollen hemorrhoids caused when blood clots block blood vessels. The severity of pain varies depending on the size, and the small clot dissolves may be dissolved, and the pain disappears after a few days. However, surgery is recommended if the size is significant because the swollen tissue may be pinched, and blood circulation is disturbed, causing tissue necrosis and pain.
These symptoms are treated with hot water sitz baths, medications, and ointments that dissolve blood clots and promote blood circulation. Still, the main treatment is surgery. Caution is required as it can quickly occur when exposed to a cold place for a long time or excessive drinking.
Q
In what cases is an anal ultrasound done?
A
Anal ultrasound is mainly used to determine local staging before surgery for cancers of the rectum and anus. In addition, it is used as an auxiliary and additional examination means for previously performed computed tomography (CT) or magnetic resonance imaging (MRI) to check for fistulas (a tube-shaped hole caused by inflammation) in the anus caused by inflammation or trauma. This is because ultrasound shows the five layers of the intestinal wall from the stomach to the anus better than computed tomography or magnetic resonance imaging. However, as explained above, in order to see the intestinal tract usually full of food or air well with ultrasound, fasting for a certain period and emptying it, then drinking water or filling the anus with ultrasound gel or water is required. In addition, it is also used to examine the prostate located in front of the anus by inserting a probe from the urinary area into the anus.
