Pain above the anus

The main cause of pain in the upper anus is anorectal diseases, such as hemorrhoids and anal fissures, which are common causes of pain in the upper anus. When this kind of pain occurs, it is best to check the rectal indications and perform an anorectal endoscopy to further determine the cause and then treat it symptomatically. Conditioning in daily life is very important. Do not exert too much force when defecating. Also, pay attention to diet and prevent constipation.

1. Non-surgical treatment

Asymptomatic hemorrhoids do not require treatment; symptomatic hemorrhoids do not require radical treatment; non-surgical treatment is the main treatment. (1) General treatment is applicable to most hemorrhoids, including the early stages of thrombotic and incarcerated hemorrhoids. Pay attention to your diet, avoid alcohol and spicy foods, increase fiber foods, eat more fruits and vegetables, drink more water, change bad bowel habits, keep bowel movements smooth, take laxatives when necessary, and clean the anus after defecation. For prolapsed hemorrhoids, be careful to gently push the hemorrhoids back with your hands to prevent them from falling out again. Avoid sitting or standing for long periods of time, do appropriate exercise, take a sitz bath with warm water (which may contain potassium permanganate) before going to bed, etc.

(2) Local medication has been widely used. The drugs include suppositories, ointments and lotions, most of which contain Chinese herbal ingredients. (3) Oral medications are generally used to treat varicose veins. (4) Injection therapy is more effective for grade I and II bleeding internal hemorrhoids. The sclerosant is injected around the venous plexus in the submucosal layer to cause an inflammatory reaction and fibrosis, thereby compressing the varicose veins. The treatment can be repeated after one month to avoid injecting the sclerosant into the mucosal layer and causing necrosis. (5) Physical therapy: laser therapy, cryotherapy, direct current therapy, copper ion electrochemical therapy, microwave thermocoagulation therapy, and infrared coagulation therapy are rarely used. (6) Rubber band ligation is used to tie the root of the hemorrhoids, blocking their blood supply and causing them to fall off and necrotize. It is suitable for grade II and III internal hemorrhoids, and is more suitable for giant internal hemorrhoids and fibrotic internal hemorrhoids.

2. Surgery

(1) Indications for surgery: Conservative treatment is ineffective, hemorrhoids are severely prolapsed, large fibrotic internal hemorrhoids are not well treated with injections, and there are anal fissures, anal fistulas, etc.; (2) Principles of surgery: The prolapsed anal cushions are repositioned through surgery, and the structure of the anal cushions is preserved as much as possible, so as to minimize the impact on the ability to control bowel movements after surgery; (3) Preoperative preparation: When there are ulcers or infections on the surface of internal hemorrhoids, conservative treatment such as laxatives and warm water sitz baths are performed first, and surgery can be performed after the ulcers have healed; bowel preparation is performed.

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