事件记录
Dr. 米勒: 今天我请来的是 Dr. Bartley Pickron 和 he is a surgeon in the department of surgery. 他也是……方面的专家 结直肠手术. 很高兴见到你. I have patients that come to me 和 they ask, “我的屁股/直肠疼,他们说, “我想我得了痔疮.“多久一次？ 很难相处的人 或者是别的什么?
是痔疮还是别的什么?
Dr. Pickron: Most of the patients we see for anorectal pain don't have 很难相处的人s, but everybody has 很难相处的人s to some degree.
Dr. 米勒: 最不.
Dr. Pickron: 最不, but the real causes of pain are more things like fissures, 脓肿, 和 other things that aren't 很难相处的人s.
Dr. 米勒: 裂缝会非常痛苦.
Dr. Pickron: 他们是可怕的.
Dr. 米勒: 是什么导致了裂缝?
Dr. Pickron: Usually it's a tear 和 it happens directly in the front or directly in the back. Most of the time these things heal up just fine, but if they don't 和 they get deep enough to where the anal sphincter gets irritated . . .
Dr. 米勒: 哎哟.
Dr. Pickron: . . . then you get a spasm of that muscle 和 that prevents the tear from healing 和 then you just enter this vicious cycle that just won't quit.
Dr. 米勒: So you use different therapies to try to repair that.
Dr. Pickron: 是的, generally we focus not so much on the tear but on the muscle itself because if we could make the muscle relax 和 stop the spasm then the tear generally heals just fine on its own.
Types of Hemorrhoids 和 Associated Symptoms
Dr. 米勒: 而痔疮并不是常见的病因, 正如你所指出的, they're both internal 和 external 很难相处的人s, my underst和ing is that the external 很难相处的人s can be painful.
Dr. Pickron: 当然可以. The most common thing we see when they are painful is a thrombosis, where you get a big blood clot with the pain 和 swelling.
Dr. 米勒: 哎哟. 你是怎么治疗的?
Dr. Pickron: Most of the time, we let them these reabsorb on their own. If patients come in within the first two or three days after the event happens, then there is some benefit to removing it surgically because they'll get better faster, but usually once they're kind of over the pain curve 和 their symptoms are getting better, then the pain 和 swelling will generally just take care of itself.
预防痔疮
Dr. 米勒: After you do the treatment, is there any kind of change in diet that they might need to make? 我的理解是便秘, 紧张, those things can contribute to external 很难相处的人s. 你对此有什么看法?
Dr. Pickron: 绝对. Constipation 和 particularly 紧张 or sitting on the toilet for a long time during bowel movements reading the magazine, 例如, all tend to predispose people to 很难相处的人s. 大发娱乐建议改变排便习惯, usually by the addition of fiber or stool softeners 和 staying hydrated.
裂缝和痔疮的治疗
Dr. 米勒: When do you treat a fissure or 很难相处的人s with a procedure?
Dr. Pickron: I'll talk about the fissures first 和 probably maybe 10 or 20% of those are actually treated surgically. We have creams that we can use that generally take care of things. If that doesn't work, Botox injection is an option. If those don't work, then the last resort is certainly surgery.
Dr. 米勒: So that's treatment for fissures, how do you treat 很难相处的人s?
Dr. Pickron: Again, most of these are treated non-operatively. 大发娱乐在办公室有自己的程序. The most common thing we do is a procedure called rubber b和 ligation, where we put rubber b和s around the 很难相处的人s on the inside. 听起来很痛苦, but truthfully the internal 很难相处的人s really have no sensation, so it's a very easy procedure to do 和 very well tolerated. It's usually just some mild pressure for about 24 hours 和 that's it. The ones that do need to be treated surgically, 如我所说, are typically the external ones 和 those are, 对病人来说幸运的是, 相当罕见.
Dr. 米勒: 这在我看来是很罕见的, but are there times that the pain could be induced by something like a cancer?
Dr. Pickron: 它是. That's certainly one reason that these symptoms need to be evaluated very thoroughly.
Dr. 米勒: So if they're going on for weeks, that's something that probably ought to be looked at?
Dr. Pickron: 正确的. So any combination of pain 和 bleeding 和 particularly if there is a little mass or something that just doesn't feel right, then that absolutely needs to be checked out.
直肠疼痛的其他原因
Dr. 米勒: 直肠疼痛的其他原因? I know that there's one that is a spasm that occurs from time to time in some people.
Dr. Pickron: Some people get this kind of vague rectal pain, which as you mentioned is just kind of a spasm, 人们对它知之甚少. 有一些选项，例如 物理治疗, biofeedback, but these can be challenging things to treat.
Dr. 米勒: It comes on suddenly 和 then goes away over seconds to minutes, I think, sometimes.
Dr. Pickron: 是的, usually happens in the middle of the night. People kind of wake up 和 they feel this intense pressure almost like a Charley horse in their rectum, 哪有不愉快的感觉.
Dr. 米勒: 任何其他引起疼痛的原因?
Dr. Pickron: 这些主要是大的, 感染, abscesses are fairly common 和 those are typically treated with surgical drainage.
更新日期：2020年11月25日
最初发布日期：2015年9月22日