This item, which is often overlooked during physical examinations, "saved" his life...

In the past two days, the topic #Anorectal doctors least want you to give up the one examination has become a hot search. The examination mentioned in the topic is digital rectal examination.

Many people feel that digital rectal examination is "shameful" and cannot get over it psychologically, so they often refuse digital rectal examination during physical examinations. But in fact, digital rectal examination is the most basic and effective means of screening anorectal diseases. It can roughly determine whether there are abnormalities in the anal canal and rectum 7 to 10 cm away from the anal margin, such as prolapse, lumps, polyps and other lesions, and can effectively diagnose anal and perianal diseases such as hemorrhoids, anal fistulas, and perianal abscesses.

Today, Science Popularization China wants to share a story with you. The "I" in the story was diagnosed with anal fistula through digital examination. I hope that after reading this story, everyone will pay more attention to the "digital anal examination".

It was a smoky afternoon, and my colleague who had just undergone an anal fistula surgery a few weeks ago stared at me with tears in his eyes.

As I listened to him babble on, I gasped and my mouth twitched from time to time, trying to use a ferocious expression to relieve the pain in my body.

The two of us who were suffering from anal fistula just huddled there, just like Xianglin Sao in Lu Xun's works.

Actually, I am quite grateful to this guy. If it were not for his painful personal experience, I would still think that the severe pain in my lower body was just an ordinary hemorrhoid attack, and I could deal with it by simply applying some Mayinglong as usual. However, what I could not have imagined was that in the next two months, I experienced a cycle from hell to purgatory.

"Will acne appear near the anus..."

It is necessary to introduce myself before the anal fistula surgery.

At that time, I was a glutton, with nicknames such as BBQ Prince, Hotpot King, and Buffet Ghost. I once topped the local big eater list for several years with 36 steaks, two roast ducks, and 17 scoops of Haagen-Dazs ice cream.

I eat a lot, but the key is that I love spicy food. If the weather is hot, I will drink ice beer. The cold beer will go into my stomach as soon as I tilt my head back. It was very refreshing at the time, but it was very miserable afterwards. I often squatted on the toilet until dawn, and sometimes I even fell asleep on the toilet.

Because of this, I developed hemorrhoids at an early age, with two granulation tissues at the age of 28. They are very noticeable, and they get inflamed once or twice a year, which makes me afraid to wear white pants for fear that others will see me "bleeding".

To make matters worse, in July 2022, my mother suffered a cerebral infarction and was hospitalized for 1 week. When she was discharged, my father needed chemotherapy for liver cancer. So I worked in the company during the day and went to the hospital to take care of them at night. When I was hungry, I would buy something from the roadside stalls, and when I was sleepy, I would sleep on the floor in the hospital.

This unhealthy lifestyle naturally had a huge impact on my body. After squatting, when I wiped my anus, I actually felt a raised lump.

Thinking back now, my first reaction was really funny. I actually took out my phone and searched “Will acne grow near the anus?”

When I first discovered this lump, the pain was not very strong, just a slight feeling, but it was fleeting. I didn't pay much attention to it. However, on the morning of the third day, when I was squatting on the toilet and my sphincter was working, I suddenly felt as if a red-hot iron rod was inserted into my anus. The intense tearing sensation made me stand up in pain and dance a Michael Jackson in the bathroom. Just beat it!

Two years have passed, but I still remember the scene: tremblingly I used paper to wipe the filth from my anus, then clamped my legs together, took small steps, and ran to the hospital to buy Ma Yinglong.

Yes, I thought it was just hemorrhoid inflammation. And after applying Mayinglong, the pain was relieved, so I didn't pay much attention to it.

But that night, when I turned over in my sleep and pressed on that little bump, I realized that I had touched the threshold of hell...

Without any preparation or hesitation, the 260-pound fat man jumped up from the bed, his eyes red with tears and sweat without even asking me.

That night, I sincerely repented and regretted using firecrackers to blow up rats and lighting plastic bags to burn ants... because I finally understood what kind of pain this was.

I finally managed to hold it in until dawn, and rushed into the hospital to register for anorectal surgery. A kind-looking doctor received me and asked me to bend over and stick out my butt.

It was so embarrassing, but the pain made me lose all other thoughts and I could only do it mechanically.

However, what happened next was beyond my imagination. I thought the doctor would just take a close look at the small bump on my anus, but she asked me to open my buttocks so that she could do a digital examination.

The moment she put her finger in, I almost fell to my knees. The intense pain made me collapse, my face flushed, my temples bulged, and I was completely dazed.

Fortunately, the digital examination was not long, and the doctor determined that I had an anal abscess and suspected that an anal fistula had formed, and advised me to have surgery as soon as possible. I was stunned when I heard that. At that time, my father was still in the hospital for chemotherapy, and I had to take care of him. How could I have surgery? I could only beg the doctor to prescribe some medicine to slow down the process.

In fact, I was a little skeptical at the time, and I didn't understand the difference between hemorrhoids and perianal abscesses. After leaving the hospital, I even searched for the keywords perianal abscess and anal fistula on my phone. However, it would have been better if I hadn't checked. When I did, I was shocked to see a recommendation pop up in the search bar: "How many years can you live with perianal abscesses?" In short, the more I checked, the more frightened I became. In the end, I even thought of my own will.

Therefore, it is really necessary to popularize the knowledge of perianal abscess and anal fistula. Many people think that this is a secret that is difficult to talk about and are ashamed to talk about it. As a result, treatment is delayed or even wrong treatment is carried out, and finally a minor illness develops into a major illness.

Fortunately, I have a colleague who has been suffering from perianal abscess for many years. He has undergone three anal fistula operations and has sufficient experience in fighting. So after returning from the hospital, I quickly consulted him, and the scene at the beginning of the article happened...

He told me from his own experience that hemorrhoids and perianal abscesses are different. Hemorrhoids are soft lumps, and as long as they do not affect life, surgery is not required; but perianal abscesses feel hard and are acute suppurative infections near the anus or rectum. If not treated in time, it will cause anal fistula.

Anal fistula is even more terrible. To put it simply, it is a hole between the inner wall of the rectum and the skin around the anus. During excretion, feces and water will accumulate here, causing inflammation, pus discharge and ulceration!

The difference between perianal abscess and anal fistula. Image source: colorectalsurgeonssydney So once a perianal abscess is diagnosed, doctors will usually recommend surgery. But my situation was really special at the time, and I had to take care of my father who was suffering from cancer, so I gritted my teeth and delayed it for a week.

But unexpectedly, my illness became more serious during this week.

It took a week

One perianal abscess turned into two, and anal fistula was formed

After settling my parents, I came to the hospital alone for the surgery.

I first reported to the nurse's station, where the nurse told me to empty my stomach and eat some light food because I had to have an enema the next day. Then I would do a color ultrasound to determine the location and depth of the anal fistula so that I could perform the surgery.

I was in a daze. After receiving the hospital gown, I went to find my bed. Along the way, I could only hear wailing in the ward, like the torture chamber of the Dali Temple where cases were solved.

When I arrived at my ward, the faces of the patients around me were all pale - the patients who had undergone surgery that day were pale because of the pain, and the patients who were going to have surgery the next day were pale because of fear.

There was an old man in the ward who was a regular customer. He called himself Kenjiro because Kenjiro in Fist of the North Star had seven scars on his chest. After he had a color ultrasound, he found that he had exactly seven internal and external hemorrhoids...

I admired his optimism and hurried to ask him for advice. Brother Jilang did have experience. He first told me that this was a minor operation and I didn't need to be nervous and just cooperate with the doctor. Then he told me that I needed to buy some adult diapers, a spray potty, candied fruits, candies, bananas, and a few pounds of sesame oil, which would be very useful.

His tone was very confident, but the occasional gasp of cold air made me twitch involuntarily, so I ran to consult the nurse and asked her if she could give me a pain pump after the operation, because I searched online and found that this operation was extremely painful.

The nurse looked at me with an expression of disbelief. She was stunned for more than ten seconds before telling me that this was a very small operation and I didn’t need to be too nervous and didn’t need a pain pump. I just had to cooperate with the doctor.

I felt relieved after hearing what my fellow patients and nurses said. I returned to my bed, turned on my computer and started working. I would like to add that although the doctors and nurses did not say it, based on my years of experience in hospitals, it is best to stay up a little later before going to bed the day before surgery. This has a miraculous effect.

I fell asleep at around 1am, and was called by the nurse to have breakfast at around 6am. I ate steamed buns and porridge at the nurse's suggestion, and then strolled around the ward. At around 7:40am, the nurse came to give me an enema.

Don't mention it, this little thing is quite unique. After taking it, my stomach instantly turned upside down. I couldn't wait to squat on the toilet, bursting out the biggest color in my life, surging and exploding the reddish-brown flowers, and I felt a lot lighter.

I asked the nurse to take me to do color Doppler ultrasound. The result of the color Doppler ultrasound shocked me. Because a week ago, when I had a digital examination, I only had one perianal abscess. I didn't expect that after just seven days, I would have another one and an anal fistula.

So I advise you again, if you are diagnosed with perianal abscess, treat it immediately and don't delay. Otherwise, you will suffer more pain.

But it had already happened, so I had to let it go. As the surgery approached, I became calm. I even joked with the anesthesiologist, telling her that I was overweight and asked her to use the amount for two people. The anesthesiologist didn't listen to my nonsense, and injected anesthetic into my spine, then pinched me and asked if I felt anything. I answered her "It hurts", and then she gave me half the amount for one person.

What happened next was very embarrassing. Three doctors gathered around my anus and commented on it. One young lady said that my big buttocks made the surgery a little troublesome, but it was an advantage during recovery. The flesh on the buttocks was a natural cushion, which allowed the incision to heal well.

They were chatting happily, but my face turned red, I was so embarrassed that my toes curled up like chicken feet. But later I learned that the doctors were not chatting, but trying to ease the patients' mood and relax their muscles for better surgery.

The operation went smoothly. An hour and a half later, I was wheeled back to the ward. The anesthetic hadn't worn off yet. I didn't feel any pain. I just felt a strong urge to urinate. The doctor told me that it would be best if I could urinate on the same day. If I didn't urinate for 24 hours, I would have to have a catheter.

But the first thing I did was to take a photo and post it on WeChat Moments - it is said that 70% of young people would use this method to ensure safety.

At that time, I was in a relaxed state of mind and had no idea what was going to happen next.

Due to the anesthesia, I couldn't get out of bed for 4 hours after I got to the hospital bed. At this time, the benefits of staying up late the day before were reflected. I fell asleep quickly on the bed. I heard from my fellow patients that I snored loudly at that time, which means that I slept very soundly.

It was also because of falling asleep that I managed to safely get through the first major hurdle after the operation, which was the severe pain after the anesthesia wore off!

It is said that it is a pain that goes straight from the coccyx to the top of the head, like the pain of being bitten by mosquitoes during childbirth - it is painful, itchy and numb. Several patients in our room were so seriously ill that they wanted to bang their heads against the wall. As for me, I fell asleep...

Yes, you read it right, I fell asleep and didn't wake up until the evening. I was a little puzzled at the time, so I turned around and asked Brother Jiro why there was a painkiller on the bedside. Brother Jiro looked at me without saying anything, but I could see envy, jealousy and the urge to beat me up in his eyes.

I quickly turned my head and thought about how to urinate. Actually, I had the urge to urinate right after the surgery, but I just couldn't urinate no matter how hard I tried. Later I found out that the reason was the bandage!

It turned out that after the operation, the doctor stuffed cotton in my anus, put gauze on it, and then tied my lower body tightly with a bandage. However, the bandage was tied too tight, which made it impossible for me to urinate.

After realizing this, I reached into the straps and made some space to let my muscles relax.

The effect of this was remarkable. After about 5 minutes, I was able to urinate smoothly, avoiding the pain of intubation and overcoming the second hurdle after the operation.

However, I was a little proud of myself at the time, but my coolness could not last for more than one night. Just a few hours later, I cosplayed as Michael Jackson again because of the pain.

Anal fistula surgery

Defecation is the biggest challenge

People say that anal fistula surgery is painless. This is true, but what everyone doesn't know is that the surgery is not painful, but it is very painful after the surgery, and it is three kinds of pain, three kinds of pain like purgatory! The first pain is the pain when the anesthetic wears off. Fortunately, I fell asleep and didn't have any profound experience. The second pain made me realize how terrible the pain is. Here is an analogy. If you have an injury on your arm, no matter how deep the cut is, it won't hurt much if you apply medicine and wrap it with gauze and don't touch it. But anal fistula surgery is not the same. Every bowel movement is like salt on the wound. The most feared friends with constipation, if they use too much strength and break the line, it's fine, at most they will have to have another knife. If the anus is scratched by stool, then they can step into the anal fissure smoothly, and they don't need to go through the discharge procedures, just wait for the second surgery. Remember, the man with seven hemorrhoids on his anus mentioned in the previous article, Brother Jiro, he told me to prepare three pounds of sesame oil, just for this time. Eating sesame oil lubricates the intestines and helps to defecate better. I just said that sesame oil is good, but I really can't drink it. So I suddenly had an idea and dipped a banana in soy sauce. Hey, you don't say it, you really don't say it. I had a bowel movement 14 hours after the anal fistula surgery! To be honest, the first bowel movement after the anal fistula surgery made me grow up. At that moment, I experienced the pain of a woman giving birth. Two years later, I still remember the feeling clearly at that time. I carefully moved to the toilet, tremblingly unzipped my pants, and sat on the cold toilet. Due to nervousness and lack of experience, I even forgot to take out the cotton in my anus. Then I shook my sphincter and prepared to exert force. The moment I exerted force, the intense pain rushed straight to my forehead along the nerves. At that moment, even my fingertips were electrocuted. I knelt on the ground, unable to exert any strength, and I couldn't help but shout out Tathagata Buddha, the compassionate Guanyin Bodhisattva, Jesus Amen, the goddess Athena... just to relieve a little pain. It took more than 20 minutes to regain some strength. Brother Jiro at the door heard my wailing and kindly came over to give me some advice. He told me to get a basin of warm water, soak my butt in it to relieve the tense muscles, and then defecate.

Thanks to Brother Jiro for the great idea. After I did it, although it was still painful, it was much better, at least it was discharged a little.

Generally speaking, my experience was relatively smooth, as pain was inevitable. However, many people are unable to defecate, and the stool accumulates, causing a series of problems.

Here is a little tip: after anal fistula surgery, you cannot just drink porridge or soup, you should eat some soft food, such as the banana dipped in sesame oil that I invented earlier, or order a bowl of Shaxian duck leg rice, and remember to ask the boss to pour a large spoonful of oil soup on the rice.

In fact, this is easy to understand, because you have given an enema before the operation, and there is no food left in your stomach, so you have no material to defecate.

As long as you get through the first bowel movement after surgery, you will feel much more relaxed afterwards. However, the third pain is still very distressing, that is the pain of the first dressing change.

It would be fine if I met a doctor who was gentle, but unfortunately the hospital I went to had four ruthless people, namely Cold-blooded, Merciless, Iron-handed and Life-chasing. And my attending doctor happened to be the most ruthless Iron-handed, who really poked me hard with tweezers! Thinking about it now still gives me chills.

It is best to keep it dry after changing the dressing. If conditions permit, you can lie on the bed and use a hair dryer to blow the incision. But you must remember to adjust the temperature properly, otherwise it will really burn your butt.

After changing the dressing several times, I have figured out a few tricks. Take off the gauze before changing the dressing, and then wash your buttocks and anus with warm water. Warm water can relax the muscles, so that it will be easier to feel when changing the dressing.

Generally speaking, you can be discharged from the hospital one week after anal fistula surgery. After discharge, you need to clean the affected area every day and go to the hospital regularly to change the dressing. If granulation tissue grows, it needs to be cut off as soon as possible.

Some friends may think that it will be very painful to cut the granulation tissue. In fact, the newly grown granulation tissue has no nerves yet, so it does not hurt when cutting it. But it will be very painful when cutting it when it grows bigger, so you must go for a check-up on time.

It is the medicine change room of the anorectal department. The wailing sounds that come one after another are probably the most ghostly chants in purgatory.

I was terrified and never wanted to experience this kind of torture again. But my colleague, the one who had been in prison three times, looked at me with ill intentions and whispered in my ear: "This disease is very likely to relapse~"

Doctor's comments

All in all, this patient met a reliable doctor, and after the treatment he was able to describe the condition of the disease so clearly, which shows that the doctor did a very good job of explaining the condition to the patient.

There is an anatomical structure in the anus called anal sinus, which usually has more than a dozen of them. They are shaped like small pockets with their openings facing upwards, so stool can easily accumulate here and cause infection. There are anal glands below the anal sinus, and the infection can easily spread along the anal glands. The tubes formed by the spread of infection are fistulas. There are more than a dozen relatively loose gaps around the anus, and the infection forms a pus cavity here, which is a perianal abscess. After the perianal abscess ruptures, pus flows out but the fistula is still there, which is an anal fistula. Therefore, in most cases, perianal abscess and anal fistula are different stages of the same disease.

Perianal abscess originates from the rectum, where there are a large number of bacteria and many types, so perianal abscesses are serious mixed infections that progress very quickly. Once diagnosed, surgery must be performed as soon as possible. Every day of delay will cause great trouble to future recovery. The patient in this case obviously suffered a great loss in this regard. But there is no need to be sad about this. There are many people who have perianal abscesses and think they can hold on. Many doctors also think so. Of course, in the end, it will be found that no one can bear it, and surgery is still necessary.

Everyone is very concerned about one question, how to prevent perianal abscesses. What disappoints everyone is that there is really no particularly clear prevention method. As for treatment, just remember one sentence firmly, as long as the doctor tells you that you have perianal abscesses, then don't hesitate, surgery! Surgery! Surgery! As for how to do the surgery, the most important part is to completely cut open the fistula. These skills are what the doctor needs to worry about. The patient only needs to know that all the fistulas should be explored and cut open.

Special emphasis is placed on postoperative care. It is not an exaggeration to say that this disease is "half surgery and half dressing change after surgery". If the dressing is not changed on time, the condition of "the outside is healed, but the inside is not healed" is formed, which is the so-called false healing, which is a headache for both doctors and patients. Therefore, you must listen to the doctor after surgery and change the dressing obediently. In this case, the patient and the doctor cooperated well and recovered smoothly.

Finally, congratulations to this friend for successfully surviving the surgery and postoperative treatment of perianal abscess!

Author: Uncle Panda, a popular science creator

Review丨Sun Yifei Director of the Medical Education History Research Office of Hebei Medical University