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Q：痔瘡有那些症狀啊???
Q：What are the symptoms of hemorrhoid?
咦?!1、2、3…算一算已經3~4天沒大便了…
蝦米?!為啥米恩恩完擦屁屁的時候衛生紙上有血跡?!
天啊!!恩恩的時候屁屁好痛喔…
以上都是你有的症頭嗎???
要小心可能你就是痔瘡(ㄉ一ˇ ㄘㄥ)患者…
A:The most common symptoms of hemorrhoids are rectal bleeding, itching, and pain.
Q：到底甚麼是痔瘡???
Q：What is hemorrhoid?
(圖片來源：http://www.holisticphysio.com/knowledge%20base/hemorrhoid/pile1.jpg)
也就是直腸出口處的靜脈曲張或膨大…
其中又分為內/外痔…
A: Hemorrhoids are enlarged or swollen veins in the lower rectum.
You may be able to see or feel hemorrhoids around the outside of the anus, or they may be hidden from view, inside the rectum.
Q：那麼要做哪些檢查才能得知並診斷自己生了痔瘡呢???
Q：How to diagnose of hemorrhoid?
很簡單…
當你有以上不適到診所或是醫院求治時…
醫師會替你指診、用內視鏡從肛門口探入…
或是你的痔瘡已經掉出肛門口(也就是所謂外痔…)
那麼就可以確診為痔瘡了…
A: To diagnose hemorrhoids, your clinician will examine your rectum and anus, and may insert a gloved finger into the rectum. If there is bleeding, testing should include a procedure that allows your healthcare provider to look inside the anus (called anoscopy) or the lower colon (sigmoidoscopy).
Q：為什麼我會生痔瘡???
Q: Why I got hemorrhoids?
(圖片來源： http://www.igotmail.com.tw/home/10928)
而到底為啥米生痔瘡這種東西呢…
有可能是你的工作需要長時間站/坐著…
或是你常常便秘…拉肚子…
(咦?! 長時間站著這不就是我嗎…哈哈哈可是阿姨我解便型態很正常喔…)
或是你正懷孕中…
A: Hemorrhoids are more common in people who are older and in those who have diarrhea, pelvic tumors, during or after pregnancy, and in people who sit for prolonged periods of time and/or strain (push hard) to have a bowel movement.
Q：那得到痔瘡該怎麼處理治療呢???
Q: The treatments of hemorrhoids.
(圖片來源：http://wakigasyu.19jihai.com/tiryou/kyuin.html)
通常這就要看你痔瘡的嚴重程度來決定了…
嚴重程度基本上分為4度…
1度：只有出血沒有脫垂
2度：出血+解便用力的時候會脫垂但可以自己縮回去
3度：出血+解便用力的時候會脫垂且必須用手推才回得去
4度：出血+解便用力的時候會脫垂且它再也無法回去了
由以上分類可以知道等級越高越嚴重…
Grade I: The hemorrhoids do not prolapse
Grade II: The hemorrhoids prolapse upon defecation but reduce spontaneously
Grade III: The hemorrhoids prolapse upon defecation and must be reduced manually
Grade IV: The hemorrhoids are prolapsed and cannot be reduced manually
不同嚴重程度在治療上就有所不同…
治療方式常見的有以下…
The common treatments of hemorrhoid are the followings.
硬化治療：局部注射硬化劑在痔瘡的地方…讓局部血管發炎纖維化後脫落…
(也就是讓痔瘡硬掉乾掉後讓它自己脫落結束生命…)
During sclerotherapy, a chemical solution is injected into hemorrhoidal tissue, causing the tissue to break down and form a scar.
紅外線治療：以雷射的方式止血
The use of laser or infrared light or heat to destroy internal hemorrhoids
橡皮筋結紮：用橡皮筋綁出凸出來的痔瘡讓它壞死脫落…
(這方法的原理就有點像是硬化治療…也是讓痔瘡自己脫落結束生命…)
Rubber band ligation is the most widely used procedure. Rubber bands or rings are placed around the base of an internal hemorrhoid. As the blood supply is restricted, the hemorrhoid shrinks and degenerates over several days.
痔瘡切除手術：直接把凸出來的痔瘡切掉後縫起來…手術過程中通常採脊椎麻醉…
Hemorrhoidectomy is the surgery which is under a spinal anaesthesia. The doctor cuts off the hemorrhoids directly and sutures the wound after the surgery.
了解以上治療方法後…依照不同嚴重程度有不同的治療方式…
1度可採取→硬化治療
2度可採取→硬化治療/紅外線治療/橡皮筋結紮
3度可採取→紅外線治療/橡皮筋結紮
4度則必須採取→橡皮筋結紮/痔瘡切除手術
Glass 1→Sclerotherapy
Glass2→Sclerotherapy, Laser, Rubber band ligation
Glass3→Laser, Rubber band ligation
Glass4→Rubber band ligation, Hemorrhoidectomy
Q：痔瘡手術後的注意事項???
Q: After the surgery.
如果非不得已真的要開刀切除痔瘡…
有一些術後注意事項跟相關合併症都必須要清楚…
(圖片來源：http://www.10month.com/ch/110603/153857873.html)
手術的麻醉方式通常是脊椎麻醉…
所以手術後回到病房必須躺在床上休息大約8個小時…
有些醫生會希望你這段時間先不要吃東西也不要喝水(免得噁心嘔吐導致嗆到)…
但有些會認為開完刀後如果先試著喝一點水沒有不舒服就可以正常吃東西了…
這就要看為你開刀醫師的決定…
Usually the doctors will tell you bed rest 6~8 hours after the surgery; some will let you eat after the surgery if you don’t feel any uncomfortable such as nausea, vomiting.
(圖片來源：http://baby.sina.com.cn/health/2003-10-15/47_51397.shtml)
另外直腸末端的神經分布很密集…所以術後疼痛是免除不了的…
等到麻醉退了之後你就會痛不欲生?!
(哈哈…不過疼痛還是會依照每個人不同感受而不一樣啦…可以盡量側躺不要去壓到肛門傷口…)
這時醫師會開給你口服的止痛藥…或是用打的止痛針劑…(嗎啡之類的)
另外還有藥膏可以擦…
There are pain killer medicines will be given after the Hemorrhoidectomy, such as oral medicine, morphine injection.
Pain-relieving creams and hydrocortisone rectal suppositories may help relieve pain, inflammation, and itching, at least temporarily.
麻醉退去之後有些人開始會覺得膀胱脹脹的但沒有辦法順利尿尿…
(這通常是因為手術麻醉或是很怕痛不敢用力的關係…)
有些幸運的人可能藉由吹口哨啦…或是打完止痛藥後還是能夠順利自己尿出來…
但如果真的尿不出來…只好再插一次尿管把尿”自動”流出來…
我們也會鼓勵病人多喝水…不然尿積在裡面也是會泌尿道感染的…
(喝多少才夠??? 大約一天喝2000~3000c.c也可以順便預防便祕喔…)
Urinary retention following hemorrhoidectomy is observed in many patients.
Pain medication also may lessen urinary retention and reduce the need for catheterization.
Urinary tract infection develops in patients after anorectal surgery, possibly secondary to occult urinary retention.
(圖片來源：http://mypaper.pchome.com.tw/ditsangwan/post/1320593071)
開完刀的隔天醫師就會幫你把塞在肛門口的紗布拿掉…
(為甚麼塞紗布??? 是用來止血的喔…)
之後就可以搭配把肛門口浸泡在溫水裡增進舒適度減緩疼痛…
(手術前都會請病人戴自己的大臉盆來…一天可以泡好幾次…一般我們都是鼓勵病人一天可以泡個4~6次…1次大概15~20分鐘…)
另外術後肛門口分泌物也會增多…所以可以使用衛生棉會比較方便…
(男生不要害羞也可以使用喔…)
The doctor will remove the anal packing coming morning of the operation day.
And we encourage patients to do warm sitz baths work by improving blood flow and relaxing the muscle around the anus. During a sitz bath, you soak the rectal area in warm water for 10 to 15 minutes two to four to six times daily.
(圖片來源：http://pixta.jp/illustration/4475454)
剛開完刀可能要等待幾天時間才會解便…醫師會開促進排便的藥物給你吃…
剛開始會解幾次帶有血的糞便也都算是正常的…
不過一直拉肚子的話就要停止服用促進排便的藥物了…
The doctors also give you stool softeners to improve your defecation. But if you start to diarrhea, then you have to stop eating the medicine.
順利解便、解尿…疼痛也可以靠吃藥緩解的話就能出院回家囉…
Patients may be discharged when feeling comfortable.
Q：如何預防痔瘡發生???
Q: How to prevent getting hemorrhoids?
(圖片來源：http://forum.yoursun.com.tw/printer_friendly_posts.asp?TID=587)
平常就要沒事多喝水…多喝水沒事囉…
然後3餐老是在外最容易沒吃到蔬菜水果(高纖維)…
常常便秘的話小心痔瘡就會找上你…
再來把你的小屁屁移開椅子…盡量不要久站/坐…適度運動促進腸胃蠕動…
Increasing fiber (is found in fruits and vegetables) in your diet and drinking enough water are the best ways to prevent getting hemorrhoids.
And better not to sit or stand for prolonged periods of time.
一起遠離痔瘡…一起變更健康…
=參考資料=
1. 吳麗彬、周繡玲‧(2010)‧成人內外科護理‧於劉雪娥總校閱，成人內外科護理(二版，(392~395頁)‧台北市：華杏出版股份有限公司
2. Ronald Bleday, MDElizabeth Breen, MD(2012) Treatment of hemorrhoids. [On-line]. Available: UpToDate database then search topic: hemorrhoid.
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