儿童痔 -是什么中山大学附属第一医院小儿外科孙俊杰
虽然儿童痔一般不会有严重的健康问题，也不是一个常见的儿童疾病，儿童痔时常既可以是一种更严重的健康问题的症状，也可以是其原因。
痔，众所周知，是肿胀的静脉，这些静脉起自于帮助肛管实现功能的痔垫周围。当某一条贯穿该区域的大静脉在足够的压力下，静脉壁胀大，随之侵占一些组织。
儿童内痔或外痔？
无论儿童或成人，如果痔发生在肛管内，齿状线以上，那么它是一个内痔。
然而，如果胀肿静脉起自齿状线下面的某一个点，它就是一个外痔。
肛管的实际开口称为肛门边缘，而齿状线是在肛门边缘向体内进入大约两厘米处。
齿状线是很重要的，因为它标志着一个主要和敏感区域的神经起始处，这些神经有助于控制肛门括约肌。内痔不怎么伤害人，因为它们都不在这一神经区域，如果有的话，除非是它们脱垂到外面了。
但是，由于位置关系，外痔一般如魔鬼一样伤害人，而儿童比成人更容易遭受到疼痛。
儿童痔的原因
儿童痔有许多潜在的原因，从便秘到克罗恩病（克罗恩病是下消化道的严重疾病），再到简单地坐在马桶上的时间过长。
虽然有相当多相对正常的原因，痔在儿童期还是非常罕见的，所以要检查有没有更严重的问题，显得尤为重要。
虽然成人可以非常清楚地知道自己的痔和便秘是不健康饮食、缺乏运动，还有久坐的结果，而孩子正常情况下不会困扰于这些问题。
孩子们，事实上都是非常多活动的，这让我们大人都疑惑他们是从哪里得到这一切能量的。不活动的生活方式，是痔的最常见原因，但对孩子来说是一个较次要的因素，因此其他问题就突出出来了。
一个更严重的儿童痔原因被称为门静脉高血压，这意味着将血液从消化道带向肝脏的门静脉内有向后的压力。影响肝脏的疾病常通过门静脉高压症表现出它的第一个迹象。
克罗恩氏病，一种慢性炎性肠紊乱，也是儿童痔的一个可能的原因。应该检查这些问题，尤其是婴儿无法清楚或准确表达受了什么伤害。
儿童痔的最常见的原因是便秘，而便秘的主要原因之一是脱水。
那些脱水的孩子就是危险之中的孩子。虽然脱水对任何人都不好，由于小儿解剖原因，脱水在孩子身上起作用特别快，孩子往往不具有像成年人那样的身体储备，来抵抗脱水，中暑，低体温等情况。
儿童便秘可以通过干的、硬的，粘土样大便，恶心，呕吐，和体重减轻来诊断，孩子内裤上的一些液体表明，孩子直肠内存储了大便，孩子因为疼痛而不希望排便。
孩子是不善于表达内部痛苦确切原因的，但如果看到厕所，就看起来会浑身用力，特别是腿和臀部，脚趾摇上摆下，脸红，哭闹。婴儿感觉到到要排便时可能会预感到会疼痛而开始哭闹。
儿童便秘通常是由和其他任何人一样的原因引起，低纤维饮食，水分不足，缺乏锻炼。
对孩子来说，有一个特别的原因是他们会忽略排便的急迫，直到为时已晚，因为他们被分心或者不想从玩耍中退出，或者因为他们害怕去重复一次痛苦的经历。
在任何情况下，都不应该让孩子羞于去厕所，因为任何羞辱或者责骂只会让相关问题更加糟糕，而且可能会损害到以前成功的如厕训练。
另一个常见的儿童脱水和痔的原因就是腹泻，腹泻是比较常见的儿童疾病。
大肠是水分被重新吸收进入人体的地方，当肠内容物过快通过大肠时，腹泻就会发生。由于各种酶和液体会被身体补充进去以消化食物，如果水分无法正常重新吸收，孩子即使喝水量相当，也毫无疑问会失水，最后引发便秘。
此外，长时间坐便，这通常涉及腹泻，用力会导致痔。无论您的孩子有无痔，不要让他们在没有进行排便时上时间呆在厕所，并给它们小儿电解质去喝。当地医生或药剂师可以帮助你挑选你所在地区最好的品牌。
蛲虫会有类似儿童痔的肛门瘙痒
儿童肛门瘙痒的另一个潜在原因是蛲虫。在决定进行什么治疗过程之前，你会想带孩子去看医生，以确认不是这些小寄生虫的问题。
在他或她有蛲虫时，试图按痔瘙痒去治疗您的孩子，既没有用，又有潜在破坏性。痔的治疗对蛲虫毫无作用，而这些寄生虫强大的感染力能让你的孩子从任何地方接触到。
作为成年人，很难感染蛲虫，只是因为成年人不会像孩子那样常常去玩泥巴及污物，这意味着如果你的孩子带来了一些回家的话，它们可以很容易地传递给你家里的其他人。
怀疑孩子有痔，什么时候去看医生
出现以下情况时，你应该带你的孩子去看医生，如果便秘发作持续了三周以上，你的孩子不能参加他们正常的活动，肛门周围的皮肤出现小裂口，正常的用力不能够排出大便，或者如果你孩子的肛门开始持续泄漏。显然，如果在肛门或附近出现肿块，应该尽快去看医生。
儿童痔带来的特殊困难
当孩子确实有痔，他们需要仔细观察，特别是如果他们有痛或痒。
孩子经常没有自我控制去避免不断抓挠的能力，这可能会导致痔撕裂开并流血。
挠抓会使痔破开，进而导致严重的感染和疼痛性炎症。此外，相关的疼痛会使孩子很烦躁，不愿去厕所，不愿离厕所，并最终将许多坏事关联到如厕训练本身。
如果便秘是一个因素，便秘带来的渗漏或泄漏也可随之带来感染的潜力，特别是如果孩子拒绝排便并试图忽视这个问题。
总而言之，对于所有相关的人，尤其是孩子来说，这是一个非常不愉快的状况，。
儿童痔的治疗-立即缓解儿童痔的措施
使用湿纸巾为您的孩子擦拭可能有所帮助，你的儿科医生或药剂师或许能够推荐比普通的水更柔的湿润剂。
应避免干的卫生纸，因为试图用它去抓、摩擦或擦洗有可能造成用力过大。
保持你的小家伙清洁、干爽，并且让孩子沐浴在拥抱和爱心之中，让他或她知道这不是世界末日，你的爱是不变的。
一旦儿科医生确定您的孩子，确实有痔，有一些事情可以做，让你的小家伙有即刻的缓解。
当前在药店没有专为儿童制造的痔药乳膏或软膏，但布洛芬确实可用在儿童和婴幼儿，并可能有助于缓解疼痛和炎症。
当然，对两岁以下的婴儿，不要使用任何不是由医生推荐的东西，但是如果你打电话问的话，你孩子的儿科医生会根据年龄和体重计算出布洛芬的适当剂量。
儿科医生必须计算用量的原因，是因为婴儿的重量如此之低，而且婴儿的新陈代谢方式与年龄较大的儿童有很大的差别。
这两个因素之间，需要一定程度的积分来为婴儿计算药物的正确剂量。
除了用药之外，一次二十分钟时间，一日三次的温水坐浴，往往会带来很大的缓解。
燕麦粉，可以在很多药店中找到，也可加入到坐浴中带来额外的舒缓力。
如果孩子瘙痒得厉害，普通玉米淀粉可以撒在该区域，以及孩子的尿布或内衣上。
有些孩子发现，坐在毛巾包裹的冰袋上几分钟，也有助于缓解疼痛。
请检查并确保你的孩子对您使用当前的洗衣皂和软化剂不具有敏感性或过敏性。如果有疑问，购买一或两瓶低过敏性的洗衣粉和柔软剂，因为这可以减少一些刺激，应该会的。
儿童痔的治疗
一旦得到即刻缓解，痔就相对容易处理了。
对任何年龄的任何人来说，痔的最佳治疗方法，都是从食品中得到更多的纤维，如全谷类，新鲜水果和蔬菜。
从水，果汁，或牛奶来源中获得足够的液体，对避免便秘来说是非常重要的。
由于对你的孩子来说，得到足够的纤维是非常重要的，不要在没有医生监督的情况下，试图用灌肠剂或泻药去治疗儿童便秘。泻药可以令你的孩子快速和危险地脱水。
如果你的孩子喝苏打水，茶或咖啡，这些东西需要去除。在其中找到的咖啡因是一种利尿药，这意味着“增加排尿。”或者，换句话说，带有咖啡因的饮料实际上是在将水分带出体外。
此外，汽水中糖分也没有帮助，因为它加速了孩子的新陈代谢，继而是消化，而规律性是最需要的东西。
运动可以是非常有益的 - 对一个孩子，这意味着身体的玩耍。
婴儿痔的治疗
如果你的孩子仍然是一个婴儿，尚未进食食物，那么无论是母乳喂养或喂养未强化铁的配方奶粉，是没有差别的。强化铁的或大豆配方的都可以导致婴儿便秘。
目前市场上有相当多的针对胃敏感或作为抗便秘特别制造的配方奶粉，这是有益的。
虽然妈妈的乳汁是最好的，并不是每一个人的选择，但要你可以尝试并尽可能接近。
增加运动和活动也是有利的，所以去阳光下玩是一个好主意，甚至能给爸爸妈妈一个呼吸的片刻。
尚未行走的婴儿喜欢像玩自行车游戏那样活动他们自己的胳膊和腿，这就是一个成年人把宝宝的脚拿在手上，交替上下移动腿和膝盖，仿佛婴儿在踩踏板一样。做这些事的时候，吟唱傻傻的歌曲，并且做着傻傻的鬼脸，当然，严格说来是可选的，但强烈推荐。
儿童痔 - 结束语
当重视和及时治疗，儿童痔会自行缓解的。
由于人类孩子独特的生物学，手术通常不是一种选择，因为他们的小身子还不能很好处理伴随着任何外科手术而来的严重身体冲击。然而，还是会有机会发生儿童痔血栓形成（这意味着发生血凝块卡在里面）或者脱垂（这是指内痔跑到身体外面），幸运的是机会相当小。这两种状况差不多都需要手术治疗，但这些发生在儿童的几率近乎没有。
大多数的儿童痔在适当饮食后，当然，还有温柔呵护下，会自行消失。
Child Hemorrhoids C what they are
While child hemorrhoids are generally not a severe health problem, they are not a common childhood disorder and child hemorrhoids can frequently be both a symptom and a cause of more severe health issues in children.
Hemorrhoids, as we know them, are swollen veins that emerge from and around the hemorrhoidal cushions that help the anal canal to function. When one of the large veins that runs through this area is put under enough strain, the vein wall swells and takes some of the tissue with it.
Internal or external child hemorrhoids?
Whether child or adult, if the hemorrhoid should occur on the inside of the anal canal, above the dentate line, then it is an internal hemorrhoid.
If, however, the swelling vein should start from a point below the dentate line, it is an external hemorrhoid.
The actual opening of the anal canal is called the anal verge, and the dentate line is approximately two centimeters further inside the body from the anal verge.
The reason that this dentate line is important is because it marks the beginning of a large and sensitive band of nerves that help to control the anal sphincter. Because they are nowhere near this band of nerves, internal hemorrhoids don’t hurt much, if at all, unless they have prolapsed to the outside.
However, due to location, external hemorrhoids usually hurt like the dickens, and children are even more vulnerable to pain than adults.
Causes of child hemorrhoids
There are many potential causes of child hemorrhoids, ranging from constipation to Crohn’s disease, which is a severe disorder of the lower intestinal tract, to simply sitting on the toilet for too long.
While there are quite a few causes that are relatively normal, hemorrhoids in child are still very rare, so it is doubly important to check for more serious problems.
While an adult may know very well that their hemorrhoids and constipation are the result of a bad diet, lack of exercise, and long periods of sitting, children normally do not suffer from these problems.
Children, in fact, are masters at making us adults wonder where the heck they get all of that energy from. An inactive lifestyle, the most common cause of hemorrhoids, is much less of a factor, and so other problems come to the forefront.
One of the more serious causes of child hemorrhoids is called portal hypertension, which means that there is backwards pressure in the portal vein that carries blood from the digestive tract to the liver. Diseases that affect the liver often show their first sign through portal vein hypertension.
Crohn’s disease, a chronic inflammatory bowel disorder, is also a possible cause of childhood hemorrhoids. These issues should be checked for, especially in infants who are unable to express clearly or accurately what hurts.
The most common cause of hemorrhoids in children is constipation, and one of the primary causes of constipation is dehydration.
Children who are dehydrated are children in danger. While dehydration is not good for anyone, due to pediatric anatomy, it works particularly quickly on children, who do not have the sorts of bodily reserves that adults use to cushion themselves against things like dehydration, heatstroke, hypothermia, and so on.
Constipation in children can be diagnosed by hard, dry, clay-like stools, nausea, vomiting, weight-loss liquid in child’s underwear indicating backed-up stool in the child’s rectum, and the child not wishing to defecate due to pain.
Children are not particularly good at expressing exact causes of internal pain, but look for all over clenching, particularly of the legs and buttocks, rocking up and down on their toes, turning red, and wailing like banshees if a toilet comes into view. Infants may start to cry at the first feeling of having an excretion, anticipating the pain.
Constipation in children is often caused the same as it is in anyone else, by low-fiber diets, insufficient water, and a lack of exercise.
A cause particular to kids is their ability to ignore the urge to defecate until too late because they are distracted or don’t want to quit playing, or because they are afraid of repeating a painful experience.
Under no circumstances whatsoever should the child be shamed into going to the toilet, as any shame or scolding will only make the bad associations worse and potentially damage previously successful toilet training.
Another frequent cause of childhood dehydration and hemorrhoids is diarrhea, which is relatively common to childhood ailments.
Diarrhea occurs when material moves too quickly through the large intestine for water to be reabsorbed into the body. Because various enzymes and liquids are added by the body to digest food, if the moisture is not properly reabsorbed, the child can be literally be losing water even if drinking fairly consistently, triggering a bout of constipation on the back end.
In addition, the long times of sitting on the toilet that are usually involved in bouts of diarrhea contribute their own strain leading to hemorrhoids. Whether or not your child has hemorrhoids or not, don’t leave them on the toilet when they’re not actually going, and give them pediatric electrolytes to drink. Your local doctor or pharmacist can help you pick the best brand in your local area.
Pinworms can mimic the anal itching of child hemorrhoids
Another potential cause of childhood anal itching is pinworms. You’ll want to take your child to the doctor to verify that these miserable little parasites are not the problem before deciding what course of treatment to take.
Trying to treat your child for hemorrhoidal itching when he or she has pinworms is both useless and potentially damaging. Hemorrhoidal treatment won’t do a thing for pinworms, and these parasites are so contagious that your child could literally have picked them up anywhere.
Pinworms are more difficult to get as adults, but only because adults don’t play in mud and dirt as often as kids, which means that they can easily pass to the rest of your family if your child should have brought some home.
When to see a doctor about suspect child hemorrhoids
You should also take your child to the doctor if episodes of constipation last for more than three weeks, your child is unable to participate in their normal activities, small tears start appearing in the skin around the anus, normal pushing is not enough to expel stool, or if your child’s anus starts consistently leaking. Obviously, if lumps appear near or in the anus, a doctor should be soon be very fast.
Particular Difficulties that Child Hemorrhoids pose
When a child does have hemorrhoids, they need to be watched carefully, especially if they are painful or itchy.
Children do not often have the self-control to keep from incessant scratching, which can cause the hemorrhoids to be torn open and bleed.
Scratching open hemorrhoids then leads to rampant infection and painful inflammation. In addition, the pain involved can make the child very cranky, unwilling to use the toilet, unwilling to get off the toilet, and eventually associate an untold number of bad things with toilet training itself.
If constipation is a factor, the seepage or leakage that constipation can bring also carries the potential of infection with it, especially if the child refuses to defecate and tries to ignore the problem.
All in all, it’s a very unpleasant situation for all concerned, not least of all the child.
Treatment for Child hemorrhoids C For the immediate relief of hemorrhoids in a child.
It may be helpful to get moistened wipes for your child to wipe with, and your pediatrician or pharmacist may be able to recommend more soothing moisteners than plain water.
Dry toilet paper should be avoided, as the temptation to scratch, rub or scrub with it may become overpowering.
Keep your tiny one clean, dry, and shower on the hugs and affection so that he or she knows this is not the end of the world and your love is constant.
Once a pediatrician has determined that your child does, indeed, have hemorrhoids, there are a number of things you can do to get your little one some immediate relief.
There are no hemorrhoidal creams or ointments currently made for children that are available over the counter, but ibuprofen does come in child and infant doses and may help with both pain and inflammation.
Of course, never give an infant under two years of age anything not recommended by a doctor, but your child’s pediatrician can calculate a proper dosage of ibuprofen for your infant based on age and weight if you call and ask.
The reason that a pediatrician has to calculate the dosage is because infant weights are so low and infant metabolisms work differently from that of even older children.
Between these two factors, it takes a degree in calculus to compute the right dosage of any medication for any infant.
Leaving medication aside, warm sitz-baths, given for twenty minutes at a time three times a day often bring great relief.
Oatmeal powder, which can be found at most drug stores, can be added to the sitz bath for extra soothing power.
If the child’s itching is bad, plain cornstarch can be dusted over the area and into the child’s diaper or underwear.
Some children find that sitting on a towel-wrapped ice pack for a few minutes can help with the pain, as well.
Do check and make sure that your child does not have a sensitivity or allergy to the current laundry soap or softeners that you use. If in doubt, purchase a small bottle or two of hypoallergenic laundry detergent and softener, as any irritation that can be banished, should be.
The cure of child hemorrhoids
Once immediate relief has been obtained, hemorrhoids are relatively easy to deal with.
The best treatment for hemorrhoids in anyone, of any age, is to get more fiber from such foods as whole-grains, and fresh fruits and vegetables.
Sufficient liquid from sources of water, fruit juice, or milk is very important to avoiding constipation.
While it is important for your child to get enough fiber, never try to cure childhood constipation with enemas or laxatives without a doctor’s supervision. Laxatives can quickly and dangerously dehydrate your child.
If your child drinks soda, tea, or coffee, those things will have to go. The caffeine found in them is a drug called a diuretic, which means “to increase urination.” Or, in other words, drinks with caffeine in them are actually pulling water out of the body.
In addition, the sugar found in soda doesn’t help, either, as it speeds the child’s metabolism, and therefore digestion, when regularity is what is most desired.
Exercise may be very beneficial C for a child this means physical playing.
The cure of infant hemorrhoids
If your child is still an infant and not yet eating food, then either breastfeeding or feeding a formula that is not iron-fortified can make all the difference. Iron-fortified or soy formulas can both lead to constipation in infants.
There are quite a few formulas on the market today specifically made for sensitive stomachs or as anti-constipation that can be beneficial.
While mom’s milk is best, that isn’t an option for everyone, but do try and get as close as you can.
Increased exercise and movement is also beneficial, so going and playing in the sunshine is a good idea, and might even give mom and dad a moment to breathe.
Infants that are not yet walking love to have their arms and legs played with in games like Bicycle, which is where an adult takes the baby’s feet in their hands and moves the legs and knees alternating up and down as if the baby were pushing pedals. Chanting silly songs and making goofy faces while doing this is, of course, strictly optional but highly recommended.
Hemorrhoids in child C Ending remarks
When paid attention to and treated promptly, childhood hemorrhoids should clear up on their own.
Due to the unique biology of human children, surgery is not usually an option, as their small bodies do not deal well with the serious bodily shock that accompanies any surgical procedure. However, the incidence of childhood hemorrhoids thrombosing, which means getting a blood clot stuck inside, or prolapsing, which refers to an internal hemorrhoid trying to come outside the body, is thankfully rather small. These two conditions almost demand surgery, but the incidence of these happening to children is close to nothing.
The vast majority of child hemorrhoids go away on their own with the proper diet, and of course, tender loving care.
中山大学附属第一医院小儿外科
孙俊杰医生
Department of Pediatric Surgery, the First Affiliated Hospital of Sun Yat-Sen University
Dr. SUN Junjie