放疗后疼痛性大便紊乱护理、调理篇

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放疗、术后直肠吻合口炎、直肠炎和肛门里急后重的成因和护理、调理方法之——疼痛性大便紊乱护理、调理篇

第一节  术前放疗或术后放疗引起的放射性直肠炎导致的大便紊乱的护理和调理方法  

直肠癌术前术后的放化疗会引起患者的一、全身消化系统、血液系统、心血管系统的反应；本人已经在《放疗副作用的中西医药的一般护理、调理方法》一文里已经详细说明，这里就不再细说，这里要说的低位直肠癌患者术前术后放疗对直肠和吻合口的伤害，和后期时好时坏的表现和导致患者大便紊乱每天十几次大便的原因和调理方法。

虽然术前就做完放疗的患者，吻合口没有受到放疗的伤害，但是直肠一样受到伤害，而放射性直肠炎也会导致吻合口炎，患者术后便秘挤破吻合口出血或者医生指检扩肛时吻合口也会受伤出血，护理不到位也会导致吻合口炎，其外敷内服的护理、调理方法都大同小异；所以，这里就合并一起说说放疗对吻合口和直肠的伤害留下的后遗症的原因和护理、调理方法。

因为吻合器的直径都比人的肠道内径小，所以做了肠道根治手术的患者吻合口都比两边的肠道狭窄，吻合口都变成了一道“关口”，加上患者术后普遍怕梗阻不敢吃有渣食物，形成的大便太软，通过吻合口时起不到一个扩开吻合口的扩肛作用，所以，术后很长的时间里这道“关口”是一直存在的，甚至有些患者术后医生没有做指检扩肛的操作，患者吻合口又没有硬便通过而导致吻合口粘连，致使吻合口比术后的吻合口还狭窄的现象时有发生；而低位直肠癌根治术之后要做放疗，放疗对吻合口新生嫩肉的伤害更大，放疗对直肠的伤害会导致放射性直肠炎是老生常谈，但是放疗对吻合口的伤害和术后便秘硬便憋伤吻合口，导致吻合口发炎，进而导致大便紊乱的事情却甚少有人提及和采取相应的规范护理和调理措施，而经验上，它是导致患者术后很长时间大便紊乱的罪魁祸首，也是患者术后营养摄入的障碍之一。

其实，中医中药可以作为护理、调理肛门的炎症的中成（草）药很多，患者术后和放疗期间，就应该有预防性外敷内服减少放疗对吻合口、直肠和肛门的伤害，放疗期间每天服用归肠经，凉血凉肠效果很好、药性温和的木棉花水，患者后期的吻合口、直肠、肛门的炎症症状明显降低，放疗后期炎症严重时服用两种大寒大苦的消炎草药，也可以减缓放疗区域肠外的炎症程度；大便之后塞消炎药膏进肛门，晚上没有大便时塞消炎栓剂进肛门帮助吻合口、直肠和肛门消炎，这种中医中药的外敷内服的方法，是减低放疗时伤害和放疗结束治疗和预防患者吻合口炎、直肠炎、肛门炎症的有效方法。放疗结束之后继续护理、调理一段时间是患者被放疗的区域尽快回复肛门功能正常、大便正常和避免日后频繁出现吻合口炎、放射性直肠炎、肛门炎症的有效方法，是6年来超过1000群友术后放化疗前备用药物，放化疗期间和之后复查康复期在我指导下实践、见证有效的护理、调理方法。

第二节  术后吻合口炎造成粘膜层糜烂、粘膜脱落拉出的成因和护理和调理方法

术后吻合口炎大概可以归咎于以下几个原因：

  1. 低位直肠癌术后放疗，射线对新长的嫩肉的副作用伤害比对直肠的肛门严重；放疗期间患者没有做相应的外敷内服的护理调理工作，导致放疗结束之后很长时间的吻合口炎，严重时导致粘膜糜烂脱落，大便时拉出透明的物质，这种吻合口炎和放射性直肠炎是最常见，也是导致患者长期肛门功能受到严重损害的罪魁祸首。
  2. 吻合口在复查医生指检时，按压吻合口旋转一周以达到解开新肉粘连和扩肛目的而做的扩肛操作；操作之后医生的手套通常会染血；医生扩肛之后患者回家没有做相应的护理、调理导致的吻合口炎；
  3. 医嘱患者自己回家扩肛的操作导致吻合口出血发炎，不及时护理、调理形成吻合口炎。
  4. 术后和回纳后患者大便便秘时，硬便通过吻合口时的挤压，也会导致吻合口出血，没有及时做外敷内服护理和调理消炎处理的患者也会导致吻合口炎；
  5. 术后和回纳后患者用蹲厕大便，骑单车和电动摩托车，经常做下蹲动作或提重物的工作，也会导致脆弱的吻合口被拉扯受伤，特别是肛门周边和术区新长组织被拉伤出血，导致患者里急后重的肛门周边炎症；进而引起患者疼痛性大便紊乱。

除了第1点，上一节已经说的放疗期间放疗射线对吻合口、直肠和肛门的副作用伤害，患者要在开始放疗、放疗期间、放疗结束之后，按照上述方法护理调理吻合口、直肠、肛门周边炎症之外；第2-3点的原因造成吻合口出血，或者感觉到吻合口哟不适的感觉时，就要自己进行护理和调理，就要口服清热解毒的中成药，或者煮木棉花水或者严重时煮大寒大苦的消炎中成药喝；大便结束清洁肛门之后塞消炎的药膏或消炎栓剂帮助吻合口消炎，通过口服凉血凉肠的中草药水，让身体和肠子血液保持在不利于身体组织容易发炎的状态上，吻合口出血就会被你消灭于出血之后，而不会反复出血发炎，导致形成吻合口炎等一系列恶性循环的后果。

而第4点术后或回纳后便秘时，一般便秘时间不能够超过两天，便秘超过两天就容易导致吻合口炎的形成，发现第一天大便干结或便秘，大便很难拉出来，或者拉出来的大便是像羊粪一样一粒一粒的，大便必须通过腹压才能够憋出肛门时，或者便后患者感觉肛门里面很不舒服；这时，细心的患者就会发现大便便秘有鲜红的血，这就是大便憋破吻合口出的血，就要立即口服清热解毒、凉肠的中成（草）药，发现便秘后口服清热解毒的中成药有两个作用和好处，就是便秘通常是由身体热气引起肠道温度过高，大便在结肠存留过久，导致结肠提水过多大便被“烘干”，干净坚硬直径大于吻合口直径，而难以通过吻合口，及时服用清热解毒的中成（草）药能够让大便迅速变软，非常容易通过吻合口，也调理了患者热气的身体，使身体变得寒凉一些，同时清热解毒的中成药也及时给第一天便秘时，大便憋破吻合口出血的伤口消炎。

第一天便秘时等于医生例行的吻合口有创扩肛，而跟进的清热解毒中成药却及时给出血的吻合口消炎，让吻合口很快恢复正常，把一天的便秘不处理的有害过程和结果变成是一个有益的扩肛过程和结果；我术后除了两次复查林医生给我做两次指检，指检时用力按压吻合口转一圈进行扩肛以外，我就没有做过任何的扩肛操作，都是利用便秘时让硬便帮我相对温柔的给我扩肛，扩大吻合口直径，而我又自己及时进行外敷内服的护理和调理，所以术后至今我没有发现一次的吻合口炎，回纳后一周基本就没有疼痛性大便紊乱，更没有一次吻合口炎严重导致粘膜层糜烂脱落，跟随大便被拉出肛门的事情。

第二节 术后和回纳后吻合口炎或肛门炎症导致内括约肌发炎引致的大便紊乱的护理和调理方法

其它的章节我已经把内括约肌和外括约肌、肛提肌组织一个完整的肛门探测、信息传递、控制、组成了不可或缺的肛门功能讲得很清楚了，还不了解整个肛门完整功能的读者可以翻看有关章节的文章，了解肛门的整体功能构造。内括约肌是组成肛门不可或缺的肛门大便探测功能的敏感器官；低位直肠癌的保肛极限跟它有关，做超低位保肛手术之后，肛门控制功能严重受损，肛门和大便无法控制，想拉就拉的，跟它有关；做超低位直肠癌保肛手术的患者术后长期要穿成人纸尿裤也跟它有关；做完超低位保肛手术之后不堪其烦，重新入院做造口手术也跟它有关；它是做低位保肛手术时，被医生严格保护的肛门功能器官之一；手术切除直肠病灶和预留安全距离时，基本都不可以跨越肛门以上4公分的距离，患者的吻合口一般都会在距离肛门4公分以上；吻合口在距离肛门4公分以下的患者，术后的肛门功能都是不完整的，甚至是完全无法控制，要长期穿成人纸尿裤生活的。

正因为它是医生切除极限的分界线，所以它也非常靠近吻合口，而内括约肌的下缘就连接着外括约肌和肛提肌；它又是一个神经发达的全自动，不受大脑控制的感觉器官，所以，吻合口炎严重时会波及内括约肌，而肛门炎症严重时也会波及内括约肌发炎；内括约肌处于吻合口和肛门中间，吻合口和肛门那个严重发炎都会影响到中间的内括约肌的探测功能，内括约肌只要有轻微的炎症（就像电动门探测器受潮，电动门就会开关混乱，电脑受潮就会乱屏一样）就会发出混乱的便意信号，特别是患者湿热和拉稀时，稀便和粘屁股的湿热大便到达内括约肌时，湿热的大便会刺激患者的内括约肌，导致内括约肌给肛门的外括约肌发出紊乱的便意信号，进而引起患者功能性大便紊乱，而肛门疼痛发炎还会引起患者疼痛性大便紊乱。

第三节   术后肛门疼痛里急后重引起的大便紊乱的护理和调理方法

而第5点，治疗期内使用蹲厕、骑单车，频繁做下蹲的动作，提重物拉扯到脆弱的吻合口，或者术区的肛提肌，肛门外括约肌，乃至肠外的手术创口新生肉芽，都会导致肛门周边发炎，出现里急后重、肛门疼痛，疼痛性大便紊乱的情况；

术后和回纳后不注意保护脆弱的吻合口、内括约肌和肛门，肛门内出现里急后重的感觉时，又没有进行有效的护理、调理的患者；是导致肛门周边和术区新长组织被反复拉伤出血发炎，特别是低位直肠癌患者手术清除身体组织较多，创口较多、新长肉芽较多的患者为甚，导致患者里急后重的肛门周边炎症反复发作；这类患者也经常出现在60岁以上，患者自己缺乏肛门术后护理知识，懂得上网学习有关知识的子女这时是上有老下有小，正忙着事业和工作，通常都不跟老人家一起住，老人家便秘大便带血，或者肛门疼痛性大便紊乱，通常会在同龄人中打听处理的方法，自己处理不了而且越来越严重时，才会告诉忙碌中的孩子，孩子再急忙到群里来求教护理和调理的方法，以帮助长辈处理这种她们自己处理不了的事情。

一般遇到这种求教的呼声之后，我都会仔细的让她们问清楚她们长辈的大便形状情况，大便拉血、拉透明物体情况，肛门疼痛情况，大便紊乱情况，去准确判断患者现在的大便紊乱情况发展到什么程度了，属于6-7种直肠癌患者大便紊乱中的哪一种，已经发展到什么程度了，给她们讲解科普造成这种情况的成因，现在的程度和应该买什么药备用在家，教会她们之后让她们教会老人家自己怎么护理和调理吻合口炎、直肠炎、内括约肌炎，肛门周边炎症，直到肛门和大便恢复正常为止。所以，我自己自创的一套不见面靠问答、靠经验判断患者属于哪种大便紊乱类型，应该怎么护理和调理的方法，是自己实践形成经验之后，在2000人的肠癌群里经过上千的患者实践有效的千锤百炼的辨别判断和调理护理的一整套行之有效的系统方法。

第四节  西医的鞭长莫及、中医的不屑一顾，患者一筹莫展的默默忍耐是现今肠癌患者护理、调理工作面临的窘境。

西医的鞭长莫及、中医的不屑一顾，患者一筹莫展的默默忍耐，是造成患者术后、治疗期、康复期护理、调理不足的主要原因，也是60岁以上肠癌患者治病后身体极度退化，难以恢复到病前身体状态；早早丧失劳动能力和自理能力的重要原因之一；也是它成为正规肠癌群每天解答量最大的护理和调理问题之一。

术后西医一般只会配1-2周的康复新液让患者术后回家泡浴，帮助患者吻合口长好，而一般不会医嘱患者不要提重物，至于像我这一章啰里啰嗦的讲解这么多患者术后确定会遇到、会大概率会遇到的问题的护理和调理方法，去教会患者或家属相应的护理和调理方法；很多的西医也未必懂得肠癌术后患者术后会遇到这么多的护理和调理的问题，基本都要求患者靠身体机能硬扛慢慢的自我恢复正常，很多患者也认为术后几个月大便紊乱很正常，慢慢就会自己好的潜意识依赖心里，也是造成大量的患者术后吻合口反复发炎，直到大便拉出所谓“脓血”或透明的物质，受惊吓之后才到群里求助，或者去手术医院求助，一般西医医生也就是打点消炎针，开点肠炎药，头痛医头脚痛医脚而已，西医也未必懂得中医中药的护理调理方法，西医知道这种术后后遗症情况，西药也缺乏治疗这类反复发作的炎症和大便紊乱的慢性炎症药物可用，所以也就懒得去护理、调理这里慢性炎症护理和调理，在治疗癌症的西医看来，西医一切治疗目就是治疗癌症，似乎不是癌症的病痛都是小病而不太重视。

西医通常针对患者术后经常便秘的患者就开益生菌或者乳果糖，发炎了就开消炎药或者肠炎药，基本没有中药的药膏和栓剂，更不会有传统的凉肠中草药提供；其实中医中药在西医治疗过程和治疗结束之后，给西医做拾遗补缺，做好患者的护理和调理方面大有可为；但是，看到西医手术、放疗、化疗三板斧统治治疗癌症市场之后；自尊心强的中医医生似乎不太重视帮助患者护理和调理这种跟肛门、大便打交道的“小病”，而总是念念不忘参与治疗癌症的大病业务；可惜，中医中药就是不能够杀死一个癌细胞，传统上中医开蛤蟆皮，小蛇，蜈蚣那些所谓“以毒攻毒”偏方治疗癌症的事情，已经被无数的病例证明不单只无效而且还有害。现在在正规的肠癌群里都沦落成一种江湖郎中的一种骗术，去到人人喊打的地步，这几年已经很少很少见正规的中医敢开这种“以毒攻毒”的偏方了。

而群里术后不经常在群学习术后肛门、吻合口护理、调理知识的群友，经常是等到患者大便拉出来透明物体和粘液脓便时，才受惊（以为是原位复发了）进群求救；那时再教他（她）认真的按照我的方法，备用各种护理和调理的药物进行护理和调理，最快起码也得2个月以上才能够彻底调理好；因为肠壁的粘膜层脱落之后失去粘膜层保护的肠壁红肿就是直肠炎，而被湿热的大便侵蚀之后肠壁溃烂就是肠溃疡了，就是在我的指导下进行正确的护理、调理得当，粘膜层长回去就得两个月时间，这个我胃溃疡时要连续服用2个月胃药粘膜层才会长回去，胃炎才能够断根是一个道理的，而经常在群里的患者或家属发现这种苗头就咨询及时采取护理和调理措施的群友，一般快2-3天，慢一周就能够调理好。 

第五节 结合中西医理论，积累的调理经验成功护理、调理上述几种大便紊乱病情之后，写成群文件被验证有效的群友复制广泛传播和模仿，成为调理经典。

我自己结合中西医理论和从小积累的护理和调理经验取得上述几种术后大便紊乱的护理、调理成功经验之后，通过解答在肠癌群里做解答个别指导，经过几年几百群友的模仿取得适应所有患者的经验之后，为了不用每天重复在群里做解答，我把它写成入群必读文件在2000人肠癌群里推广，被成百上千的患者和家属所模仿，《肠癌诊治、护理调理经验集成》文件成为千锤百炼的肠癌就医指南和护理、调理方法方式的经典。

看到我总结提炼的护理、调理方法写成文件被广泛传播之后就可以不用每天解答就能够帮助成千上万的群友；故此才萌发了建一个专门分享肠癌诊治、和护理、调理、康复经验的网站，在原来不断增加的入群必读文件的基础上写成一本肠癌诊治、护理、调理、康复的电子书，等筹集够足够的出版费用之后，再出版纸质书让所有知道这本工具书的患者都能够每个人人手一本，成为肠癌科学诊治路径盲公竹；成为能够解决患者和家属90%以上肠癌护理、调理、康复的准百科全书。根据经验掌握这本书的知识经验的患者能够减少一半以上不必要的痛苦；能够让患者治疗期间更加顺利配合医生治疗，患者能够康复得更快更好；而纸质书能够让占肠癌绝大部分的老年不会上网学习的患者，人手一本自己就可以对号入座的自己处理绝大部分的康复期护理和调理工作，可以极大的解放患者子女家属沉重的护理、调理工作负担和牵挂。

故此，虽然我专业是学mba工商管理专业的，每次一百几十页的商业计划书和行业、市场分析报告，企业管理的各种规章制度和运作程序、员工的培训材料写得不少，但是从来都没有系统的没有写过、出版过一本书；在群友的不断鼓励下，我还是终于动笔尝试写一本肠癌诊治、护理、调理、康复的书，希望通过纸质书的发行和翻译（书还没写就已经有念英文博士的患者家属答应义务帮我翻译成英文书）让天下一切看到这本书的患者或家属，都能够从中学到肠癌的诊治、护理、调理、康复知识；都能够最大限度的顺利完成治疗疗程和像我一样康复到确诊前的身体状态，以完成我这个肠癌康复患者今生最有意义的历史使命。

相关文章 Related posts:

饮食篇(2) - 全国各地患者选用化疗期间食疗-食材的四大原则
饮食篇(3)确诊后治疗期肿瘤患者营养不良的原因和权威专业肿瘤医院西医的调理对策
术后护理 (2)
肠癌康复期复查篇 — 如何看懂血常规、生化复查报告，指导身体调理方向
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