Hemorrhoids is an inflammatory disease of the rectum, during which the venous nodes of the internal rectum expand;in some cases, inflamed nodes may fall outward;combined forms of hemorrhoids also occur.
How are hemorrhoids manifested?
Inflammatory processes are often accompanied by bleeding from enlarged venous nodes.With this disease, patients may feel difficulty, burning and itching in the anus, as well as pain during defecation.
Hemorrhoids are a very common pathology of the rectum that affects both men and women.This disease is characterized by a gradual progression;in the absence of timely therapeutic measures, the patient may need emergency help.Statistics show that in a single country, 75% of diagnosed hemorrhoid cases are treated surgically.Surgical interventions can be avoided if you consult a specialist in the initial stages of hemorrhoids.
Etiology and pathogenesis of hemorrhoids
The main etiological factor in the formation of hemorrhoids in the venous accumulation of hemorrhoids is circulatory disturbance, which causes dystrophic changes in the muscle and connective tissues that fix the nodes inside the anal canal.
Factors predisposing to the disease play an important role in the development of hemorrhoids: a sedentary lifestyle, a tendency to bowel disorders (frequent diarrhea or constipation), alcohol abuse and spicy foods.
Hemorrhoids can also be caused by occupational characteristics that require prolonged sitting (pilots, drivers and others).In addition to these factors, the development of the disease can also be caused by certain sports (weightlifting, horse riding, cycling).
In the female population, hemorrhoids are often a consequence of pregnancy and childbirth.
Classification and symptoms of hemorrhoids
When establishing a diagnosis, specialists use the classification of hemorrhoids with regard to the localization of the pathological process.According to this classification, hemorrhoids have three forms: external (external), internal and combination (mixed form).Internal hemorrhoids are often the result of the expansion of the internal rectal hemorrhoidal plexuses, and external hemorrhoids are mainly formed from the subcutaneous venous plexus of the anus.The combined form of hemorrhoids means the presence of internal and external hemorrhoids.
Internal hemorrhoids
Despite the stereotype of domestic medicine in the field of proctology, most foreign specialists believe that internal hemorrhoids are a necessary condition for the diagnosis of hemorrhoids;based on such considerations, the concept of isolated external hemorrhoids does not exist in foreign medical practice.Therefore, the individual hemorrhoids are called "skin tags" or "anal fimbriae".
Combined hemorrhoids
Combined hemorrhoids develop when internal hemorrhoid plexuses extend beyond the anal canal and merge with the saphenous veins.These concepts are quite reasonable and modern, but they are not currently universally accepted.
According to the nature of the course, acute and chronic hemorrhoids are distinguished, which are actually stages of a disease.
The clinical picture of hemorrhoids is presented in four stages:
- The first stage of hemorrhoids means the presence of bloody discharge from the anus, which has a characteristic scarlet color and periodic manifestations;
- Hemorrhoids II.stage is characterized by prolapse and self-reduction of the hemorrhoids.Bleeding does not always occur;
- The progress of the third stage of hemorrhoids is indicated by the following signs: the presence of prolapsed hemorrhoids that cannot be reduced by themselves;reduction must be done manually.Bleeding may or may not be present;
- stage, repositioning the prolapsed hemorrhoid becomes impossible.
Symptoms of hemorrhoids
The symptoms of hemorrhoids depend on their form.In acute hemorrhoids, the clinical symptom is thrombosis of the external hemorrhoid or prolapse of the internal thrombosed nodes.
In the process of thrombosis of the hemorrhoids, they become significantly larger, and the patient feels rather intense proctalgia (pain in the anus), which increases with defecation.
The main clinical manifestations of chronic hemorrhoids are: burning and itching in the perianal area, episodic bleeding from the anus, periodic hemorrhoid prolapse.With loose closure of the anal sphincter and frequent prolapse of hemorrhoids from the anus, a transparent mucous discharge may appear.
A very common symptom of hemorrhoids is bleeding from the anus.10% of the world's population periodically experience bleeding from the anus, and 70-80% of examined patients with this complaint are found to have hemorrhoids.Unfortunately, the majority of people with such symptoms do not seek medical help, since the bleeding is small and intermittent, which in itself increases the health risk, since it is possible to avoid surgical intervention in the early stages of hemorrhoids.Some patients come to the proctologist embarrassed or afraid of the examination methods.
Bleeding usually occurs during bowel movements.It can be blood marks on the paper or a splash of scarlet red during the straining.Blood can also come out of the stool in the form of dark clots if it remains in the rectum after the previous bowel movement.
Symptoms of chronic hemorrhoids
The chronic form of hemorrhoids with long-standing internal hemorrhoids is characterized by outward prolapse of these nodules.Initially, node prolapse occurs after a bowel movement or straining.As the disease progresses, nodes may fall out even when sneezing or coughing, they cease to retract on their own, and manual reduction becomes necessary.In the absence of treatment, manual reduction is not possible, the prolapse of the nodes becomes permanent.Prolapsed nodes are prone to thrombosis and cause severe discomfort to the patient.
The clinical symptom of hemorrhoids is often anal itching, which is caused by constant irritation of the skin of the anus with secretions.
Diagnosis of hemorrhoids
The diagnosis of hemorrhoids is quite simple and consists of several procedures.After collecting the patient's medical history, the doctor performs a proctological examination.This examination can be performed in different positions of the patient - lying on the left side, on the back, in a gynecological chair, or in the knee-elbow position.Most often, lying on the left side is preferred because it is the most comfortable for the patient, but the doctor may recommend different positions for different purposes of the examination.
Examination of the perianal area
At the beginning of the proctological examination, the patient's bottom is carefully stretched, and the doctor examines the perianal area in a relaxed, tense state.In this case, prolapsed and external hemorrhoids, changes in the skin of the anus, ulcers and anal fissures can be identified.After the examination, a palpation of the perianal area is carried out, which makes it possible to identify pain and inflammatory seals.
Finger examination
A very important step in the proctological diagnosis is the digital examination of the rectum.The process of the study does not require special instrumentation and seems quite simple.But despite the simplicity of implementation, this type of examination is very informative.A digital examination allows you to obtain information about the condition of the walls of the rectum and anus, the presence of tumors or hemorrhoids, muscle tone, the pelvic cavity and nearby organs (prostate, uterus).About 80-90% of the data obtained during the digital examination can be fully compared with the results of subsequent instrumental examinations.
Anoscopy
In order to confirm the data obtained during the above examinations, the patient must undergo anoscopy.Anoscopy is an examination of the anal canal and is the most informative method for diagnosing hemorrhoids, which is performed using special tubes of various designs.The anoscope is made in the form of a small tube, 8-12 cm long, equipped with a strong light source.Anoscopes can be disposable or reusable, beveled or straight-ended, and have side windows for viewing.
The anoscope is not only used in the diagnostic process, but is also an integral part of many surgical procedures.During the anoscopy, the size, number, location, changes (inflammation, bleeding, erosion) of the internal hemorrhoids can be determined, and the degree of mobility and prolapse can be assessed.
Sigmoidoscopy
In order to make an accurate diagnosis and to identify simultaneous pathologies of the rectum and colon (polyps, tumors, ulcerative changes, various forms of colitis, diverticula), the patient must undergo a sigmoidoscopy (rigid sigmoidoscopy).This examination method allows for a complete examination of the rectum and part of the sigmoid colon (20-30 cm).
Differential diagnosis
An important step in the diagnosis of hemorrhoids is the differential diagnosis, the purpose of which is to rule out other diseases with clinical manifestations similar to hemorrhoids.Such pathologies include:
- rectal cancer;
- colon and rectal cancer;
- acute and chronic form of anal fissure;
- villous tumors of the rectum;
- rectal fistulas;
- rectal prolapse;
- Crohn's disease;
- non-specific ulcerative colitis;
- proctitis (after infection, radiation, etc.);
- solitary rectal ulcer;
- endometriosis;
- prolapse of hypertrophic anal papillae.
For the purpose of differential diagnosis, the doctor may prescribe several additional tests (irrigography, colonoscopy, ultrasound, CT).
Treatment of varicose veins
Treatment methods for hemorrhoids depend on the extent of the disease and the presence of concomitant pathologies.In the initial stages of hemorrhoids, conservative therapy is often sufficient.In addition, in the first stage of hemorrhoids, healing is possible with the help of sclerotherapy or electrocoagulation.In the second and third stages of hemorrhoids, it is advisable to use a bandage (latex ring bandage or suture bandage).In the third stage of hemorrhoids, the Longo transanal resection technique is considered a productive treatment method.Hemorrhoidectomy (surgical excision of the hemorrhoid) is an indication for the fourth stage of hemorrhoids.In the acute period of the disease, only conservative therapy is recommended.
Conservative type of treatment
Conservative treatment of hemorrhoids is aimed at eliminating or alleviating clinical manifestations and alleviating the acute process.At this stage of the treatment, the patient is prescribed a diet to normalize the stool.In some cases, the use of laxatives is recommended.The patient is also prescribed medications that help strengthen the vein walls.The complex of conservative methods for the treatment of hemorrhoids includes the prescription of ointments and rectal suppositories with pain-relieving, healing, anti-inflammatory, local blood flow-improving and hemostatic effects.
In case of severe bleeding, the patient may be prescribed increased blood thinners.
Treatment of internal and external hemorrhoids in later stages
Patients with stages 2, 3 and 4 should be aware that conservative treatment is temporary and that more effective procedures and surgical interventions will definitely be required.
Hemorrhoidectomy performed in the later stages means the removal of the hemorrhoid, during which the complete excision of the venous plexuses is performed, which eliminates the possibility of relapses.
In most cases, hemorrhoids do not require emergency intervention (except for heavy bleeding with severe anemia), so the patient has the right to independently choose the treatment methods recommended by the doctor.Only after an examination, a doctor can determine how to treat one or another stage of hemorrhoids.Since hemorrhoids cause a lot of trouble and constant discomfort, their symptoms are unpleasant and painful, patients often willingly agree to get rid of this disease with the help of radical treatment methods.The price of hemorrhoid treatment in specialized clinics also depends on the advanced stage of the process, so the best solution for the patient is to treat hemorrhoids immediately after diagnosis.
The prognosis of this disease depends on its stage, but is favorable in almost all cases.
Prevention of hemorrhoids
The basis of the prevention of hemorrhoids is the prevention or elimination of factors that contribute to the disturbance of blood flow in the vessels of the rectum, as well as the normalization of the digestive system.
It is important to immediately treat the diseases, the clinical manifestations of which can be diarrhea and constipation, as well as the normalization and rationalization of nutrition.
In order to prevent hemorrhoids, it is necessary to carry out regular hygiene procedures, thoroughly clean the anus after defecation, use soft type of paper, if necessary, refuse to use toilet paper and wash the anus at room temperature.
Sedentary people should incorporate exercise into their daily routine and walk more.At the first symptoms of hemorrhoids, all heavy physical activity should be avoided.