Hemorrhoids is an inflammatory disease of the rectum, in which internal rectal venous nodes develop;in some cases, inflamed nodes may prolapse outward;combined forms of hemorrhoids also occur.
How are hemorrhoids real?
Often the inflammatory process is accompanied by bleeding from an enlarged venous node.With this disease, patients may feel heaviness, burning and itching in the anus and pain during defecation.
Hemorrhoids are a very common rectal pathology, which affects both men and women.The disease is characterized by gradual development;in the absence of timely therapeutic measures, the patient may require emergency assistance.Statistics show that in one country, 75% of diagnosed hemorrhoid cases are subject to surgical treatment.Surgical intervention can be avoided if you contact a specialist at an early stage of hemorrhoids.
Etiology and pathogenesis of hemorrhoids
The main etiological factor in the development of hemorrhoids is circulatory dysfunction in the collection of hemorrhoidal veins, which causes dystrophic changes in the structure of the muscles and connective tissue that secures the nodes in the anal canal.
An important role in the development of hemorrhoids is played by factors predisposing to this disease: an inactive lifestyle, a tendency to bowel disorders (frequent diarrhea or constipation), abuse of alcohol and spicy food.
Hemorrhoids can also be caused by job characteristics that require prolonged sitting (pilots, drivers, etc.).In addition to these factors, the development of this disease can be caused by certain sports (heavy lifting, horse riding, cycling).
In the female population, hemorrhoids are often the result of pregnancy and childbirth.
Classification and symptoms of hemorrhoids
In the process of making a diagnosis, experts use the classification of hemorrhoids based on the localization of the pathological process.According to this classification, there are three forms of hemorrhoids: external (external), internal and combined (mixed form).Most often, internal hemorrhoids are the result of the expansion of the internal rectal hemorrhoidal plexus, and external hemorrhoids are mainly formed from the rectal subcutaneous venous plexus.The combined form of hemorrhoids implies the presence of internal and external hemorrhoids.
Internal hemorrhoids
Despite the stereotypes of domestic medicine in the field of proctology, most foreign experts believe that internal hemorrhoids are a necessary condition for making a diagnosis of hemorrhoids;based on such considerations, in foreign medical practice there is no concept of isolated external hemorrhoids.Therefore, single hemorrhoids are called "skin tags" or "anal fimbriae".
Combined hemorrhoids
Combined hemorrhoids develop when the internal hemorrhoidal plexus spreads outside the anal canal and joins the saphenous vein.These concepts are quite reasonable and modern, but currently they are not generally accepted.
According to the nature of the course, acute and chronic hemorrhoids are distinguished, which, in fact, is the first stage of the disease.
The clinical picture of hemorrhoids is presented in four stages:
- The first stage of hemorrhoids implies the presence of bloody discharge from the anus, which has a characteristic red color and periodic manifestations;
- Stage II hemorrhoids are characterized by prolapse of the hemorrhoids and their reduction.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 itself;their reduction must be done manually.Bleeding may or may not be present;
- in stage IV, repositioning prolapsed hemorrhoids becomes impossible.
Symptoms of hemorrhoids
Symptoms of hemorrhoids depend on their form.In acute hemorrhoids, the clinical signs are external hemorrhoidal thrombosis or internal thrombosed node prolapse.
In the process of thrombosis of hemorrhoids, they grow significantly, and the patient feels a 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 prolapse of hemorrhoids.With loose closure of the anal sphincter and frequent hemorrhoids from the anus, transparent mucus 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, 70-80% of patients examined with such complaints turn out to have hemorrhoids.Unfortunately, the majority of people with such symptoms do not seek medical help, because the bleeding is small and periodic, which in itself increases the threat to their health, because in the early stages of hemorrhoids there is an opportunity to avoid surgical intervention.Some patients are embarrassed to see a proctologist or are afraid of the examination method.
Usually, bleeding occurs during a bowel movement.This may be blood stains on the paper or splashes of red blood during straining.Blood may also come out in the stool in the form of dark clots if it remains in the rectum after a previous bowel movement.
Symptoms of chronic hemorrhoids
The chronic form of hemorrhoids with long-standing internal hemorrhoids is characterized by the prolapse of these nodes to the outside.Initially, node prolapse occurs after defecation or straining.As the disease progresses, nodes may fall off even when sneezing or coughing, stop retracting on their own, and manual reduction becomes necessary.In the absence of treatment, manual reduction is not possible, and node prolapse becomes permanent.Prolapsed nodes are prone to thrombosis and cause severe discomfort to the patient.
Often the clinical sign of hemorrhoids is itching of the anus, the cause of which is constant irritation of the skin of the anus with secretions.
Diagnosis of hemorrhoids
Diagnosis of hemorrhoids is quite simple and consists of several procedures.After collecting the patient's medical history, the doctor conducts a proctological examination.This examination can be carried out in different patient positions - lying on the left side, on the back, as in a gynecological chair, or in a knee-elbow position.Most often, preference is given to the position lying on the left side, because it is the most comfortable for the patient, but for the purpose of different examinations the doctor may suggest a different position.
Examination of the perianal area
At the beginning of the proctological examination, the patient's back is carefully spread, the doctor examines the perianal area in a state of rest and tension.In this case, it is possible to identify prolapsed and external hemorrhoids, wounds on the skin of the anus, ulcers and anal fissures.After the examination, a palpation examination of the perianal area is carried out, which allows you to identify the area of \u200b\u200bpain and seal inflammation.
Finger check
A very important stage in the diagnosis of proctology is the digital examination of the rectum.The process of this study does not require the use of special instrumental equipment and seems quite simple.But, despite the simplicity of implementation, this type of examination is very informative.Digital examination allows you to get information about the condition of the rectum and anal wall, the presence of neoplasms or hemorrhoids, muscle tone, pelvic cavity and nearby organs (prostate, uterus).About 80-90% of the data obtained from the digital examination is fully comparable to the results of subsequent instrumental studies.
Anoscopy
To confirm the data obtained during the above study, the patient is recommended to undergo anoscopy.Anoscopy is an examination of the anal canal and the most informative method for diagnosing hemorrhoids, which is performed using special tubes of different designs.Anoscope is made in the form of a small tube, 8-12 cm long, equipped with a bright lighting source.Anoscopes can be disposable or reusable, with beveled or straight ends, and they can also have side windows for viewing.
Anoscope is used not only in the diagnostic process, it is also part of many surgical interventions.During anoscopy, you can determine the size, number and location of internal hemorrhoids, their changes (inflammation, bleeding, erosion), as well as assess the mobility and degree of prolapse.
Sigmoidoscopy
To make an accurate diagnosis and identify concomitant pathologies of the rectum and colon (polyps, tumors, ulcerative lesions, various forms of colitis, diverticula), patients must undergo sigmoidoscopy (rigid sigmoidoscopy).This method of examination allows you to fully examine the rectum and part of the sigmoid colon (20-30 cm).
Differential diagnosis
An important stage in the diagnosis of hemorrhoids is the differential diagnosis, the purpose of which is to exclude other diseases that have clinical manifestations similar to hemorrhoids.Such pathologies include:
- anal cancer;
- colon and rectal cancer;
- acute and chronic forms of anal fissure;
- rectal villi tumor;
- rectal fistula;
- rectal prolapse;
- Crohn's disease;
- non-specific ulcerative colitis;
- proctitis (after infection, radiation, etc.);
- solitary rectal ulcer;
- endometriosis;
- hypertrophied anal papilla prolapse.
For the purpose of differential diagnosis, the doctor may prescribe some additional studies (irrigography, colonoscopy, ultrasound, CT).
Hemorrhoid treatment
Treatment methods for hemorrhoids depend on the stage of the disease and the presence of concomitant pathology.In the early stages of hemorrhoids, conservative therapy is often sufficient.Also, in the first stage of hemorrhoids, healing is possible with the help of sclerotherapy or electrocoagulation.For the second and third stage of hemorrhoids, it is advisable to apply a ligature (ligation with a latex ring or suture ligation).In the case of third-degree hemorrhoids, Longo's transanal resection technique is considered a productive treatment method.Hemorrhoidectomy (hemorrhoid removal surgery) is an indication for stage four hemorrhoids.In the acute period of the disease, conservative therapy is exclusively indicated.
Conservative type of treatment
Conservative treatment of hemorrhoids aims to eliminate or reduce clinical manifestations and weaken the acute process.At this stage of treatment, the patient is prescribed a diet to normalize the stool.In some cases, the use of laxatives is recommended.Patients are also given medication that helps strengthen the vein walls.The complex of conservative methods for treating hemorrhoids includes the prescription of rectal ointments and suppositories with analgesic, healing, anti-inflammatory, increasing local blood flow and hemostatic effects.
In case of severe bleeding, the patient may be prescribed an enhanced hemostatic agent.
Treatment of internal and external hemorrhoids at a later stage
Patients with stages 2, 3 and 4 should be aware that conservative treatment is temporary and in any case requires more effective surgical procedures and interventions.
Performed at a later stage, hemorrhoidectomy involves the removal of hemorrhoids, where complete isolation of the venous plexus is performed, which eliminates the possibility of recurrence.
In most cases, hemorrhoids do not require emergency intervention (except for heavy bleeding with severe anemia), so the patient has the right to freely choose one of the treatment methods suggested by the doctor.Only a doctor after an examination can determine how to treat hemorrhoids at one stage or another.Since hemorrhoids cause many problems and constant discomfort, the symptoms are unpleasant and painful, patients often voluntarily agree to get rid of this disease with the help of radical treatment methods.The price for hemorrhoid treatment in a specialized clinic also depends on the advanced stage of the process, so the best option for patients is to treat hemorrhoids immediately after diagnosis.
The prognosis for this disease depends on its stage, but in almost all cases it is favorable.
Prevention of hemorrhoids
The basis for the prevention of hemorrhoids is the prevention or elimination of factors that contribute to the dysfunction of blood flow in the rectal tract, as well as the normalization of the digestive tract.
It is important to treat the disease immediately, clinical manifestations that may be diarrhea and constipation, and to normalize and rationalize nutrition.
To avoid hemorrhoids, it is necessary to carry out normal hygiene procedures, clean the anus thoroughly after defecation, use a soft type of paper, if necessary, refuse to use toilet paper and toilet anus by washing with water at room temperature.
People who lead a sedentary lifestyle should include physical exercise in their daily routine and walk more.At the first symptom of hemorrhoids, you should avoid all strenuous physical activity.