Hemorrhoids are an inflammatory disease of the rectum, in which the internal venous nodes of the rectum expand.In some cases, inflamed nodes may protrude outward.combined forms of hemorrhoids also occur.
How do hemorrhoids manifest?
Often inflammatory processes are accompanied by bleeding from dilated venous nodes.With this disease, patients may feel heaviness, burning and itching in the anus and pain during bowel movements.
Hemorrhoids are a very common pathology of the rectum, affecting both men and women.This disease is characterized by gradual development.in the absence of timely therapeutic measures, the patient may need urgent help.Statistics show that in one country alone, 75% of cases of diagnosed hemorrhoids undergo surgical treatment.Surgery can be avoided if you contact a specialist at the initial stage of hemorrhoids.
Etiology and pathogenesis of hemorrhoids
The main causative factor in the development of hemorrhoids is circulatory dysfunction in hemorrhoidal venous accumulations, which causes dystrophic changes in the muscular and connective structures that secure the nodes inside the anal canal.
Factors that predispose to this disease play an important role in the development of hemorrhoids: sedentary lifestyle, tendency to bowel disorders (frequent diarrhea or constipation), abuse of alcohol 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 this disease can be caused by certain sports (weightlifting, horse riding, cycling).
In the female population, hemorrhoids are quite often a consequence of pregnancy and childbirth.
Classification and symptoms of hemorrhoids
In the process of diagnosis, experts use the classification of hemorrhoids in relation to the localization of the pathological process.According to this classification, there are three forms of hemorrhoids: external (external), internal and combined (mixed form).Often, internal hemorrhoids are the result of an extension of the internal hemorrhoidal plexus of the rectum, and external hemorrhoids are formed mainly from the subcutaneous venous plexus of the anus.The combined form of hemorrhoids implies the presence of internal and external hemorrhoids.
Internal hemorrhoids
Despite the established stereotype of domestic medicine in the field of proctology, most foreign experts believe that internal hemorrhoids are a necessary condition for the diagnosis of hemorrhoids.based on such considerations, in foreign medical practice there is no concept of individual external hemorrhoids.Therefore, individual hemorrhoids are called "skin tags" or "anal fibrils."
Combined hemorrhoids
Combined hemorrhoids develop when internal hemorrhoidal plexuses spread beyond the anal canal and merge with the saphenous veins.These concepts are quite logical and modern, but at the moment they are not generally accepted.
Depending on the nature of the course, acute and chronic hemorrhoids are distinguished, which, in fact, are stages of a 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 of hemorrhoids is characterized by prolapse of hemorrhoids and their self-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 themselves;their reduction must be done manually.Bleeding may also be present or absent.
- in stage IV, repositioning prolapsed hemorrhoids becomes impossible.
Symptoms of hemorrhoids
The symptoms of hemorrhoids depend on their form.In acute hemorrhoids the clinical sign is thrombosis of external hemorrhoids or prolapse of internal thrombosed nodules.
In the process of thrombosis of hemorrhoids, they enlarge significantly, and the patient feels quite intense proctalgia (pain in the anus), which intensifies 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 prolapse of hemorrhoids from the anus, transparent mucous discharge may occur.
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 examined patients with such a complaint turn out to have hemorrhoids.Unfortunately, the majority of people with such symptoms do not seek medical help, as the bleeding is minimal and periodic, which in itself increases the threat to their health, because in the early stage of hemorrhoids there is a chance to avoid surgery.Some patients are embarrassed to see a proctologist or are afraid of the examination methods.
Typically, bleeding occurs during bowel movements.This can be traces of blood on paper or splashes of red blood during stretching.Blood can also pass in the stool as dark clots if it remains in the rectum after a previous bowel movement.
Symptoms of chronic hemorrhoids
The chronic form of hemorrhoids with long-term internal hemorrhoids is characterized by prolapse of these nodes to the outside.Initially, prolapse of nodes occurs after defecation or stretching.As the disease progresses, nodes may fall out even when sneezing or coughing, stop contracting on their own, and manual reduction becomes necessary.In the absence of treatment, manual reduction is not possible and prolapse of nodes 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 the constant irritation of the skin of the anus with secretions.
Diagnosis of hemorrhoids
Diagnosing 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, as in a gynecological chair or in the knee-elbow position.Most often, the position on the left side is preferred because it is the most comfortable for the patient, but for different purposes of the examination the doctor may suggest different positions.
Examination of the perianal area
At the beginning of the rectal examination, the patient's buttocks are carefully spread, the doctor examines the perianal area in a state of rest and tension.In this case, it is possible to identify prolapse and external hemorrhoids, lesions of 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 areas of pain and inflammatory seals.
Finger examination
A very important stage in proctological diagnosis is the digital examination of the rectum.The procedure of this study does not require the use of a special instrument and seems quite simple.But, despite the simplicity of execution, this type of examination is very informative.A digital examination allows you to get information about the condition of the rectum and anal walls, the presence of neoplasms or hemorrhoids, muscle tone, the pelvic cavity and nearby organs (prostate, uterus).About 80-90% of the data obtained from a digital examination are fully comparable with the results of subsequent organic studies.
Review
To confirm the data obtained during the above studies, it is recommended that the patient undergo anoscopy.Anoscopy is an examination of the anal canal and the most informative method for diagnosing hemorrhoids, which is carried out using special tubes of a different design.The anoscope is made in the form of a small tube, the length of which is 8-12 cm, equipped with a bright light source.Anoscopes can be disposable or reusable, with a beveled or straight tip, and can also have a side window for viewing.
Anoscope is not only used in the diagnostic process, it is also an integral part of many surgical procedures.During anoscopy, you can determine the size, number and location of internal hemorrhoids, their changes (inflammation, bleeding, erosion), as well as assess mobility and the degree of prolapse.
Sigmoidoscopy
In order to make an accurate diagnosis and detect concomitant pathologies of the rectum and colon (polyps, tumors, ulcerative lesions, various forms of colitis, diverticulitis), the patient must undergo a sigmoidoscopy (rigid sigmoidoscopy).This method of examination allows you to examine the entire 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:
- 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.)
- isolated rectal ulcer;
- endometriosis?
- prolapse of hypertrophic anal papillae.
For the purposes of differential diagnosis, the doctor may prescribe several additional studies (anerography, colonoscopy, ultrasound, computed tomography).
Treatment of hemorrhoids
Treatment methods for hemorrhoids depend on the degree of the disease and the presence of accompanying pathologies.In the initial stage of hemorrhoids, conservative treatment is often sufficient.Also, in the first stage of hemorrhoids, treatment is possible with the help of sclerotherapy or electrocoagulation.For the second and third stage of hemorrhoids, it is recommended to apply ligation (ligation with latex rings or ligation with sutures).In the case of the third stage of hemorrhoids, the Longo peranal excision technique is considered a productive method of treatment.Hemorrhoidectomy (surgical removal of hemorrhoids) is an indication for the fourth stage of hemorrhoids.In the acute period of the disease, only conservative treatment is indicated.
Conservative type of treatment
Conservative treatment of hemorrhoids is aimed at eliminating or alleviating clinical manifestations and mitigating 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.The patient is also prescribed drugs 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 analgesic, healing, anti-inflammatory, improving local blood flow and hemostatic effect.
In case of severe bleeding, the patient may be prescribed enhanced hemostatic agents.
Treatment of internal and external hemorrhoids in later stages
Patients with stages 2, 3 and 4 should know that conservative treatment is temporary and in any case will require more effective procedures and surgical interventions.
Performed in the last stages, hemorrhoidectomy involves the removal of hemorrhoids, during which a complete excision of the venous plexus is performed, which eliminates the possibility of recurrences.
In most cases, hemorrhoids do not require emergency interventions (except for heavy bleeding with severe anemia), so the patient has the right to independently choose one of the treatment methods recommended 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, their symptoms are unpleasant and painful, patients often willingly agree to get rid of this disease with the help of radical treatment methods.Prices for the treatment of hemorrhoids in specialized clinics also depend on the advanced stage of the process, so the best option for the patient is to treat hemorrhoids immediately after diagnosis.
The prognosis of 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 the factors that contribute to the dysfunction of the blood flow in the vessels of the rectum, as well as the normalization of the digestive tract.
It is important to treat diseases in a timely manner, the clinical manifestations of which can be diarrhea and constipation, as well as to normalize and rationalize the diet.
To prevent hemorrhoids, it is necessary to carry out regular hygiene procedures, thoroughly clean the anus after defecation, use soft types of paper if necessary, refuse to use toilet paper and wash the anus with water at room temperature.
Sedentary people should incorporate physical exercise into their daily routine and walk more.At the first symptoms of hemorrhoids, you should avoid any vigorous physical activity.