Hemorrhoids

Hemorrhoids are a disease in which there is blood stasis and abnormal changes in the veins of the rectum or in the area surrounding the anus. Such sensitive pathology has no age or gender restrictions.

The fundamental factor that leads to the formation of hemorrhoidal cones is stagnation which, in turn, results from a large number of other predisposing factors.

The pathology is characterized by characteristic symptoms that a person cannot ignore. The most specific clinical signs of hemorrhoids are itching and burning in the anal area, rectal bleeding and severe pain in the perianal region.

The clinician will be able to establish an accurate diagnosis based on a physical examination, but some laboratory and instrumental examinations may also be needed.

The treatment of hemorrhoids directly depends on the severity of the course of the disease, which is why it can be both conservative and surgical.

Because the pathology has several variants, it is coded with several meanings in the International Classification of Diseases.

Etiology

The main reason for the appearance of hemorrhoidal cones is:

• violation of the work of the veins of this organ;
• increased arterial blood flow;
• venous plexus outflow disorder;
• loss of rectal vein tone, leading to their dilation and the appearance of nodules.

In addition, clinicians identify a huge number of adverse factors that lead to the above processes, which is why they are usually divided into several groups - pathological and physiological.

The first category of causes of hemorrhoids includes:

• chronic constipation - hardened feces injures the walls of the rectum and anus;
• severe intoxication of the body - this should include poisoning by alcoholic beverages, toxic and chemical substances, as well as poor quality food;
• abundant diarrhea of an infectious nature;
• formation of malignant, less often benign tumors in the intestine;
• diseases of the pelvic organs, such as prostatitis or cystitis;
• inflammatory diseases of the digestive system;
• hormonal disorders;
• portal hypertension and cirrhosis of the liver, as well as other diseases of this organ. The association of hemorrhoids with the liver is due to the presence of common veins;
• pathological influence of pathogenic bacteria leading to the development of infections.

In addition to diseases and disorders, the causes of hemorrhoids may not be related at all to the presence of one or another disease in the body. Among the physiological factors it is worth noting:

• lack of physical activity - this occurs against the background of a wide range of sources - laziness, severe illness that deprives the patient of the ability to move, as well as specific working conditions under which a person is forced to sit or stand working hours;
• excess weight;
• poor nutrition - this includes the abuse of fatty, spicy foods, smoked meats, sweets, sodas, semi-finished products, fast food and other harmful ingredients. For this reason, diet therapy is one of the components of hemorrhoid treatment;
• non-selective use of drugs, including laxatives or oral contraceptives;
• incorrect performance of proctological diagnostic procedures or enemas;
• unconventional sexual inclinations, namely anal sex;
• prolonged impact of stressful situations;
• performing heavy physical activities;
• engaging in certain sports, in particular cycling or motorcycling, equestrian sports and other types of weightlifting;
• excessive drinking and cigarette smoking;
• the period of childbirth or childbirth;
• menstruation.

Genetic predisposition plays an important role in the development of the disease. Diagnosing a similar pathology in one of the closest relatives greatly increases the likelihood of a bump. Knowing this, you can prevent the onset of the disease on your own, you just need to follow all the rules to prevent hemorrhoids.

Classification

By its clinical nature, the disease is:

• acute - this is the first manifestation of hemorrhoids that has not been previously diagnosed;
• chronic - is characterized by alternating phases of worsening of symptoms and their withdrawal.

Depending on the area of hemorrhoid formation, cavernous pathology is divided into:

• external hemorrhoids - this is the case if a lump appears under the skin of the anus and not under the lining of the rectum. It is considered the rarest form of the disease;
• internal hemorrhoids are the most common type of pathology in which there is the appearance of vascular cones directly in the anal canal;
• mixed hemorrhoids - the second most common type of disease, characterized by the presence of signs of the two forms described above.

In addition, there are types of hemorrhoids divided by severity:

• mild course - symptoms may be completely absent or be insignificant. Conservative methods predominate in therapy;
• moderate - differs in the addition of pain sensations caused by the growth of nodules and their fecal injuries. Internal lumps fall out during the act of defecation, after which they adjust. It is possible to eliminate the disease by minimally invasive methods;
• severe - characterized by the expression of such a sign of hemorrhoids as bleeding. Nodes can fall out not only during bowel emptying, but also in all other situations leading to an increase in intra-abdominal pressure. In such cases, they can only be set manually. Tactics for getting rid of hemorrhoids can include both minimally invasive procedures and extensive surgery;
• complicated - it is expressed by an increase in the symptoms of the disease, and during the diagnosis the development of complications is often observed, one of which may be thrombosis. However, it should be noted that the consequences of untimely treatment of hemorrhoids do not occur in all cases.

Symptoms

The first signs of hemorrhoids can be so small that a person does not pay attention to them. The initial clinical manifestations are considered to be:

• mild discomfort in the anus;
• mild itching of the anal area;
• pain during bowel movements;
• swelling of the entrance to the anal canal.

As the disease progresses, the following symptoms of hemorrhoids begin to manifest:

• tingling and severe itching;
• increased pain, which will occur not only during stool, but also during intense walking or prolonged sitting;
• the appearance of impurities of blood and mucus in the stool. Significantly, pathological clots will not mix with the feces, but are located on it;
• prolapse of the hemorrhoidal nodule, leading to severe pain;
• redness of the skin of the perianal region;
• rectal bleeding - if in the early stages such a sign of hemorrhoids could manifest itself only in the form of lubrication with blood on toilet paper or underwear, then complicated course of bleeding can reach the intensity of the current. This is what often makes a person ask for help.

In addition to specific clinical manifestations, the above symptoms of hemorrhoids may be supplemented by an increase in body temperature, which indicates the progression of the inflammatory process.

Diagnosis

It often happens that when the symptoms of a disease appear, a person does not know which doctor to consult because of hemorrhoids. A proctologist or surgeon is involved in the diagnosis and treatment of hemorrhoids, but you can contact a therapist for the first consultation. It should be borne in mind that if the child has signs, it should be shown immediately to a pediatrician, and if she is pregnant, first consult an obstetrician-gynecologist.

The first phase of diagnosis involves the work of a clinician focused on:

• detailed examination of the patient for the first time signs of hemorrhoids appear - to determine the stage of the disease;
• getting acquainted with the medical history and life history not only of the patient, but also of his relatives - often this is enough to determine the sources why hemorrhoids appear;
• conducting an objective examination aimed at assessing the condition of the perianal region, as well as a digital examination of the rectum, which will allow to distinguish internal from external hemorrhoids and determine the location of the nodule.

The second phase in determining the correct diagnosis are laboratory examinations, ie general, biochemical blood test and coagulogram.

The final part of the diagnosis are instrumental examinations of the patient, which aim to assess the appearance of hemorrhoids and ensure:

• sigmoidoscopy;
• anoscopy;
• colonoscopy;
• contrast radiography;
• Ultrasound of abdominal organs.

Only after studying the results of the examination, the clinician develops tactics on how to cure hemorrhoids in the patient.

Treatment

The treatment regimen will depend on the severity of the disease, but common methods of treating hemorrhoids include:

• use of drugs for local and general effects. In the first case, rectal suppositories, ointments, creams and gels are used, and in the second - tablets to improve blood circulation, strengthen veins and neutralize the accompanying symptoms;
• adherence to a frugal diet - shown for both external and internal hemorrhoids. All recommendations regarding the menu and cooking methods are given by the attending physician;
• minimally invasive hemorrhoid removal techniques;
• open operation;
• use of alternative medicine prescriptions. This should include preparing candles and ointments from natural ingredients at home, as well as decoctions of herbs and herbs, which are used for swallowing or as microclysters and sitz baths.

Among the minimally invasive methods of treating hemorrhoids, it is worth noting:

• introduction of sclerosing substances directly into the node;
• ligation with latex rings;
• infrared and electrocoagulation;
• cryodestruction;
• irritation.

Hemorrhoid removal tactics will be determined at the pathology stage.

With the ineffectiveness of conservative methods, as well as in cases of complicated course of the disease, open surgical operation - hemorrhoidectomy is indicated.

An obstetrician-gynecologist and a pediatrician will ask how to treat hemorrhoids in pregnant women and children.

Possible complications

Neglecting severe clinical manifestations and late treatment of hemorrhoids often leads to the development of the following consequences:

• access to secondary infection;
• spread of the inflammatory process;
• anal sphincter insufficiency;
• heavy bleeding leading to anemia;
• proctitis and paraproctitis;
• blood clot formation;
• anal fissures.

Prevention and prognosis

To prevent the appearance of hemorrhoids, the following prevention rules must be followed:

• lead a healthy and moderately active lifestyle;
• eat properly and balanced;
• strengthen the muscles of the pelvis and abdomen;
• take medication only as directed by your doctor;
• if possible, avoid physical and emotional stress;
• timely deal with constipation and other pathological causes of hemorrhoids;
• make sure your body weight is within normal limits;
• undergo a complete physical examination regularly.

It is impossible to unambiguously answer the question of the prognosis of hemorrhoids, because the outcome depends on several factors - stage and form of the disease, age category, time of onset of treatment of hemorrhoids and compliance with the patient's recommendations of all clinicians.

Often people who have been diagnosed with hemorrhoids wonder if it can go away on its own? The doctor's answer will always be negative - the disease will turn into a chronic form.