Hemorrhoids are an inflammatory disease of the rectum, during which the internal rectal venous nodes expand;in some cases, inflamed nodes may prolapse outward;combined forms of hemorrhoids also occur.
How do hemorrhoids manifest?
Inflammatory processes are often accompanied by bleeding from enlarged 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, which affects both men and women.This disease is characterized by a gradual progression;in the absence of timely therapeutic measures, the patient may require emergency assistance.Statistics show that in one country 75% of cases of diagnosed hemorrhoids undergo surgical treatment.Surgical interventions can be avoided if you consult a specialist in the initial stage of hemorrhoids.
Etiology and pathogenesis of hemorrhoids
The main etiological factor in the formation of hemorrhoids is circulatory dysfunction in hemorrhoidal venous clusters, which causes dystrophic changes in the muscle 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 food.
Hemorrhoids can also be caused by work characteristics that require prolonged sitting (pilots, drivers, etc.).In addition to these factors, the development of this disease can also be caused by certain sports (weightlifting, 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 establishing a diagnosis, experts use the classification of hemorrhoids with regard to the localization of the pathological process.According to this classification, three forms of hemorrhoids are distinguished: external (external), internal and combined (mixed form).Internal hemorrhoids are often the result of the expansion of the internal rectal hemorrhoidal plexus, and external hemorrhoids mostly arise 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 specialists believe that internal hemorrhoids are a necessary condition for diagnosing hemorrhoids;based on such considerations, there is no concept of isolated external hemorrhoids in foreign medical practice.Therefore, individual hemorrhoids are called "skin seals" or "anal fimbriae".
Combined hemorrhoids
Combined hemorrhoids occur when internal hemorrhoidal plexuses extend beyond the anal canal and join the saphenous veins.These concepts are quite reasonable and modern, but they are not currently widely accepted.
According to the nature of the flow, acute and chronic hemorrhoids are distinguished, which are, in fact, stages of one 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 crimson 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
Symptoms of hemorrhoids depend on their shape.In acute hemorrhoids, the clinical sign is thrombosis of external hemorrhoids or prolapse of internal thrombosed nodes.
In the process of thrombosis, the hemorrhoids increase 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, 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, 70-80% of examined patients with such complaints turn out to have hemorrhoids.Unfortunately, most people with these symptoms do not seek medical help, because bleeding is scarce and periodic, which in itself increases the risk to health, because in the early stages of hemorrhoids there is a chance to avoid surgical intervention.Some patients are ashamed of going to a proctologist or are afraid of examination methods.
Bleeding usually occurs during bowel movements.It can be traces of blood on paper or splashes of crimson blood during exertion.Blood can also come out 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 the prolapse of these nodes to the outside.Initially, prolapse of nodes occurs after defecation or straining.As the disease progresses, nodes may fall out even during 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.Nodes that fall out are prone to thrombosis and cause severe discomfort to the patient.
Often, the clinical sign of hemorrhoids is anal itching, the cause of which is 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 history, the doctor performs a proctological examination.This examination can be performed in different positions of the patient - lying on her left side, on her back, as in a gynecological chair, or in the knee and 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 different purposes of the examination, the doctor may suggest different positions.
Examination of the perianal area
At the beginning of the proctological 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 prolapsed 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 process of this study does not require the use of special instrumental equipment and seems quite simple.But, despite the simplicity of execution, this type of review is very informative.A digital examination allows you to get information about the condition of the rectum and anus walls, the presence of neoplasms or hemorrhoids, muscle tone, pelvic cavity and nearby organs (prostate, uterus).About 80-90% of the data obtained by digital examination are fully comparable with the results of subsequent instrumental studies.
Anoscopy
In order to confirm the data obtained during the above studies, 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 various designs.The anoscope is made in the form of a small tube, the length of which is 8-12 cm, equipped with a source of strong illumination.Anoscopes can be single-use or reusable, beveled or straight-ended, and may have a side viewing window.
The anoscope is used not only in the diagnostic process, but is also an integral part of many surgical interventions.During anoscopy, you can determine the size, number and location of internal hemorrhoids, their changes (inflammation, bleeding, erosions), as well as assess the mobility and degree of prolapse.
Sigmoidoscopy
In order to make an accurate diagnosis and identify accompanying pathologies of the rectum and colon (polyps, tumors, ulcerative lesions, various forms of colitis, diverticula), the patient must undergo a 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 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 hypertrophied anal papillae.
For the purpose of differential diagnosis, the doctor may prescribe several additional studies (irrigography, colonoscopy, ultrasound, CT).
Treatment of hemorrhoids
Methods of treatment of hemorrhoids depend on the degree of the disease and the presence of accompanying pathologies.In the initial stage of hemorrhoids, conservative therapy is often sufficient.Also, in the first stage, hemorrhoids can be cured with the help of sclerotherapy or electrocoagulation.For the second and third stage of hemorrhoids, it is recommended to apply ligatures (ligation with latex rings or ligation with sutures).In the case of the third stage of hemorrhoids, the Longo technique of transanal resection is considered a productive method of treatment.Hemorrhoidectomy (surgical removal of hemorrhoids) is an indication for stage four hemorrhoids.In the acute period of the disease, only conservative therapy is indicated.
Conservative type of treatment
Conservative treatment of hemorrhoids is aimed at removing or alleviating clinical manifestations and alleviating the acute process.In this phase 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, medicinal, anti-inflammatory, improving local blood flow and hemostatic effect.
In case of severe bleeding, the patient may be prescribed enhanced haemostatics.
Treatment of internal and external hemorrhoids in the later stages
Patients with stages 2, 3 and 4 should be aware that conservative treatment is temporary and will in any case require more effective procedures and surgical interventions.
Performed in the later stages, hemorrhoidectomy implies the removal of hemorrhoids, during which a complete excision of the venous plexus is performed, thus eliminating the possibility of recurrence.
In most cases, hemorrhoids do not require emergency intervention (except for profuse bleeding with severe anemia), so the patient has the right to independently choose one of the treatment methods suggested by the doctor.Only a doctor after an examination can determine how to treat hemorrhoids in one or another stage.Since hemorrhoids cause a lot of trouble and constant discomfort, its symptoms are unpleasant and painful, patients often willingly agree to get rid of this disease with the help of radical treatment methods.The prices for treating 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 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 vessels of the rectum, as well as the normalization of the digestive tract.
It is important to timely treat diseases whose clinical manifestations can be diarrhea and constipation, and to normalize and rationalize nutrition.
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 toilet anus with water at room temperature.
People who lead a sedentary lifestyle must include physical activity in their daily routine and walk more.At the first symptoms of hemorrhoids, you should avoid all heavy physical activities.