Hemorrhoids are an inflammatory disease of the rectum in which the internal rectal venous nodes dilate;in some cases the inflamed nodes may protrude outwards;Combined forms of hemorrhoids also occur.
How do hemorrhoids manifest themselves?
Inflammatory processes are often accompanied by bleeding from enlarged venous nodes.With this condition, patients may experience heaviness, burning and itching in the anus, as well as pain during bowel movements.
Hemorrhoids are a very common rectal disease that affects both men and women.This disease is characterized by a gradual progression;If timely therapeutic measures are not taken, the patient may need emergency assistance.Statistics show that in a single country, 75% of cases of diagnosed hemorrhoids require surgical treatment.Surgical intervention can be avoided if you contact a specialist at the initial stage of hemorrhoids.
Etiology and pathogenesis of hemorrhoids
The main etiological factor in the development of hemorrhoids is impaired blood circulation in the hemorrhoidal venous collections, which provokes dystrophic changes in the muscular and connective tissue structures that hold the nodes in the anal canal.
An important role in the development of hemorrhoids is played by factors that predispose to this disease: a sedentary lifestyle, a tendency to intestinal 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 (weight lifting, horse riding, cycling).
In the female population, hemorrhoids are often a result of pregnancy and childbirth.
Classification and symptoms of hemorrhoids
When making a diagnosis, specialists use the classification of hemorrhoids in terms of the localization of the pathological process.According to this classification, there are three forms of hemorrhoids: external (external), internal and combination (mixed form).Often, internal hemorrhoids are the result of dilation of the internal rectal hemorrhoid plexus, while external hemorrhoids arise primarily 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 the diagnosis of hemorrhoids;Due to these considerations, there is no concept of isolated external hemorrhoids in foreign medical practice.Therefore, individual hemorrhoids are called “skin tags” or “anal fimbriae.”
Combined hemorrhoids
Combined hemorrhoids occur when the internal hemorrhoid plexuses extend beyond the anal canal and fuse with the saphenous veins.These concepts are quite reasonable and modern, but are not currently widely accepted.
Depending on the type of course, a distinction is made between acute and chronic hemorrhoids, which are actually 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 scarlet color and periodic manifestations;
- Stage II of hemorrhoids is characterized by prolapse of the hemorrhoids and their self-reduction.Bleeding does not always occur;
- The progression of the third stage of hemorrhoids is indicated by the following signs: the presence of prolapsed hemorrhoids that cannot be reduced on their own;Their reduction must be done manually.Bleeding may also be present or absent;
- In stage IV, repositioning of prolapsed hemorrhoids becomes impossible.
Symptoms of hemorrhoids
The symptoms of hemorrhoids depend on their shape.In acute hemorrhoids, the clinical sign is thrombosis of external hemorrhoids or prolapse of internal thrombosed nodes.
During the course of thrombosis of hemorrhoids, they enlarge significantly and the patient feels quite severe proctalgia (pain in the anus), which increases during bowel movements.
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 regularly suffers from bleeding from the anus, 70-80% of the examined patients with such a complaint have hemorrhoids.Unfortunately, most people with such symptoms do not seek medical help because bleeding is scanty and periodic, which in turn increases the danger to their health, since in the early stages of hemorrhoids there is an opportunity to avoid surgical intervention.Some patients are embarrassed to go to the proctologist or are afraid of the examination methods.
Bleeding typically occurs during bowel movements.These can be traces of blood on the paper or scarlet blood splatters when pressed.Blood may also come out in the stool in the form of dark blood clots if it remains in the rectum after a previous bowel movement.
Symptoms of chronic hemorrhoids
The chronic form of hemorrhoids with internal hemorrhoids that have existed for a long time is characterized by an outward prolapse of these nodes.First, a prolapsed lump occurs after defecation or straining.As the disease progresses, the nodes may also fall out when sneezing or coughing, stop retracting on their own, and may require manual reduction.Without treatment, manual reduction is not possible and the prolapse becomes permanent.Falling out nodes are prone to thrombosis and cause severe discomfort to the patient.
The clinical sign of hemorrhoids is often anal itching, the cause of which is constant irritation of the anus skin by secretions.
Diagnosis of hemorrhoids
Diagnosing 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 with the patient in different positions - in the left lateral position, on the back, as in a gynecological chair, or in the knee-elbow position.Most often, the left side position is preferred as it is most comfortable for the patient.However, the doctor may also suggest other positions for different purposes of the examination.
Examination of the perianal area
At the beginning of the proctological examination, the patient's buttocks are carefully spread and the doctor examines the perianal area while calm and tense.In this case, it is possible to detect prolapsed and external hemorrhoids, lesions of the anus skin, ulcers and anal fissures.After the examination, a palpation examination of the perianal area is carried out, which makes it possible to identify areas of pain and inflammatory seals.
Finger examination
A very important step in proctological diagnostics is the digital examination of the rectum.The process of this study does not require any special instrumentation and appears to be quite simple.However, despite the simplicity of its implementation, this type of investigation is very informative.A digital examination allows you to obtain information about the condition of the rectum and the walls of the anus, the presence of neoplasms or hemorrhoids, muscle tone, the pelvic cavity and neighboring organs (prostate, uterus).Approximately 80-90% of the data obtained from a digital examination is fully comparable to the results of subsequent instrumental examinations.
Anoscopy
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 carried out using special tubes of different designs.The anoscope consists of a small tube 8 to 12 cm long equipped with a bright light source.Anoscopes can be disposable or reusable with beveled or straight ends and may also have a side window for viewing.
The 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, as well as 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), the patient must undergo sigmoidoscopy (rigid sigmoidoscopy).This examination method allows you to fully examine the rectum and part of the sigmoid colon (20-30 cm).
Differential diagnosis
An important step in the diagnosis of hemorrhoids is differential diagnosis, the purpose of which is to exclude other diseases whose clinical manifestations are similar to those of hemorrhoids.These 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;
- nonspecific ulcerative colitis;
- Proctitis (after infection, radiation, etc.);
- single rectal ulcer;
- endometriosis;
- Prolapse of hypertrophied anal papillae.
For differential diagnosis, the doctor may prescribe several additional examinations (irrigography, colonoscopy, ultrasound, CT).
Treatment of hemorrhoids
Treatment methods for hemorrhoids depend on the degree of the disease and the presence of accompanying pathologies.In the early stages of hemorrhoids, conservative therapy is often sufficient.Even in the first stage of hemorrhoids, healing is possible with the help of sclerotherapy or electrocoagulation.In the second and third stages of hemorrhoids, the use of ligatures (ligation with latex rings or suture ligation) is recommended.In the third stage of hemorrhoids, Longo's transanal resection technique is considered a productive treatment method.Hemorrhoidectomy (surgical removal of hemorrhoids) is an indication for the fourth stage of hemorrhoids.In the acute course of the disease, only conservative therapy is indicated.
Conservative type of treatment
Conservative treatment of hemorrhoids is aimed at eliminating or alleviating clinical manifestations and attenuating the acute process.At this stage of treatment, the patient is prescribed a diet to normalize bowel movements.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 analgesic, healing, anti-inflammatory, improving local blood circulation and hemostatic effects.
If bleeding is severe, the patient may be prescribed increased hemostatic medications.
Treatment of internal and external hemorrhoids in later stages
Patients with stages 2, 3 and 4 should be aware that conservative treatment is temporary in nature and in any case requires more effective procedures and surgical interventions.
Hemorrhoidectomy performed in later stages involves the removal of hemorrhoids with complete removal of the venous plexuses, 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 one of the treatment methods suggested by the doctor.Only a doctor, after an examination, can decide how to treat hemorrhoids at one stage or another.Since hemorrhoids cause a lot of trouble and constant discomfort, and the symptoms are unpleasant and painful, patients are often ready to get rid of this disease using radical treatment methods.Prices for hemorrhoid treatment in specialized clinics also depend on the advanced stage of the process.Therefore, the best option for the patient is to treat hemorrhoids immediately after diagnosis.
The prognosis of this disease depends on the stage, but is favorable in almost all cases.
Prevention of hemorrhoids
The basis for the prevention of hemorrhoids is the prevention or elimination of factors that contribute to impaired blood circulation 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, and 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, avoid using toilet paper if necessary, and clean the anus by washing with water at room temperature.
People who lead a sedentary lifestyle need to incorporate physical exercise into their daily routine and walk more.At the first symptoms of hemorrhoids, you should avoid any heavy physical activity.