Hemorrhoids are an inflammatory disease of the rectum in which the internal rectal venous nodes are enlarged;in some cases, the inflamed nodules may prolapse outward;combined forms of hemorrhoids also occur.
How do hemorrhoids manifest?
Often, inflammatory processes are accompanied by hemorrhages 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 that affects both men and women.This disease is characterized by 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 are subject to 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 for the development of hemorrhoids is the dysfunction of blood circulation in the hemorrhoidal venous accumulations, which provokes dystrophic changes in the muscle and connective structures that fix the nodes inside the anal canal.
Factors predisposing 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, etc.).In addition to these factors, the development of this disease can be triggered by certain sports (weightlifting, horse riding, cycling).
In women, hemorrhoids are quite often a consequence of pregnancy and childbirth.
Classification and symptoms of hemorrhoids
In the process of diagnosis, specialists 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 combinations (mixed form).Often, internal hemorrhoids are the result of enlargement of the internal rectal hemorrhoidal plexus, 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 local medicine in the field of proctology, most foreign specialists believe that internal hemorrhoids are a necessary condition for diagnosing hemorrhoids;based on these considerations, there is no concept of isolated external hemorrhoids in foreign medical practice.This is why single hemorrhoids are called "skin scars" or "anal fimbriae."
Combined hemorrhoids
Combined hemorrhoids develop when the internal hemorrhoidal plexuses extend outside the anal canal and merge with the saphenous veins.These concepts are quite reasonable and modern, but they are not generally accepted at the moment.
According to the nature of the course, acute and chronic hemorrhoids are distinguished, which are actually stages of the same disease.
The clinical picture of hemorrhoids manifests itself 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 the 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 prolapsing 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
Symptoms of hemorrhoids depend on their form.In acute hemorrhoids, the clinical sign is thrombosis of external hemorrhoids or prolapse of internal thrombosed nodes.
In the process of thrombosis of hemorrhoids, they significantly increase, and the patient experiences quite intense proctalgia (pain in the anus), which intensifies during 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 a complaint turn out to have hemorrhoids.Unfortunately, the majority of people with such symptoms do not seek medical help, since the bleeding is scarce and periodic, which in itself increases the threat to their health, since in the early stage of hemorrhoids there is a chance to avoid surgical intervention.Some patients are worried about visiting a proctologist or are afraid of research methods.
Bleeding usually occurs during a bowel movement.This could be blood marks on paper or splashes of scarlet blood during wringing.Blood may 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-standing internal hemorrhoids is characterized by prolapse of these nodes to the outside.Initially, nodal prolapse occurs after defecation or straining.As the disease progresses, nodules may fall out even during sneezing or coughing, cease to retract on their own, and manual reduction is required.In the absence of treatment, manual reduction is impossible and nodal prolapse becomes permanent.Nodes that fall are prone to thrombosis and cause great discomfort to the patient.
Often, the clinical sign of hemorrhoids is anal itching, the cause of which is the constant irritation of the skin of the anus with discharge.
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 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 lying on the left side is preferred, as it is the most comfortable for the patient, but for the 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 opened, 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, palpation of the perianal area is performed, which allows you to identify areas of pain and inflammatory seals.
Examination of the fingers
A very important stage in proctological diagnostics is the digital examination of the rectum.The process of this research does not require the use of special instrumental equipment and seems quite simple.But despite the simplicity of implementation, this type of research is very informative.The digital examination allows you to get information about the state of the rectum and anus walls, the presence of neoplasms or hemorrhoids, muscle tone, the pelvic cavity and nearby organs (prostate, uterus).About 80-90% of the data obtained during a digital examination are fully comparable with the results of subsequent instrumental studies.
Anoscopy
To confirm the data obtained during the above examinations, 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.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, beveled or straight-ended, and may also have a side viewing window.
The anoscope is not only used in the diagnostic process, it 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, erosion), as well as assess mobility and the degree of prolapse.
Sigmoidoscopy
In order 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 should 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 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.);
- single rectal ulcer;
- endometriosis;
- prolapse of hypertrophied anal papillae.
For the purposes of differential diagnosis, the doctor may prescribe several additional tests (irrigography, colonoscopy, ultrasound, CT).
Treatment of hemorrhoids
Methods for treating hemorrhoids depend on the degree of the disease and the presence of concomitant pathologies.In the initial stage of hemorrhoids, conservative therapy is often sufficient.Also, in the first stage of hemorrhoids, treatment is possible using sclerotherapy or electrocoagulation.In the second and third stages of hemorrhoids, it is recommended to apply ligatures (ligation with latex rings or ligation with threads).In the case of the third stage of hemorrhoids, the Longo transanal resection technique is considered a productive method of treatment.Hemorrhoidectomy (surgical excision of hemorrhoids) is an indication for stage four hemorrhoids.In the acute period of the disease, extremely conservative therapy is indicated.
Conservative type of treatment
Conservative treatment of hemorrhoids is aimed at eliminating or alleviating the clinical manifestations and weakening the acute process.At this stage of treatment, the patient is prescribed a diet to normalize stools.In some cases, the use of laxatives is recommended.The patient is also prescribed drugs that help strengthen the venous walls.The complex of conservative methods for the treatment of hemorrhoids includes the prescription of ointments and rectal suppositories with an 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 a later stage
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 later stages, hemorrhoidectomy involves the removal of hemorrhoids, during which a complete excision of the venous plexuses is performed, which eliminates the possibility of recurrence.
In most cases, hemorrhoids do not require emergency intervention (except for severe bleeding with severe anemia), so the patient has the right to independently choose one of the treatment methods proposed 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, its symptoms are unpleasant and painful, patients often voluntarily agree to get rid of this disease with the help of radical treatment methods.The 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 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 contributing 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 promptly treat diseases, the clinical manifestations of which can be diarrhea and constipation, as well as 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 paper if necessary, give up the use of toilet paper and wash the anus 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 symptoms of hemorrhoids, you should avoid any heavy physical exertion.