Hemorrhoids are an inflammatory disease of the rectum, during which the internal rectal venous nodes expand;in some cases, inflamed joints may prolapse outward;combined forms of hemorrhoids also appear.
How are hemorrhoids manifested?
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 gradual progression;in the absence of timely therapeutic measures, the patient may seek emergency help.Statistics show that in a single country, 75% of diagnosed hemorrhoid cases undergo surgical treatment.Surgical interventions 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 the dysfunction of blood circulation in the hemorrhoidal venous accumulations, which provokes dystrophic changes in the muscular and connective structures that provide the joints inside the anal canal.
Predisposing factors for this disease play an important role in the development of hemorrhoids: a sedentary lifestyle, a tendency to bowel disorders (frequent diarrhea or constipation), alcohol abuse 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 also be caused by some 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 establishing the 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 combined (mixed form).Often, internal hemorrhoids are the result of the expansion of internal rectal hemorrhoidal plexuses, and external hemorrhoids are mainly formed by the subcutaneous venous plexus of the anus.The combined form of hemorrhoids means 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 making a diagnosis of hemorrhoids;based on such considerations, the concept of isolated external hemorrhoids does not exist in foreign medical practice.Therefore, single hemorrhoids are called "skin tags" or "anal fimbria".
Combined hemorrhoids
Combined hemorrhoids develop when internal hemorrhoidal plexuses spread beyond the anal canal and join the saphenous veins.These concepts are quite reasonable and modern, but at the moment they are not generally accepted.
According to 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 means the presence of bloody discharge from the anus, which has a characteristic bright 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 these 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 form.In acute hemorrhoids, the clinical sign is thrombosis of external hemorrhoids or prolapse of thrombosed internal nodes.
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 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 patients examined with such a complaint turn out to have hemorrhoids.Unfortunately, most people with such symptoms do not seek medical help, as the bleedings are few and periodic, which themselves increase the threat to their health, because in the early stage of hemorrhoids there is an opportunity to avoid surgical intervention.Some patients are ashamed to see a proctologist or are afraid of examination methods.
Typically, bleeding occurs during bowel movements.This can be traces of blood on paper or splashes of red blood during straining.Blood can also pass in the stool as a dark clot if it remains in the rectum after a previous bowel movement.
Symptoms of chronic hemorrhoids
The chronic form of hemorrhoids with long-existing internal hemorrhoids is characterized by the prolapse of these nodes from the outside.Initially, joint prolapse occurs after defecation or straining.As the disease progresses, the nodes may drop even during sneezing or coughing, cease to retract on their own, and manual reduction becomes necessary.In the absence of treatment, manual reduction is not possible and joint prolapse becomes permanent.Prolapsed nodes 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 the constant irritation of the skin of the anus with secretions.
Diagnosis of hemorrhoids
The diagnosis of 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 patient positions - lying on the left side, on the back, as in a gynecological chair, or in the knee-elbow position.Most often, the lying position on the left side is preferred, because it is more comfortable for the patient, but for different examination purposes 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 performed, which allows you to identify areas of pain and inflammatory seals.
Finger examination
A very important stage in the 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 examination 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, 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 instrumental studies.
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 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 bright light source.Anoscopes can be disposable or reusable, beveled or straight-ended, and may also have a side window for viewing.
Anoscopy 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, erosion), as well as assess the mobility and degree of prolapse.
Sigmoidoscopy
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 should 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 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 fistula;
- rectal prolapse;
- Crohn's disease;
- nonspecific 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 some 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 of hemorrhoids, healing is possible with the help of sclerotherapy or electrocoagulation.For the second and third stage of hemorrhoids, the application of ligatures (ligation with latex rings or ligation with sutures) is advised.In the case of the third stage of hemorrhoids, the Longo transanal resection technique 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, exclusively conservative therapy 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 stool.In some cases, the use of laxatives is recommended.The patient is also prescribed medications 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 effect, improving local blood circulation and hemostatic effect.
In case of severe bleeding, the patient may be prescribed enhanced hemostatic agents.
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 in any case will require more effective surgical procedures and interventions.
Performed in the later stages, hemorrhoidectomy involves the removal of hemorrhoids, during which a complete removal of the venous plexuses is performed, which eliminates the possibility of recurrence.
In most cases, hemorrhoids do not require urgent intervention (except for heavy 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 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 the treatment of hemorrhoids in specialized clinics also depend on the advanced stage of the process, so the best option for the patient is the treatment of hemorrhoids immediately after the 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 circulation in the vessels of the rectum, as well as the normalization of the digestive tract.
It is important to treat diseases in time, the clinical manifestations of which can be diarrhea and constipation, as well as the normalization and rationalization of nutrition.
To prevent hemorrhoids, it is necessary to carry out regular hygienic procedures, thoroughly clean the anus after defecation, use soft types of paper, if necessary, refuse to use toilet paper and do the toilet of the anus by washing 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 activity.