Hemorrhoid is an inflammatory disease of the rectum, during which the internal rectal venous nodes expand;in some cases, inflamed nodes may extend outward;Combined forms of hemorrhoids also occur.
How does hemorrhoids manifest themselves?
Often, inflammatory processes are accompanied by bleeding from enlarged venous nodes.Patients with this disease 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 care.Statistics show that 75% of hemorrhoids diagnosed in a country undergo surgical treatment.If you contact a specialist in the initial stage of hemorrhoids, surgical interventions can be avoided.
Etiology and pathogenesis of hemorrhoids
The main etiological factor in the development of hemorrhoids is a violation of blood circulation in hemorrhoidal venous collections, which causes dystrophic changes in the muscles and connective structures that supply the nodes inside the anal canal.
An important role in the development of hemorrhoids is played by factors predisposing to this disease: a sedentary lifestyle, a tendency to bowel disorders (often diarrhea or constipation), abuse of alcohol and spicy foods.
Hemorrhoids can also be caused by occupations that require prolonged sitting (pilots, drivers, etc.).In addition to these factors, the development of this disease can be caused by certain sports (weightlifting, horse riding, cycling).
Hemorrhoids in women are often the result of pregnancy and childbirth.
Classification and symptoms of hemorrhoids
In the process of diagnosis, specialists use the classification of hemorrhoids based on the localization of the pathological process.According to this classification, there are three forms of hemorrhoids: external (external), internal and combined (mixed form).Most often, internal hemorrhoids are the result of the expansion of the internal rectal hemorrhoidal plexus, and external hemorrhoids are mainly formed from the subcutaneous venous plexus of the anus.The combined form of hemorrhoids involves the presence of internal and external hemorrhoids.
Internal hemorrhoids
Despite the established stereotype of local medicine in the field of proctology, most foreign experts 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, single hemorrhoids are called "skin tags" or "anal fimbriae".
Mixed hemorrhoids
Combined hemorrhoids develop when internal hemorrhoidal plexuses extend beyond the anal canal and merge with the saphenous veins.These concepts are quite reasonable and modern, but currently they are not generally accepted.
According to the nature of the course, acute and chronic hemorrhoids, which are actually stages of a disease, are distinguished.
The clinical picture of hemorrhoids is presented in four stages:
- The first stage of hemorrhoids involves 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 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 or may not be present;
- It is impossible to change the location of prolapsed hemorrhoids in stage IV.
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 grow significantly, and the patient feels quite intense proctalgia (pain in the anus), which is aggravated by 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 discharge of hemorrhoids from the anus, clear mucous discharge can be seen.
A very common symptom of hemorrhoids is bleeding from the anus.10% of the world's population periodically experiences bleeding from the anus, 70-80% of patients examined with such a complaint have hemorrhoids.Unfortunately, most people with such symptoms do not seek medical help, because the bleeding is small and periodic, which in itself poses a threat to their health, since there is a chance to avoid surgical intervention in the early stages of hemorrhoids.Some patients are embarrassed to consult a proctologist or are afraid of examination methods.
Typically, bleeding occurs during bowel movements.It can be blood stains on paper or splashes of red blood during stress.Blood may also pass as dark clots in the stool 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 outward prolapse of these nodes.Initially, prolapse of the nodes occurs after defecation or straining.As the disease progresses, the nodules may fall off even when sneezing or coughing, stop regressing on their own, and manual reduction becomes necessary.In the absence of treatment, manual reduction is impossible and the prolapse of the nodes becomes permanent.Falling nodes are prone to thrombosis and cause serious discomfort to the patient.
A frequent clinical sign of hemorrhoids is anal itching, which is due to 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 medical history, the doctor conducts a proctological examination.This examination can be carried out in different positions of the patient - on the left side, as in the gynecological chair, lying on the back or in the knee-elbow position.Most often, the lying position on the left side is preferred because it is the most comfortable for the patient, but the doctor may suggest different positions for different purposes of the examination.
Examination of the perianal area
At the beginning of the proctological examination, the patient's hips are carefully separated from each other, the doctor examines the perianal region in a state of rest and tension.In this case, it is possible to identify prolapse and external hemorrhoids, damage to the skin of the anus, ulcers and anal fissures.After the examination, a palpation examination of the perianal region is performed, which allows to determine the areas of pain and inflammatory seals.
Finger examination
A very important step in proctological diagnosis is the digital examination of the rectum.This research process does not require the use of special instrumental equipment and seems quite simple.However, despite the simplicity of implementation, this type of examination is very informative.Digital examination allows obtaining information about the condition of the walls of the rectum and anus, the presence of neoplasms or hemorrhoids, muscle tone, pelvic cavity and nearby organs (prostate, uterus).About 80-90% of the data obtained from the digital examination can be fully compared 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 the most informative method for the diagnosis of hemorrhoids, which is performed by examining the anal canal and using special tubes of various designs.Anoscope is made in the form of a small tube with a length of 8-12 cm, equipped with a bright light source.Anoscopes can be disposable or reusable, have a curved or straight end, and have a side window for viewing.
Anoscope is used not only in the diagnostic process, but also as a component of many surgical interventions.During anoscopy, you can evaluate the size, number and location of internal hemorrhoids, their changes (inflammation, bleeding, erosion), as well as mobility and the degree of prolapse.
Sigmoidoscopy
In order to make a correct 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 method of examination allows a complete examination of 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 with the same clinical manifestations as 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 differential diagnosis, the doctor may prescribe several additional studies (irrigography, colonoscopy, ultrasound, CT).
Hemorrhoid treatment
Treatment methods for hemorrhoids depend on the degree of the disease and the presence of accompanying pathologies.In the initial stage of hemorrhoids, conservative therapy is often enough.Also, treatment with the help of sclerotherapy or electrocoagulation is possible in the first stage of hemorrhoids.For the second and third stages of hemorrhoids, it is recommended to apply ligatures (tying with latex rings or suture ligation).During the third stage of hemorrhoids, the Longo transanal resection method is considered a productive treatment method.Hemorrhoidectomy (surgical excision of hemorrhoids) is indicated for the fourth stage of hemorrhoids.In the acute period 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 weakening 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 drugs that help strengthen the venous walls.The complex of conservative methods for the treatment of hemorrhoids includes the appointment of ointments and rectal suppositories that improve local blood flow and hemostatic effect, which are analgesic, therapeutic, anti-inflammatory.
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 know that conservative treatment is temporary and in any case will require more effective procedures and surgical interventions.
Hemorrhoidectomy performed in the later stages involves the removal of hemorrhoids, during which complete cutting of the venous plexus is performed, which eliminates the possibility of relapse.
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 offered by the doctor.After examination, only a doctor can determine how to treat hemorrhoids at this or that stage.Since hemorrhoids cause a lot of discomfort and constant discomfort, and its symptoms are unpleasant and painful, patients often agree to get rid of this disease with the help of radical treatment methods.Prices for hemorrhoid treatment in specialized clinics also depend on the advanced stage of the process, so the best option for the patient is hemorrhoid treatment immediately after diagnosis.
The prognosis of this disease depends on its stage, but is favorable in almost all cases.
Prevention of hemorrhoids
The basis of hemorrhoid prevention is the prevention or elimination of factors that cause blood flow in the vessels of the rectum, as well as the normalization of the digestive system.
It is important to treat diseases whose clinical manifestations are diarrhea and constipation in time, normalize and rationalize nutrition.
To prevent hemorrhoids, it is necessary to regularly perform hygiene procedures, thoroughly clean the anus after defecation, use soft types of paper, refuse toilet paper if necessary, and wash the anus with water at room temperature.
People who lead a sedentary lifestyle should include physical exercises in their daily routine and walk more.At the first signs of hemorrhoids, you should avoid all strenuous physical activity.