Hemorrhoids are an inflammatory disease of the rectum, during which the internal rectal venous nodes expand;in some cases, the inflamed lymph nodes may prolapse outward;Combined forms of hemorrhoids also occur.
How do hemorrhoids manifest themselves?
Often inflammatory processes are accompanied by hemorrhages from dilated 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 rectal condition 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 a single country, 75% of diagnosed hemorrhoid cases are subject to surgical treatment.Surgical interventions can be avoided if you contact a specialist in the early stage of hemorrhoids.
Etiology and pathogenesis of hemorrhoids
The main etiological factor in the development of hemorrhoids is circulatory dysfunction in the hemorrhoidal venous accumulations, which causes dystrophic changes in the muscular and connective structures that fix the nodes inside the anal canal.
An important role in the development of hemorrhoids is played by the 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 professional characteristics that require prolonged sitting (pilots, chauffeurs and others).In addition to these factors, the development of this disease can be caused by certain sports (weightlifting, horse riding, cycling).
In the female population, hemorrhoids are very often a consequence of pregnancy and childbirth.
Classification and symptoms of hemorrhoids
In the process of diagnosis, specialists use the classification of hemorrhoids regarding the localization of the pathological process.According to this classification, there are three forms of hemorrhoids: external (external), internal and combined (mixed form).Internal hemorrhoids are often the result of expansion of the internal rectal hemorrhoid plexuses, while external hemorrhoids form 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 making a diagnosis of hemorrhoids;based on such considerations, the concept of isolated external hemorrhoids does not exist in foreign medical practice.Therefore, individual hemorrhoids are called “cutaneous fimbriae” or “anal fimbriae”.
Combined hemorrhoids
Combined hemorrhoids develop when the internal hemorrhoid plexuses extend beyond the anal canal and fuse with 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 reality, are stages of the same disease.
The clinical picture of hemorrhoids presents itself in four phases:
- 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 advancement of the third stage of hemorrhoids is indicated by the following signs: presence of prolapsed hemorrhoids that cannot be reduced on their own;their reduction must be done manually.Bleeding may also be present or absent;
- at stage IV the 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 the external hemorrhoids or prolapse of the internal thrombosed lymph nodes.
In the process of thrombosis of hemorrhoids, they enlarge significantly and the patient feels rather 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 hemorrhages 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 experiences bleeding from the anus, 70-80% of examined patients with such ailment are found to have hemorrhoids.Unfortunately, most people with such symptoms do not seek medical help, since the bleeding is scanty and periodic, which in itself increases the threat to health, because in the initial stage of hemorrhoids there is a possibility of avoiding surgical intervention.Some patients are embarrassed to see a proctologist or are afraid of the examination methods.
Typically, bleeding occurs during bowel movements.It could be traces of blood on the paper or splashes of scarlet blood during filtration.Blood may also leak into 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-lasting internal hemorrhoids is characterized by the prolapse of these nodes outward.Initially, prolapse of the nodes occurs after defecation or straining.As the disease progresses, the lymph nodes may fall out 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 lymph node prolapse becomes permanent.Falling nodes are prone to thrombosis and cause serious inconvenience 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 carries out a proctological examination.This examination can be carried out 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, 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 parted, 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 palpatory examination of the perianal area is carried out, which allows us to identify areas of pain and inflammatory seals.
Finger examination
A very important stage in proctological diagnosis is 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 exam is very informative.The digital examination allows you to obtain information on the state of the rectum and the walls of the anus, the presence of neoplasms or hemorrhoids, muscle tone, the pelvic cavity and nearby organs (prostate, uterus).Approximately 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 of 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 illumination source.Anoscopes can be disposable or reusable, with a blunt or straight end, and may also have a side window for viewing.
The anoscope is used not only in the diagnostic process, but is also an integral part of many surgical interventions.During anoscopy it is possible to determine the size, number and location of internal hemorrhoids, their changes (inflammation, bleeding, erosion), as well as evaluate 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 completely 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 present 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;
- nonspecific ulcerative colitis;
- proctitis (after infection, radiation, etc.);
- solitary rectal ulcer;
- endometriosis;
- prolapse of hypertrophic anal papillae.
For the purpose of differential diagnosis, the doctor may prescribe numerous 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 concomitant pathologies.In the initial stage of hemorrhoids, conservative therapy is often sufficient.Also, in the first stage of hemorrhoids, cure is possible with the help of sclerotherapy or electrocoagulation.For the second and third stages of hemorrhoids it is advisable to apply ligatures (ligature with latex rings or ligation with sutures).In the case of the third stage of hemorrhoids, Longo's transanal resection technique is considered a productive treatment method.Hemorrhoidectomy (surgical excision of hemorrhoids) is an indication for the fourth stage of hemorrhoids.In the acute period of the disease, only conservative therapy is indicated.
Type of conservative 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 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 prescription of rectal ointments and suppositories with analgesic, wound healing, anti-inflammatory effect, 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 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 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 interventions (with the exception of 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 in 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.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 of 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 timely treat diseases whose clinical manifestations can be diarrhea and constipation, as well as normalize and rationalize nutrition.
To prevent hemorrhoids, it is necessary to carry out regular hygiene procedures, carefully clean the anus after defecation, use soft paper if necessary, refuse to use toilet paper and clean the anus by washing with water at room temperature.
People who lead a sedentary lifestyle need to include exercise in their daily routine and walk more.At the first symptoms of hemorrhoids, you should avoid any heavy physical activity.