Hemorrhoids are an inflammatory disease of the rectum in which the internal rectal venous nodes are enlarged;In some cases, inflamed lymph nodes may prolapse;Combined forms of hemorrhoids also occur.
How do hemorrhoids manifest?
Usually inflammatory processes are accompanied by bleeding from dilated venous nodes.With this disease, the patient may feel heaviness, burning, itching in the anus and pain during bowel movements.
Hemorrhoids are a very common rectal disease, affecting both men and women.This disease is characterized by a gradual progression;In the absence of timely treatment, the patient may need emergency assistance.Statistics show that in one country, 75% of cases diagnosed with hemorrhoids require surgical treatment.Surgical intervention can be avoided if you contact a specialist at the early stages of hemorrhoids.
Causes and pathogenesis of hemorrhoids
The main etiological factor leading to the development of hemorrhoids is circulatory dysfunction in the accumulation of hemorrhoidal veins, causing dystrophic changes in the muscular and connective structures that protect the nodes inside the anal canal.
An important role in the development of hemorrhoids is played by factors leading to this disease: sedentary lifestyle, tendency to intestinal disorders (frequent diarrhea or constipation), abuse of alcohol and spicy food.
Hemorrhoids can also be caused by occupational characteristics that require sitting for long periods of time (pilots, drivers and others).In addition to these factors, the development of this disease can be caused by certain sports (weightlifting, horseback riding, cycling).
In women, hemorrhoids are often a consequence of pregnancy and childbirth.
Classification and symptoms of hemorrhoids
During diagnosis, specialists use a classification of hemorrhoids that involves the localization of the pathological process.According to this classification, hemorrhoids have three types: external hemorrhoids (external), internal hemorrhoids and mixed hemorrhoids (mixed form).Normally, internal hemorrhoids are the result of dilation of the internal rectal hemorrhoidal plexus, while external hemorrhoids are mainly formed 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 prejudice of domestic medicine in the field of rectal disease, most foreign experts believe that internal hemorrhoids are a necessary condition for the diagnosis of hemorrhoids;Based on such considerations, in foreign medical practice there is no concept of simple external hemorrhoids.Therefore, single hemorrhoids are also called “skin tags” or “anal hairs”.
Combined hemorrhoids
Combined hemorrhoids develop when the internal hemorrhoidal plexuses extend beyond the anal canal and fuse with the saphenous veins.These concepts are quite reasonable and modern, but they are not widely accepted at present.
According to the nature of the course, acute and chronic hemorrhoids are distinguished; in fact, these are stages of one disease.
The clinical picture of hemorrhoids is presented in 4 stages:
- The initial stages of hemorrhoids imply the presence of bloody discharge from the anus, which has a characteristic bright red color and periodically manifests itself;
- Stage II hemorrhoids are characterized by prolapse of hemorrhoids and their spontaneous reduction.Bleeding does not always occur;
- The progression of stage 3 hemorrhoids is indicated by the following signs: the appearance of prolapsed hemorrhoids that cannot go away on their own;Reducing them must be done manually.Bleeding may or may not be present;
- In stage IV, repositioning the prolapsed hemorrhoid becomes impossible.
Symptoms of hemorrhoids
Symptoms of hemorrhoids depend on their form.In acute hemorrhoids, clinical signs are thrombosis of external hemorrhoids or prolapse of internal thrombosed lymph nodes.
During thrombosis of hemorrhoids, they enlarge significantly and the patient feels quite severe rectal pain (pain in the anus), which intensifies when defecating.
The main clinical manifestations of chronic hemorrhoids are: burning and itching in the perianal area, intermittent bleeding from the anus, and periodic prolapse of hemorrhoids.When the anal sphincter closes loosely and hemorrhoids frequently prolapse from the anus, a clear mucus 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 complaints turn out to have hemorrhoids.Unfortunately, the majority of people with such symptoms do not seek medical help, since the bleeding is small and periodic, which increases the threat to their health, since at the early stages of hemorrhoids there is a chance of avoiding surgical intervention.Some patients are embarrassed to see a colorectal specialist or are afraid of the examination procedures.
Usually, bleeding occurs during bowel movements.This can be blood stains on paper or bright red blood stains from stress.Blood may also come out as a black clot if it remains in the rectum after a previous bowel movement.
Symptoms of chronic hemorrhoids
The chronic form of hemorrhoids with long-term internal hemorrhoids is characterized by the prolapse of these lymph nodes to the outside.Initially, prolapse of the lymph nodes occurs after defecation or exertion.As the disease progresses, the nodes, which can fall out even when sneezing or coughing, stop retracting on their own and manual reduction becomes necessary.In the absence of treatment, manual reduction is impossible and the lymphadenopathy becomes permanent.Falling buttons are prone to thrombosis and cause serious discomfort to the patient.
Usually the clinical sign of hemorrhoids is anal itching, which is caused by continuous irritation of the anal skin accompanied by secretions.
Diagnosis of hemorrhoids
Diagnosing hemorrhoids is quite simple and involves several procedures.After collecting the patient's medical history, the doctor conducts a rectal examination.This examination can be performed in different positions of the patient - lying on the left side, lying on the back, as on a gynecological chair or in an elbow position.Usually, lying on the left side is preferred because this position is most comfortable for the patient, but for different examination purposes, the doctor may recommend different positions.
Check the area around the anus
At the beginning of the anal examination, the patient's buttocks are carefully separated, and the doctor examines the perianal area in a state of rest and tension.In this case, prolapsed and external hemorrhoids, anal skin lesions, ulcers and anal fissures can be identified.After the examination, palpation of the perianal area is performed, which allows you to identify painful areas and inflammations.
Check your fingers
A very important stage in rectal diagnosis is digital rectal examination.This research process does not require the use of special equipment and appears to be quite simple.However, despite its simplicity, this type of test is very informative.Digital examination allows you to obtain information about the condition of the rectum and anal walls, the presence of tumors or hemorrhoids, muscle tone, pelvic cavity and neighboring organs (prostate, uterus).About 80-90% of the data obtained from digital testing are fully comparable with the results of subsequent instrumental studies.
Endoscopy
To confirm the data obtained in the above studies, patients were recommended to undergo endoscopy.Endoscopy is an examination of the anal canal and is the most informative method for diagnosing hemorrhoids, performed using special tubes of different designs.The endoscope is made in the form of a small tube, 8-12 cm long, equipped with a bright light source.Endoscopes may be disposable or reusable, have beveled or straight ends, and they may also have side windows for viewing.
Endoscopy is not only used in the diagnostic process but is also an integral part of many surgical interventions.During endoscopy, you can determine the size, number and location of internal hemorrhoids, their changes (inflammation, bleeding, erosion), as well as evaluate the mobility and degree of hemorrhoid prolapse.
Sigmoidoscopy
To accurately diagnose 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 examine the entire rectum and part of the sigmoid colon (20-30 cm).
Differential diagnosis
An important stage in the diagnosis of hemorrhoids is differential diagnosis, the purpose of which is to exclude other diseases with similar clinical manifestations of hemorrhoids.Such pathologies include:
- anal cancer;
- colon and rectal cancer;
- acute and chronic anal fissures;
- villous tumor of the rectum;
- rectal fistula;
- rectal prolapse;
- Crohn's disease;
- nonspecific ulcerative colitis;
- proctitis (post-infectious, radiation, etc.);
- solitary rectal ulcer;
- Endometriosis;
- prolapse of enlarged anal papillae.
For the purpose of differential diagnosis, the doctor may prescribe a number of additional tests (hydrography, endoscopy, ultrasound, CT).
Treatment of hemorrhoids
Treatment for hemorrhoids depends on the severity of the disease and the presence of accompanying diseases.In the early stages of hemorrhoids, conservative treatment is usually sufficient.In addition, in the early stages of hemorrhoids, the disease can be cured with sclerotherapy or electrocautery.For stage 2 and 3 hemorrhoids, ligation method (tying with a rubber ring or suturing with a ring) should be applied.In the case of stage 3 hemorrhoids, the Longo transanal excision technique is considered an effective treatment method.Hemorrhoidectomy (surgical removal of hemorrhoids) is a sign for stage 4 hemorrhoids. In the acute stage of the disease, conservative treatment is indicated.
Type of conservative treatment
Conservative treatment of hemorrhoids is aimed at eliminating or reducing clinical manifestations and relieving 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.Patients are also prescribed medication to help strengthen vein walls.The complex of conservative methods of treating hemorrhoids includes the prescription of ointments and rectal suppositories that have analgesic, healing, anti-inflammatory, improving local blood flow and hemostatic effects.
In cases of severe bleeding, the patient may be prescribed enhanced hemostatic agents.
Treatment of internal and external hemorrhoids in later stages
Patients in stages 2, 3 and 4 should be aware that conservative treatment is only temporary and in any case will require more effective surgical procedures and interventions.
Performed at a later stage, hemorrhoidectomy involves the removal of hemorrhoids, in which complete excision of the venous plexus is performed, eliminating the possibility of recurrence.
In most cases, hemorrhoids do not require urgent intervention (except in cases 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 examination can determine how to treat hemorrhoids at one stage or another.Since hemorrhoids cause constant trouble and discomfort, unpleasant and painful symptoms, patients are often willing to get rid of this disease with radical treatment methods.The price of treating hemorrhoids at specialized clinics also depends on the stage of progression of the process, so the best choice for patients is to treat hemorrhoids immediately after diagnosis.
The prognosis of this disease depends on its stage, but in most cases it is favorable.
Prevent 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 rectal vessels, as well as the normalization of the digestive tract.
It is important to promptly treat diseases with clinical manifestations of diarrhea and constipation, and to normalize and rationalize nutrition.
To prevent hemorrhoids, it is necessary to practice regular hygiene, thoroughly clean the anus after defecation, use soft tissues, if necessary, refuse to use toilet paper and clean the anus by rinsing with water at room temperature.
People with a sedentary lifestyle need to exercise daily and walk more.When you have the first symptoms of hemorrhoids, you should avoid any strenuous physical activity.