Hemorrhoids are an inflammatory disease of the rectum, during which the internal rectal venous nodules expand;in some cases, inflamed nodules may prolapse outwards;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 experience heaviness, burning and itching in the anus and pain during bowel movements.
Hemorrhoids are a very common pathology of the rectum, affecting 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 undergo surgical treatment.Surgical interventions can be avoided by contacting a specialist at the initial stage of hemorrhoids.
Etiology and pathogenesis of hemorrhoids
The main etiological factor in the development of hemorrhoids is circulatory dysfunction in hemorrhoidal venous accumulations, which causes dystrophic changes in the muscular and conjunctive structures that fix the nodules 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 intestinal disorders (frequent diarrhea or constipation), abuse of alcohol and spicy foods.
Hemorrhoids can also be caused by occupational characteristics that require prolonged stay (pilots, drivers and others).In addition to these factors, the development of this disease can be caused by certain sports (weight lifting, horseback riding, cycling).
In the female population, hemorrhoids are often a consequence of pregnancy and childbirth.
Classification and symptoms of hemorrhoids
In the diagnostic process, experts use the classification of hemorrhoids in terms of the location 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 the internal rectal hemorrhoidal plexuses, and 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 stereotype of domestic medicine in the field of proctology, most foreign experts believe that internal hemorrhoids are a necessary condition for diagnosing hemorrhoids;Based on such considerations, in foreign medical practice there is no concept of isolated external hemorrhoids.Therefore, single hemorrhoids are called “skin tags” or “anal fimbriae.”
Combined hemorrhoids
Combined hemorrhoids develop when the internal hemorrhoidal plexuses spread beyond the anal canal and merge 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 fact, are stages of the same disease.
The clinical picture of hemorrhoids presents itself in four stages:
- The first stage of hemorrhoids implies the presence of bloody discharge from the anus, with a characteristic scarlet color and periodic manifestations;
- Stage II hemorrhoids is characterized by the prolapse of the hemorrhoids and their self-reduction.Bleeding does not always occur;
- The evolution of the third stage of hemorrhoids is indicated by the following signs: presence of prolapsed hemorrhoids that cannot be reduced on their own;its reduction must be done manually.Bleeding may also be present or absent;
- in stage IV, 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 external hemorrhoids or prolapse of internal thrombosed nodules.
In the process of hemorrhoid thrombosis, they increase 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 region, episodic hemorrhages 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 has periodic anal bleeding, 70-80% of patients examined with this complaint have hemorrhoids.Unfortunately, most people with these symptoms do not seek medical help, as bleeding is rare and periodic, which in itself increases the threat to their health, because in the initial phase of hemorrhoids there is the 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.These could be traces of blood on the paper or splashes of scarlet blood during exertion.Blood may also come out in the stool in the form of 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 nodules outward.Initially, lymph node prolapse occurs after defecation or straining.As the disease progresses, the nodules may fall off even during sneezing or coughing, fail to retract on their own, and manual reduction becomes necessary.In the absence of treatment, manual reduction is not possible and the node prolapse becomes permanent.Nodules that fall off 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 constant irritation of the skin of the anus with secretions.
Diagnosis of hemorrhoids
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 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 of the time, preference is given to lying on the left side, as 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 spread apart, 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, lesions on the skin of the anus, ulcers and anal fissures.After the examination, a palpation examination of the perianal region is carried out, which allows you to identify areas of pain and inflammatory seals.
Finger exam
A very important step in 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 obtain information about the condition 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).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, it is recommended that the patient undergo anoscopy.Anoscopy is an examination of the anal canal and the most informative method for diagnosing hemorrhoids, which is carried out using special tubes of different models.The anoscope is made in the form of a small tube 8 to 12 cm long, equipped with an intense illumination source.Anoscopes can be disposable or reusable, with a beveled or straight end, and can also have a side window for viewing.
The anoscope is not only used 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 assess mobility and the 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 step in the diagnosis of hemorrhoids is differential diagnosis, the objective of which is to exclude other diseases that present clinical manifestations similar to hemorrhoids.These 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 hypertrophied anal papillae.
For the purpose of differential diagnosis, the doctor may prescribe several additional studies (irrigography, colonoscopy, ultrasound, computed tomography).
Hemorrhoids treatment
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 usually sufficient.Furthermore, 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 (ligation with latex rings or ligation with suture).In the case of third stage hemorrhoids, the Longo transanal resection technique is considered a productive method of treatment.Hemorrhoidectomy (surgical excision of hemorrhoids) is an indication for the fourth stage of hemorrhoids.In the acute period of the disease, exclusively conservative therapy is indicated.
Conservative type of treatment
Conservative treatment of hemorrhoids aims to eliminate or alleviate clinical manifestations and mitigate 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 given medications that help strengthen the venous walls.The complex of conservative methods for treating hemorrhoids includes the prescription of rectal ointments and suppositories with analgesic, healing, anti-inflammatory effects, 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 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 complete excision of the venous plexuses is performed, which eliminates the possibility of recurrence.
In most cases, hemorrhoids do not require emergency interventions (except for heavy bleeding with severe anemia), therefore 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 problems and constant discomfort, their symptoms are unpleasant and painful, patients often willingly 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 to treat hemorrhoids immediately after diagnosis.
The prognosis of this disease depends on its stage, but in almost all cases it is favorable.
Hemorrhoid prevention
The basis for the prevention of hemorrhoids is the prevention or elimination of factors that contribute to 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 whose clinical manifestations may include diarrhea and constipation, and to normalize and rationalize nutrition.
To prevent hemorrhoids, it is necessary to carry out regular hygiene procedures, clean the anus well after defecating, use soft paper if necessary, refuse to use toilet paper and sanitize the anus by washing with water at room temperature.
People who lead a sedentary lifestyle need to include physical exercise in their daily routine and walk more.At the first symptoms of hemorrhoids, all intense physical activity should be avoided.