Hemorrhoids are an inflammatory disease of the rectum, during which the internal rectal venous lymph nodes enlarge;in some cases, the inflamed lymph nodes may prolapse outwards;combined forms of hemorrhoids also occur.
How do hemorrhoids manifest?
Inflammatory processes are often accompanied by hemorrhages due to enlarged venous lymph nodes.With this disease, patients may experience heaviness, burning and itching in the anus as well as 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 need emergency assistance.Statistics show that in one country alone, 75% of diagnosed cases of hemorrhoids 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 circulatory dysfunction in hemorrhoidal venous accumulations, which causes dystrophic changes in the muscular and connective structures that attach the nodes inside the anal canal.
Predisposing factors for this disease play an important role in the development of hemorrhoids: a sedentary lifestyle, a tendency to intestinal disorders (frequent diarrhea or constipation), abuse of alcohol and spicy foods.
Hemorrhoids can also be caused by work characteristics requiring prolonged sitting (pilots, conductors and others).In addition to these factors, the development of this disease can be provoked by certain sports (weightlifting, horse riding, cycling).
In the female population, hemorrhoids are quite often a consequence of pregnancy and childbirth.
Classification and symptoms of hemorrhoids
When making a 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).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 involves the presence of both internal and external hemorrhoids.
Internal hemorrhoids
Despite the established stereotype of national 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, in foreign medical practice there is no concept of isolated external hemorrhoids.Therefore, simple hemorrhoids are called “skin tags” or “anal fimbriae.”
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 at the moment they are not generally accepted.
Depending on the nature of the development, we distinguish between acute and chronic hemorrhoids, which are in fact stages of the same disease.
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 scarlet color and periodic manifestations;
- Stage II hemorrhoids are characterized by prolapse of hemorrhoids and their self-reduction.Bleeding does not always occur;
- The development of the third stage of hemorrhoids is indicated by the following signs: the 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, repositioning of prolapsed hemorrhoids becomes impossible.
Symptoms of hemorrhoids
The symptoms of hemorrhoids depend on their form.In acute hemorrhoids, the clinical sign is thrombosis of external hemorrhoids or prolapse of thrombosed internal lymph nodes.
During the process of thrombosis of hemorrhoids, they enlarge considerably and the patient experiences 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 periodically suffers from bleeding from the anus, 70-80% of examined patients with such a complaint turn out to have hemorrhoids.Unfortunately, the majority of people with such symptoms do not consult a doctor, since hemorrhages are rare and periodic, which themselves increase the threat to their health, since in the early stage of hemorrhoids it is possible to avoid surgical intervention.Some patients are embarrassed to see a proctologist or are afraid of examination methods.
Typically, bleeding occurs during bowel movements.These may be traces of blood on paper or splashes of scarlet blood during exercise.Blood may also come out in 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-standing internal hemorrhoids is characterized by prolapse of these lymph nodes outwards.Initially, lymph node prolapse occurs after defecation or straining.As the disease progresses, the nodes may fall out even when sneezing or coughing, stop shrinking 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 severe discomfort for the patient.
The clinical sign of hemorrhoids is often anal itching, the cause of which is constant irritation of the skin of the anus by secretions.
Diagnosis of hemorrhoids
Diagnosing hemorrhoids is quite simple and involves 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 her left side, on her back, as in a gynecological chair, or in a knee-elbow position.Most often, preference is given to the position 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 apart, 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 carried out, which allows you to identify painful areas and inflammatory seals.
Finger examination
The digital examination of the rectum is a very important step in proctological diagnosis.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 walls of the anus, the presence of neoplasms or hemorrhoids, muscle tone, the pelvic cavity and neighboring 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 for diagnosing hemorrhoids, carried out using special tubes of different designs.The anoscope comes in the form of a small tube with a length of 8 to 12 cm, equipped with a light source.Anoscopes may be disposable or reusable, with a beveled or straight end, and they may also have a side window for viewing.
The anoscope is used not only in the diagnostic process, but it is also an integral part of many surgical procedures.During anoscopy, you can determine the size, number and location of internal hemorrhoids, their changes (inflammation, bleeding, erosion), as well as assess 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 differential diagnosis, the purpose of which is to exclude other diseases with 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, radiotherapy, etc.);
- solitary rectal ulcer;
- endometriosis;
- prolapse of enlarged anal papillae.
For the purposes of differential diagnosis, the doctor may prescribe several additional studies (irrigography, colonoscopy, ultrasound, CT scan).
Treatment of hemorrhoids
Methods for treating hemorrhoids depend on the degree of the disease and the presence of concomitant pathologies.At the initial stage of hemorrhoids, conservative treatment is often sufficient.In addition, at the first stage of hemorrhoids, healing is possible through sclerotherapy or electrocoagulation.For the second and third stages of hemorrhoids, it is advisable to apply ligatures (ligation with latex rings or suture ligation).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, exclusively conservative treatment is indicated.
Type of conservative treatment
Conservative treatment of hemorrhoids is aimed at eliminating or attenuating clinical manifestations and attenuating 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.The patient is also prescribed medications that help strengthen the vein walls.The set of conservative methods of treating hemorrhoids includes the prescription of rectal ointments and suppositories that have analgesic, healing, anti-inflammatory, improving local blood flow and hemostatic effect.
In case of heavy 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 temporary and will in any case require more effective procedures and surgical interventions.
Carried out at later stages, hemorrhoidectomy involves the removal of hemorrhoids, during which a complete excision of the venous plexuses is carried out, which eliminates the possibility of relapses.
In most cases, hemorrhoids do not require emergency interventions (with the exception of heavy bleeding accompanied by severe anemia), therefore the patient has the right to independently choose one of the treatment methods offered 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, their symptoms are unpleasant and painful, patients often willingly agree to get rid of this disease using radical treatment methods.Prices for hemorrhoid treatment in specialized clinics also depend on the advanced stage of the process.The best option for the patient is therefore 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 of 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 promptly treat diseases, the clinical manifestations of which can be diarrhea and constipation, as well as to normalize and streamline 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 should include physical exercise in their daily routine and walk more.From the first symptoms of hemorrhoids, you should avoid any strenuous physical activity.