Hemorrhoids are an inflammatory disease of the rectum in which nodules of veins in the rectum are enlarged.In some cases, the inflamed nodule may prolapse outward; mixed forms of hemorrhoids may also occur.
What are the symptoms of hemorrhoids?
The inflammatory process is often accompanied by bleeding from dilated venous nodes.With this disorder, patients may experience heaviness, burning, and itching in the anus, as well as pain during bowel movements.
Hemorrhoids are a very common rectal pathology affecting both men and women.The disease is characterized by a gradual progression; without prompt treatment, patients may require emergency assistance.Statistics show that 75% of diagnosed hemorrhoid cases in a country require surgical treatment.If you contact a specialist in the early stages of hemorrhoids, you can avoid surgical intervention.
The causes and pathogenesis of hemorrhoids
The main cause of the development of hemorrhoids is circulatory dysfunction due to accumulation of hemorrhoidal veins, which causes dystrophic changes in the muscles and connective structures that anchor the nodes within the anal canal.
Factors that predispose to this disease play an important role in the development of hemorrhoids: sedentary lifestyle, tendency to intestinal diseases (frequent diarrhea or constipation), alcohol abuse and spicy food.
Hemorrhoids may also be caused by occupations characterized by long periods of sitting (pilots, drivers, etc.).In addition to these factors, certain sports (weight lifting, horse riding, cycling) may also contribute to the development of this disease.
In women, hemorrhoids are often a result of pregnancy and childbirth.
Classification and symptoms of hemorrhoids
During the diagnostic process, experts use the classification of hemorrhoids to determine the location of the pathological process.According to this classification, hemorrhoids can be divided into three forms: external hemorrhoids (external hemorrhoids), internal hemorrhoids and mixed hemorrhoids (mixed hemorrhoids).Usually, internal hemorrhoids are the result of dilation of the hemorrhoidal plexus in the rectum, while external hemorrhoids are mainly formed by the subcutaneous venous plexus of the anus.The combined form of hemorrhoids means the presence of both internal and external hemorrhoids.
Internal hemorrhoids
Although domestic medicine has formed a stereotype in the field of proctology, most foreign experts believe that internal hemorrhoids are a necessary condition for the diagnosis of hemorrhoids; based on this consideration, there is no concept of isolated external hemorrhoids in foreign medical practice.Therefore, single hemorrhoids are called "skin tags" or "anal hairs."
mixed hemorrhoids
Mixed hemorrhoids form when the internal hemorrhoid plexus spreads beyond the anal canal and merges with the saphenous vein.These concepts are quite reasonable and modern, but are not currently universally accepted.
Depending on the nature of the course of the disease, hemorrhoids are divided into acute and chronic hemorrhoids, which are actually different stages of one disease.
The clinical manifestations of hemorrhoids are divided into four stages:
- The first stage of hemorrhoids means the appearance of a bloody discharge from the anus, with a characteristic scarlet color and cyclical appearance;
- Stage II hemorrhoids are characterized by prolapse of the hemorrhoids and their spontaneous reduction.Bleeding does not always occur;
- The progression of the third stage of hemorrhoids is indicated by the following signs: The appearance of prolapsed hemorrhoids that cannot be reduced on their own; their reduction must be done manually.Bleeding may also be present or absent;
- In the fourth stage, repositioning of prolapsed hemorrhoids becomes impossible.
Symptoms of hemorrhoids
The symptoms of hemorrhoids depend on their form.The clinical symptoms of acute hemorrhoids are external hemorrhoid thrombosis or internal thrombosis nodule prolapse.
During the process of thrombosis, hemorrhoids will enlarge significantly, and the patient will feel quite strong rectal pain (anal pain), which will worsen with defecation.
The main clinical manifestations of chronic hemorrhoids are: perianal burning sensation, itching, paroxysmal anal bleeding, and periodic prolapse of hemorrhoids.Hemorrhoids often protrude from the anus due to the loose closure of the anal sphincter, and a clear mucus discharge may occur.
A very common symptom of hemorrhoids is anal bleeding.10% of the world's population periodically experiences anal bleeding, and 70-80% of patients examined with such symptoms turn out to have hemorrhoids.Unfortunately, most people with such symptoms do not seek medical help because the bleeding is infrequent and cyclical, which in itself increases the risk to health as there is an opportunity to avoid surgical intervention in the early stages of hemorrhoids.Some patients are embarrassed to see a proctologist or are afraid of the test method.
Often, bleeding occurs during bowel movements.This could be blood on the paper or scarlet blood splattered from force.Blood in the stool may also come out as a black clot if blood remains in the rectum after the last bowel movement.
Symptoms of chronic hemorrhoids
Chronic hemorrhoids, where internal hemorrhoids have been present for a long time, are characterized by the outward prolapse of these lymph nodes.Initially, tubercle prolapse occurs after defecation or straining.As the disease progresses, the lymph nodes may become detached and no longer retract on their own, even when sneezing or coughing, requiring manual repositioning.Without treatment, manual reduction is impossible and lymph node prolapse will become permanent.Detached lymph nodes are prone to thrombosis, causing serious discomfort to patients.
The clinical symptom of hemorrhoids is usually anal itching, which is caused by persistent irritation of the anal skin by secretions.
Diagnosis of hemorrhoids
The diagnosis of hemorrhoids is very simple and consists of several procedures.After taking the patient's medical history, the doctor will perform a rectal examination.This examination can be performed with the patient in different positions - lying on the left side, supine (such as a gynecological chair) or in the knee-elbow position.In most cases, the left lateral decubitus position is preferred because it is most comfortable for the patient, but your doctor may recommend different positions for different purposes.
Perianal area examination
The rectal examination begins with the patient's buttocks carefully spread apart and the doctor examining the perianal area while at rest and under tension.In this case, prolapsed external hemorrhoids, anal skin lesions, ulcers and anal fissures can be identified.After the examination, the perianal area will be examined with palpation so that you can identify areas of pain and inflammation.
finger check
A very important stage in the diagnosis of proctopathy is the digital examination of the rectum.The process of this research does not require the use of special equipment and seems to be quite simple.However, despite being simple to perform, this type of inspection can be very informative.A digital examination can give you information about the condition of the rectal and anal walls, the presence of tumors or hemorrhoids, muscle tone, the pelvis and nearby organs (prostate, uterus).Approximately 80-90% of the data obtained from digital examinations are fully comparable to the results of subsequent instrumental studies.
anoscopy
To confirm the data obtained in the above studies, patients were advised to undergo anoscopy.Anoscopy is an examination of the anal canal and is the most effective way to diagnose hemorrhoids. It is performed using special tubes of different designs.The anoscope is in the shape of a small tube, 8-12 cm in length, and equipped with a bright light source.Anoscopes can be disposable or reusable, have beveled or straight ends, and can also have side windows for viewing.
Anoscopes are not only used in diagnostic procedures but are 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
In order to make an accurate diagnosis and identify accompanying lesions of the rectum and colon (polyps, tumors, ulcerative lesions, various forms of colitis, diverticula), the patient must undergo a sigmoidoscopy (rigid sigmoidoscopy).This examination method allows you to fully 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, which aims to exclude other diseases with similar clinical manifestations to hemorrhoids.Such conditions include:
- anal cancer;
- colon and rectal cancer;
- Acute and chronic anal fissures;
- Villous tumors of the rectum;
- Rectal fistula;
- Rectal prolapse;
- Crohn's disease;
- Nonspecific ulcerative colitis;
- Proctitis (after infection, radiation, etc.);
- solitary rectal ulcer;
- Endometriosis;
- Hypertrophic anal papilla prolapse.
For differential diagnosis purposes, the doctor may order several additional tests (enema, colonoscopy, ultrasound, CT).
Treat hemorrhoids
Treatment of hemorrhoids depends on the extent of the disease and the presence of concomitant conditions.In the initial stages of hemorrhoids, conservative treatment is usually sufficient.Additionally, in the first stages of hemorrhoids, they can be cured with the help of sclerotherapy or electrocoagulation.For second and third stage hemorrhoids, ligation (latex ring ligation or suture ligation) should be used.For stage III hemorrhoids, the Longo transanal excision technique is considered an effective treatment.Hemorrhoidectomy (surgical removal of hemorrhoids) is an indication for stage four hemorrhoids.In the acute phase of the disease, only conservative treatment is required.
Conservative treatment type
Conservative treatment of hemorrhoids is aimed at eliminating or reducing the clinical manifestations and attenuating the acute course.During this phase of treatment, the patient is required to undergo a diet to normalize bowel movements.In some cases, laxatives are recommended.Patients also need to take medications that help strengthen the walls of the veins.The conservative approach to treating hemorrhoids is complex and includes the prescription of ointments and rectal suppositories with analgesic, healing, anti-inflammatory, local blood flow improvement, and hemostatic properties.
If the bleeding is severe, the patient may be given enhanced hemostatic agents.
Later treatment of internal and external hemorrhoids
Patients with stages 2, 3, and 4 should be aware that conservative treatment is temporary and will require more effective surgery and surgical intervention anyway.
Hemorrhoidectomy performed at a later stage involves removal of the hemorrhoids, during which complete excision of the venous plexus is performed, thereby eliminating the possibility of recurrence.
In most cases, hemorrhoids do not require urgent intervention (except for severe bleeding accompanied by severe anemia), so the patient has the right to choose one of the treatments proposed by the doctor.Only a doctor can determine after examination how to treat hemorrhoids at one stage or another.Because hemorrhoids cause so much trouble and constant discomfort, and their symptoms are unpleasant and painful, patients often prefer radical treatments to get rid of the disease.The price of hemorrhoids treatment in specialist clinics also depends on the advanced stage of treatment, so the best option for patients is to treat hemorrhoids immediately after diagnosis.
The prognosis of this disease depends on its stage, but is favorable in almost all cases.
Prevent hemorrhoids
The basis for preventing hemorrhoids is the prevention or elimination of factors causing dysfunction of rectal vascular blood flow and the normalization of the digestive tract.
Prompt treatment of diseases whose clinical manifestations may be diarrhea and constipation and normalization and rationalization of nutrition is very important.
To prevent hemorrhoids, perform regular hygiene procedures, clean the anus thoroughly after defecation, use soft paper towels, refuse to use toilet paper when necessary, and flush the anus with room temperature water.
People who live a sedentary lifestyle need to incorporate physical activity into their daily routine and walk more.When the first symptoms of hemorrhoids appear, you should avoid all strenuous physical activity.