In our culture, body bottom and its functions are a topic that is not customary to talk about in a company. Therefore, diseases affecting these parts of the body cause suffering not only of physical but also of psychological nature. Unfortunately, one of these diseases – hemorrhoids – is not as rare as we would like; it affects at least 10-15% of the entire adult population of the Earth. Most often people from 30 to 50 years old suffer from hemorrhoids, and men are four times more likely than women. Alas, not all patients, feeling the signs of the disease started, go to the doctor. Many people are prevented by false shame, they prefer to self-medicate than they only worsen their situation. But hemorrhoids, like other diseases, are the easiest to treat in the early stages.
- What is hemorrhoids and its causes
- Symptoms of hemorrhoids
- How does hemorrhoids manifest
- Stages of development of the disease
- Complications of hemorrhoids
- Hemorrhoids during pregnancy and childbirth
- Which doctor should you go to if you suspect hemorrhoids?
- Diagnosis of the disease
- How to treat hemorrhoids
- Surgical treatment of hemorrhoids
- Home hemorrhoids treatment
- Hemorrhoid Prevention
What is hemorrhoids and its causes
The end part of the digestive tract, the last segment of the colon, is called the rectum; it begins somewhere at the level of the third sacral vertebra and ends at the anus. Its blood supply is provided by five arteries (one of which is unpaired and is called hemorrhoidal), and the outflow of blood is carried out by a widely branched network of veins located in the submucosal layer of the rectum. In the lower part of the rectum, or the hemorrhoidal zone, beneath the mucous membrane are cavernous, or cavernous, bodies pierced by a network of tiny veins. Normally, the walls of these vessels should support connective tissue, but if it is weakened, the blood flow is increased, and the outflow is disturbed, the walls of the vessels swell, the cavernous bodies are filled with blood in excess and bulge, filling the entire cavity and sometimes even showing out through the anus. Hemorrhoids are the very blood swollen and bulging cavernous bodies. Sometimes the occurrence of hemorrhoids is caused by mechanical causes, when under the influence of some factors the muscle fibers of the longitudinal rectum muscle are stretched and weakened, which causes the hemorrhoids to shift to the anus and fall out of it. The number of nodes in patients is very different – from one to several, which can fill the entire anal area. Their sizes are also very different – from 5 mm to 3 cm.
Although the exact causes of the development and the development of hemorrhoids have not yet been identified, it is considered that the following factors contribute to it:
Sedentary lifestyle. Especially the occurrence of hemorrhoids are susceptible to people who, by the nature of their activity, have to be in a sitting or standing position for a long time. When a person is sitting or standing for a long time, there is stagnation of blood in the pelvic organs, which can disrupt the blood flow through the veins.
Physical labor. However, exercise is not a panacea; people working in areas that require long and constant hard physical labor also suffer from hemorrhoids.
Complications of defecation – whether diarrhea or chronic constipation. Both of these conditions cause an increase in pressure in the abdominal cavity, which, in turn, leads to an increase in hemorrhoids and their loss.
Improper nutrition. Increased alcohol consumption, spicy food causes arterial inflow to the cavernous bodies of the rectum, which contributes to their expansion. Food, poor in fiber, causes constipation, and an abundance of fatty foods – diarrhea.
Overcooling or overheating of the pelvic region. Both of these conditions impair blood circulation and contribute to blood stagnation in the pelvic area.
Pregnancy, childbirth. In this state, the woman increases the pressure in the abdominal region, and the outflow of blood through the veins may be disturbed. As a result, hemorrhoids can form.
Obesity. Especially the occurrence of hemorrhoids susceptible to people whose fat is mainly deposited in the abdomen.
Some sexual practices, including anal sex.
Various diseases: liver diseases (when they are broken venous outflow of blood, blood pressure in the veins increases, which contributes to the development of hemorrhoids) diseases of the pelvic organs (bladder, prostate); neoplasms and / or inflammations in the pelvis, intestines.
Inherited causes: functional insufficiency of the connective tissue, impaired nervous regulation of the venous wall tone, pathology of the heart and blood vessels.
Symptoms of hemorrhoids
Hemorrhoids appear gradually and imperceptibly; a person does not experience any particular inconvenience, except that from time to time after a bowel movement may feel discomfort, pain, itching in the anus. Soft tissue in the area of the anus may swell. Mucus can be expelled from the rectum, irritating the anus and causing burning. Sometimes the patient feels as if there is a foreign body in the anus; after stool, frequent aching pains are frequent. These phenomena are aggravated by a violation of the diet or disorders of the gastrointestinal tract. But most often, people go to a doctor after detecting blood in the feces, toilet paper or underwear in the form of small drops, strips or, in rare cases, with intensive bleeding.
However, bleeding from the anus is not always associated with hemorrhoids (especially if the patient is over 40 years old). Rectal bleeding can also occur with the following diseases:
- anal fissure
- oncological diseases of the rectum
- prolapse of the rectum
- colitis, polyps, condyloma
The patient should pay attention to whether the occurrence of bleeding is associated with a change in bowel behavior, the appearance of a stool of a different color or texture than usual. With such symptoms, you should immediately consult a doctor – possibly the occurrence of bleeding elsewhere in the gastrointestinal tract.
How does hemorrhoids manifest
Hemorrhoids can be external or internal. In external hemorrhoids, hemorrhoids that are formed from the inferior venous plexus and are located directly at the anus expand. Since inflammation is not inside the rectum, but outside it, if you wish, you can examine this area with your own eyes. Bleeding with this type of hemorrhoids is practically absent, but patients are very concerned about pain in the rectal area. External nodes are often inflamed, injured by coarse linen and more often reborn into oncological formations. This type of hemorrhoids is relatively rare – no more than 10% of the total number of patients suffer from them.
Internal hemorrhoids are located in the submucosal layer of the rectum, see them with the naked eye is possible only in the later stages of the disease, when the shell of the cavernous bodies is so deformed that it looks out through the anus. The main symptoms of internal hemorrhoids are the presence of blood in the feces (although most often it is scarlet, arterial, it is also possible the appearance of dark venous blood with clots), pain during defecation. In the later stages of the disease, hemorrhoids fall out of the anus; at first they retract inside themselves, but later patients have to do it manually.
There is also a combined hemorrhoids, in which both the cavernous bodies of the rectum and the subcutaneous venous plexus of the anal region are deformed.
Hemorrhoids are acute (when symptoms develop rapidly, nodes become inflamed, inflammation passes to neighboring tissues, the patient suffers from pain; necrotic changes of the nodes are also possible due to thrombosis) and chronic. Then the disease lasts for a long time, for months and even for years, at the same time it periodically becomes acute – bleeding occurs, the nodes fall out, become pinched and cause a great deal of inconvenience. During periods of remission, subject to the precautions, the patient feels almost no discomfort.
Stages of development of the disease
Most cases of hemorrhoids are diagnosed at late stages – either because the patients did not pay attention to the symptoms, attributing them to other reasons, or because of false shame delayed the visit to the doctor. There are four hemorrhoid stages.
The first stage. Symptoms are expressed implicitly, occurring only in special cases (for example, with intestinal disorders, after heavy physical labor, long standing or sitting on the spot, eating disorders, overheating or overcooling). Sometimes the patient feels discomfort during stool, burning and itching after it. On examination, the doctor notes the presence of stagnation of blood and stretching of the vessel walls. If hemorrhoids can be diagnosed at this stage, the treatment is quick and without problems.
The second stage. Hemorrhoids increase in size, their walls become thinner, small gaps can form on them, which leads to bleeding. The patient after heavy physical exertion, complicated bowel movement or hypothermia may experience traces of blood in the feces, on toilet paper or underwear, but the bleeding is very small and passes quickly. Hemorrhoids are somewhat enlarged and can fall out of the anus after a bowel movement, however, setting back on their own. Their appearance is caused by an increase in pressure in the peritoneum with high tension, whether it is physical labor or a strong cough. At this stage, you can still resort to conservative treatment.
The third stage. The anal sphincter undergoes dystrophic changes and weakens, as a result of which the dropped hemorrhoids can only be adjusted manually. The patient is worried about severe itching, frequent and heavy bleeding. Conservative treatment is no longer possible.
The fourth stage. Nodes are so enlarged that it is not possible to set them right. The muscles of the anus are greatly weakened, the sphincter tone is reduced. For the loss of nodes enough even the smallest physical activity. The nodes themselves can take the form of a seal, they are inflamed; inflammation can also affect nearby tissues.
Complications of hemorrhoids
Fortunately, complications of hemorrhoids are not very common. Although most of all with a patient’s hemorrhoids are frightened by the sight of blood, it is not released so much that it represents a danger to life. However, long-term persistent bleeding may cause anemia.
The flow of mucus from the anus causes itching and can lead to eczema.
With the further development of the disease, when the hemorrhoids have already passed into the third or fourth stage, the patient has a lot of inconvenience in manual reposition of the nodes. And they can already fall out not only after stool, but also with a strong cough, sneezing, physical exertion.
In rare cases, dropped hemorrhoids can be pinched by the muscle of the anal sphincter, which causes severe pain. If the nodes do not correct, thrombosis can develop. This is the hardest possible complication of hemorrhoids, which requires immediate medical attention. In this condition, the hemorrhoidal nodules are swollen, tense, greatly enlarged in size, may develop a purulent infection in the patient’s body. Patients lose their appetite, their temperature rises, they feel sick.
Any disease becomes worse if it is not treated. No exception and hemorrhoids – if not treated, it progresses, which can lead to irreversible changes in the veins of the rectum.
Hemorrhoids during pregnancy and childbirth
The reason for the development of hemorrhoids in pregnant women is squeezing of the veins of the cavernous bodies of the rectum by the enlarged uterus, which causes disturbances in blood flow, overflow of blood vessels and the formation of hemorrhoids. Also, the appearance of hemorrhoids in pregnant women can cause constipation, when fecal masses stretch the walls of the rectum and injure the cavernous bodies. As a rule, in the last months of pregnancy, a woman is forced to lead a sedentary lifestyle, which also does not contribute to a healthy body. During childbirth, the muscles of the perineum are strained, the cavernous bodies of the rectum are stretched and injured. With a strong stretching of the muscles of the perineum, the anal sphincter may weaken and, as a result, the nodes will fall out.
Often, women giving birth confuse the symptoms of hemorrhoids with the effects of childbirth and do not immediately see a doctor, thereby provoking the development of the disease.
Which doctor should you go to if you suspect hemorrhoids?
If a person is disturbed by discomfort in the anus, itching, and blood, you should consult a proctologist or coloproctologist.
Diagnosis of the disease
Typically, for the diagnosis of hemorrhoids enough visual inspection of the anal area of the patient’s body. In this case, the patient either assumes a knee-elbow position, or takes a gynecological chair. The doctor examines the patient’s anus, paying special attention to the condition of the skin, the presence of hemorrhoids, their size and position.
To confirm the diagnosis, the doctor may conduct other studies:
Finger rectal examination. The doctor examines the tissues of the anal canal, assesses the condition of the mucous membrane of the rectum, as well as the organs and tissues surrounding it, determines the location of hemorrhoids, their size and degree of pain, and whether there is bleeding. True, the exact size of the nodes cannot be established – when groping, they, as a rule, decrease in size. In this case, the patient may lie on his side, on his back, or stand on all fours, and a gloved doctor with his index finger examines the rectum from the inside. After the finger examination, the doctor may prescribe anoscopy and sigmoidoscopy.
Anoscopy. During anoscopy, a special device is inserted into the back, which allows the doctor to examine the surface of the rectum for 10-15 cm. With the help of an anoscope, the doctor determines where the cavernous bodies are affected, whether there are tumor-like processes and inflammatory diseases in the rectum. Also anoscope is used for taking tests – biopsy and smears. This procedure is painless and has practically no contraindications; exception – the stage of exacerbation of inflammatory diseases. Then the doctor recommends that you first remove the inflammation and then conduct an examination.
Although anoscopy is a fairly simple procedure, it requires advance preparation. So that nothing prevents the examination of the rectum, the patient should refrain from eating food the night before, and also make two cleansing enemas – one half a day before the time of the procedure and the second – a couple of hours before it. It is also possible that the doctor will ask the patient to take a laxative the day before.
Also, to eliminate the risk of developing cancer pathology, the doctor may suggest that the patient undergo sigmoid and rectal sigmoid examination. In this study, the doctor can examine the inner surface of the rectum even further – up to 25 cm. If for some reason it is impossible to perform a sigmoidoscopy (suppose the patient has pathological disorders of the rectum), a colonoscopy is performed instead – when using an endoscope.
Thanks to this approach, the doctor can get a clear picture of the disease, at what stage it is and how it will develop. Along the way, it is possible to identify other diseases that affect the functioning of body systems located nearby. Often, hemorrhoids are accompanied by diseases of the anal part of the body and colon caused by bleeding from hemorrhoids. Sometimes there is also irritable bowel syndrome.
How to treat hemorrhoids
After the diagnosis, the doctor decides what treatment to prescribe. But with all the stages of hemorrhoids, from the first to the last, treatment is carried out that allows to stop the symptoms of the disease – to reduce pain, to stop the bleeding. If hemorrhoids of the first or second stage, it can be cured with the use of the so-called. conservative treatment – that is, the use of drugs that will relieve pain, prevent complications, and also contribute to the postoperative rehabilitation of patients. Best results are obtained by the joint use of drugs for external and internal use.
|Non-steroidal anti-inflammatory drugs and analgesics||Relieve inflammation, reduce swelling, relieve pain||Oral||Analgin, Diclofenac , Nise, Ibuklin|
|Anti-venous||Improves vascular tone, reduces stretching of veins, prevents blood clots||Orally, externally||Detralex , Phlebodia, Venoton , Troxevasin (tablets, gel)|
|Hemostatics||Stop bleeding||Orally, in the form of injections||Vikasol, Ditsinon, calcium chloride|
|Ointments||Relieve spasm and inflammation, relieve pain||Outwardly||Nitroglycerin
Vishnevsky ointment, Levomekol
|Anticoagulant||Prevent hemorrhoidal thrombosis||Injections||Heparin|
|Laxatives||Normalize the chair||Oral||Dufalak, Normase, Bisocadil|
|Enemas||Normalize the chair||Outdoor||Warm water, liquid paraffin, potassium chloride or magnesia solution|
|Rectal suppositories||Stimulation of the blood supply, analgesic, anti-inflammatory||Outdoor||Proktozan, Relief, Troxevasin, Procto-Glevenol, Troxerutin, Posterized|
If after a week or two no positive changes are observed, you should undergo a repeated examination by a proctologist, who will suggest another method of treatment.
If hemorrhoids of the second or third stage and it is impossible to cure it with some drugs, apply the so-called minimally invasive techniques – unlike operating theaters, they are less traumatic for the patient, patients spend less time in the hospital and recover faster. These include:
Infrared radiation. With the help of an infrared coagulator, the doctor acts on the hemorrhoids with a high temperature, burning the vessels. This operation does not require anesthesia (except in cases of high individual sensitivity of this area to the patient) and has a low trauma. Coagulation is also possible with laser beams.
Sclerotherapy. A special substance is injected into the patient’s hemorrhoids, which glues the walls of the vessels. Usually, during sclerotherapy, the substance is administered to no more than two nodes so that the patient does not develop pain syndrome. The next session is held in two weeks.
Ligation (ligation) of hemorrhoids with latex rings. This method is most often used to treat hemorrhoids in elderly patients who have complicating the treatment of the disease. At the same time, a small latex ring is superimposed on the base of the knot, which gradually squeezes the knot, leading to its necrosis and rejection. At the same time bleeding does not occur, since the stump is blocked by a ring; subsequently, healthy connective tissue forms in its place. The procedure is almost painless, has a low invasiveness, and the ring can be quickly applied with an anoscope.
Cryotherapy. With this method of treatment, the hemorrhoidal site is exposed to low temperatures, after thawing it dies off, the resulting wound heals over time and connective tissue forms at the site of the site. The operation is performed under local anesthesia.
All minimally invasive treatment methods are used only in the absence of acute hemorrhoids. If hemorrhoids enter the acute stage, it is first necessary to relieve inflammation and reduce bleeding.
Surgical treatment of hemorrhoids
In the fourth stage of hemorrhoids, surgical treatment is indicated. The operation (hemorrhoidectomy) is carried out in the following way: the main groups of hemorrhoids undergo excision, ligatures are superimposed on their bases, wound edges are stitched. Although it sounds scary, but in fact the operation, although rather unpleasant, is very effective and has the smallest number of relapses. However, after it, complications are possible: severe pain, bleeding, scars, which deform the anal canal, anal strictures, wound suppuration, paraproctitis. After the operation, it is necessary to observe the regimen prescribed by the doctor – for a while, abandon physical activity and hot baths.
Home hemorrhoids treatment
There are many folk remedies for hemorrhoids, but not all of them are effective, and some can be harmful. It is recommended to use them only with the approval of the attending physician.
Reduce inflammation and normalize the tone of blood vessels will help the decoctions of highlander kidney, rose hips and raspberry leaves. You can also wash the anus and hemorrhoids, especially after a bowel movement, with decoctions of herbs with anti-inflammatory effects (calendula, St. John’s wort, chamomile). You can also make warm baths for 10-15 minutes with them to reduce inflammation and pain.
The easiest way to avoid the occurrence or exacerbation of hemorrhoids, eating properly, so that the chair was soft, and there was no constipation. To do this:
There are foods high in fiber – fruits, vegetables, cereal cereals. This softens the stool and increases its volume, which helps to avoid an increase in pressure in the abdominal cavity. However, dietary fiber should be added to your diet in small portions so that they do not cause increased gas formation. It is recommended to avoid spicy dishes, seasonings and alcohol.
Drink plenty of fluids. It is recommended to drink six to eight glasses of water or other liquids per day (alcohol is not included here) so that the stool is softer and does not injure the walls of the rectum.
Add to your diet drugs containing dietary fiber. Most people do not get enough fiber per day (25 g recommended for women, 38 g for men). Some nutritional supplements can improve the general condition of the patient with hemorrhoids developed. But do not forget that with the introduction in the diet of additives with a high content of dietary fiber should increase the consumption of water or other liquids (not alcohol) up to eight glasses a day or more. Otherwise they may cause constipation.
Do not strain during bowel movements. Excessive tension and breath holding when trying to relieve creates a lot of pressure in the veins of the rectum.
Time to visit the toilet. If a person, for whatever reason, defends a bowel movement, the stool may become dry and it will be more difficult to remove it from the body. However, you should not get involved in laxatives – with a constant intake, they can irritate the anal area and even contribute to the development of inflammatory processes in the rectum.
Exercise. It is recommended to do exercises or engage in any other physical activity – this will improve the condition of the body’s vascular system, improve blood flow and reduce pressure on the veins. When sitting or standing, it is advisable to take a short break every couple of hours, walk, stretch, do some exercises.
Avoid long periods of immobility. Too long sitting or standing can increase pressure on the veins in the rectal area.