Chronic hemorrhoids – the existing expansion of the kavernozny textures located in a submucous layer of the lower part of a rectum and in hypodermic cellulose of a zone of an exit from the anal channel is long. It is shown by bleedings, an itch, burning in the field of an anus, increase and loss of gemorroidalny knots. Pains in a zone of back pass are possible. Chronic hemorrhoids are diagnosed on the basis of the anamnesis, clinical symptomatology, data of survey, a manual rectal research, an anoskopiya, rektoromanoskopiya and other researches. Treatment – medicamentous therapy, an alloying, cryotherapy, coagulation, a gemorroidopeksiya, a gemorroidektomiya.
Chronic hemorrhoids – the chronic pathological increase in arteriovenozny kavernozny textures in the field of back pass which is followed by bleedings, loss, thrombosis and infringement of gemorroidalny knots. Is the most widespread proktologichesky disease. The pathologies given about frequency are ambiguous. Statistically, in Russia chronic hemorrhoids suffers from 13-14,5% of adult population. Foreign scientists specify figures from 4,4 to 36%. Researchers believe that the frequent asymptomatic course of chronic hemorrhoids is the reason of so contradictory statistical information. According to data of the American proctologists, 80% of patients with the gemorroidalny knots revealed during planned medical examination did not ask for the help due to the lack of complaints. Treatment is performed by experts in the field of a proktologiya.
Reasons of chronic hemorrhoids
Gemorroidalny knots arise at pathological increase in the arteriovenozny kavernozny textures which are formed during pre-natal development and in the structure of the genitalia reminding kavernozny bodies. One group of such textures settles down over the gear line, in a submucous layer of the lower departments of a rectum. The second is localized under the gear line, in hypodermic cellulose of a zone of an exit from the anal channel. Both groups of educations are connected among themselves by anastomoza.
Thanks to the ability to be filled with blood kavernozny bodies in the field of back pass provide additional sealing of an anus at a close sphincter. It was traditionally considered to be that chronic hemorrhoids result from a varicosity of this anatomic zone, however, modern researchers believe that the disease develops under the influence of a number of factors. Among the factors promoting developing of chronic hemorrhoids – increase in amount of blood in kavernozny bodies because of acceleration of arterial inflow and/or delay of venous outflow, thrombosis, inflammatory changes of a vascular wall and dystrophic processes in muscles and a linking of this anatomic zone.
It is established that at the patients having chronic hemorrhoids, the top rectal artery is wider, than at healthy people. Besides, increase in quantity and density of small vessels in an anus zone is found in patients with this pathology. Because of weakening of muscles and sheaves gemorroidalny knots become mobile. Pressure of kalovy masses and a natuzhivaniye promote the shift of knots in the disteel direction. At the long course of chronic hemorrhoids degenerately changed sheaves are broken off, the knots located above the gear line begin to drop out of back pass.
In the list of the conditions promoting development of chronic hemorrhoids, experts include sedentary work, an inactive way of life, irrational food, locks and heavy physical activities. Some researchers specify that chronic hemorrhoids are more often diagnosed for people with multimoment defecation (option of physiological norm at which kalovy masses is allocated not at once and in stages, divided by small periods) in case they are accustomed to accelerate defecation by an excessive natuzhivaniye. At women chronic hemorrhoids quite often develop in the pregnancy period that is caused by increase in pressure in an abdominal cavity. There is a hereditary predisposition.
Classification of chronic hemorrhoids
Taking into account localization of gemorroidalny knots (above or below the gear line) distinguish the external, internal and combined disease forms. During chronic hemorrhoids allocate four stages:
- 1 stage – bleedings from back pass are observed. Patients with chronic hemorrhoids can show complaints to unpleasant feelings in the field of an anus. Loss of gemorroidalny knots is absent. Strengthening of the vascular drawing of a mucous membrane and initial dystrophic changes of a musculocopular framework are noted.
- 2 stage – at patients with chronic hemorrhoids bleedings, an anal itch, release of slime and loss of knots with their subsequent independent reposition come to light. Dystrophic changes of muscles and sheaves insignificant.
- 3 stage – clinical symptomatology are similar to the second stage of chronic hemorrhoids. Independent reposition of gemorroidalny knots is absent, after the act of defecation the patient should set knots hands. Dystrophy of a musculocopular framework progresses, muscles lose elasticity.
- 4 stage – intensive pains and an incontience of kalovy masses are added to the listed clinical displays of chronic hemorrhoids. Knots often drop out of back pass, their manual reposition is complicated. The expressed dystrophy of muscles and sheaves which is followed by insolvency of a musculocopular framework is noted.
Symptoms of chronic hemorrhoids
The disease develops gradually. In the beginning patients with chronic hemorrhoids note insignificant discomfort and feeling of weight in a zone of back pass. After a while the discomfort becomes more expressed, there are bleedings caused by damage of gemorroidalny knots during the act of defecation. Blood at chronic hemorrhoids bright red, appears after an otkhozhdeniye a calla, follows from the arteries which are carrying out blood supply of arteriovenozny kavernozny textures. If during the previous defecation a part of blood remained in a rectum, before emergence of kalovy masses from back pass dark clots can be allocated.
At initial stages of chronic hemorrhoids of bleeding usually insignificant, arise only at locks and violation of a diet, stop independently and do not demand rendering the qualified medical care. Blood is found in the form of droplets on linen and toilet paper or is emitted with a small stream after the act of defecation. When progressing chronic hemorrhoids of bleeding become regular and more plentiful. Blood appears at each act of defecation and heavy physical activities.
At late stages of chronic hemorrhoids of bleeding arise independently, without communication with the act of defecation or physical activities. The volume of blood loss can vary. In most cases the organism of the patient with chronic hemorrhoids adapts to small repeated blood losses, anemia is absent. At the plentiful bleedings, a thicket which are observed at male young patients and also at late stages of a disease development of iron deficiency anemia can be noted.
At external hemorrhoids the patient can independently find the gemorroidalny knots representing small elastic roundish meshkovidny educations. At internal hemorrhoids knots settle down from a sphincter inside and come to light when carrying out a rectal research. In the absence of complications diameter of knots usually does not exceed 2 cm, the palpation is painless or is followed by feeling of discomfort. At thrombosis or an inflammation knots increase in a size, become sharply painful.
Character of a pain syndrome at chronic hemorrhoids changes depending on a stage of a disease, existence or lack of complications. Usually pains not intensive, prevalence of burning and feeling of a raspiraniye is noted during the act of defecation. After completion of defecation the discomfort usually gradually disappears, in certain cases burning remains within several hours, giving to sick chronic hemorrhoids the expressed inconvenience. At an inflammation and thrombosis intensity of a pain syndrome increases. Pains become holding apart or pulsing, amplify at cough and heavy lifting. In hard cases the sleep is interrupted, the patient cannot be in a sitting position.
Typical symptom of chronic hemorrhoids is the itch of perianalny area caused by release of slime, loss of gemorroidalny knots and formation of sites of maceration. Some patients with chronic hemorrhoids with the reason of an itch have a dermatitis which developed when using medicines of local action with the irritating effect. Perianalny hypostasis for chronic hemorrhoids is uncharacteristic, emergence of this symptom is usually connected with frequent loss of knots. The most widespread complication of chronic hemorrhoids is thrombosis of gemorroidalny knots. Less often hematomas of area of the anal channel, plentiful bleedings at infringement and a necrosis of internal knots meet. In some cases infringement of knots can become complicated paraproktity.
Diagnosis of chronic hemorrhoids
The diagnosis is established taking into account complaints, the clinical record, data of survey of field of back pass, a manual research, an anoskopiya and rektoromanoskopiya. Survey of back pass at suspicion of chronic hemorrhoids is carried out in knee and elbow situation or on a gynecologic chair. During survey the proctologist pays attention to a condition of a sphincter, existence of the increased external gemorroidalny knots, sites of maceration, blood traces, a calla and slime. At a rectal research and an anoskopiya define localization and the size of internal gemorroidalny knots, for more exact assessment of a condition of knots of the patient with chronic hemorrhoids ask to natuzhitsya.
At suspicion appoint a kolonoskopiya and an irrigoskopiya to defeat of overlying departments of a large intestine. The listed researches give the chance to exclude or confirm existence of other damages of a digestive tract which are followed by rectal bleedings. All patients with chronic hemorrhoids are directed to consultation to the therapist. In the course of differential diagnostics exclude other diseases of a rectum and the anal channel, first of all – malignant new growths.
Treatment of chronic hemorrhoids
In the course of treatment of this pathology conservative therapy, low-invasive techniques and classical surgeries is used. Medical tactics is defined depending on a stage of a disease, existence or lack of complications, by expressivenesses of a pain syndrome and other factors. Indications to conservative therapy are initial stages of chronic hemorrhoids, and also late stages of a disease during pregnancy and in the presence of contraindications to carrying out surgical intervention.
To the patients having chronic hemorrhoids appoint a diet with the high content of vegetable cellulose, apply soft depletive to normalization of activity of a digestive tract and elimination of locks. Use trombolitik, anesthetics and resolvents, appoint physiotherapeutic procedures. In the absence of effect carry out by sick chronic hemorrhoids a sklerozirovaniye, bipolar or infrared coagulation, an alloying of gemorroidalny knots with use of latex ligatures and other low-invasive procedures. At late stages carry out a gemorroidopeksiya or a gemorroidektomiya.