Loss of gemorroidalny knots is the exit varikozno the changed vascular knots of the anal channel out of its limits arising when progressing chronic hemorrhoids. It is shown by existence in area of an anus of the small knots of the small size causing strong feeling of a foreign matter in back pass. Pathology is diagnosed by method of survey, an anoskopiya and a rektoromanoskopiya, use an endorectal ultrasonografiya of a rectum and the anal channel less often, appoint laboratory researches. Knocking over of symptoms is carried out by conservative methods, in the subsequent carry out treatment of the main disease.
Loss of gemorroidalny knots
Loss of gemorroidalny knots – happens when progressing chronic hemorrhoids, is characterized by an exit of expanded venous textures from the anal channel at a natuzhivaniye or physical effort from the patient. The disease is quite widespread, according to experts in the sphere of a clinical proktologiya, occurs at 130-145 people on one thousand population. Very often patients with hemorrhoids for the first time see a doctor already at a stage of loss of gemorroidalny knots as they do not pay attention to earlier symptoms. Representatives of both floors are ill approximately with an identical frequency though at many women progressing of a disease after pregnancy and childbirth can be noted. From loss of gemorroidalny knots people who conduct sedentary, low-active lifestyle very often suffer. As in the modern world of such people becomes more and more, relevance of a problem increases. Treat a disease and doctors proctologists are engaged in its diagnostics.
Reasons and risk factors
Loss of gemorroidalny knots happens because of a number of the dystrophic pathological processes in fibrous muscular tissue leading to violation of a blood-groove, stagnation of blood, stretching of walls of vessels. A way of life with low physical activity, sedentary work, constant locks, alcoholism and household alcoholism, improper feeding, pregnancy, difficult delivery with injuries are the reason of the specified changes.
In process of increase in knots they move to the lower sites of a rectum. Walls of knots become thinner, they bleed and inflame. Dystrophic changes extend on mucous and the supporting intestines device. Sphincters are not able to hold expanded kavernozny sine, there is a loss of gemorroidalny knots from an anus gleam. Visually they look as small shishechka or balls of cyanotic color. On structure represent the vascular educations consisting of a set of the cavities divided by smooth muscles and connecting fabric. At loss of gemorroidalny knots in walls of kavernozny educations symptoms of dystrophy, an inflammation, in cavities – a blood congestion, sometimes single or multiple blood clots take place.
Loss of gemorroidalny knots approximately in five years after the first displays of chronic hemorrhoids begins, this symptom characterizes transition of a disease from the first stage in the second. In the beginning knots go beyond an anus only at defecation, strong physical tension, at cough, sneezing. As function of sphincters and fibrous muscular tissue remains so far, knots come back to a rectum. The patient begins to feel a foreign matter in back pass, sometimes for elimination of loss of gemorroidalny knots it needs to strain a sphincter consciously. Such manifestations increase risk of an inflammation, damage of knot, bleedings become frequent.
The following stage characterizes transition of chronic hemorrhoids to the third stage. Loss of gemorroidalny knots can happen even out of the act of defecation, at sharp change of position of a body, quiet walking, lifting of weights when the patient makes an effort. Spontaneously knots cannot return to an intestines gleam any more, to have to return to the patient them into place in the manual way. Strengthening of symptoms is closely connected with further dystrophic changes in crotch tissues, rectum walls which lead to considerable weakening of sokratitelny function of sphincters. Except loss of the gemorroidalny knots sick the constant anal itch, different intensity of pain in back pass, frequent bleedings disturbs.
At the last stage of a muscle and a sheaf in the field of an anus and a crotch collapse almost completely and replaced with connecting fabrics. Loss of gemorroidalny knots already constant, they cannot be set even in the manual way, without having caused at the same time bleeding. Walls of knots often adjoin to the external environment, they are injured when sitting on a chair, walking, depletion of intestines, hygienic procedures in the field of an anus why their fabric grows coarse and is strongly condensed. At this stage the risk of infectious complications which first symptom is sharp pain in the field of an anus increases; high temperature can join. Also the disease often is complicated by thrombosis of gemorroidalny knots, severe bleedings.
Diagnostics and difdiagnostika
It is simple to diagnose the last stages of loss of gemorroidalny knots. At survey of the proctologist around an anus pathological roundish formations of different degree of mobility are defined. They cyanotic color, through walls the vascular grid is looked through. On a surface of knots often there are macerations, wounds, the inflammation centers.
It is more difficult to diagnose initial stages. During proktologichesky survey the expert estimates a condition of knots, defines whether there are no cracks and macerations in the field of an anus, symptoms of bleeding. Also extent of loss of gemorroidalny knots, their pliability and a possibility of manual reposition becomes clear. Force of an anal reflex is checked by weak irritation of skin near back pass or by means of the special probe. The manual research gives an idea of the sizes of knots in a gut, allows to reveal painful points, to estimate a condition of an anal sphincter, force of its any reductions.
Confirm the diagnosis of loss of gemorroidalny knots generally by means of endoscopic techniques of a research. The simplest of them – an anoskopiya. The technique allows to examine about 8-12 centimeters of a rectum, including anorektalny area. If the patient begins to make an effort, it is possible to see distinctly loss of gemorroidalny knots by means of an anoskop that considerably facilitates diagnostics of early stages of a disease.
The plan of compulsory diagnostic procedures at loss of gemorroidalny knots and hemorrhoids includes a rektoromanoskopiya. By means of a rektoromanoskop examine overlying departments of a rectum at distance about 25 centimeters from an anus. Inspection allows to consider in more detail all changes of the top (proximal) departments of a rectum. The increasing popularity in a proktologiya is found by an endorectal ultrasonografiya of a rectum and the anal channel. It gives the chance not only to reveal changes in gemorroidalny knots, but also to carry out differential diagnostics with tumoral diseases, cysts, rectum polyps.
Very often loss of gemorroidalny knots is combined with other pathologies of a large intestine therefore in the presence of the corresponding indications to the patient carry out a kolonoskopiya, is more rare an irrigoskopiya. These researches help to reveal diseases which often complicate symptoms of hemorrhoids and provoke loss of gemorroidalny knots. Differentiate loss of gemorroidalny knots with tumors in a rectum and the anal channel, loss of a rectum, gemangiomy, any polyps, a hypertrophy of anal nipples.
Treatment of loss of gemorroidalny knots
At the first stages appoint conservative therapy. For this purpose use medicines of local action – candles, creams and gels. These medicines kill symptoms of an inflammation and pain, at bleedings the quite good result is yielded by candles with adrenaline or thrombin. But conservative treatment is not capable to cure completely a disease, it only facilitates its current and slows down progressing. Indications to such type of therapy are minor changes in structure of knots, need to prepare the patient for operation. Also conservative therapy is carried out as a palliative when there are contraindications to surgery.
For elimination of loss of gemorroidalny knots in a proktologiya several techniques are used. At the initial stage of a disease carry out medicamentous sclerotherapy of gemorroidalny knot or its photocoagulation by means of the laser, thermal coagulation by infrared beams. These procedures are performed on an outpatient basis, the patient does not have need to lay down in office of a proktologiya. More effective technique which can be used both at the second, and at the third stage of hemorrhoids – an alloying of gemorroidalny knots latex rings or as an alternative, a sutural alloying. At permanent loss of gemorroidalny knots use a transanal gemorroidektomiya on Longo and a gemorroidektomiya to Milligan-Morgan. To reach the best effect, often combine different ways of treatment.
Forecast and prevention
Recommend to change all patients with hemorrhoids in an initial stage for prevention of loss of gemorroidalny knots a way of life and a diet. It is necessary to move, play more sports with adequate physical activities. Especially it concerns patients with sedentary work. It is important to watch closely a chair and not to allow locks. To regulate activity of intestines and to counteract locks, recommend to eat food rich with cellulose, if necessary appoint laxatives. It is necessary to watch closely hygiene, to keep clean and not to injure area of an anus.
The forecast at loss of gemorroidalny knots depends on expressiveness of changes and existence of complications. Modern methods of therapy yield resistant results at timely diagnostics. At later stages the forecast not so favorable. Treatment becomes complicated in the presence of an infection, thromboses and bleedings with big loss of blood are very dangerous.