Gemorroidalny bleeding is the pathological state which is followed by the expiration of blood from gemorroidalny knots of a rectum. Pathology is shown by the periodic releases of blood from an anus arising under the influence of provocative factors. For diagnostics external examination, manual inspection of a rectum, a rektoromanoskopiya, an irrigoskopiya, a X-ray analysis of abdominal organs, the general blood test, biochemical blood test are used. Conservative techniques, low-invasive and radical surgeries are applied to treatment of bleeding from gemorroidalny knots.
Gemorroidalny bleeding - the release of blood from the anal channel arising against the background of hyper plastic changes in kavernozny bodies of a rectum. Such bleedings demonstrate against the background of a gemorroidalny disease which is observed more than at 10% of world's population. Hemorrhoids occupy 40% in structure of all diseases of a rectum. This pathology mainly develops at males. The age peak of a gemorroidalny disease is necessary from 30 to 50 years. Experts in the field of a modern proktologiya actively are engaged in search of new methods of treatment of hemorrhoids and bleedings from gemorroidalny knots. Treatment and diagnosis of a disease are performed by the proctologist who appoints adequate therapy depending on a disease stage.
Reasons and risk factors
Most often gemorroidalny bleedings are a consequence of damage of internal gemorroidalny knots during the act of defecation. Generally it is observed at long locks and an excessive natuzhivaniye. Among the reasons it is also possible to allocate violation of outflow of blood on venula from kavernozny bodies in rectum walls, existence of branched kavernozny little bodies, a congenital functional underdevelopment of connecting fabric change of an innervation of a venous wall.
Increase in pressure in system of veins because of locks, long stay in a sitting or standing position, hard physical activity or pregnancy belongs to risk factors which can lead to development of gemorroidalny bleeding. Also can lead regular abuse of alcoholic beverages and spicy food to this state. Gemorroidalny bleeding develops also against the background of cirrhosis with the accompanying portal hypertensia. Besides, obesity belongs to risk factors.
The giperplaziya of kavernozny system thanks to the strengthened arterial inflow on small arteriola to kavernozny little bodies is the cornerstone of this pathology. Under the influence of risk factors there are microscopic injuries which lead to migration of gemorroidalny knots on the course of the anal channel. Gemorroidalny bleeding is preceded by thinning of walls of knot as a result of stagnation of blood and violation of a local venous blood-groove. Small anguishes and erosion which become the reason a blood izlitiya from a knot cavity are formed. In the presence of corresponding pathological in kavernozny fabric the venous vessels contacting among themselves with folded walls are found.
Symptoms of gemorroidalny bleeding
Pathology is shown in the form of drops and splashes of bright scarlet blood from back pass. They arise directly after the act of defecation. Besides, spots of blood can be found on toilet paper, in excrements, on underwear and so on. As a rule, gemorroidalny bleeding is not followed by pain and can develop absolutely unexpectedly. Often release of blood from gemorroidalny knots comes to the end upon termination of the act of defecation and can repeat again at the following.
At a combination of hemorrhoids and loss of a rectum gemorroidalny bleeding can be very essential and lead to heavy iron deficiency anemia. Depending on expressiveness of clinical symptoms, gemorroidalny bleeding is divided on plentiful and not plentiful. Plentiful bleeding is shown practically at each act of defecation in the form of massive releases and even splashes of blood. Not plentiful bleeding develops only at sharp errors in a diet and long locks.
Besides, often in parallel with gemorroidalny bleeding other pathological conditions of rectal area, such as anal crack develop, sharp paraproktit also rectum fistulas. Thereof, besides bleeding symptoms, in clinic of a disease emergence of purulent and mucous allocations, and also temperature increase can be observed.
Diagnostics and difdiagnostika
Existence of bloody allocations from a rectum testifies to possible gemorroidalny bleeding or other pathology of the lower departments of a GIT and is a reason for consultation of the proctologist. The expert has to survey area of a rectum. In the presence of sharp bleeding only external survey and a manual research is carried out. These simple methods allow to reveal existence of the increased gemorroidalny knots and to examine them regarding bleeding.
Endoscopic researches are conducted only after subsiding of sharp symptomatology. From tool methods endoscopy of a direct and sigmovidny gut – the rektoromanoskopiya allowing to specify localization of bleeding is performed. Also the kolonoskopiya representing an endoscopic research of all departments of a large intestine can be carried out. From laboratory methods the general and biochemical blood test is carried out. In the general blood test pay attention to the level of erythrocytes and hemoglobin which can decrease at persistent frequent bleedings.
Endoscopic techniques allow to exclude the oncological reason of bloody allocations from a rectum. For differential diagnosis of gemorroidalny bleeding the X-ray analysis of a large intestine with contrast - an irrigoskopiya can be used. In the presence of gemorroidalny bleeding ultrasonography of abdominal organs for assessment of structure of a liver and an exception of portal genesis of gemorroidalny bleeding is shown.
For an exception of purulent complications of hemorrhoids estimate the level of a leykotsitoz and existence of shift of a formula to the left. These changes in blood are found at inflammatory complications. In case of frequent recurrent gemorroidalny bleedings it is necessary to carry out assessment of functionality of a liver and to define hemostasis indicators. As a rule, at dysfunction of a liver and pathology of system of a hemostasis gemorroidalny bleeding can be more plentiful and frequent.
Treatment of gemorroidalny bleeding
Rare bleedings at uncomplicated hemorrhoids are treated conservatively. Therapy in this case is directed to elimination of the inflammatory phenomena and normalization of a chair. The complete elimination of heavy physical activities and observance of the correct diet is important. If gemorroidalny bleeding often recurs and is followed by thromboses and loss of gemorroidalny knots, then performing expeditious treatment is shown to such patients. Hemorrhoids operations are performed after preliminary preparation which includes anti-inflammatory therapy within 5-7 days.
In the period of an exacerbation of gemorroidalny bleeding it is recommended to exclude physical activities. In food sick hemorrhoids it is necessary to increase the maintenance of products which have poslablyayushchy effect: it is desirable to use more vegetables and fruit. Conservative treatment includes holding various physiotherapeutic actions, the most effective of which are sedentary local medical bathtubs with antiseptics. As drug treatment it is used , . Apply anti-inflammatory suppositories to treatment of gemorroidalny bleedings.
In the presence of thrombosis of gemorroidalny knots purpose of heparin is recommended. If bleeding is followed by an itch, pains and burning, then patients need to apply complex medicines with kseroformy, belladonna extract, trokserutiny, fluokortolony. At severe pains in a rectum analgetics are shown.
From surgical low-invasive methods of treatment carrying out infrared coagulation, bipolar electrothermic coagulation, a latex alloying is shown. Modern effective methods of expeditious treatment of gemorroidalny bleeding are the alloying of gemorroidalny arteries, skleroziruyushchy therapy and cryotherapy. Open surgeries are required at inefficiency of low-invasive techniques.
Forecast and prevention
At the timely address to the proctologist the forecast at gemorroidalny bleeding favorable. Modern techniques allow to eliminate or to significantly reduce displays of the main disease and to prevent development of repeated bleedings. As preventive actions the alcohol exception, hygienic care of anal area, an exception of a hard work, correction of a sedentary life, daily gymnastics for pregnant women is recommended.
1. Clinical recommendations. Coloproctology / Shelygin Yu. A. - 2015
2. Clinical recommendations about diagnostics and treatment of adult patients with sharp and chronic hemorrhoids / Association of coloproctologists of Russia - 2013
3. Clinical operational coloproctology. Practical guidance / Fedorov of V.D. - 1994
|Hemorrhoids operations||21383 . 3|
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