Hemorrhoids – the disease which is characterized by varicose change of veins of back pass and a rectum with formation of gemorroidalny knots. It is symptomatic shown by feeling of burning, weight, an itch in back pass, bleedings scarlet blood from knots. Can be complicated by loss, infringement and thrombosis of gemorroidalny knots. The inflammation of knots leads to developing of rectal fistulas and a paraproktita. Long gemorroidalny bleedings lead to development of anemia.
Hemorrhoids are one of the most widespread proktologichesky diseases. Hemorrhoids represent pathologically increased gemorroidalny knots which are inclined to an inflammation, bleeding and loss from back pass. The name of a disease represents the Greek term designating bleeding in translation. Bleedings are the brightest, but not the only symptom at development of hemorrhoids.
Gemorroidalny venous textures at the person settle down in a submucous layer of a wall of the anal channel, are similar on the structure to kavernozny bodies of genitals and as it is supposed, play a role in providing a full smykaniye of back pass and deduction of kalovy masses. Distinguish internal and external gemorroidalny knots. Increase in these venous educations is found in most of people different degree sooner or later. The increase in gemorroidalny knots revealed at survey and which is not followed by clinical symptomatology is not considered a disease.
Clinically hemorrhoids are shown by loss internal, thrombosis of external gemorroidalny knots, bleedings, an itch and burning in a rectum, morbidity at defecation. Now in Russia in 75% of cases resort to surgical removal of pathologically increased knots (in comparison in the USA and Europe this indicator makes about 20% of cases). Efficiency of not surgical methods of treatment is promoted by early detection of a disease and the timely address to the doctor.
Etiology and pathogenesis of hemorrhoids
Pathogenetic factor of development of hemorrhoids is the broken blood circulation in gemorroidalny venous congestions, promoting development of dystrophic changes in soyedinitelnotkanny and muscular structures which fix knots in the anal channel. Development of a disease is promoted by the following factors: tendency to frustration of a chair (frequent locks or ponosa), sedentary life, abuse of spicy food and alcohol.
Among professional factors It should be noted the professions demanding long stay in a sitting position (drivers, pilots, etc.). Besides, violation of blood circulation in a perianalny zone can be promoted by some sports: horse, bicycle, weightlifting. At women development of hemorrhoids can be promoted by pregnancy and childbirth.
Classification and symptoms of hemorrhoids
Classification of chronic hemorrhoids:
In the clinical course of hemorrhoids allocate four stages. The first stage is characterized by periodic release of scarlet blood from an anus. Loss of gemorroidalny knots is not noted.
At the second stage there is a loss of gemorroidalny knots and their independent reposition. Perhaps both to be followed by bleeding, and to proceed without it.
At the third stage the dropping-out gemorroidalny knots are not set independently, and it is necessary to return them to the anal canal manually. Bleeding can be also present or absent.
Hemorrhoids of the fourth stage are characterized by impossibility of reposition of the gemorroidalny knots which are constantly dropping out of the anal channel. Besides, distinguish sharp and chronic hemorrhoids.
- Sharp hemorrhoids
Clinically sharp hemorrhoids are shown by thrombosis of external gemorroidalny knots, or loss from the anal channel of trombirovanny internal knots.
Main clinical symptoms of chronic hemorrhoids: episodes of bleedings from back pass, an itch and burning in perianalny area, periodic losses of internal gemorroidalny knots. The leaky smykaniye of a sphincter of back pass and continuous loss of gemorroidalny knots can promote emergence of transparent mucous allocations from back pass.
Bleeding – very widespread symptom of hemorrhoids is also supposed that periodic episodes of bleeding from back pass happen at 10% of the population. In 70-80% of cases hemorrhoids are the reason of these bleedings. However, the most part of patients do not ask for medical care as bleedings poor and rare and to them do not attach special significance. Besides, many hesitate to address the proctologist or to be afraid of inspection methods.
Gemorroidalny bleeding develops, as a rule, during defecation, It can be scarlet splashes at the time of a natuzhivaniye or blood traces on paper. If blood after defecation remained in a rectum, next time it leaves in the form of dark clots.
For a long time existing hemorrhoids are shown by loss of internal gemorroidalny knots. Originally knots drop out at a natuzhivaniye during defecation. Further when progressing a disease knots drop out even more often, at cough, sneezing. Independently are not set, it is necessary to perform manual reposition. Over time, loss of knots becomes constant, knots do not give in to reposition. The gemorroidalny knots which are dropping out outside can bring considerable discomfort, besides they are inclined to a trombirovaniye.
Often hemorrhoids are followed by the anal itch caused by constant irritation of skin in the field of an anus allocations.
Diagnosis of hemorrhoids
Despite quite simple diagnosis of this disease, it is worth approaching it seriously as insufficiency of inspection can lead to the wrong diagnosis and not identification of significant complications or the accompanying pathologies.
Patients with suspicion of hemorrhoids are examined in a gynecologic chair with the maximum reduction of knees to a stomach, or in a knee and elbow position. Make external examination of back pass and perianalny area, noting an anus form, the available deformations, cicatricial changes, fistulas, a gaping of back pass. Pay attention to color and a condition of integuments, estimate expressiveness of external gemorroidalny knots, note extent of loss internal, and also a possibility of their reposition.
Check of an anal reflex is carried out by means of shaped irritation of a perianalny zone by the probe. Then part edges of back pass and examine walls of the anal channel on existence of an anal crack. After external examination make a manual research of a rectum, noting a condition of external and internal anal sphincters, their tonic tension, force of strong-willed reductions, morbidity degree. Investigate a mucous membrane of the channel on presence of defects, anal polyps and hems.
Often exact definition of localization and the sizes of gemorroidalny knots at a manual research can represent a certain difficulty because knots at a palpation decrease in sizes. Therefore at a research to the patient suggest to natuzhitsya for more accurate identification and inspection of knots. About 8-12 cm of the anal channel can be considered in details at an anoskopiya. This research is quite well postponed by patients and allows to examine a zone of an arrangement of internal gemorroidalny knots. At a natuzhivaniye internal gemorroidalny knots can drop out in a gleam of an anoskop.
Rektoromanoskopiya is appointed to all patients with suspicion of hemorrhoids. If there is no opportunity to make a rektomanoskopiya up to the height of 25 centimeters, or there are assumptions of pathologies of the top departments of a large intestine, make an irrigoskopiya or a kolonoskopiya. Ultrasonography of abdominal organs allows to exclude or reveal associated diseases of a digestive tract. For a bleeding exception of the top departments of a gastrointestinal tract appoint gastroscopy.
Practice shows that diseases of the anal channel and a large intestine are found in a third of the patients having hemorrhoids, some of them can also be the cause of bleeding from back pass. Quite often at survey and inspection concerning hemorrhoids it is possible to diagnose rectum cancer.
Treatment of hemorrhoids
Tactics of treatment of hemorrhoids is chosen proceeding from a disease stage. At hemorrhoids of the first and second stage it is possible to stop on conservative therapy, or to offer treatment by means of electrothermic coagulation or sclerotherapy. Imposing of ligatures (a sutural alloying or an alloying latex rings) can be effective at the second and third stage.
Besides, at hemorrhoids in the third stage the gemorroidektomiya technique across Longo can be applied. The fourth stage of hemorrhoids demands surgical excision of gemorroidalny knots (gemorroidektomiya).
During the sharp period of hemorrhoids everything, except conservative therapy, techniques of treatment are contraindicated. Besides, are often limited to drug treatment at the first and second stage of a disease. At conservative treatment appoint the diet contributing to normalization of a chair at frequent diarrheas and to its softening at the complicated defecation. If necessary appoint laxative medicines. As the general therapy the medicines promoting strengthening of venous walls are also recommended (flebotropny means – ). Locally apply candles and ointments with the anti-inflammatory, healing, anesthetizing, styptic and improving a local blood-groove means.
Purpose of local medicines depends on expressiveness of these or those symptoms. Most often choose the multicomponent means including anti-inflammatory, anesthetizing and haemo static elements. The means containing anti-inflammatory medicines (corticosteroids and nonsteroid medicines) are appointed short courses in order to avoid side effects. At the expressed bleedings apply effective alginate of sodium haemo statics.
Conservative therapy at hemorrhoids is directed to simplification of clinical symptoms and attenuation of an aggravation. It is necessary to remember that it is the symptomatic therapy which is not leading to disposal of a disease and temporary. Tendency to a sedentary life or excess physical activities promote development of new aggravations and progressing of hemorrhoids.
Effective measures of treatment of hemorrhoids at early stages are low-invasive techniques of removal of gemorroidalny knots (sclerotherapy, infrared coagulation, an alloying). Often the combined treatment is in practice applied. Despite high degree of safety and convenience to patients, low-invasive techniques are not always applicable.
For removal of knots at late stages of a disease carry out surgical intervention: gemorroidektomiya. At the same time kavernozny venous textures excise entirely, excepting probability of a recurrence of a disease. Modern technicians of performance of operations allow to reduce the postoperative period and as much as possible to exclude probable complications.
As hemorrhoids are not the disease posing a threat for life in all cases, except the persistent bleeding leading to the expressed anemia the patient himself resolves an issue of expediency of surgical intervention depending on recommendations of the doctor. As patients with frequent aggravations usually ask for medical assistance, hemorrhoids give them a noticeable inconvenience and considerably worsen quality of life, a task of the proctologist is careful inspection and the competent recommendation of an optimum technique of treatment.
Prevention of hemorrhoids
Prevention of hemorrhoids includes the prevention of the factors promoting violation of a blood-groove in vessels of a rectum and a measure for normalization of work of a digestive tract. Timely treatment of the diseases which are shown locks or diarrhea, the healthy balanced diet contribute to normalization of a consistence of a chair and to regular comfortable depletion of intestines.
Prevention of hemorrhoids is promoted by hygienic measures for care of the field of back pass: careful clarification after defecation, use of soft grades of paper (if necessary refusal of toilet paper in favor of washing by cool water), regular washing, wearing the linen from the natural breathing fabrics which is not constraining movements. At the first symptoms of hemorrhoids it is desirable to refuse the kinds of activity connected with regular heavy physical activity. To the people inclined to a sedentary life, it is worth going in for physical culture, swimming, to carry out regular foot walks.