Hemorrhoids is a proctological disease characterized by varicose veins in the rectum. Pathology can manifest itself in the form of the formation of thrombosis, varicose veins, changes in their shape, nodes.
According to some reports, approximately 20% of the population have a history of the diagnosis: hemorrhoids. And about 70% of all people at least once in their lives have experienced various symptoms of the disease, itching or discomfort in the anus.
Etiology and pathogenesis
The classification of hemorrhoids is quite extensive, but the factors that provoke the development of the disease are the same for all cases.
It can be elementary pressure surges in the veins from mechanical damage. Infectious diseases that affect the decrease in the tone of the veins can affect the development of the disease. Some people have anatomical features that adversely affect the vascular system of the anus. People who play hard sports or do hard physical work often have this problem.
Pregnancy and childbirth itself can trigger the development of hemorrhoids. If a person is in one position for a long time or has frequent stool disorders, then a problem may also arise. Cancerous growths in the genitourinary system, anus and in the abdominal cavity can provoke the development of hemorrhoids.
Classification
Today, doctors distinguish two stages of the course of the disease:
- chronic;
- spicy.
According to the form of pathology, the disease is divided into:
- internal;
- outer;
- combined.
Chronic form
Classification of hemorrhoids by stages:
| 1 | At this stage, there is no hemorrhoid prolapse, but there is bloody discharge from the anus. The course of the disease is characterized by a slight change in the submucosal layer of the rectum. However, already single muscle cells are susceptible to dystrophic changes. Hemorrhoids can even bulge into the lumen of the anal canal, and it is for this reason that bleeding occurs. This stage can only be diagnosed with anoscopy. |
| 2 |
This stage is already characterized by the prolapse of the node, and not necessarily with bleeding. Dystrophic processes are growing, the nodes are increasing in size. In such a situation, self-reduction into the anal canal often occurs. At this stage, they are already seriously thinningwalls of the mucous membrane of the nodes. |
| 3 | At this stage, the knot falls out more often and has to be manually reset all the time. Despite serious dystrophic changes, nevertheless, the submucosal layer of the rectum retains its elasticity, therefore it can perform its functions almost to the full extent. |
| 4 | At this stage, there is a constant prolapse of hemorrhoids. But not only nodes are already falling out, but also the mucous membrane of the rectum, so it will no longer be possible to independently reduce it. As in other stages, everything happens with or without bleeding. This stage is characterized by almost complete replacement of elastic cells with connective tissue, multiple ruptures are observed in the ligamentous apparatus. |
Sharp shape
This form is actually a complication of the chronic form. The classification of acute hemorrhoids consists of three stages:
- Thrombosis without inflammation on internal and external hemorrhoids.
- Thrombosis, but with an already inflammatory process.
- At the third stage, the inflammatory process begins on the subcutaneous tissue, swelling may appear on the perianal skin, and mucosal necrosis develops.
Classification of hemorrhoids by degrees reflects the pathogenesis of pathology and gives physicians the opportunity to objectively assess the indications and adequately select a course of treatment.
Most oftenthe pathology proceeds against the background of a change in the chronic stage to an acute inflammatory process. Acute provocateurs include:
- increased constipation;
- inflammation of the perineum, anal canal or rectum.
Such processes lead to the fact that thrombosis increases, and the inflammatory process passes to the surrounding tissues.
Diagnosis
The simplest examination technique is on a gynecological chair, when the patient presses his legs to his stomach as much as possible, or the examination can be carried out in the knee-elbow position. The doctor also evaluates which clinic, classification of hemorrhoids. On examination, assesses the condition of the anus, its gaping, determines whether there are deformations or other changes, the possibility of self-reduction of the node.
A probe is already being used to determine the presence or absence of an anal fissure.
The finger method allows you to determine the tonic state of the sphincters, volitional contractions. Also, this method allows you to identify scars, polyps and mucosal defects. Although the technique does not allow with full confidence to determine the size and location of the nodes.
Anoscopy is the most effective way to determine the presence of the disease at an early stage. This is an instrumental technique that is well tolerated by patients and allows you to assess the condition of the anal canal at a distance of 8-12 centimeters.
Also, when clarifying the diagnosis and classification of hemorrhoids, a sigmoidoscopy or colonoscopy is performed. Althoughthese examinations cannot completely replace the examination by a proctologist, they allow to identify concomitant pathologies. Indeed, according to statistics, every third patient diagnosed with hemorrhoids is diagnosed with other diseases, both in the anus and in the colon or rectum, which, in fact, lead to bleeding.
Often, against the background of hemorrhoids, an anal fissure is detected, which occurs due to chronic microtrauma of the mucous membrane.
Special attention in the diagnosis is given to patients who often have bleeding, because they can talk not only about the presence of hemorrhoids, but also about the development of cancer in the rectum or colon.
Treatment of the 1st stage of the disease
Depending on the classification of hemorrhoids, a method of treatment is selected. In the first stage of the chronic form, they resort to conservative treatment, less often to sclerotherapy or infrared photocoagulation.
Conservative or drug therapy is aimed at stopping the unpleasant symptoms that accompany the disease and preventing possible complications. To date, a fairly large arsenal of medicines, the action of which is well studied. First of all, rectal suppositories are used.
There is even a classification of suppositories from hemorrhoids:
- With analgesic effect. In such preparations there is novocaine or anesthesin. The main side effect of such suppositories is a strong increase in the patient's blood pressure.
- Hemostatic. The effect of these candlesaimed at increasing blood clotting. As part of the funds may be present: vikasol, calcium chloride, dicynone.
- Candles that reduce the inflammatory process. Such agents also have a bactericidal effect. Medicines usually contain sea buckthorn oil, propolis, St. John's wort and other natural ingredients that speed up the healing process.
To date, the most popular candles called "Relief". In addition to suppositories, gels and ointments can be used, which also help to relieve the inflammatory process, for example: Aurobin, Heptrombin G ointment. Pregnant women are advised to use natural products, such as Natalsid.
Depending on the classification of hemorrhoids and the degree of pain, tablet forms of drugs based on analgesics, as well as venotropic and laxatives can be prescribed.
Sclerotherapy may be recommended at this stage. This operation is completely simple and lasts only a few minutes, painless. Patients who have passed this stage, forever lose the feeling of discomfort in the anus.
Treatment stage 2
At this stage, the same methods are used as in the first stage of the disease.
The infrared coagulation technique allows the infrared light flux to penetrate into the node tissue and coagulate the tissue. This procedure is recommended in the presence of bleeding. Depending on the classification of hemorrhoids and the severity of symptoms, maycarried out from 1 to 6 coagulations. However, this technique can lead to a number of complications: pain, mucosal necrosis, node thrombosis.
Ligation with latex rings reads as a drastic measure, but still effective. This procedure is indicated only for the 2nd or 3rd stage of the disease. There are two ways to carry out the procedure, but in both cases, elastic latex rings are used, which for 12-14 days compress the tissues of the hemorrhoid, with a phased crossing of the leg. This technique allows in 80% of cases to avoid hemorrhoidectomy.
Combined treatments can be used at this stage of the disease.
Treatment of the 3rd stage of the disease
If, according to the classification of hemorrhoids, we can already talk about the 3rd stage, then in addition to ligation with latex rings, transanal resection of the mucosa according to the Longo method can be offered. The essence of the technique is to remove a small area of the mucous membrane of the rectum. The wound is then sutured with titanium staples. And most importantly, the nodes themselves are not removed, but contracted, that is, the volume of blood flow decreases. Over time, the blood supply to the nodes becomes less intense, and the nodes are tightened with connective tissue.
4th stage treatment
If, according to the classification of chronic hemorrhoids, the 4th stage has already been determined, the patient's ability to work sharply decreases, hemorrhoids regularly fall out during defecation, then there is only one way out - hemorrhoidectomy, that is, surgical intervention. This method is also usedin case of diagnosing an external hemorrhoid.
Medication prevention
Despite the little knowledge of the importance of drug therapy in preventing the development of hemorrhoids, yet the doctor determines its need individually when examining each patient. There is a risk group, which includes people with a sedentary lifestyle, with a large overweight, women during pregnancy, or people who drink alcohol in large quantities.
