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Hemorrhoids (in translation from Greek — bleeding) — very widespread disease resulting from increase in the hemorrhoidal nodes located in the field of the proctal channel. Under unfavorable conditions, in hemorrhoidal fabrics there is a stagnation of blood that leads to increase in sizes of hemorrhoidal nodes and to destruction of sheaves and muscles which hold nodes in an anus.
Hemorrhoidal nodes consist of cavernous little bodies, and are located in the form of 3 small pillows in an anus (these are internal nodes) and 3 small pillows in a crotch near the proctal channel (outside nodes).
Allocate internal hemorrhoids when only internal hemorrhoidal nodes, and outside when outside nodes are increased are increased. Also increase in at the same time internal and outside nodes is observed, then it is possible to speak about the combined hemorrhoids.
Besides, distinguish two types of hemorrhoids – primary and secondary. Primary arises because of increase of intra belly pressure, at pregnancy, hard physical work, sedentary work, frequent locks, abuse of spicy, smoked food, alcohol. Secondary appears as a result of other diseases, for example, at the cirrhosis, tumors leading to disturbance of venous outflow of blood from a basin and a rectum. Allocate also chronic and acute hemorrhoids. The acute form most often is complication of chronic hemorrhoids. More than 10% of adult population of the planet have hemorrhoids.
Most of specialists agrees in opinion that the main reason of hemorrhoids — dysfunction of vessels of a lower part of a rectum which leads to increase in inflow of blood and its stagnation in rectum veins owing to what hemorrhoidal nodes increase. One more factor of developing of hemorrhoids is the so-called mechanical factor. Under influence of adverse factors and the increased hemorrhoidal nodes, there is a gradual destruction of the copular and muscular device which holds nodes in an anus. Thus, as a result of increase in hemorrhoidal nodes, and also dystrophic changes in the sheaves and muscles holding them inside they begin to be displaced to edge of the proctal channel and to drop out of an anus.
However it is only one of possible factors, besides the following reasons of hemorrhoids are noted:
- genetic predisposition to hemorrhoids;
- frequent locks;
- long sitting in a toilet, a natuzhivaniye at defecation;
- pregnancy and childbirth;
- the excessive use of the spicy, tinned food causing irritation in proctal area;
- frequent use of strong coffee, tea, alcoholic drinks;
- slow-moving, is more often a sedentary life;
- strong exercise stresses;
- raising of weights;
- excess weight;
- proctal sex;
- stressful situations;
- diseases of bodies of a small pelvis.
Usually hemorrhoids develop gradually, at the initial stage the discomfort is felt only at disorders of intestines, after intensive exercise stresses, an overheat or overcooling. Most often hemorrhoids proceed in a chronic form with periodic aggravations.
The first symptoms of hemorrhoids are shown by feeling of discomfort in an anus, lungs a proctal itch, burning, feeling of weight, the feeling of a foreign body, release of bright red blood at defecation appears. Owing to expansion and thinning of walls of cavernous vessels small gaps therefore bleeding develops are formed. These symptoms can disturb the person within several years. Gradually symptoms amplify, pains at defecation develop, releases of blood during defecation, pain when walking and during sitting, in fecal masses blood stains can be observed. Gradual increase in hemorrhoidal nodes and development of dystrophic processes in the muscular and copular device cause the shift of nodes in I will shift an anus. It also leads to their loss. On this background anemia, the general weakness, an asthma, a cardiopalmus, decrease in hemoglobin in blood can be observed.
Chronic hemorrhoids are subdivided into four stages:
The first stage is characterized by formation of the hemorrhoidal nodes in a rectum which are not acting from an anus. The discomfort can be observed during defecation, there can also be bleedings. However these symptoms of hemorrhoids can be observed not always.
At the second stage hemorrhoidal nodes during defecation drop out of an anus, but are independently set. Nodes increase in sizes that leads to the fact that walls of mucous membranes of a node and to constant bleedings become thinner during defecation. Patients often complain of burning in an anus.
At the third stage the muscular and copular device holds nodes in the proctal channel, but dystrophic changes interfere with normal reduction of this muscle, the proctal sphincter weakens so the nodes which dropped out during defecation need to be set independently. The severe itch disturbs, plentiful bleedings are observed. Losses of blood can lead to sharp decrease in level of hemoglobin in blood.
The fourth stage is characterized by the fact that hemorrhoidal nodes and a mucous membrane of a rectum drop out at the slightest physical efforts. At this stage the muscular and copular office of proctal channel which held nodes collapses. Thrombosis of hemorrhoidal nodes, plentiful bleedings, an involuntary otkhozhdeniye liquid a calla, slime is observed.
Acute hemorrhoids most often are complication of chronic hemorrhoids and proceed with thrombosis of outside and internal painfully edematous hemorrhoidal nodes. Allocate three stages of acute hemorrhoids.
On the first patients feel burning in an anus, especially after defecation, hemorrhoidal nodes small in size, are painful at a palpation.
At the second stage of pain in an anus are observed constantly, amplify when walking and in a sitting position, the palpation of the condensed inflamed hemorrhoidal nodes is very painful, body temperature increases.
Puffiness of an anus is characteristic of the third stage, thrombosis extends to hemorrhoidal nodes, nodes gain crimson or dark and cherry color, pains very intensive.
At any form of a disease timely treatment of hemorrhoids is required, at its absence the dropped-out nodes gradually nekrotizirutsya, mucous membranes ulcerate that can lead to an acute paraproctitis.
Hemorrhoids at pregnant women
Very often hemorrhoids develop during the last trimester of pregnancy and childbirth. The overclamping is the increased uterus of veins of intestines the reasons of emergence of hemorrhoids that leads to deterioration in a blood-groove from intestines and from a crotch. Veins increase in the diameter and change a form. Periodic locks at pregnant women can also provoke emergence of hemorrhoids.
However at most of women symptoms of hemorrhoids pass a puerperal period therefore it is considered that hormonal changes can be the reasons of hemorrhoids. It is necessary to treat hemorrhoids at once after detection of its first symptoms. It is important to fight against locks, for example, accepting drugs for ease of a chair (Forlaks, Laminaridum, Metiltselyuloza), to follow rules of hygiene (an anus podmyvaniye after defecation). Medicines from hemorrhoids (Aurobin, Relif, etc.) are used generally outwardly in the form of ointments and candles. An operative measure is carried out only at hard cases.
Prevention of hemorrhoids has to is carried out from the first days of pregnancy – to make a competent diet for the prevention of locks, not to wear hard belts, to spend more time in the fresh air, foot walks are useful.
Diagnosis of hemorrhoids
Hemorrhoids are diagnosed at survey of an anus of the patient. Outside hemorrhoidal nodes are defined in the form of the fimbrias surrounding an anus. At the first stage of an illness internal hemorrhoidal nodes are defined hardly, and at development of a disease begin to appear in a gleam of the proctal channel, at a natuzhivaniye they can drop out. The main diagnosis of hemorrhoids includes:
- rectum palpating;
- the rektoromanskopiya is carried out for survey of a mucous membrane of a straight line and a lower part of a sigmoid gut;
- the kolonoskopiya is carried out for definition of a condition of a mucous rectum;
- the anoskopiya which is carried out at hemorrhoids gives the chance to estimate existence, an arrangement and extent of increase in internal nodes. By means of an anoskopiya the choice of a method of treatment is carried out.
Such complex researches allow to reveal also accompanying diseases of bodies of a digestive tract, and, if necessary to carry out treatment.
Treatment of hemorrhoids
The choice of a method of treatment of hemorrhoids depends on a stage of a disease, degree of manifestation of symptoms, and also on existence of associated diseases. For treatment of hemorrhoids complex treatment is usually carried out.
At the initial stage chronic hemorrhoids (the 1st and 2nd stages) are subject to the conservative treatment directed to fight against the aggravations which are followed by bleeding for elimination of a pain syndrome. If to begin treatment in time, then it can reduce process of a disease very much. Observance of a special diet and correct diet, with regular bowel emptying is very important. It is necessary to exclude hot, spicy, fat dishes, alcohol from a diet. It is necessary to use the products rich with vegetable fibers (fresh vegetables, grain, grain crops), bran, to drink more mineral water, to regularly play sports, to wash an anus cool water after defecation. Without observance of these rules of an exacerbation of a disease will repeat more often.
Treatment of hemorrhoids successfully uses as the general, and local anesthetics, ointment compresses, antiinflammatory and flebotonichesky drugs. Candles are generally applied at internal hemorrhoids, ointment – at outside.
In the presence of an itch and other painful feelings it is recommended to apply rectal candles with anaesthesin, novocaine, on the basis of cocoa butter or lanolin. At treatment of chronic hemorrhoids apply candles with thrombin. The pain syndromes connected with inflammatory processes in the thrombosed node or in surrounding fabrics remove by means of non-narcotic analgesics (nayz, Voltarenum, diclofenac), and also the local combined anesthetizing drugs in the form of ointments and gels (gepatrombin, ultraprokt).
For removal of an inflammation apply ointment compresses on the fabrics surrounding a node (levomekol, Vishnevsky's ointment). At an itch it is possible to do compresses of ointment with a hydrocortisone, candles with proktosedily. Thrombosis of hemorrhoidal nodes is treated by use of the combined drugs, with anesthetics, the antiinflammatory and thrombolytic components removing an inflammation in nodes (gelpan, gepatrombin, the venobena).
At bleedings use haemo static drugs which resolve at introduction to the proctal channel, forming the film blocking the bleeding sites of nodes (a sponge with Adroxonum, beriplast). Doctors also appoint flebotonichesky drugs which raise a tone of vessels (Detralex).
For increase of efficiency of local drugs, reception of the means improving a tone of venous vessels and interfering a thrombogenesis is necessary (Troxevasinum, Detralex, a ginkor forte, endotelon). At chronic forms of hemorrhoids use of the combined medicamentous therapy can give positive temporary effect.
The low-invasive methods of treatment of hemorrhoids which are carried out on an outpatient basis gain ground. Operation is necessary if at the patient losses of hemorrhoidal nodes which it is impossible to set into place, severe rectal pains, an itch, bleeding are observed. Apply the following methods to treatment of patients of the 1st and 2nd stages of hemorrhoids:
- sclerotherapy (introduction to a node of the vessel of sclerosing substance causing flattening);
- focal infrared coagulation (impact of the heat energy on a node causing pasting of a vessel because of evaporation of intracellular water);
- alloying of hemorrhoidal nodes latex rings (on the bases of nodes the ring causing disturbance from blood supply owing to which nodes are torn away attacks);
- cryotherapy (freezing of a node for 2-3 min. then the last dies off).
One more widespread method of treatment of hemorrhoids is Longo's method (truncation of a site of a mucous membrane of a rectum above a hemorrhoidal node). Surgical removal of nodes (gemorroidektomiya), it is shown at the 3rd and 4th stages of a disease, in the presence of big nodes, plentiful bleeding, associated diseases of a rectum. Recently began to apply a gemorroidektomiya method the stapler (brackets) – circular imposing of brackets on protrusions anorectal mucous by means of the stapler.
It should be noted, at all their low-injury and insignificant morbidity (except a gemorroidektomiya) these manipulations, after their carrying out complications can develop, namely: recurrence of a disease, rectal bleedings, the expressed pain syndrome, a paraproctitis.
It is important to remember that symptoms of hemorrhoids can be displays of other diseases, for example anorectal bleeding, tumors of a rectum and the proctal channel, a proctal crack, a hemangioma, endometriosis, injuries of a rectum, loss of the proctal channel and many others. Therefore at the first emergence of the symptoms stated above, do not postpone visit to the doctor.
In house conditions, for reduction of hypostases and pains, at hemorrhoids sedentary heat fifteen-minute baths 3 times a day after defecation are shown. It is possible to add potassium permanganate solution to water (potassium permanganate), or medicinal herbs decoction – a nettle, alder leaves, a clover, a grass of the peppery mountaineer. In a drugstore it is possible to get special antihemorrhoidal collecting.
At treatment of hemorrhoids folk remedies are very often used, but without consultation with the doctor self-treatment can lead to undesirable effects. Hemorrhoids at pregnant women treat only under supervision of the doctor, not under what circumstances it is not necessary to apply traditional medicine during pregnancy.
Prevention of hemorrhoids
Prevention of development of hemorrhoids, both before development of a disease, and after operation consists in normalization of activity of a digestive tract, observance of a low-calorie diet, treatment of locks. Not to allow formation of hemorrhoids it is necessary to provide normal functioning of intestines, to fight against frustration of a chair, to avoid an overstrain at defecation.
Also it is necessary to eat, use properly as much as possible mineral water, to limit the use of spicy, spicy and marinated food, the alcoholic drinks causing inflow of blood to area of a small pelvis, to follow rules of hygiene, to wash an anus cool water after defecation, to be engaged regularly in physical exercises. It is worth avoiding overcoolings. During the sedentary work each hour it is worth carrying out 10 minutes several physical exercises standing. The gymnastics, foot walks is recommended to pregnant women.