Hemorrhoids - a disease based on the pathological condition of the cavernous plexuses of the rectum, accompanied by stagnation of blood in them. The development of hemorrhoids is facilitated by a violation of the outflow of blood from the cavernous plexuses located in the wall of the rectum, due to chronic constipation, a sedentary lifestyle, and a violation of the blood supply to the pelvic organs, for example, during pregnancy.
There are internal hemorrhoids when the cavernous plexuses located on the walls of the rectum expand and the external hemorrhoidal nodes formed from the venous arterial plexus of the lower hemorrhoidal vessels distributed under the skin around the anus.
In the clinical picture , a period of precursors is distinguished, during which there are unpleasant sensations in the anus, slight itching, difficulty in defecation. Then there is bleeding from the anus during bowel movements (from traces of blood to its plentiful discharge), which may be accompanied by the development of anemia . In the future, the internal hemorrhoidal nodes may fall out of the anus (stage I - nodes fall out during defecation and self-repair; II - nodes fall out during defecation, but do not self-adjust, manual reduction is necessary; III - nodes fall out at the slightest exertion) . In some cases, thrombosis of hemorrhoidal nodes and their infringement are possible. Thrombosis of hemorrhoids (acute hemorrhoids) is characterized by pain in the anus, edema and inflammatory infiltration of the nodes, in some cases necrosis and swelling of the tissue around the anus. In advanced cases, acute paraproctitis may develop.
In diagnostics, the results of examination and digital rectal examination, which are performed in the knee-elbow position of the patient, are of primary importance. On examination, it is possible to identify external hemorrhoidal nodes, and with careful pushing the edges of the external sphincter of the anus - internal nodes. Using a digital rectal examination, which should be carried out in all cases, except for those when an exacerbation of the process is noted, it is possible to establish the presence of condensed hemorrhoids, the tone of the sphincter of the anus, and to identify concomitant rectal diseases. To ascertain the loss of hemorrhoids, the patient is invited to strain. The doctor, in addition, must perform a sigmoidoscopy. A thorough examination of the patient eliminates the anal fissure, paraproctitis , polyps and colorectal cancer.
In the initial stages of hemorrhoids, conservative treatment is indicated. The patient is recommended a diet that prevents the development of constipation (vegetables, wholemeal bread, lactic acid products); annoying foods, spices and alcohol are excluded. Prescribe medicinal and cleansing enemas, cool baths and washings; candles with belladonna extract, anestezin, heparin, proteolytic enzymes. In acute external hemorrhoids, warm baths, an ointment with anesthesin or heparin, and light laxatives are indicated. When bleeding from the rectum, rectal suppositories with adrenaline are used.
In cases of treatment failure, complications (heavy bleeding, thrombosis of hemorrhoidal nodes or their infringement), the patient must be hospitalized.
In the hospital, surgical intervention can be taken, especially in cases where there is a prolapse of internal hemorrhoids or heavy bleeding with the development of anemia . The most effective surgical intervention is hemorrhoidectomy - excision of the internal and external hemorrhoidal nodes and restoration of the mucous membrane of the anus. The patient's ability to work after surgery is restored within 3-4 weeks.
Non-progressive and uncomplicated hemorrhoids can cause the patient only some inconvenience for many years. Early conservative treatment, a rational mode of work and rest in these cases often contribute to the fact that the patient becomes practically healthy.
Prevention - the exclusion of factors contributing to the development of hemorrhoids, a rational diet, instilling, from childhood, certain hygiene skills (thorough toilet of the anus after defecation). Persons leading a sedentary lifestyle, regardless of whether they work sitting or standing, need to do gymnastics, which helps to normalize the motor-evacuation function of the colon and prevent stagnation of blood in the pelvic organs.