Hemorrhoids occur mainly in middle-aged people, although cases of its development in children and the elderly are described. Men are ill more often than women.
Etiology and pathogenesis.
The pathogenetic mechanisms of hemorrhoids are explained in different ways. Among the factors predisposing and contributing to the emergence of hemorrhoids are two main groups: 1) anatomical features of the structure of the venous system of the anorectal region and 2) adverse effects exogenous and endogenous. Of the many theories proposed to explain the formation of hemorrhoids, the following deserve attention: 1) mechanical theory; 2) infectious and 3) the theory of congenital anomalies of the vascular system of the anorectal region.
The mechanical theory explains the occurrence of hemorrhoids by the influence of factors contributing to stagnation of blood and increased venous pressure in the pelvic organs. These include high tension during physical exertion, prolonged standing or sitting position, long walking due to production activity, chronic constipation, pregnancy, swelling and pelvic organs. Under the influence of these factors, there is a weakening of the venous wall, gradually increasing veins, stagnation of blood in them.
Infectious theory explains the development of hemorrhoids with progressive chronic endophlebitis, arising from various inflammatory processes in the anorectal region.
Most supporters of the theory of congenital anomalies of the vascular system of the anorectal region believe that the origin of hemorrhoids is dominated by innate features of the structure of the hemorrhoidal plexus and venous wall.
Depending on the etiology, hemorrhoids are divided into congenital or hereditary (in children), and acquired. Acquired hemorrhoids may be primary and secondary or symptomatic. Localization distinguishes between internal, or submucosal, external and interstitial, in which the nodes are located under a transitional fold, the so-called Hilton line. With the flow, the chronic and acute stages of hemorrhoids are isolated.
Clinical picture.
Depends on the degree of severity of hemorrhoids and the presence of complications. For a long time, hemorrhoids can be asymptomatic without disturbing the patient at all. Then there is a slightly pronounced feeling of inconvenience, an itch in the anus. Usually, these phenomena occur when violations of the intestine, after drinking alcohol.
The clinic of the advanced stage of the disease depends on the localization, presence and severity of hemorrhoidal complications. Usually the first symptom is bleeding, which occurs mainly during defecation. Bleeding occurs, as a rule, with internal hemorrhoids, the external nodes do not bleed. The patient discovers blood on feces, on toilet paper sometimes blood drips after defecation from the anus. Bleeding appears periodically, the blood is usually fresh, liquid. This is the difference from rectal bleeding in colorectal cancer or in nonspecific colitis, in which the altered blood is secreted during each defecation.
In most patients, hemorrhoids flow with periodic exacerbations, inflammation, prolapse and infringement of hemorrhoids. In the initial stages of exacerbation there is a painful swelling of the nodes, a feeling of raspiraniya in the anus, a feeling of awkwardness when walking. In more pronounced stage, the nodes sharply increase in size, there is severe pain, edema of the entire area of the anus is observed. Defecation is very painful.
Complications often observed with hemorrhoids include anal fissures, anal itching, acute paraproctitis and fistulas of the rectum, and proctalgia.
In addition to the described hemorrhoids, a secondary one is distinguished, which is a symptom of another disease. It can occur with cirrhosis of the liver, with tumors of the retroperitoneal space, with cardiac decompensation.
Treatment.
All methods of treating hemorrhoids are divided into three groups: 1) conservative; 2) injection and 3) operational. Depending on the location, the size of the hemorrhoids, the presence of complications apply this or that type of treatment.
All uncomplicated cases of external and internal hemorrhoids with rare minor bleeding are subject to conservative treatment. The patient is contraindicated in taking acute, spicy food, drinking alcohol. Food should contain a sufficient amount of fiber (vegetables, fruits, black bread), which is the prevention of constipation. With persistent constipation, not amenable to diet, laxative enemas are shown. It is also necessary to adhere to hygiene, to wash off after each act of defecation.
Of the physiotherapeutic methods for the treatment of hemorrhoids, it is most often recommended to use a cool ascending shower and darsonvalization.
When bleeding occurs, inflammation of the nodes use a variety of medications. With moderate bleeding, the patient is laid in bed, a sparing diet is prescribed. In the inflammatory process, anti-inflammatory suppositories are prescribed.
Indications for surgical treatment for hemorrhoids are:
- Persistent hemorrhoidal bleeding, not amenable to conservative treatment;
- Hemorrhoids, accompanied by repeated fallout, infringement, inflammation of the nodes and bleeding;
- Ulceration of hemorrhoids, which can lead to degeneration into a malignant tumor;
- Large hemorrhoids, which violate the act of defecation.