Hemorrhoids

HemorrhoidsHemorrhoids are, in fact, just normal anatomical structures of the anal canal in the form of pads made of vascular structures (arteries and veins), smooth muscle and connective tissue, and every person has them. Normally there are three such pads, one on the left and two on the right side of the anal canal and normally they cannot be seen.
Irregular lifestyle may disturb hemorrhoids and cause hemorrhoidal disease. Poor diet, inadequate fluid intake, constipation, diarrhea, straining, long sitting, etc., can lead to pathological changes of hemorrhoids, and then we speak of hemorrhoidal disease.

Hemorrhoidal disease may manifest itself in various ways. There are external and internal types, and their appearance is very varied.
Usually there is a painless bleeding after discharge, which may be of varying intensity, only a couple of drops of blood to larger amounts. In addition, there can be a “protrusion”, i.e. prolapse of hemorrhoidal nodules, which may or may not spontaneously or manually be put back into the anal canal .
Another aspect of the manifestation is perianal thrombosis, which is most evident and painful to the patient. It is a weakness of the wall of the hemorrhoids blood vessel, which splits open due to straining, but the skin remains whole, so as to form subcutaneous collection of blood that is extremely painful and can in time spontaneously burst and discharge in the form of a clot or old blood, or it can be reabsorbed slowly over a period of a few weeks .In addition, various other problems can occur as well, such as a trapped hemorrhoids with necrosis , which require urgent proctology treatment.

 

Classification of hemorrhoidal disease is designed so the manifestation of symptoms may be compared and in order to determine the appropriate treatment, including:

  • Grade 1: no prolapse, blood vessel evident through anoscopy as a potential source of bleeding
  • Grade 2: hemorrhoidal nodule protrudes after defecation, spontaneously returns in the anal canal
  • Grade 3: hemorrhoidal nodule protrudes after defecation, but must be manually returned to the anal canal
  • Grade 4: hemorrhoidal nodule protrudes from the anal canal and cannot be returned

 

The diagnosis of hemorrhoidal disease is given during the rectal exam, and perianal inspection, rectal touche and anoscopy. Examination is absolutely painless and only such an examination can obtain adequate insight into the situation and avert suspicion of another condition (anal fissure, fistula, abscesses, colorectal cancer, etc.).
Prevention of hemorrhoidal disease consists simply in an orderly lifestyle, consumption of fresh foods, adequate intake of fluids, hiking and avoiding straining during defecation, as long sitting in the bathroom.
The treatment consists of conservative and surgical approach. With hemorrhoids of lower degree, conservative treatment of hygienic and diet regime, application of ointments and suppositories and use of diosmine-based tablets may be adequate.

 

In the event that this kind of treatment does not lead to the desired results, a variety of interventions can be applied, such as sclerotherapy (injection of sclerosing agents in piles, which turns it into a scar), ligation with rubber bands (placing of rubber bands via a special device above the root of hemorrhoids, thus returning the prolapsed node into the anal canal and forms into a scar which has the function of keeping the node there), and various types of cauterization.

 

Surgery is the last in a series of approaches for those suffering from hemorrhoids. Clear indications for surgery are defined, and it needs to be performed by a surgeon who has experience in proctology, especially because inadequate experience in performing these types of surgeries and poor knowledge of the physiology of the anal canal can lead to complications with consequences which are later very difficult, and sometimes impossible, to correct. The type of operative treatment will be proposed by an experienced surgeon – proctologist, depending on the local condition of hemorrhoids and general condition of the patient.

 

For the patient, it is necessary to accept the following recommendations:
- Any blood in the stool, pain in the anus or other discomfort that does not have to indicate a problem with hemorrhoids. An examination by a proctologist is therefore essential.
- Proctology examination consists of perianal inspection (visual inspection of the skin around the anus), rectal touche (touching the anal canal and the final part of the colon with the index finger) and anoscopy (visual examination of the anal canal and the final part of the colon by a device called anoscope). Examination is painless! Experienced proctologist will, in case he notices the change that causes pain, treat it first, and after a couple of weeks make an appointment again, when there is no risk of any pain .
- The fault of the presence of blood in the stool should not be blamed on hemorrhoids. It is necessary to view the entire colon in order to exclude other diseases that can cause blood in the stool which can be life-threatening (diverticulums, polyps, cancer, inflammatory disease of the large bowel, etc.), as opposed to hemorrhoids, which usually are not. Therefore, the proposal for a colonoscopy should be seen as a good intention by your doctor who has in mind only your well-being and health and should not be avoided.

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Author: Josip Kucinic

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