About this "inconvenient" disease we have questioned Vyacheslav Valentinovich Maslova, Ph.D., Head of the Department of Oncology and Prosthodontics, Central Library No. 2 named after. Semashko OJSC Russian Railways.
- How often is a disease like hemorrhoids? Who is sick more often, are men or women?
- The word "hemorrhoids" comes from the Greek haimorrhoe - bleeding (from haima - blood and rheo - leacha). Hemorrhoids are varicose veins of the rectum, mainly in the anus.
In the structure of the diseases of the rectum and colon in the adult population, as well as in men and women separately, it ranks first.
According to various authors, the prevalence of the disease ranges from 44 to 86% in the adult population, equally common in men and women.
In 82.1% of cases, hemorrhoids are the main disease and 17.9% accompany other proctologic pathologies.
- What provokes the development of hemorrhoids and at what age is the peak of morbidity?
- Development of hemorrhoids contribute to the factors that cause increased pressure and blood clots in the veins of the small pelvis and venous plexuses of the rectum.
The most significant ones include the following:
- Chronic constipation and, consequently, misuse of laxatives, enemas;
- Malnutrition (diet, poor fiber, spicy food, coffee, alcohol);
- Sedentary lifestyle (hypodynamia) or work associated with low motor activity;
- Activity associated with excessive muscle tension (high physical activity);
- Excessive intensive hygiene of the anus, irritating the mucous membrane;
- Oral contraceptives;
- Anal sex;
- Pelvic tumors and abdominal cavity, causing violations of outflow of blood from the rectum, as well as inflammatory and tumorous changes in the liver;
- In women anatomical features of the uterus, pregnancy;
Hemorrhoids are registered in patients of different ages, from 19 to 84 years, but in people younger than 30 years it is rare (up to 5%). The peak of incidence is due to the working age (from 40 to 60 years), which directly indicates the impact of lifestyle features, motor behavior and nutrition.
- Is there a hereditary predisposition to hemorrhoids?
- Hemorrhoids are not an hereditary disease, but there is still some genetic predisposition to its occurrence. When exposed to the human body, certain factors of the disease receive an incentive for development and progression.
Specialists often diagnose the "kinship" of this disease, with the disease begins to develop at a certain age. On average, 28-60% of patients suffering from hemorrhoids mark the presence of the disease in their close relatives.
The tendency to develop hemorrhoids is due not to the genetic mechanisms of its transmission, but to the peculiarities of the structure of the venous vessels and the walls of the rectum. It should be remembered that the hereditary predisposition to the disease does not at all mean 100% probability of its development.
That is why so many and persistently talk about the need for prevention.
- What are the initial symptoms of hemorrhoids? What should I pay attention to?
- Patients with hemorrhoids have a longer history before seeking a doctor in comparison with other coloproctological diseases. This fact, apparently, is associated with a slow increase in symptoms and low alertness of patients prior to the release of blood from the anus.
A typical symptom-complex of the chronic course of the disease consists of periodic bleeding, usually associated with defecation and loss of hemorrhoids from the anus during and after the act of defecation.
The nature of the bleeding varies according to the duration, frequency, color of blood. The most commonly noted patients are red blood cells in the course of or immediately after bowel movement, and the allocation of blood between the bowel movements is less frequently noted. Often, the constant allocation of blood can lead to a decrease in hemoglobin and the development of anemia, which requires further treatment, up to blood transfusion.
It should be noted that more often red blood is released from the anal canal in the form of drops after defecation, separately from the intestinal contents. Sometimes patients note "strips" of blood on stool. Relatively rarely bleeding is permanent. There are cases where the blood stagnates in the rectum, and then it is possible to isolate clots and dark red blood. The volumes of blood loss can be different. Blood can be barely noticeable on toilet paper, and may tear the toilet.
BUT: before asserting that it is hemorrhoidal bleeding, a number of studies (irrigo- and/or colonoscopy) must be conducted to exclude other causes of the release of blood from the rectum (tumor formations, inflammatory changes).
The second most common symptom of hemorrhoids is the loss of hemorrhoids. In the initial stages, hemorrhoidal nodes independently enter the anal canal, and later need a manual adjustment or even their constant loss of anal canal.
Pain syndrome is not a hallmark of chronic hemorrhoids, but it is necessary to distinguish between pain in the rectum and perineum (whether it is acute or chronic, whether it is associated with an act of defecation, or whether the use of analgesics is stopped).
Discomfort and anal itching are characteristic signs of late stages of the disease. Anal itching in case of hemorrhoids is usually associated with nodule nodes and the ingestion of mucus on the skin, as a result of which the maceration of the skin of the perianal region develops. There have been cases of development of contact dermatitis.
For acute hemorrhoids, the development of perianal edema of the skin is characteristic. Edema is accompanied by a sense of discomfort, which patients take for the sensation of heaviness in the perineum and the anus, and the desire to empty the intestines.
Pathological secretions from the rectum in the form of mucus are considered as one of the hallmarks of hemorrhoids.
SOME of the above symptoms can not be considered specific to hemorrhoids. And in case of these complaints, specialist consultation is required in order to exclude other diseases and pathological conditions of the colon and rectum, anal canal.
- When blood in the stool or pains in the rectum should be addressed to any of the specialists? What kind of surveys will be required to pass?
- To the proctologist, oncologist or surgeon. The doctor will conduct a survey and digital examination of the anus. For a more complete study, an overview of the rectum with an anoscope and recto-monoscope is used. If necessary, the examination may include performing such studies as irrigoscopy, fibrocolonoscopy, computed tomography of the abdominal cavity and pelvic organs.
A doctor should be contacted immediately because the symptoms of hemorrhoids are very similar to the symptoms of such diseases as anal fibrinous polyps, anterophora melanoma, secondary syphilis, nonspecific ulcerative colitis, rectal cancer, and many others.
- What are the modern methods of treating hemorrhoids?
- There are several approaches to treatment, depending on the stage of the disease and the clinical manifestation of the disease. The main directions, methods of treating hemorrhoids are as follows:
- Fight against pathological constipation;
- "Anti-hemorrhoids" preparations in the form of ointments, gels, candles;
- Sclerotherapy, infra-red coagulation, latex ligation of hemorrhoids;
- Surgical removal of hemorrhoids (hemorrhoidectomy);
- Minimally invasive surgery (THD - transanal hemorrhoidal dearthurization, Longo operation);
In itself, the presence of hemorrhoids is not an indication to the operation. Unpleasant symptoms such as itching, inflammation, swelling and pain are eliminated by phlebotropic drugs (such as Venerus) in combination with ointments and candles. The question of surgical intervention is solved with the complicated course of the disease: thrombosis, bleeding, loss of internal nodes. The choice of treatment depends directly on the stage of hemorrhoids and on the presence of concomitant diseases.
In chronic hemorrhoids, manifested only by bleeding, without the expressed increase and loss of internal nodes, the use of injections of sclerosing substances can be used.
In cases where the general condition of the patient does not allow surgical intervention, and the inflammatory phenomena do not allow the possibility of sclerosing treatment, as well as with the loss of internal nodes in the somatic weakened patients, the ligation of individual nodes by latex rings is performed using a special apparatus. This method has the similarity with the principle laid in the dressing nodes, but much more sparing, does not cause pain reaction, does not restrict the behavior and mode of the patient.
In chronic hemorrhoids, complicated by the fallout of nodes, radical surgical treatment (hemorrhoidectomy) is shown. At present, surgical interventions, such as the Longo operation, when the mucosal area is removed, as well as de-arterisation, intersecting arteries leading to hemorrhoids, are becoming increasingly common.
- Hemorrhoids - is it immediately surgical treatment, or can they help the pill or the ointment?
- Conservative methods for treatment of hemorrhoids - is the application of various ointments or rectal candles containing a complex of substances that reduce the inflammatory process, reduce pain and itching, improve blood supply and promote the resorption of blood clots. Do not forget that such measures are aimed at reducing the manifestations of the disease, but not the cause of its occurrence.
- Can I use ointments or candles to prevent hemorrhoids with constipation or hereditary predisposition?
- Given the leading role in the development and further progress of hemorrhoidal disease such factors as constipation and hereditary predisposition, the issues of prevention are still relevant. In this case, they will be part of the treatment aimed at the cause of the disease.
- What complications can lead to hemorrhoids, if timely not to start treatment?
- Periodic discharge of red blood from the anal canal is one of the initial symptoms of hemorrhoids. But the continuous bleeding from the anus is already a complication of the disease. In addition, prolonged allocation of blood from hemorrhoids causes dizziness, weakness, increased pulse and fall in blood pressure. This is a chronic blood loss with the development of anemia.
The complication of acute hemorrhoids is an inflammatory, and often purulent process that develops in the surrounding subcutaneous tissue of the perineum as a result of thrombosis of hemorrhoids.
In the later stages of the disease there is an itch and cracks in the anal canal. In addition, the prolonged loss of hemorrhoids, especially in the elderly, leads to insufficient sphincter of the anus and, of course, to incontinence of gases, and sometimes the intestinal contents.
- Can I prevent the development of hemorrhoids? How to prevent?
- The purpose of preventive measures: to minimize the probability of occurrence, to reduce the clinical manifestation of the disease by eliminating certain moments of development of hemorrhoids.
- Timely treatment of digestive disorders (constipation, diarrhea) - this preventive measure is also mandatory in the treatment of hemorrhoids, both surgical and conservative;
- Restriction of alcohol, acute and salty food;
- Hygienic procedures, anal area toilet after defecation, manganese baths during exacerbation of the disease;
- The transition from hard physical labor to a lighter at the initial stage of the disease;
- Gymnastics for pregnant women, regular walks on foot, putting on the diet of products, refusal to wear tight belts;
- Performing special gymnastics, swimming classes for people who have a sedentary lifestyle;
- Taking Venotonium courses for two months twice a year (Venusus et al.) To strengthen the venous wall from the inside.
In the prevention of hemorrhoids it is very important to strengthen the abdominal muscles. This allows you to improve blood circulation in the pelvic organs.