Hemorrhoids

Hemorrhoids is a disease associated with abnormal enlargement of hemorrhoids. Hemorrhoids are special vascular formations located in the lower part of the rectum, outside (in the area at the entrance to the anus) and inside (above the border of the anal canal).

One of the most common manifestations of hemorrhoids is bleeding when using the toilet. However, it is important to know that such a symptom can be a sign of a much more serious problem, even a malignant neoplasm (cancer) of the rectum or other parts of the intestine. That is why do not postpone a visit to the proctologist, deciding that this is just a symptom of hemorrhoids, and it is not dangerous!

Why does hemorrhoids develop?

The rectum is abundantly supplied with blood, it is here that the arterio-venous plexuses – external and internal hemorrhoids – are located. For various reasons, blood stagnation occurs in the area of ​​the hemorrhoidal plexus – in the anal canal and the lower part of the rectum. The walls of the veins stretch, bulge out in some places, and a hemorrhoid is formed. It is believed that dystrophic processes in the connective tissue structures of the submucous layer of the rectum and in the ligament, which to a certain extent retains the internal nodes inside the rectum, play a significant role in the occurrence of internal hemorrhoids, and when weakened, it contributes to the loss of nodes from the anal canal.

Hemorrhoid provoking factors:

1. Excessive physical activity (with an increase in intra-abdominal pressure, which leads to the prolapse of hemorrhoids);
2. Straining with constipation (pressure in the rectum increases and blood flow to hemorrhoids increases, which contributes to their increase and subsequent loss);
3. Alcohol abuse (vasodilation in the anal area can cause hemorrhoidal bleeding);
4. Pregnancy (with an increase in the uterus, the pressure in the abdominal cavity increases);
5. A sedentary lifestyle (leads to congestion in the pelvic area and primarily in the rectum).

Hemorrhoid symptoms

• Painful lump-shaped lumps in the anus with external hemorrhoids;
• Loss of hemorrhoids during bowel movements (with internal hemorrhoids), as well as in the later stages – even when lifting weights, coughing, sneezing;
• Bleeding that occurs during bowel movements (admixture of scarlet blood to the stool, discharge of blood in the form of drops or a thin stream);
• Itching and burning in the perianal region;
• Pain in the anus, usually associated with thrombosis of the nodes;
• Discomfort in the anus, heaviness associated with a feeling of incomplete emptying of the intestines. The feeling of discomfort directly depends on the size of the hemorrhoids
• Bleeding develops when the mucous membrane of the node is injured, which is overstretched at the site of formation of the node and is easily vulnerable when passing through a dense stool. Diarrhea (diarrhea) can also provoke hemorrhoidal bleeding, irritating and damaging the mucous membrane in the area of ​​the hemorrhoid.
• One important thing to mention here is: many people confuse anal skin tags as anal fissure or something like that. But they are not that serious. You can easily shrink hemorrhoid skin tags at home.

External and internal hemorrhoids

External hemorrhoids located closer to the anus are covered with skin with a large number of pain receptors. Thrombosis of the external nodes is accompanied by severe pain, which is often the reason for seeking emergency proctological care.

Internal hemorrhoids are formed inside the anal canal at the site of its transition to the rectum. The pain sensitivity of the nodes is insignificant, since there are practically no pain receptors in the mucous membrane above the dentate line. The first symptoms of internal hemorrhoids are bleeding and prolapse during bowel movements.

Most often, there is a simultaneous increase in both external and internal nodes, such hemorrhoids are called combined.

Hemorrhoids: a clinical picture

An acute course is more often characteristic of external hemorrhoids and is the formation of a blood clot in the hemorrhoidal node as a result of prolonged stagnation of blood, physical activity, sudden weight lifting, etc.

Thrombosed hemorrhoids cause severe pain, aggravated by movement, coughing, sneezing. The node itself is bluish in color, edematous, tense and sharply painful. Subsequently, it is possible to join the thrombosis of inflammation involving the subcutaneous tissue. Also, the acute course of the disease includes profuse bleeding from internal nodes, which requires urgent hospitalization.

Typical signs of chronic hemorrhoids are regular bleeding, usually associated with defecation and prolapse of hemorrhoids from the anus.

The chronic course of internal hemorrhoids is divided into 4 stages:

1. Bleeds during bowel movements, nodes do not fall out of the rectum
2. The nodes fall out, subsequently they are independently adjusted into the anal canal. With or without bleeding.
3. The nodes fall out, manual reduction into the anal canal is required. With or without bleeding.
4. The nodes constantly fall out, it is impossible to put them in the anal canal. With or without bleeding.

Diagnosis of hemorrhoids

The diagnosis of external or internal hemorrhoids is made on the basis of the patient’s complaints and the results of examination of the anus and anal canal. Sometimes the doctor may recommend performing rectoscopy to diagnose concomitant diseases of the rectum and sigmoid colon, or colonoscopy if the patient is suspected of having inflammatory diseases or neoplasms of the colon. Recommendations for colonoscopy for patients who complain of blood in the stool and discomfort in the anus are explained by the caution of coloproctologists in relation to cancer of the rectum and colon.

Hemorrhoid treatment

Hemorrhoids are not a sentence! It can (and should) be completely cured!

The method of treatment is selected individually for each patient based on the leading complaints.

Our clinic uses methods of both surgical and conservative treatment of hemorrhoids:

• Conservative treatment is recommended at the initial stage, when the symptoms of hemorrhoids (enlargement of nodes, bleeding during bowel movements) are disturbed for the first time, or if the increase in symptoms is rare and their duration is short. But even if you have been suffering from hemorrhoids for several years, this does not mean that conservative treatment is not for you. Often, understanding the problem, the necessary correct recommendations for lifestyle, nutrition and preventive medication can help significantly reduce the number of exacerbations and slow down the development of the disease as much as possible. The European schemes of conservative treatment that we use in some cases are quite effective.
• Minimally invasive methods (outpatient surgery) – a mini-operation performed in a doctor’s office under anesthesia using the latest surgical techniques and instruments, after which the patient goes home with recommendations for dressings (care for the wound for proper and quick healing) and the appointment of a repeated doctor’s appointment.
• Surgical treatment – after a preliminary (preoperative) examination, the operation is performed in the operating room of the hospital, with obligatory anesthesia (pain relief), after which the patient spends one or several days in the ward under the supervision of a doctor. Usually one day is sufficient.

With external thrombosed hemorrhoids, an operation to remove a thrombus or excision of the thrombosed node itself is carried out if the time from the onset of the disease is no more than 48-72 hours and the patient experiences unbearable pain. In cases where more time has passed, the pain syndrome, as a rule, is significantly reduced, and the patient is prescribed conservative therapy. Later, after 4-6 weeks, the swollen node decreases in size and only a small seal remains under the skin or in the anal canal.

Treatment for internal hemorrhoids depends on the severity of the symptoms and the degree of prolapse of the nodes. It is extremely rare for a patient to be immediately prescribed surgical treatment. Conservative therapy is a modern approach to the treatment of patients with hemorrhoid disease and is performed in 90% of patients with chronic hemorrhoids. If, after conservative therapy, the activity of the disease has decreased and the normal quality of life has been restored, then supportive therapy is offered.

Our experience shows that most cases of chronic hemorrhoids could be successfully treated at an early stage with therapeutic methods – a diet that promotes soft, regular stools, hygiene procedures and, in some cases, medications in the form of suppositories and ointments. However, the bulk of patients complains that are characteristic already for stages 2-3 with pronounced clinical manifestations, when self-medication does not help, and the disease causes significant inconvenience.

Surgical treatment of enlarged hemorrhoids with bleeding and prolapse of up to grade 3 can be performed on an outpatient basis without hospitalizing the patient. The so-called minimally invasive techniques are used that do not require anesthesia or are performed under local anesthesia.

Ligation is the application of an elastic latex or silicone ring to the base of an internal hemorrhoid in order to stop its blood supply. Gradually, hemorrhoids die off and are rejected during bowel movements (usually after 5-10 days), and small scars remain in their place. The method is applicable mainly for the treatment of internal hemorrhoids in the second, sometimes third stage, and when the nodes are in the anal canal region above the so-called dentate line, where there are no pain receptors, therefore, if the procedure is performed correctly, the patient does not experience severe pain. At the same time, no more than 1-2 nodes can be ligated, the procedure is repeated no earlier than 2 weeks later.

After the procedure, the patient may experience slight soreness, a feeling of a foreign body in the anus, false urge to defecate, which persists for several days. The process of rejection of the hemorrhoid may be accompanied by minor bleeding, which quickly passes.

Ligation is the most common method of outpatient treatment of hemorrhoids, but practice shows that relapse of the disease occurs after 1.5-2 years in more than 30-70% of patients, since the procedure does not eliminate the causes of hemorrhoids.

Desarterization of hemorrhoids under the control of ultrasound Doppler, HAL (Hemorrhoidal Artery Ligation), is used to treat stage 2-3 internal hemorrhoids. An ultrasound sensor determines the position of the branches of the artery supplying blood to the lower rectum, the vessels above the dentate line are sutured and ligated. Thus, the blood supply to the mucous membrane in the area of ​​formation of hemorrhoids is stopped. A variation of the technique is dearterization with mucopexy HAL-RAR (Recto Anal Repair). Mucopexy is an additional stitching of the sagging mucous membrane with a thread and pulling the stitched tissue up. Hemorrhoids collapse, stop bleeding and, in most cases, are replaced by connective tissue. In addition, along with the ligation of the vessels, the internal nodes are reliably fixed in the rectum.

The advantages of the method are insignificant painful sensations, quick recovery of working capacity. The method has been very popular in the last 10 years, but the accumulated data indicate almost 50% recurrence of the disease.

Radical intervention – surgical removal of internal hemorrhoids (hemorrhoidectomy) is used for stage 3-4 hemorrhoids, prolapsing and non-managing nodes, in the absence of the effect of conservative treatment and the ineffectiveness or impossibility of using minimally invasive techniques. 

During a hemorrhoidectomy, excess tissue is removed that causes bleeding and prolapse of the nodes. In the surgical treatment of hemorrhoids in a hospital (hemorrhoidectomy by the Milligan-Morgan method), EMC coloproctologists use an ultrasonic harmonic scalpel and a bipolar coagulator: these instruments provide reliable coagulation and virtually bloodless removal of hemorrhoids without using suture material. Although the treatment is more painful, relapses are much less common, in our experience, in only 1-5% of cases. The operation is performed under general or epidural anesthesia.

In some cases, stapler hemorrhoidopexy or Longo’s operation is used to treat internal hemorrhoids. Excision of a part of the mucous membrane reduces the blood supply to the nodes, which are gradually overgrown with connective tissue.

It should be remembered that the treatment of hemorrhoids is most effective in its initial stage. Therefore, EMC doctors recommend that at the first sign of hemorrhoids not to postpone a visit to a coloproctologist. You should also consult a doctor if the patient detects blood during bowel movements or in the stool, pain, itching and a feeling of a foreign body in the anus, since similar symptoms are observed in more serious proctological diseases, including cancer

If the diagnosis is made on the basis of classical and modern methods of functional diagnostics, remember that consent to the operation (as well as to any other treatment) is your voluntary decision. Do not agree to the proposed treatment if there is even the slightest doubt. For complete confidence, get a “Second Opinion” from EMC proctologists.