Hemorrhoids are inflammation of the venous areas of the rectum, as well as their bleeding, enlargement and prolapse. As statistics collected from official data show, every seventh inhabitant of our planet suffers from a similar illness. This one makes up 15% of the total population. However, not everyone rushes to see a doctor when the first symptoms of the disease appear. Therefore, it can be assumed that approximately a quarter of the world's population suffers from hemorrhoids.

Many people have a stereotype that talking about such illnesses is simply ugly and uncivilized. It is for this reason that most patients are in no hurry to visit a doctor. As a result, they come to a specialist when hemorrhoids have reached an advanced stage or when they do not have the strength to fight the disease on their own. It is worth noting that this disease affects both men and women equally.

Causes of hemorrhoids

To prevent the appearance of hemorrhoids, you should clearly understand the factors that provoke the occurrence of this pathology. For the development of varicose pathology itself (weakness of vascular walls, dilation of veins and the appearance of nodes) in the perianal area, a provoking condition is necessary:

• inadequate bowel function (frequent constipation/diarrhea);
• inactivity (a sedentary lifestyle is a direct path to hemorrhoids);
• alcohol abuse (alcohol increases blood flow to the pelvis, and its regular use negatively affects the vascular wall);
• unhealthy diet (overeating leading to obesity, leaning on spicy/salty foods increases the load on the intestines as a whole, increases pressure on the rectum and irritates its mucous membrane);
• non-traditional types of sexual pleasure lead to excessive compression of the hemorrhoidal plexus and stretching of the rectal ligaments, which provokes hemorrhoids;
• lifting weights professionally or as a hobby (power athletes, loaders and people engaged in heavy physical labor must understand that their type of activity is fraught with the development of hemorrhoids);
• pregnancy (hemorrhoids in women appear during pregnancy, especially not the first one);
• inflammatory pathology and tumor diseases small pelvis.

It is wrong to believe that hemorrhoidal disease is exclusively an “adult” pathology. In children, the development of hemorrhoids occurs against the background of frequent constipation, prolonged sitting on the potty and regular hysterical crying. However, in children, hemorrhoids are treated more effectively due to timely treatment, age-related elasticity of blood vessels and the ability to recover during growth.

Types of disease

Symptoms and treatment of hemorrhoids in 2019 largely depend on its type. There are 3 types of this disease:

1. External, it is often also called anal. The nodes protrude outward in the anus area and are easy to see. This form is characterized by an abundance of unpleasant sensations.
2. Internal, in which the disease manifests itself in the lumen of the rectum. This form develops relatively slowly, and there is no clear clinical picture.
3. Combined. It is not difficult to guess from the name itself that this species is a combination of the first two. Such hemorrhoids are considered the most severe; they develop, as a rule, due to ignoring the advice of doctors and not taking their own health seriously.

There are often cases when hemorrhoids lead to various complications. Among them are anemia, which causes a general loss of strength, dizziness and fatigue. This occurs due to blood loss and a decrease in the number of red blood cells in it. In some cases, especially advanced forms lead to gangrene; such an unpleasant phenomenon can be observed with the internal form of hemorrhoids. The blood flow is disrupted or stopped altogether, as a result, the processes of tissue death and necrosis begin.

First signs

The main signs of external hemorrhoids:

1. Itching and burning.
2. Unpleasant sensations in the anus and rectum. There may be a feeling of heaviness, incomplete bowel movement, or a foreign body inside.
3. Pain in the anus and rectum. At first, the pain can be expressed in the form of a slight tingling sensation, then it turns into a pulling sensation. In this case, swelling of the node can be observed.
4. Bleeding, which most often begins to occur after a bowel movement.
5. Prolapse of hemorrhoidal node.

The symptoms of internal hemorrhoids are often similar to those listed above. The main difference is that with internal hemorrhoids the nodes do not protrude out, which often makes it difficult to make an accurate diagnosis and examination.

Symptoms of hemorrhoids

When hemorrhoids occur, the symptoms (see photo) differ slightly depending on the current condition - remission or exacerbation. During the remission stage, the symptoms subside and cease to bother the patient, and when the disease worsens, the symptoms reappear and cause constant discomfort.

The main signs of hemorrhoids include:

1. Itching and burning in the anus. Itching or burning indicates erosion of the walls of the hemorrhoids.
2. Sensation of a foreign body, feeling of heaviness. People suffering from hemorrhoids often feel a foreign body in the anus, as well as heaviness in the groin when walking. Such symptoms appear in people suffering from hemorrhoids due to hemorrhoids filled with blood.
3. Pain during bowel movements, walking and sitting. Infringement of the hemorrhoidal node is accompanied by severe pain, sometimes unbearable. The pain is severe due to the fact that there are many receptors near the anus. This pain occurs most often during bowel movements, but sometimes also when walking. This pain is a sign of an incipient attack of acute hemorrhoids.
4. Bleeding during bowel movements, blood in the stool. With severe constipation, a lot of hard feces accumulate in the intestines, which begins to put pressure on the venous walls. They, in turn, due to pressure, begin to be poorly supplied with oxygen, and due to their prolonged overflow with blood, they begin to stretch. As a result of stretching, the walls become thinner, and ruptures occur in some places, which leads to bleeding. In this case, blood flows only before or after defecation. Blood can flow either in small droplets that remain on the paper or in streams. If the bleeding is intense, it can result in iron deficiency anemia. It should be noted that bleeding from the anus is the main symptom of hemorrhoids, which indicates a tumor in the large intestine!
5. Soreness to the touch of hemorrhoids. If touching the hemorrhoids causes you severe pain, and the nodes themselves become purple or plum in color, then this is a sign of thrombosis. Plum spots can reach two centimeters in diameter. If you have at least one of the above symptoms, it is better to consult a doctor and not wait for miraculous self-healing. Although you can also use folk remedies for treating hemorrhoids, because even in ancient times, hemorrhoids were not considered a disease at all. Hemorrhoids were such an insignificant disease that they perceived them as we now see them as a splinter.

Another main symptom of hemorrhoids is the prolapse of hemorrhoids from the anus, which is a consequence of the development of degenerative processes. And the development of dystrophic processes is caused by strong and prolonged straining during bowel movements, as well as simply sitting in the toilet for a long time reading a newspaper. Another reason may be smoking. By the way, if you want to quit smoking, this is the place for you.

What hemorrhoids look like, photo

The photo below shows how the disease manifests itself in humans.

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Stages

The development process goes through four stages:

Stage 1	the person begins to complain of bleeding from the rectum. This usually happens during the act of defecation. An important difference from other stages is the absence of prolapse of hemorrhoids.
Stage 2	In addition to bleeding, the patient begins to worry about prolapse of nodes, which occurs during straining during bowel movements. After the act of defecation, the nodes correct themselves.
Stage 3	the nodes provoke bleeding; during defecation they fall out, and at the same time they cannot be reduced on their own; the patient himself has to do this manually. In this case, prolapse is also possible in other situations when the patient’s pressure in the abdominal cavity increases, for example, when coughing, lifting something heavy, sneezing, etc.
Stage 4	the last stage of hemorrhoids, in which the entire anal area is involved in the pathological process. The patient is bothered by frequent and massive bleeding, nodes that fall out even after minor loads, and they cannot be reduced. Often at this stage thrombosis develops, which causes an attack of acute hemorrhoids, in which inflammation affects not only the anus, but also subcutaneous tissue surrounding tissues.

Complications

A progressive disease in the absence of proper treatment usually leads to a number of complications, and they can hardly be called pleasant.

1. Inflammatory processes localized in surrounding tissues. In some cases, this leads to paraproctitis, characterized by inflammation of the tissue around the rectum. This disease is a very serious complication; it requires immediate and quite serious treatment.
2. Anemia. This disease develops with a long course of hemorrhoids, accompanied by heavy and regular bleeding.
3. Cracks. This is the main cause of pain with hemorrhoids. It is worth remembering that anal fissures create ideal conditions under which all kinds of bacteria penetrate deep into the tissue and develop there. As a result, this phenomenon can cause an abscess. This is a limited purulent inflammation, accompanied by severe pain, fever and general malaise. If such a complication occurs, surgical intervention is required.

In older people, fecal incontinence and anal sphincter insufficiency may occur.

Treatment of hemorrhoids

When hemorrhoids develop, there are two treatment methods: conservative and surgical.

Conservative treatment consists of the use of systemic and local medications and is used in the initial stages of the disease. It is aimed at relieving pain, preventing complications and exacerbations, and is used for preoperative preparation and postoperative rehabilitation of patients.

Drug therapy for hemorrhoids includes the following types of medications:

• Nonsteroidal anti-inflammatory drugs and analgesics are used to relieve inflammation and pain in the anus. Patients are prescribed drugs such as Analgin, Diclofenac, Nise, Ibuklin;
• venotonics to normalize the tone of venous vessels - Detralex, Phlebodia, Venoton, Troxevasin;
• hemostatics to stop bleeding from hemorrhoidal cones - Vikasol, Ditsinon, Calcium chloride;
• ointments based on Nitroglycerin to relieve spasm of the anal sphincter;
• heparin-based ointments to prevent thrombosis of hemorrhoids;
• laxatives to normalize stool - Dufalak, Normaze, Bisocadil.

Surgical removal of hemorrhoids is used when conservative therapy is ineffective or in the event of complications. For this purpose, minimally invasive techniques and hemorrhoidectomy can be used.

Ointments and suppositories

During conservative treatment, ointments and suppositories are used.

1. Sea buckthorn candles. They restore immune cells, relieve swelling and eliminate itching. Suppositories are good at killing bacteria and have a detrimental effect on histamine (cells that provoke inflammation). Anuzole suppositories and Fleming's ointment have the same effect.
2. Heparin ointment. Its use can relieve symptoms and eliminate exacerbation of the disease. This medicine is the main component of the treatment of pathology. The use of heparin ointment is especially effective during inflammation of the seals. It prevents the appearance of blood clots, relieves pain and relieves swelling.
3. Proctosan ointment. Proctosan ointment is widely used. It is used in the first and second stages of the disease. Apply the product to the affected areas. An ointment is used to relieve inflammation in the rectum.

Relief ointment and levomekol also stimulate immune cells well and counteract inflammation. They are known for their wound healing effect and vasoconstrictor effect.

Folk remedies

Traditional methods are also effective in practice; it is important to choose the right hypoallergenic composition to eliminate the risk allergic reactions. Below are suggested good recipes treatment of anal fissures and bumps.

1. Peel the potatoes and cut a candle out of it. Insert at the entrance to the rectum at night, perform the procedure before bedtime. Such “potato sessions” should be carried out for 5-7 nights in a row to completely get rid of hemorrhoids.
2. Sea buckthorn oil will help with external hemorrhoids. It is necessary to soak a cotton pad in the oil base, and then apply it to the painful lump overnight. In total, carry out 10 procedures to completely get rid of hemorrhoids.
3. Yarrow is a folk remedy for hemorrhoids, which should be used in the form of natural juice or medicinal decoction. If you don’t have a juice squeezing machine, it is recommended to prepare a water infusion that you can use for medicinal baths before bed.

Baths for hemorrhoids at home

This is a quick method to relieve pain and relieve inflammation. A bath for hemorrhoids has no contraindications, side effects are also excluded. Doctors recommend following daily hygiene rules, using toilet soap without additives, and then rinsing the problem area with a decoction of chamomile, calendula, and yarrow.

This water procedure does not provide emergency relief, but it reduces the number of painful relapses. A particularly effective composition is crushed garlic with fresh milk in water.

Diet and proper nutrition

Nutrition for hemorrhoids is no less important than drug treatment or surgery. You need to eat fractionally - 5-6 times a day in small portions. The drinking regime should be sufficient - 1.5-2.5 liters of still water without sugar per day.

• Food should be processed using gentle heat treatment methods - boiling, baking, stewing, steaming, and also contain a sufficient amount of fiber.
• For hemorrhoids, it is recommended to consume foods such as fermented milk, pumpkin, zucchini and zucchini, tomatoes, cucumbers, beets, carrots and other vegetables, fruits, cereals, and whole grain bread. Give preference to cereals, salads, especially vinaigrette, boiled or stewed lean meat, chicken, fish, steamed cutlets, soups, casseroles.

Gymnastics

Sphincter gymnastics is also very useful for external hemorrhoids; it should be performed every day, these are just 3 simple exercises:

• The exercise is done while lying on your back, squeezing your buttocks, counting slowly to 5, while pulling your rectum as much as possible. You should also relax on the count to 5. Repeat the exercise 15 times.
• Lie on your stomach, put your hands under your chin - alternately lift your straight legs one at a time, 10 times the left one, 10 times the right one.
• Lie on your right side, bend your right arm at the elbow under your head, while left hand also bent, but in front of the chest, bend the right leg too. For 4 counts, raise your left leg and bend it at the knee, straighten it, moving it back, then lower it. Do a similar exercise on the left side 10 times.

Minimally invasive techniques

Minimally invasive treatment of hemorrhoids allows you to quickly and without serious injury get rid of such a delicate problem. Therapeutic methods in most cases only muffle the symptoms of the disease and delay the moment when it is necessary to use more radical methods. Before prescribing a particular procedure, the doctor examines the patient’s medical history, conducts a comprehensive examination, and evaluates all possible risks.

Minimally invasive technologies for hemorrhoid removal include:

1. Electrocoagulation is carried out under the control of an anoscope. An electrode is applied to the leg of the node and the tissues are coagulated (welded), after which they quickly die. In one procedure it is possible to get rid of 1-2 pathological foci. After gluing, the hemorrhoid stops feeding and growing, and after a while it completely disappears.
2. Sclerotherapy is a low-traumatic treatment of hemorrhoids using special sclerosing substances that are introduced into the node, glue its walls, making it possible to stop their nutrition and die off in the future. The technique is carried out only at stages 1-3 of hemorrhoids. It does not eliminate the risk of relapse of the disease and is effective only for small hemorrhoids.
3. Cryotherapy is a short-term treatment of hemorrhoids with liquid nitrogen. After this, the hemorrhoidal node dies and falls off. The procedure is performed under local anesthesia, so there is no pain.
4. Latex ligation. With this technology for removing hemorrhoids, special latex rings are used. They are inserted through an anoscope into the anus and a knot is tied with them. This completely blocks the blood flow in it, and after 1-2 weeks the node itself is rejected along with the ligature. This technique will be used in later stages of hemorrhoids (3 and 4).

Minimally invasive methods of combating hemorrhoids can be used only at stages 1-3 of the disease, always without exacerbation of the inflammatory process. All procedures are carried out after local anesthesia. There is no need to use general anesthesia. Only 1-3 nodes can be removed in one session. Sometimes treatment takes place in several stages, at intervals of several weeks.

Latex ligation

Surgery for hemorrhoids: hemorrhoidectomy

This is the excision of the hemorrhoid along with part of the mucous membrane, with suturing of its stem. The operation is indicated for chronic hemorrhoids in the last stages, severe bleeding, frequent relapses and thrombosis of hemorrhoids.

The duration of hospitalization is up to 10 days. The duration of the recovery period is 2-3 weeks. Immediately after surgery, pain may appear; postoperative sutures sometimes suppurate and hurt.

To make you feel better, special analgesic drugs, anti-inflammatory drugs, and sitz baths are prescribed after each bowel movement.

Prevention

To prevent the development of hemorrhoids, you should follow a balanced diet. The daily diet should include a sufficient amount of liquid (1.5–2 liters) and dietary fiber of plant origin (vegetables, bran, etc.). It is necessary to avoid drinking alcoholic beverages and overly hot and spicy foods.

1. It is recommended to avoid overload during defecation (excessive straining); it is preferable to wet the perianal area after defecation, preferably with cool water.
2. During pregnancy, in order to reduce venous stagnation, daily exercises, walking, and a rational diet with plenty of laxative foods are recommended.

Remember that the treatment of hemorrhoids should only be entrusted to professionals. You should not neglect this disease or self-medicate.

We all know what varicose veins are. Such vascular pathology is difficult to hide, it clearly catches the eye, but hemorrhoids can be seen. To put it simply, this is the same dilation of the veins, only localized in the area of ​​the anus and lower part of the rectum hidden from public view.

Enlarged hemorrhoids with internal and external hemorrhoids With hemorrhoids, the so-called hemorrhoids expand. A hemorrhoidal node is an anastomosis: a direct connection of fairly large vessels, but not through a network of capillaries, but directly. The basis of hemorrhoids is cavernous formations, arranged in the form of 3-4 pillows. There are internal hemorrhoids, localized under the mucous membrane of the anus, and external, located subcutaneously. When you strain, excess pressure forms in the abdominal cavity, and the blood, accordingly, has to go somewhere. It flows into these anastomoses, that is, hemorrhoids.

Statistics on the incidence of hemorrhoids in different sources vary from 44 to 86%. The last figure seems rather inflated, but this is only at first glance: how many people do you think will want to advertise their, let’s say, delicate illness? By the way, it’s completely in vain. Hemorrhoids are an absolutely “normal” disease, so to speak, and certainly not a reason for false modesty.

Reasons for the development of hemorrhoids

There are two main causes of hemorrhoids: vascular, when dysfunction develops between the inflow and outflow of blood from the cavernous bodies, and mechanical. In the second case, under the influence of unfavorable factors, the longitudinal muscle of the submucosal layer of the rectum, which holds the hemorrhoids in place, is stretched, and they begin, in the literal sense of the word, to “fall out” out. What factors influence the development of hemorrhoids?

• constipation and its treatment (abuse of enemas, laxatives);
• taking oral contraceptives;
• Surprisingly, excessive hygiene of the anus also contributes to hemorrhoids (the reason is irritation of the anal mucosa);
• improper diet (tea, coffee, alcohol, fiber deficiency);
• anal sex;
• sports (riding a motorcycle, cycling, lifting weights);
• occupation that requires prolonged sitting (risk groups – drivers, pilots, programmers).

View of hemorrhoidal cones of external hemorrhoids (on the left is a photograph, on the right is a drawing)

I will allow myself a small lyrical digression within the framework of this chapter. Another reason for the development of hemorrhoids is the presence in the toilet of a tablet, smartphone or various types of printed materials: books, magazines, newspapers, necessary for some in order to “brighten up” a long vigil in the toilet and combine business with pleasure. So: there is nothing useful here. The fact is that prolonged sitting on the toilet waiting for the “second wave” of bowel movements, straining the abdominal muscles with a relaxed sphincter and an empty rectum (since after the first bowel movement, feces have not yet arrived there from the large intestine) leads to a large influx blood to hemorrhoids. Now I have described the so-called two-stage bowel movement, which, according to statistics, up to 90% of people suffering from hemorrhoids are prone to. There is a very wise saying, which, if somewhat literary for publication, sounds like this: “If you don’t want to perform an act of defecation at the moment, don’t torture your anus.” This, by the way, is a most valuable means of preventing hemorrhoids (meaning reducing the time spent on the toilet, excuse me for such physiological details).

Symptoms of hemorrhoids

Clinically, the disease is silent and unnoticeable at first. The first symptom of hemorrhoids is discomfort in the anus, expressed in the sensation of a foreign body in it. This symptom is incoming, usually appearing with intestinal disorders (constipation or diarrhea), diet disorders, and alcohol abuse. The main symptom of hemorrhoids is scarlet bloody issues after defecation (they can be seen, for example, on toilet paper or in the feces themselves). Other symptoms of hemorrhoids:

• prolapse of hemorrhoids. In the initial stage, they correct themselves, then they require “manual” intervention;
• constant pain (especially during bowel movements), itching in the anus.

As with any disease, hemorrhoids are characterized by acute and chronic variants, and the latter of them is more typical. During chronic hemorrhoids there are 4 stages, each of which has its own features, associated mainly with the condition of hemorrhoids. At the first stage, hemorrhoids do not fall out, only bloody discharge from the anus is noted. At the second and third stages, the nodes already begin to fall out during defecation, and if at the second stage they are set independently, then at the third this manipulation has to be done manually. At the fourth stage, prolapse of nodes is already observed during sneezing, coughing, and physical exertion. It becomes almost impossible to straighten them.

Hemorrhoids in women

Hemorrhoids are not aware of gender prejudice: although for some reason it is considered a male disease, it is by no means alien to victims among the fair half of humanity. I deliberately omitted pregnancy and childbirth from listing the causes of hemorrhoids in order to talk about this separately. In the second half of pregnancy, the uterus increases significantly in size and begins to put pressure on the rectum, which makes it difficult to empty the intestines, which in turn leads to constipation - one of the reasons for the development of hemorrhoids.

In addition to the rectum, blood vessels are also compressed, which means that the outflow of blood from the pelvic organs is hampered, which also provokes hemorrhoids during pregnancy. Severe straining during childbirth also leads to hemorrhoids. There is one more circumstance favorable to hemorrhoids, characteristic only of the female sex: menstruation, during which there is a rush of blood, including to the hemorrhoids, which leads to an exacerbation of hemorrhoids.

Diagnosis of hemorrhoids

It's not particularly difficult. The main thing is sleight of hand, because... hemorrhoids are diagnosed by rectal examination and palpation (feeling). At the same time, compaction of the hemorrhoidal nodes, weakening of the sphincter tone are clearly visible, and when straining, prolapse of the nodes is noted.

How to treat hemorrhoids?

The first thing you should do is contact a doctor who treats hemorrhoids - a proctologist. But, if you want to get a free appointment with a proctologist, you will initially need to visit a surgeon who will listen to your complaints and then issue a referral to the desired proctologist. Below are the dates for recommendations for the prevention and treatment of hemorrhoids, you can use them while you wait for your appointment with a doctor.

At the initial stages of the disease, doctors recommend conservative treatment, i.e. treatment of hemorrhoids at home. Diet is very important in the prevention and treatment of hemorrhoids. Even so: extremely important. Of course, everyone has individual characteristics nutrition, but there are certain groups of foods that cause irritation of the colon and rectum in the vast majority of people. These are onions, garlic, marinades, canned food, mustard, smoking and, of course, alcohol. The diet should be rich in lactic acid products, vegetables, brown bread, fibrous and fiber-rich foods (read: foods that prevent constipation). Eat cauliflower, honey, fish, rice more often and don’t forget to drink more!

Try to walk more and do special exercises - this helps prevent blood stagnation in the pelvis and helps strengthen the muscles of the anal sphincter of the rectum.

After defecation, it is imperative to wash yourself with ice water for several minutes, but it is best to do cold and hot shower, i.e. direct the stream to the anus cold water, term to the maximum, then take a five-minute break and repeat the procedure. This is useful not only in treatment, but also in the prevention of pathology.

Ointment for hemorrhoids - “Gepatrombin G” for external and rectal use. For internal hemorrhoids, suppositories with heparin (Nigepan, Gepatrombin G, Gepazolon), anesthesin, belladonna extract, medicinal enemas with chamomile, oak bark, alder fruit, St. John's wort, burnet rhizome are prescribed. For external use, an ointment for hemorrhoids, for example, the same Hepatrombin G only in a different form of release. Although, thanks to the special attachment that comes with the kit, this ointment can also be used in the treatment of internal hemorrhoids.

Treating hemorrhoids at home is not complete without the use of medications taken orally, i.e. tablets. To increase the tone of the walls of blood vessels, reduce their distensibility and venous stagnation, proctologists recommend taking Detralex or, due to the high cost of the French drug, its Russian analogue Venarus.

If all of the above does not have the desired effect, then the next stage of treatment is hospitalization of the patient followed by surgery, primarily hemorrhoidectomy, i.e. excision of hemorrhoids, both external and internal, with restoration of the anal mucosa. Recovery after such an operation takes 3 to 4 weeks.

There are also a number of minimally invasive methods for treating hemorrhoids, which are successfully used in combination with surgical treatment. This is sclerotherapy (introduction of special drugs into the hemorrhoidal node that promote the formation of connective tissue in it), infrared photocoagulation (sclerosation of the hemorrhoidal node under the influence of an infrared probe), ligation (ligation) of the hemorrhoidal node using a latex ring, which leads to its death.

Prevention of hemorrhoids

In principle, everything about prevention has already been said above. This includes the fight against digestive disorders, dietary restrictions, controlled physical activity (needed to prevent stagnation of blood in the pelvis, but excessive stress that contributes to straining is contraindicated), proper anal hygiene.

What are hemorrhoids? Hemorrhoids are enlarged blood vessels in the anus and rectum (the right colon is the end of the large intestine). In particular, the expansion of the so-called cavernous bodies (located at the transition between arterial and venous vessels), which usually exist in this area. This vascular network contains arterial blood.

Prevalence

Hemorrhoids are so common that it is estimated that 90% of people experience the condition occasionally.

Hemorrhoids are more common in industrialized countries. According to statistics, more than 10% of the adult population suffers from hemorrhoids. The disease affects people of working age after 20 years. The most affected group are people aged 40 to 65 years. Hemorrhoids affect both sexes, with a slight predominance in favor of men.

The disease has a chronic progressive development and often leads to disability. Despite its widespread prevalence, only a small number of people seek medical help for the disease, most of whom suffer for many years before seeking medical help. Only 10% to 20% of them had surgery.

Causes of hemorrhoids

There is no specific cause for hemorrhoids. It is known that the vertical position occupied by the body has a very high pressure in the rectal veins, and this, in turn, leads to their disease. There are a number of reasons that lead to the appearance of hemorrhoids.

Among the most common causes of hemorrhoids are:

• Constipation is one of the most important factors for the occurrence of hemorrhoids. The effect on bowel movements increases pressure in the venous plexuses, making it difficult for blood to dry out of them, leading to enlargement.
• Generalized diarrhea can also cause hemorrhoids.
• Hemorrhoids often appear as a result of prolonged sitting, which prevents the drainage of venous blood.
• Particular attention should be paid to pregnancy as a specific condition, often accompanied by hemorrhoids. Due to changes in hormones, weakening of the vascular wall and expansion of the uterus, which mechanically puts pressure on the blood vessels and prevents normal blood circulation in the anal area, pregnancy usually contributes to the formation of hemorrhoids or exacerbation of symptoms.
• For occupations that involve long-term sitting (drivers, office workers, etc.), due to the lack of movement, venous drainage is difficult. This leads to the appearance of hemorrhoids.
• Of course, there is a genetic predisposition. The genetic elasticity of the connective tissue from which the veins are formed determines whether a person will suffer from hemorrhoids and to what extent the condition can be aggravated. The combination of hemorrhoids, flat feet and varicose veins is characteristic of congenital weakness of connective tissue.
• Diet is another one important reason hemorrhoids. Fatty foods, hot and spicy foods, and fried foods irritate the lining of the colon. Alcohol, carbonated drinks, tobacco also have negative impact. Restricted fluid intake can also cause hemorrhoids. People who do not consume alcohol or foods that irritate the intestinal lining also suffer from hemorrhoids. This is due to the wrong combination of food consumed.
• Inadequate hydration (caused by inadequate water intake or excessive consumption of diuretic liquids such as coffee) can cause hemorrhoid irritation.
• With age, tissue elasticity decreases, changes in diet and lifestyle, and this leads to the occurrence of hemorrhoids.
• During physical activity, intra-abdominal pressure increases, and this leads to venous stagnation and the occurrence of hemorrhoids.
• Chronic liver diseases lead to intravenous stagnation in the rectum and, consequently, hemorrhoids appear.

Risk factors

According to statistics, about 75% of people develop hemorrhoids at some point in their lives. Knowing your personal risk factors for hemorrhoids can help a person take precautions to avoid this painful and unpleasant condition. Although hemorrhoids can affect everyone, some people face a higher risk of developing the condition.

Among the main risk factors for hemorrhoids:

• Persistent constipation or diarrhea – these conditions can lead to straining to have bowel movements.
• Family history of hemorrhoids. If you have relatives who suffer from this condition, the risk of developing hemorrhoids in the future is greater.
• Age – Although hemorrhoids can occur in younger people, they are more common in middle and old age. Half of people over 50 years of age seek treatment for hemorrhoids.
• Pregnancy and Childbirth - As the fetus grows during the last 6 months of pregnancy, blood volume and pressure on the pelvic blood vessels increases. Additionally, due to the increase in hormones during this period, progesterone can weaken the vein walls, which can contribute to the formation of hemorrhoids. Pregnancy at birth can also cause hemorrhoids.
• Overweight
• Diet - eating foods high in fat and low in fiber.
• Classes. People with occupations that require long periods of time with little or no movement are at high risk of hemorrhoids.
• Lack of physical activity
• Alcoholism
• Severe liver and/or cardiovascular disease

Types of hemorrhoids

According to location, hemorrhoids are divided into external and internal.

• External hemorrhoids develop on the outside around the anus and are located under the skin. They may feel swollen and cause symptoms such as itching, pain and bleeding.
• Internal hemorrhoids are located below the rectal mucosa and cannot be felt in good condition. They are usually painless and the main symptom is bleeding during and after bowel movements. It is possible that in a more advanced state, internal hemorrhoids will rupture through the anus and will not be able to return, resulting in severe pain.

Stages of hemorrhoids

There are four stages of development.

1. Stage I - hemorrhoids are above the line and not visible from the outside. Clinically, it develops with bleeding and itching, and usually there is no pain.
2. Stage II. Hemorrhoids protrude. They react spontaneously, initiating fibrotic changes. Clinically rare bleeding is observed. Sometimes mucus is released.
3. Stage III. Prolapse of hemorrhagic nodes during defecation cannot be caused spontaneously, but must be reproduced with help. There is increased anal sphincter tone and progressive fibrosis. Clinical manifestations are mucus secretion, pain, itching and irritation of the mucous membrane.
4. Stage IV. As in the third stage, prolapse of hemorrhoids occurs, but at this stage they are irremovable. At this stage there are many complaints, usually with severe pain and damage to the mucous membrane.

Pathophysiological process

The exact pathophysiology of hemorrhoid development is poorly understood. For decades, the varicose vein theory has been popular, which postulates that hemorrhoids are caused by varicose veins veins in the anal canal, but the concept is now outdated, since hemorrhoids and anorectal varicose veins have turned out to be separate entities. In fact, patients with portal hypertension and varicose veins do not have an increased incidence of hemorrhoids.

In the anal canal between them there are three large elevations and several small ones. The anal elevations in patients with hemorrhoids show significant pathological changes. These changes include abnormal vein dilatation, vascular thrombosis, degenerative processes in collagen fibers and fibroelastic tissues, and deformation and rupture of subepithelial muscle. In addition to these findings, there is a severe inflammatory response involving the vascular wall and surrounding connective tissue associated with mucosal ulceration, ischemia, and thrombosis.

Symptoms of hemorrhoids occur with an excessive increase in venous pressure. There are two types of hemorrhoids: internal to the superior hemorrhoidal plexus and external to the inferior hemorrhoidal plexus.

Pathophysiology of symptoms of internal hemorrhoids

Internal hemorrhoids cannot cause skin pain because they are located above the dentate (combine) line and are not innervated by the cutaneous nerve. However, they can cause bleeding, prolapse and, through irritating deposition on sensitive perianal skin, cause perianal itching and irritation. Internal hemorrhoids can cause perianal pain by shedding and causing the sphincter complex around the hemorrhoid. This spasm leads to discomfort while the hemorrhoids prolapse.

Internal hemorrhoids can cause severe pain when encased and trapped. Again, the pain is associated with spasm of the sphincter complex. Strangulation with necrosis may cause deeper discomfort. This sphincter spasm can also cause external thrombosis. External thrombosis causes sharp pain in the skin. This constellation of symptoms is called acute hemorrhoidal pain and usually requires urgent treatment.

Internal hemorrhoids most often cause painless bleeding with bowel movements. The overlying epithelium is damaged by the force of defecation with bleeding at the base.

Internal hemorrhoids may deposit mucus on the perianal tissue with prolapse. This mucus can cause localized dermatitis called itch.

Pathophysiology of external symptoms of hemorrhoids

External hemorrhoids cause symptoms in two ways. First, acute thrombosis of the underlying external hemorrhoidal vein may occur. Acute thrombosis is usually associated with a specific event, such as exercise, constipation, diarrhea, or dietary changes. These are acute, painful events.

The pain is the result of rapid swelling of the nerve skin from the clot and surrounding swelling. The pain lasts 7-14 days, progressing through resolution of the thrombosis. The stretched tumor persists as excess skin or skin tags (acrochordons).

External thromboses sometimes destroy the overlying skin and cause bleeding. Recurrence occurs in approximately 40-50%, in the same place (since the damaged vein is located there). Removing the blood clot and leaving the weakened vein in place, rather than removing the vein with the clot, predisposes the patient to relapse.

External hemorrhoids can also cause difficulty in hygiene due to the excess skin left after acute thrombosis (skin tags) responsible for these problems. External hemorrhoidal veins under the perianal skin obviously cannot cause hygiene problems, but excess skin in the perianal area can interfere mechanically.

Symptoms and signs of hemorrhoids

The most common symptoms that occur with hemorrhoidal disease are:

• Itching and burning around the anus occurs mainly after defecation. They are caused by irritation of the surrounding skin.
• Discomfort when walking occurs periodically and is felt mainly in the left lower intestine.
• Pain is more common in external hemorrhoids and is mainly caused by trauma to the area, especially with constipation and hard feces. Pain is also typical when complications of hemorrhoids occur with thrombosis. There is also pain when there is a combination of hemorrhoids and anal fissure.
• Bleeding occurs at the end of the bowel movement, from a few drops to jugular bleeding. This is usually not accompanied by pain. Bleeding occurs due to thinning of the mucous membrane and rupture of the walls of the cavernous bodies. About 80% of patients were detected. The consequence of bleeding can be chronic iron deficiency anemia. In general, bleeding is more common in internal hemorrhoids.
• Anal secretion leaves behind dirty laundry and sometimes leads to inflammation of the skin in the surrounding area.
• Prolapse occurs when internal hemorrhoids pass through the anus due to enlargement. In the beginning they come out with traction and physical effort, and they react (come back), but in more advanced stages they come out spontaneously and remain outside, unable to return. Weakening of the anus leads to a feeling of weight, spots, discharge and secondary skin infections. This can lead to necrosis, gangrene and secondary fistulas.

Diagnosis of hemorrhoids

Hemorrhoidal complaints are usually not associated with other diseases or illnesses. However, patients with the following diseases and conditions have an increased risk of hemorrhoidal symptoms:

Inflammatory bowel disease and hemorrhoid problems; unusual hemorrhoidal signs should alert the physician to the potential presence inflammatory disease intestines

Several anorectal conditions can cause symptoms similar to those associated with hemorrhoids. Factors that may indicate a more serious illness and should be prompted by a colonoscopy include: changes in bowel movements, abdominal pain, weight loss, rectal bleeding in the stool, or a family history of colon cancer.

Differential diagnosis of hemorrhoids includes:

• Anal fissure
• Anogenital warts
• Anorectal fistula
• Perianal abscess
• Diverticulosis
• Eczema
• Fungal infection
• Stagnation of feces
• Infections (sexually transmitted diseases)
• Rectal polyps
• Rectal prolapse
• Rectal trauma
• Ulcerative colitis
• Crohn's disease
• Anal cancer
• Colorectal tumor

Medical tests for hemorrhoids

If you suspect hemorrhoids, you need to perform a few simple and simple ways to confirm or reject the diagnosis of hemorrhoids.

Tests required to diagnose hemorrhoids:

1. Analysis of the anal area involves a rigorous examination of the anus and its surroundings, looking for external or prolactic hemorrhoids.
2. A rectal pinch is an exploration of the anus and lower rectum using a finger. In a rectal examination to check for hemorrhoidal bulges, indications of rectal polyps or tumors, abscesses or prostate adenoma in men.
3. Anoscopy is performed using a device called an anoscope. This is a hollow tube with front lighting that allows viewing of the rectum and anus for internal hemorrhoids.
4. Endoscopic examination includes sigmoidoscopy and colonoscopy. A sigmoidoscopy examines the sigmoid colon and a colonoscopy is used to examine the entire colon. The purpose of endoscopic examination is to differentiate hemorrhoids from other diseases that occur with bleeding from the anus.

Treatment of hemorrhoids

Treatment of hemorrhoids is divided into:

• conservative
• mini-invasive procedures
• surgical treatment.

The treatment method depends on the stage of the disease and the patient’s wishes. Sometimes a combination of several treatment methods is required.

Non-operative treatment

Non-operative treatment is usually used in stages I and II of hemorrhoidal disease. It includes:

Hygienic dietary regime

• It is recommended to avoid foods and drinks (spicy foods, strong spices, alcohol, etc.) that irritate hemorrhoids. You should consume foods rich in fiber. In addition, you need to take more fluids.
• Active movement throughout the day is recommended.
• It is necessary to regulate bowel movements with mild laxatives.
• Always wash the anal area after defecation and dry it with a soft cotton cloth. The water should be cold, not hot. Toilet paper should not be used.

Drug treatment

Drug treatment is aimed at reducing pain, inflammation and bleeding. There are medicines in various forms - tablets, ointments, creams, gels, suppositories (suppositories), foam, etc. Baths with antiseptic solutions - potassium permanganate, betadine, iodazept, etc. also have a good effect. Ointments, creams and gels for external hemorrhoids are applied in a thin layer around the anus, and internal hemorrhoids are applied through a finger or special applicators to the medicine.

Most medications contain more than one active ingredient, most containing one of the following: an anticonvulsant—most often a local anesthetic (lidocaine); vasoconstrictor component - reduces blood and, to some extent, pain; antiseptic ingredient - prevents inflammation. For acute hemorrhoidal crises, drugs containing diosmin are also used.

Minimally invasive procedures

Minimally invasive procedures are procedures that can be performed in an outpatient setting without the need to visit a hospital and have few complications. They are recommended for I, II, III hemorrhoidal diseases.

There are several types of procedures that sometimes need to be combined with each other.

• Cryotherapy is done by freezing hemorrhoidal tissue. It was used in the past in the belief that freezing the beginning of the anal canal would reduce blood supply and lead to fibrosis of the hemorrhoid. Unfortunately, the procedure was painful and associated with a long recovery period, and for this reason it is rarely used.
• Electrotherapy is the drying of hemorrhoids with an electrical charge. This method is painless and very effective in stopping hemorrhoids quickly.
• Sclerotherapy is the injection of a sclerosing agent (an irritant) into hemorrhoids. This shrinks the blood vessels, connective tissue is formed, and hemorrhoids disappear. This used to be common, but with the introduction of new methods it is used less and less.
• Laser therapy or infrared therapy - uses light in the infrared spectrum. This method is very effective in stopping bleeding. This method can be used as a stand-alone stage I and II and in combination with another stage III process. Today, the combination of infrared therapy with band ligation is the “gold standard” in minimally invasive hemorrhoid procedures. This method is absolutely painless and is applicable to outpatient treatment.
• Rubber band ligation (strip ligation) is the placement of an elastic rubber ring at the base of the hemorrhoid. Thus, its blood supply is cut off and it subsides without further intervention after a week or ten days. If the node falls out, there may be some bleeding and a small wound at the site of the node, which takes about 14 days to heal. Special endoscopic equipment is used, which can be performed on an outpatient basis and does not require anesthesia. Band ligation is only applicable to internal hemorrhoids since they do not have pain receptors like external ones. The procedure can be repeated over a period of approximately three weeks. This procedure is relatively contraindicated in patients taking antiagonists or those with compromised immune defenses.
• Over the past 10 years, ligation and infrared coagulation have been the first choice for outpatient treatment of hemorrhoidal disease for effect and minimal discomfort.

Surgery

Surgery used for internal hemorrhoids III and IV, thrombosis, external hemorrhoids, prolonged and heavy bleeding with anemia when the possibilities of the other two treatment methods have been exhausted.

There are several surgical methods for removing hemorrhoids, including the classic Milligan-Morgan surgery, the Parkes procedure, the Longo procedure (with a mechanical suture), and the Whitehead procedure. These hospital stays, anesthesia, known pain, long recovery period, relapse and complications.

Natural Remedies for Hemorrhoids

Often, mild pain, swelling and inflammation of hemorrhoids can be relieved with a home remedy.

Natural remedies for hemorrhoids include:

• The cold compress will help the hemorrhoids shrink and become smaller in size. This will reduce pain and reduce itching. Wrap some ice in a clean cloth and apply it directly to the hemorrhoids. After doing this several times, it will take you a day to contract the blood vessels and effectively shrink the hemorrhoids.
• Pure and natural apple cider vinegar is very beneficial in this condition and is one of the most popular natural treatments for hemorrhoids. For external hemorrhoids, take a cotton swab and soak in apple cider vinegar. Apply it directly to hemorrhoids for immediate relief. Keep in mind that apple cider vinegar applied directly may sting for some time, but it will immediately relieve itching and pain. Alternatively, you can add vinegar to your bath. For internal hemorrhoids, drinking one teaspoon of vinegar with water can relieve pain and bleeding.
• Hard stools can make hemorrhoids worse, causing more bleeding and pain. Indian plantain psyllium is rich in fiber, softens stools and eases bowel movements. Regular consumption can help reduce stress in swollen veins and speed up healing time.
• Soaking in a warm water bath can provide immediate relief from pain and itching. Keep the inflamed area immersed in warm, but not hot, water for 15-20 minutes. Wipe the area with a soft, damp cloth to dry. Regular bath with warm water helps in reducing hemorrhoids effectively.
• Recent studies have shown the benefits of tea tree oil to reduce inflammation and cure hemorrhoids naturally. Because tea tree oil is very strong, it needs to be diluted. Add one or two drops of tea tree oil to Castor oil or sweet almond oil, and the resulting mixture is applied directly to the inflamed area using a clean cotton swab. Using this natural remedy regularly reduces hemorrhoids until they are completely cured. Other essential oils that may have a healing effect are lavender and rosemary essential oil.
• If you have witch hazel at home, it can help reduce pain, itching, and bleeding from hemorrhoids. Apply a small amount of chamomile regularly to the inflamed area for long-term benefits.
• Aloe Vera is an effective natural ingredient that helps relieve hemorrhoids quickly. The anti-inflammatory effect of aloe vera soothes symptoms in a quick and easy way. For internal hemorrhoids, cut the aloe vera into strips, removing the thorns. Apply it to the inflamed area to reduce inflammation. For external hemorrhoids, apply a gel extracted from the plant to soothe and moisturize swollen veins.
• The antioxidants contained in lemons help in treating this disease. Apply lemon juice directly to the inflamed area or consume ginger with honey to reap the benefits of the fruit to reduce pain and inflammation.
• Olive oil is another ingredient that helps in treating the symptoms of hemorrhoids. It has anti-inflammatory properties that soothe the affected area and reduce discomfort. It also increases the elasticity of blood vessels, reducing trauma when passing hard stool. Regular consumption of small amounts of olive oil with food may improve bowel function due to the presence of unsaturated fatty acids in olive oil.
• Known for its soothing properties, almond oil is mainly used to treat external hemorrhoids. Dip a cotton ball in pure almond oil and apply it to the affected area. It moisturizes and soothes inflammation, relieves burning and itching in the area around the anus. Do this several times a day.
• Dryness can make hemorrhoids worse and may lead to excessive bleeding. Never use a dry towel to wipe the affected area as this may cause unwanted scratches which can aggravate the swollen blood vessels. Instead, use a damp cloth to wipe the affected area without rubbing the skin. You can also place vitamin E capsules in the anus to soothe and moisturize the area.
• Some lifestyle changes such as drinking water and maintaining good hygiene will help you get rid of hemorrhoids quickly. Adequate water intake hydrates the entire body, also promotes bowel movements and keeps stool soft, reducing the need to strain during bowel movements. Never delay defecation as this may worsen the condition and delay treatment. Always wear comfortable clothes to reduce inflammation due to hemorrhoids.
• Eat plenty of vegetables and fruits. Since hemorrhoids can be caused by constipation or straining during bowel movements, increasing your fiber intake may improve your condition. Fiber helps soften stools and is important for the health of the gut and digestive system in general. Sources of fiber include vegetables of all kinds, flaxseeds, almonds, walnuts, peanuts, dried prunes, pears and beans.

How to prevent hemorrhoids?

Hemorrhoids are usually not life-threatening, but can cause significant discomfort.

Most cases of hemorrhoids are caused by several different factors. If you prevent these most common causes from occurring, you would be able to prevent the painful and annoying symptoms of hemorrhoids.

Preventing hemorrhoids involves several components:

Diet rich in fiber

Almost all hemorrhoids are caused by constipation or diarrhea, both of which can be treated with a healthy diet that includes enough fiber and water every day. Adding fiber to your diet is one of the best natural ways to prevent hemorrhoids.

High-fiber foods, such as fresh fruits, vegetables and whole grains, protect against hemorrhoids by helping digestion, cleanse the rectal wall and promote painless and easy bowel movements. Every day you need to take about 25-35 g of fiber to maintain the health of the gastrointestinal tract.

Drink enough water

This hemorrhoid prevention strategy is simple, but very few people actually do it. Along with a healthy diet with plenty of fiber, water is the key to normal bowel movements and the absence of hemorrhoidal problems.

Drinking plenty of fluids, especially during meals, helps for good digestion and prevents stool from becoming hard. In addition to water, you can consume other types of healthy liquids, such as fruit and vegetable juices.

A sufficient amount of water intake for an adult is 6-8 glasses of water per day.

Physical activity

Prevention of hemorrhoids also includes regular physical activity and exercise and maintaining a healthy weight.

Physical activity helps improve body functions, including digestive system, allowing you to easily remove waste and prevent intestinal pathologies such as constipation and diarrhea. Exercise also helps reduce weight and reduce the risk of hemorrhoids.

Changing Daily Activities

Certain daily activities can also be a risk factor for this discomfort, so changing them is necessary to prevent hemorrhoids:

• Avoid prolonged sitting and, if possible, take short walks.
• If possible, avoid frequent heavy lifting. If a heavy object still needs to be lifted, always breathe as you lift it and hold your breath.
• During pregnancy, sleeping on one side will reduce pressure on the blood vessels in the pelvic area.
• Stress is also one of the common causes of hemorrhoids, so reducing stress is important in prevention.

Defecation habits

The key to preventing hemorrhoids is maintaining a regular bowel movement schedule. No bowel movement should be delayed if there is an impulse for it. Otherwise, the stool will become hard and dry, and therefore must exert additional pressure to remove the body, resulting in swelling of the veins and tissues of the rectal wall (hemorrhoids).

You should not spend long periods of time on the toilet, as gravity and pushing can cause unwanted pressure on the tissues of the rectum. For this reason, reading while sitting on the toilet should be avoided.

In addition, good hygiene is important - you need to wash the anus. After defecation, the anal area should be gently wiped with damp, soft, unscented toilet paper and then dried. More intensive cleansing and excess moisture around the area should be avoided as this can cause irritation and inflammation of the rectal tissues, leading to hemorrhoids.

Diet

Establishing a consistent structure of eating habits and diet is part of hemorrhoid prevention. Jumping or constant changes in meal times should be avoided as this may lead to poor digestion, which in turn can cause hemorrhoid symptoms.

Taking herbal and nutritional supplements

Taking certain herbal and dietary supplements offers beneficial options for preventing hemorrhoids.

Using fiber as a dietary supplement is an alternative to getting enough fiber for your body. To avoid bloating and flatulence, supplementation is started gradually over several days.

Butcher's broom and wild chestnuts are useful in preventing hemorrhoids, both are used for circulatory problems, although they should not be taken by people with high blood pressure, benign hyperplasia prostate gland, alpha blockers, MAO inhibitors or blood thinners, and in pregnant or breastfeeding women.

Suitable dietary supplements for the prevention of hemorrhoids include bioflavonoids as well as antioxidants. Bioflavonoids are chemical compounds found in fruits such as citrus fruits and blueberries. Antioxidants come from many healthy foods, including green tea and blueberries. Although you can take them in capsule form, it is often better to simply eat foods rich in them.

Grade

• Prevalence

• Risks

• Treatment

Hemorrhoids during pregnancy and after childbirth

• How to treat hemorrhoids during pregnancy and breastfeeding?

Causes of hemorrhoids in women during pregnancy and after childbirth (doctor's review) - video

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Haemorrhoids is a disease in which the veins in the anus and rectum dilate.

Hemorrhoids in numbers and facts:

• Although hemorrhoids can cause a lot of discomfort, they are often easy to treat and prevent.
• The disease occurs 3-4 times more often in men than in women.
• It is believed that hemorrhoids affect approximately 10% of adults worldwide. It accounts for 40% of all diseases of the rectum.
• According to the Mayo Clinic, approximately half of people by the age of 50 begin to experience itching, discomfort, and bleeding in the rectal area. In most cases, these symptoms indicate hemorrhoids.
• Most often, the disease affects people aged 45-65 years.
• Scientists believe that 75% of people in Europe and America will experience hemorrhoids at some point in their lives.
• According to statistics, only 4% of people experiencing hemorrhoid symptoms seek medical help.

Features of the anatomy of the rectum and hemorrhoidal veins

The rectum is the final section of the intestine. In humans, it begins at the level of the upper edge of the third sacral vertebra and ends with the anus. The main function of the rectum is the evacuation of feces.

The outflow of blood from the rectum is carried out through the inferior vena cava system. Venous vessels around the intestine form hemorrhoidal plexus. There are three venous plexuses:

• Subcutaneous. Located under the skin in the anal area.
• Submucosal. Located under the mucous membrane of the rectum, it is divided into lower, middle and upper sections.
• Subfascial. Located between the muscle layer of the intestinal wall and the fascia.

How are external hemorrhoids different from internal hemorrhoids?

Depending on which veins are dilated and where the hemorrhoid is located, there are four types of hemorrhoids:

• Internal hemorrhoids. The veins involved are those located inside the rectum under the mucous membrane. Internal hemorrhoids are usually not painful, but painful bleeding may occur.
• Prolapsed hemorrhoids. The hemorrhoid stretches so much that it falls out of the rectum and ends up outside. Usually if you press on it a little it will go back in.
• External hemorrhoids. The node is located outside the anus, on the skin. Patients are often bothered by pain and itching. The nodes may crack and bleed.
• Combined hemorrhoids. It is a combination of internal and external hemorrhoids. Occurs in approximately 40% of patients.

Why do hemorrhoids occur?

The disease occurs when the veins of the hemorrhoidal plexus become stretched. The following factors may contribute to this:

• Severe straining during bowel movements due to chronic constipation.
• Chronic diarrhea. Also leads to straining during bowel movements.
• Obesity. The more fat tissue accumulates in the body, the more difficult it is for the heart to push blood through it. As a result, blood stagnation begins in the veins of the lower body.
• Pregnancy. In pregnant women, the outflow of venous blood from the pelvic cavity is disrupted due to an enlarged uterus.
• Anal sex. Frequent anal intercourse can lead to irritation of the rectal mucosa and an inflammatory process, which contributes to the development of hemorrhoids.
• Hereditary predisposition. If a person's parents and close relatives suffer from hemorrhoids, the risk also increases slightly.
• Poor nutrition: low protein content in the diet, frequent consumption of alcohol, coffee, spicy foods.
• Sedentary lifestyle. The development of hemorrhoids is facilitated by prolonged standing or sitting, so the risk of the disease is increased in people of certain professions (office workers, surgeons who have to stand for long periods during operations).
• Intense physical activity, which increases pressure in the abdominal cavity and veins.
• Age. As you age, the walls of the veins weaken and stretch more easily.
• Inflammatory processes in the intestines.
• Frequent stress.

Symptoms

Possible symptoms of hemorrhoids:

• Painless bleeding. The patient may notice blood on toilet paper or in the toilet. Sometimes the bleeding is quite heavy. In this case, the blood is not mixed with feces, but covers it.
• Irritation, itching in the anal area. They occur as a result of exposure to the skin of mucus, which is secreted in large quantities by the rectal mucosa.
• Nodes protruding in the anal area.
• Discomfort, pain in the anus.
• Swelling in the anal area.

Symptoms depend on where the hemorrhoid is located. Internal hemorrhoids usually have no symptoms, do not cause pain or discomfort, and cannot be seen or felt. When stool passes, the surface of the hemorrhoid may be damaged and bleeding may occur.

Over time, the internal node begins to fall out of the anus. Loss is often accompanied by pain, discomfort, and irritation.

External hemorrhoids most often look like a lump in the anus. Patients are often bothered by symptoms such as itching, pain, and bleeding.

Stages

There are four stages of hemorrhoids (stages of prolapse of hemorrhoids):

Stage	Description
I	The nodes protrude into the lumen of the rectum, but their prolapse does not occur.
II	During defecation, the hemorrhoids fall out and then retract on their own.
III	The nodes fall out not only during bowel movements, but also with minor physical activity. Self-reduction of the nodes does not occur: you have to set them back by hand.
IV	The fallen knots cannot be set even by hand.

Complications of hemorrhoids

• Bleeding from hemorrhoids. Sometimes bleeding from hemorrhoids is so severe that it leads to anemia. Symptoms such as pallor, weakness, increased fatigue, headaches, and dizziness occur.
• Blood clot formation. Blood clots (thrombi) can form inside the hemorrhoid, causing it to swell, become painful, and become inflamed.
• Incarceration of the hemorrhoidal node. A common complication at stages III-IV of the disease. The muscle sphincter of the rectum pinches the node, as a result, blood circulation in it is disrupted. There is severe pain in the anus, a sensation of a foreign body, and swelling. The color of the dropped node changes: from pink or red it becomes bluish-burgundy, black. Eventually, necrosis of the node may occur due to poor circulation. Sometimes a blood clot in a hemorrhoidal node leads to such consequences.
• Eczema. Sometimes this skin disease occurs as a result of constant irritation of the skin by mucus from the rectum.
• Inflammation of hemorrhoids. Quite a common complication. Infection can penetrate through damaged hemorrhoids.

What does hemorrhoids look like?

Which doctor diagnoses and treats hemorrhoids?

Diagnosis and treatment of hemorrhoids is carried out by:

• proctologists– specialists in diseases of the rectum;
• coloproctologists– specialists in diseases of the colon and rectum.

In what cases should you consult a doctor?

Often the first symptom of hemorrhoids that a patient notices is bleeding from the rectum. Many people do not go to the doctor, they think that nothing serious is happening, they are treated traditional methods or on the advice of family and friends.

If you experience symptoms of hemorrhoids, you should always see a doctor. In most cases, bleeding during bowel movements is actually due to hemorrhoids. But the reasons can be much more serious, even rectal cancer. In this case early diagnosis may help save a person's life.

If your stool has become very dark, tar-like, or if there are clots or blood in it, you need to go to the hospital to figure out which part of the intestine is bleeding.

If you have been treating hemorrhoids for some time with folk remedies, but the disease does not go away, consult a doctor.

You should call an ambulance if you have severe bleeding, weakness, dizziness, or your general health has deteriorated significantly.

What questions should you ask your doctor?

It’s better to make a list of questions in advance so that you don’t forget anything during the conversation with your doctor. You may want to know the answers to the following questions:

• Why do I have these symptoms? What could possibly be the reason?
• Is there a risk of complications?
• What treatment will you prescribe for me? For what purpose? What effect can most likely be expected?
• If the treatment is ineffective, what are you going to prescribe for me in this case?
• Is surgical treatment indicated in my case? Why shown/not shown?
• What else can I do on my own to cope with the disease?
• I have other health problems - will this affect the treatment of hemorrhoids?

Questions your doctor may ask you

The proctologist may ask you some questions:

• When did your symptoms begin?
• How much inconvenience do they cause you?
• How do you eat? What foods do you consume most often? How much fiber is in your diet?
• Do you often drink coffee and alcohol?
• What usually makes your symptoms worse?
• What usually relieves your symptoms?
• Has anyone in your family had hemorrhoids or rectal cancer?
• Have you noticed other changes in your bowel habits?
• Have you noticed blood on toilet paper or in the toilet?

Patient examination

If hemorrhoids are suspected, the doctor performs a digital examination of the rectum. The procedure is performed as follows:
1. The patient is asked to take off his clothes and take a knee-elbow position on the couch (standing on all fours, leaning on his knees and elbows).
2. The doctor puts on latex gloves and wets forefinger Vaseline.
3. The doctor inserts the index finger into the rectum and feels it from the inside. At the same time, he can detect hemorrhoids and other pathological formations.

Diagnosis of hemorrhoids

Study title	Description	How is it carried out?
Anoscopy	During the procedure, the doctor examines the patient's rectum using a special instrument - anoscope, - which is inserted to a depth of 12 cm. Indications for anoscopy: stool disorders; discharge of pus, mucus, blood from the anus; hemorrhoids that cannot be palpated during digital examination of the rectum; suspected rectal cancer; condylomas, polyps and other formations; inflammation of the rectum.	An anoscope is a small rod or cone with a handle, hollow inside, with a plug. Anoscopes come in reusable metal and disposable plastic. The doctor lubricates the anoscope with Vaseline and inserts it into the patient’s rectum, examining its internal surface. The study makes it possible to detect not only hemorrhoids, but also other pathological processes in the gut.
Sigmoidoscopy	A procedure during which a doctor, using a special instrument, - sigmoidoscope, - examines the mucous membrane of the rectum and partially the sigmoid colon. Inspection is possible to a depth of approximately 25-30 cm. A sigmoidoscope is a metal tube containing a light source and a device for pumping air.	The patient is asked to lie on the couch on his left side and pull his legs towards his stomach. The procedure is virtually painless, so in adults it can be performed without anesthesia. In children, general anesthesia is most often used. The doctor lubricates the sigmoidoscope and inserts it into the patient’s rectum. During insertion of the instrument, the patient is asked to take a deep breath. The doctor gradually moves the sigmoidoscope deeper, pumping air into the rectum using a bulb. This helps to stretch the intestines and allow them to be examined better. If pain occurs or the instrument begins to move with great difficulty, the study is stopped.
Colonoscopy	A type of endoscopic examination during which a colonoscope– a tool that is a flexible hose with a light source and a miniature video camera. During a colonoscopy, the doctor can examine the patient's entire colon (approximately 150 cm). Colonoscopy for hemorrhoids may be prescribed in the following cases:: suspicion of diseases of the large intestine; the patient has risk factors for colon cancer; The patient's age is more than 50 years, if he has not undergone this study for a long time.	During the procedure, the doctor inserts a colonoscope into the patient's intestines through the anus. The procedure is painless, but may be accompanied by discomfort. Some clinics offer to undergo a study in a state of medicated sleep. A person is given a drug that induces deep sleep. Its effect lasts for about an hour. This time is enough to perform a colonoscopy. The patient can usually leave the hospital and go home the same day.
Biopsy	A biopsy is a test during which the doctor obtains a fragment of the intestinal mucosa and sends it to the laboratory for examination. This is necessary when cancer is suspected.	A fragment of the mucous membrane for biopsy can be taken during an endoscopic examination.

Treatment

If hemorrhoids are small and cause only minor discomfort to the patient, the doctor usually prescribes conservative treatment in the form of ointments, creams, and suppositories.

Suppositories for hemorrhoids

Suppositories for hemorrhoids may contain medicinal substances that have a vasoconstrictor effect, help cope with inflammation, swelling, pain and itching, improve the healing of the mucous membrane and prevent infection.

The doctor may prescribe you Relief, Anuzol, Proctosedyl suppositories, etc. To improve tissue regeneration, rectal suppositories with methyluracil are used. Typically, suppositories are recommended for use in the morning, evening and after each bowel movement. The duration of the course of treatment is determined by the attending physician.

Before using rectal suppositories, you need to perform thorough hygiene of the anal area.

Ointment

Many ointments for hemorrhoids have the same healing effects as suppositories. The doctor may prescribe ointments whose main active ingredient is heparin (Heparin ointment, Hepatrombin G) - a substance that prevents the formation of blood clots.

Ointments are applied to the skin in the area of ​​hemorrhoids. Sometimes ointments are produced in special tubes with screw caps - such a cap must be inserted into the rectum and a small amount of ointment squeezed out, like an enema. The kit may include a special applicator for convenient application of the drug. The frequency of use and duration of treatment is determined by the attending physician.

Pills

Tablets and capsules for hemorrhoids, such as Venoruton, Vasoket, Detralex, Venarus, Phlebodia 600, strengthen and tone the vein walls and improve microcirculation. Your doctor may also recommend that you use biologically active additives to improve intestinal function and normalize stool, such as Proctonis.

Laxatives for hemorrhoids

Laxatives are available in the form of tablets, granules for dissolution in water, drops for oral administration, and microenemas. They help relieve constipation, which worsens the symptoms of hemorrhoids.

You should not use laxatives frequently or for a long time, especially without medical supervision. A “ricochet effect” may occur - over time, constipation worsens, and the person can no longer go to the toilet on his own, without medication. In addition, frequent unnecessary use of laxatives leads to electrolyte imbalance.

Operations for hemorrhoids

Minimally invasive interventions

Minimally invasive procedures are often used when hemorrhoids are accompanied by pain and constant bleeding. They can be performed on an outpatient basis. The following treatment methods are used:


Surgical interventions

The doctor may prescribe surgery if the hemorrhoids are large or other treatment methods have not helped. Sometimes surgical treatment can be performed on an outpatient basis, in other cases hospitalization in a hospital is necessary.

Types of operations for hemorrhoids:

Hemorrhoids: risk groups, how the disease develops, symptoms, treatment methods - video

Hemorrhoids: symptoms and complications, causes and mechanism of development, what diseases can lead to hemorrhoids, methods of diagnosis and treatment, opinion of a coloproctologist - video

Surgical treatment of hemorrhoids using the Longo method - video of the operation

How to deal with hemorrhoids at home?

There are some things you can do on your own to help relieve the symptoms of hemorrhoids. However, it is worth remembering that they will not help get rid of the disease:

• Warm baths are good for hemorrhoids. You can take a bath or just sit in a bowl of water. You need to place the anus area in warm water for 10-15 minutes 2-3 times a day.
• Careful hygiene of the anal area. You need to take a bath or shower every day and thoroughly wash the anal area.
• Do not use soap or other products that may cause irritation in the anal area. Avoid using scented wipes that contain alcohol.
• Don't use regular toilet paper. It is better to use wet wipes, but without alcohol.
• Use cold. To relieve swelling in the anal area, you can use cold heating pads, ice packs, or a cloth soaked in cold water.

Diet for hemorrhoids

The diet for hemorrhoids has two goals: to prevent constipation and irritation in the rectal area. Basic recommendations:

• Drink enough fluids. This will help make the stool softer and make it easier to pass through the intestines.
• Your diet should include more vegetables, fruits, and grains. They contain vegetable fiber which helps prevent constipation.
• Alcohol, coffee, and strong tea should be avoided.
• Limit spicy foods and spices.
• It is better to take food in small portions, 4-5 times a day.
• Eat around the same time every day.
• Physical activity also helps normalize bowel function.

Is it necessary to do enemas for hemorrhoids?

For hemorrhoids, 4 types of enemas are used:

• Cleansing. Used for constipation. Water at room temperature is injected into the rectum, which helps get rid of feces. Cleansing enemas are also used during preparation for diagnostic procedures, for example, colonoscopy.
• Oily. Helps make stool easier to pass. 100 ml of sunflower, olive or vaseline oil at a temperature of 37 o C is injected into the rectum.
• Medicinal. A solution of a medicinal substance is injected into the rectum, which helps eliminate inflammation and bleeding. Traditional medicine is often used as therapeutic enemas: infusion of chestnut, wormwood, chamomile, oak bark.
• Hypertensive. A concentrated salt solution, for example, 10% sodium chloride or 30% magnesia, is injected into the rectum. Due to this, fluid enters the intestinal lumen, which dilutes the stool and facilitates its passage.

Before using any type of enemas, you should definitely consult your doctor.

Traditional methods of treatment

Herbal remedies for hemorrhoids and other traditional medicines can help relieve the symptoms of the disease and improve the condition, but they will not eliminate the cause. Before using them, you should consult your doctor. All information below is provided for informational purposes only.

Sea buckthorn oil for hemorrhoids

Medicinal effects sea ​​buckthorn oil for hemorrhoids:

• Strengthening the vascular wall with vitamin C.
• Reducing the inflammatory process and fighting infection due to organic acids and tannins.
• Reducing swelling.
• Acceleration of healing of the mucous membrane.

For hemorrhoids, sea buckthorn oil and suppositories are used. They can be bought in pharmacies. Soak a piece of gauze in oil and apply a bandage to the area of ​​external hemorrhoids overnight.

Propolis for hemorrhoids

Medicinal effects of propolis for hemorrhoids:

• Prevents infection by containing naturally occurring antibiotics.
• Thinning the blood, preventing its stagnation in hemorrhoids and the formation of clots.
• Reducing swelling in the anal area.
• Improving healing of the skin, mucous membrane, preventing bleeding.
• Fights itching and pain due to its drying and cauterizing action.

Folk recipe for making ointment with propolis:

• Take 100 grams of butter (not salted) or animal fat. Place in a saucepan.
• Put on fire, bring to a boil.
• Add 10 grams of purified propolis.
• To stir thoroughly. Leave for 30 minutes until completely cooled.

Mode of application: Apply to hemorrhoids in the morning and evening, as well as after each bowel movement, 2-3 times a day.

Potatoes for hemorrhoids

Folk recipes for using potatoes for hemorrhoids were common among Russian peasants of past centuries. Medicinal effects of raw potatoes for hemorrhoids:

• Reducing pain, itching, irritation.
• Improved healing of the mucous membrane.
• Reducing swelling and inflammation.
• Strengthening the vascular wall with vitamin C.

Ways to use raw potatoes for hemorrhoids:

• Wash the potatoes thoroughly so that there is no dirt left on them, grate them on a fine grater. Squeeze the juice out of the resulting pulp and do microenemas of 30 ml at night for 10 days.
• Make dressings with grated raw potatoes at night.

Chamomile for hemorrhoids

Medicinal effects of chamomile for hemorrhoids:

• Reducing inflammation.
• Reducing pain.
• Antiseptic effect – preventing infection.

Chamomile decoction is used for hemorrhoids. Preparation:

• Pour one glass of boiling water over two tablespoons of dried flowers.
• Place in a water bath for 20 minutes.
• Cool, strain.

Use of chamomile decoction for hemorrhoids:

• For hygiene of the anal area.
• In the form of lotions for the night.
• In the form of sitz baths - in this case you will have to prepare more decoction. It should be warm, but not hot. The baths are done for 10-15 minutes, the total duration of the course is 8-10 days.
• Microclysters at night for 8-10 days, 40-50 ml of decoction.

Chinese patches for hemorrhoids

Nowadays you can often see them for sale on the Internet. Chinese plasters and musky ointment for hemorrhoids. Do they help cope with the disease?

Chinese patches most often contain medicinal plants. Thus, they are a means of traditional medicine. They may relieve the symptoms of hemorrhoids in the early stages, but there is no reliable data on their effectiveness.

Musk is widely used in Eastern folk medicine. Its effectiveness has not been proven. In Western countries, this substance is mainly used in perfumery.

Traditional method of treating hemorrhoids - video

Exercise for hemorrhoids

Exercise can make hemorrhoid symptoms worse, especially if it involves heavy lifting. Most often, the deterioration is temporary. If exercise doesn't make you feel worse or worsen your symptoms, there's no point in giving it up.

Prevention of disease

In most cases, preventing hemorrhoids comes down to preventing constipation:

• Eat more fiber-rich foods: vegetables, fruits, whole grains. This will help make the stool softer and increase its volume, improving passage.
• Use dietary supplements containing plant fiber. Consult your doctor first.
• Drink more. 6-8 glasses of liquid daily will help soften stools and improve their passage. But it is better to avoid alcoholic drinks completely.
• Don't be patient if you need to go to the toilet. The longer you wait, the harder the stool becomes.
• Be physically active. Regular exercise helps improve bowel function.
• Don't sit for too long. If you have a sedentary job, take periodic breaks, get up, and walk around.

Hemorrhoids during pregnancy and after childbirth

Among women haemorrhoids most often occurs during pregnancy, after childbirth . Causes:

• The enlarged uterus compresses the veins, disrupting the outflow of blood from the rectum.
• During pregnancy, women often experience constipation. This makes you push harder and longer on the toilet, and blood pressure in the hemorrhoidal plexus increases.

How to treat hemorrhoids during pregnancy and breastfeeding?

During pregnancy and breastfeeding, not all medications for the treatment of hemorrhoids can be used. You need to see a doctor to prescribe treatment. In addition, you must follow the recommendations described in the paragraph “How to deal with hemorrhoids at home?”.

Causes of hemorrhoids in women during pregnancy and after childbirth (doctor's review) - video

Is it possible to have sex with hemorrhoids?

Having sex with hemorrhoids is not contraindicated. But you need to remember some rules:

• You shouldn't have anal sex. It can lead to damage to the intestinal mucosa and increased symptoms of hemorrhoids.
• In bed, you need to choose positions in which you do not experience increased tension.
• Don't have sex for too long, remember moderation.

What is the ICD code for hemorrhoids?

The general code used in ICD-10 to designate all types of hemorrhoids is I84. Codes for individual forms of the disease:

• I84.0 – internal hemorrhoids with thrombosis;
• I84.1 – strangulated, bleeding, ulcerated, prolapsing internal hemorrhoids;
• I84.2 – uncomplicated internal hemorrhoids;
• I84.3 – external hemorrhoids with thrombosis;
• I84.4 – strangulated, bleeding, ulcerated, prolapsing external hemorrhoids;
• I84.5 - uncomplicated external hemorrhoids;
• I84.6 – residual hemorrhoidal marks on the skin;
• I84.7 – unspecified hemorrhoids on the skin;
• I84.8 – strangulated, bleeding, ulcerated, prolapsing unspecified hemorrhoids;
• I84.9 – uncomplicated unspecified hemorrhoids.

Do hemorrhoids increase the risk of cancer?

No, hemorrhoids do not lead to cancer. But the symptoms of these diseases are often very similar. Therefore, in any case, it is worth visiting a doctor and getting examined.
Before use, you should consult a specialist.

According to official data, up to 10-15% of the adult population suffer from hemorrhoids. According to statistics, men get sick more often, but women seek medical help more often, apparently due to a more attentive attitude to their health.

In addition to unpleasant and humiliating sensations, this disease is dangerous due to numerous complications in the form of iron deficiency, thrombosis, strangulation of hemorrhoids, etc.

Reasons for the development of hemorrhoids

Hemorrhoids are an interesting disease in their own way, which appeared in people as payback for walking upright. No cat, dog or horse will face such a problem. Gravity acts evenly on the entire body of these animals, so blood will not stagnate in the hind legs and final sections of the intestines. But in an upright person, the same gravity increases the load on the corresponding vessels.

Depending on your profession and lifestyle, the risk of developing this disease varies greatly. It is not for nothing that hemorrhoids are considered an occupational disease of people with sedentary or standing work - drivers, programmers, accountants, teachers.

The development of hemorrhoids is promoted by prolonged periods, as well as pregnancy and childbirth, i.e. conditions in which there is a strong increase in intra-abdominal pressure.

Symptoms of hemorrhoids

• discharge of blood from the rectum after defecation;
• streaks of blood in the stool;
• prolapse of hemorrhoids from the anal canal;
• pain and irritation in the anal area.

Diagnosis of hemorrhoids

A proctologist diagnoses and treats hemorrhoids. Depending on the complaints and clinical picture, the patient undergoes the following studies.

1. Digital examination is performed on all patients and is the main method for diagnosing hemorrhoids and other proctological diseases.
2. Sigmoidoscopy is the most common, accurate and reliable method for examining the rectum and lower section sigmoid colon. It is performed using a sigmoidoscope.
3. Anoscopy is an examination of the anal canal and lower rectum using an anoscope (rectal mirror).
4. Colonoscopy is an endoscopic examination of the colon.
5. Irrigoscopy of the colon.
6. Coprogram - analysis of stool for qualitative composition, i.e. for foreign inclusions, remnants of undigested food and mucus.
7. Fecal occult blood test.
8. A blood test is performed to determine the presence or absence of anemia (a decrease in the level of hemoglobin in the blood with hemorrhoids is due to chronic).

What can you do

If you notice symptoms of hemorrhoids, try to consult a proctologist as soon as possible. Do not put off visiting a doctor for a long time, because, despite the seeming harmlessness, hemorrhoids have a number of serious complications.

An important place in the treatment of hemorrhoids is the fight against chronic constipation by following a diet high in fiber (vegetables, fruits, bran, etc.), regular physical exercise and taking various laxatives.

How can a doctor help?

To reduce pain and inflammation in the rectum, rectal suppositories, various gels and ointments are used. However, the main method of treatment remains surgical. Depending on the severity and intensity of bleeding, various surgical correction methods can be used.

Complications of hemorrhoids

Most dangerous complication hemorrhoids is acute thrombosis of hemorrhoidal veins with the development of inflammation. This disease is characterized by a sharp increase in pain, it becomes permanent, and not only defecation, but also walking becomes difficult. Such patients require urgent hospitalization.