Hemorrhoids: types, stages, treatment

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Hemorrhoids are a pathological expansion of the cavernous (that is, cavernous or spongy in structure) vascular plexuses located in the anus, with the formation of external and / or internal nodes. Many of us are facing issues with hemorrhoids or hemorrhoids skin tags. In this article, we will discuss how to treat hemorrhoids skin tags.

The causes of hemorrhoids

  • Lifestyle associated with prolonged static stress: hemorrhoids are a “occupational” disease of drivers, office workers, security guards, etc.
  • Excessive physical activity, lifting weights, sharp tension.
  • Excessive consumption of alcohol, spicy and pickled foods.
  • Constipation, straining with difficult bowel movements (bowel movement).
  • Pregnancy and childbirth.
  • Heredity.

Hemorrhoid symptoms

  • Discomfort or pain in the anus.
  • Sensation of a foreign body in the anal canal.
  • Discharge of blood during bowel movements, blood in the feces.
  • Anal nodes.

Disease classification

Acute hemorrhoids are hemorrhoids thrombosed. External manifestation is a dense, painful external or internal cyanotic node, filled with a blood clot.

Acute hemorrhoids are classified into three degrees of severity:

I degree – Thrombosis of external or internal hemorrhoids without inflammation.

II degree – Thrombosis, complicated by inflammation of the hemorrhoids.

III degree – Thrombosis of hemorrhoids, complicated by inflammation of the subcutaneous tissue in the perianal region.

Therapeutic tactics involves both complex conservative treatment and surgical treatment .

The indication for surgical treatment is acute thrombosis of the hemorrhoid. In the early stages of the disease, optimally up to 72 hours, thrombectomy is indicated – removal of thrombotic masses. It is performed on an outpatient basis. The operation leads to a significant reduction in the duration of treatment.

At later stages, it is possible to either remove the thrombosed node, or conservative treatment followed by elective surgery. Hospitalization is indicated for the III degree of the disease, when the inflammatory process spreads to the surrounding tissues of the perianal region and the anal canal.

Stages of development of the disease

Chronic hemorrhoids are divided into four stages.

 Typical symptoms:

Stage I – Recurrent bleeding from the rectum without prolapse of hemorrhoids. The method of treatment is conservative therapy.

Stage II – Hemorrhoids fall out during bowel movements, but they adjust on their own. Bleeding may or may not be present. Also, the loss of nodes is possible with intense physical activity.

At the second stage, conservative treatment and minimally invasive proctological manipulations are combined, which specialists of the XXI Century Medical Center carry out in an outpatient clinic.

Stage III – Manual assistance is required to reposition the nodes in the anal canal. Bleeding becomes more profuse, there is a periodic inflammation of the hemorrhoids.

Treatment is prompt. Operations are performed by surgeons-proctologists at the Outpatient Surgery Center of the XXI Century Medical Center.

Stage IV – Hemorrhoids are constantly in a prolapsed state. This is the most difficult stage. Loss occurs even with the slightest exertion: a change in body position, cough, gas release from the intestines. The walls of the node are constantly injured and inflamed.

Only surgical treatment is indicated.

IV – Hemorrhoids are constantly in a prolapsed state. This is the most difficult stage. Loss occurs even with the slightest exertion: a change in body position, cough, gas release from the intestines. The walls of the node are constantly injured and inflamed.

Only surgical treatment is indicated.

Hemorrhoid treatment

Methods for the diagnosis of proctological diseases

  1. During an external examination, the doctor pays attention to the shape of the anus, its gaping, cicatricial changes or deformities, fistulous openings, the condition of the skin and mucous membrane of the anal canal when the folds are straightened. It determines the severity of external hemorrhoids, the stage of the disease, the degree of bleeding and prolapse of the nodes, the possibility of their independent reduction into the anal canal, assesses the anal reflex.
  2. A finger examination helps to determine the tone of the sphincter, the presence of neoplasms, mucosal defects and the degree of their pain.
  3. Anoscopy – performed using a special disposable anoscope device, which allows you to examine the inner surface of the rectum and anal canal up to 10 cm. The procedure is painless, preparation is not required. With the help of anoscopy, the proctologist can assess the state of internal hemorrhoids, the presence of inflammatory changes in the mucous membrane, detect anal canal polyps, mucosal defects, blood clots and possible sources of bleeding.
  4. Sigmoidoscopy – examination of the rectum and the distal part of the sigmoid colon up to 25 cm using a special endoscopic device, which allows assessing the state of these parts from the side of the internal lumen of the intestine.

Thanks to a complex of diagnostic studies, a specialist can identify not only hemorrhoids, but also concomitant diseases.

Conservative treatment of hemorrhoids

The therapy is based on a specialized diet aimed at normalizing the stool. The patient’s diet should include food rich in plant fiber and a large amount of liquid. Also, the doctor prescribes medicines that stimulate bowel movements.

To relieve inflammation, ointments, creams and suppositories with an anti-inflammatory combined effect are used. The therapy is complemented by the intake of phlebotonics – drugs that increase the tone of the vascular wall.

With severe bleeding, agents of local and general hemostatic (hemostatic) action are prescribed.

For the conservative treatment of hemorrhoidal thrombosis, combined local agents with anesthetic, anti-inflammatory, absorbable, decongestant effect are used.

Minimally invasive methods of surgical treatment of hemorrhoids

  • Sclerotherapy of hemorrhoids

Indications for surgery are chronic hemorrhoids of stages I – II, accompanied by bleeding.

A special substance, a sclerosant, is injected into the lumen of the hemorrhoid using the thinnest injection needles. This drug glues the walls of the vessels inside the node, preventing further progression of the pathology. The operation is performed in an outpatient clinic.

Contraindications:

– Hemorrhoidal thrombosis
– Paraproctitis
– Anal fissure

  • Ligation of internal hemorrhoids

It is indicated for chronic hemorrhoids II and III degrees, if the nodes are located separately from each other and have clearly defined boundaries.

The operation is performed in an outpatient clinic. A latex ring (ligature) is applied to the base of the inner knot, the power of the knot is disrupted and it is rejected along with the ligature after 7-10 days. Ligation of several nodes at once can cause pain in the patient, a decrease in blood pressure and bradycardia, so the procedure is usually performed at 2-3 week intervals.

Surgical methods of treatment carried out in the Medical Center “XXI century”

  • Laser vaporization of hemorrhoids

It is carried out for chronic hemorrhoids II and III stages. Also suitable for the treatment of small external hemorrhoids. The operation is performed using the Milon-Lakhta surgical laser, which destroys (evaporates) the fluid-rich hemorrhoidal tissue while preserving the mucous membrane. The light guide is inserted into the lumen of the internal hemorrhoid through a small 1-2 mm puncture of the anoderm. The manipulations are performed under general anesthesia in the Outpatient Surgery Center of our clinic.

The advantages of the technique:

– Reducing the time of the operation.
– A significant decrease in the intensity of pain in the postoperative period compared to classical hemorrhoidectomy.
– Significant reduction in the healing time of surgical wounds and punctures.
– More comfortable postoperative period and quick recovery of working capacity.

Contraindications:

– Hemorrhoids IV stage
– Purulent and oncological diseases of the rectum

Postoperative treatment of hemorrhoids takes place on an outpatient basis. The proctologist surgeon monitors, makes dressings, gives nutritional recommendations and prescribes medications for the recovery period.

Experienced proctologists at the XXI Century Medical Center will be happy to help you solve your problems.