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Hemorrhoids: types, stages, treatment

December 25, 2021

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.

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.

Middle-aged man with hemorrhoids

Heredity.
Hemorrhoid symptoms
Discomfort or pain in the anus.
Sensation of a foreign body in the anal canal.
Discharge of blood during bowel movements, admixture of blood in the feces.
Anal nodes.
Disease classification
Acute hemorrhoids are hemorrhoids thrombosis. External manifestation is a dense, painful external or internal bluish knot 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 involve 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 classified 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.

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.

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 escape 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
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.
A finger examination helps to determine the tone of the sphincter, the presence of neoplasms, mucosal defects and the degree of their pain.
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.
Sigmoidoscopy – examination of the rectum and distal part of the sigmoid colon up to 25 cm using a special endoscopic device that allows you to assess 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.