HEMORRHOIDS - Symptoms and treatment
Hemorrhoids are dilated and inflamed veins in the anus and rectum, which can cause pain, itching and anal bleeding
Hemorrhoids (piles) are dilated and inflamed veins in the anus and rectum, which can cause pain, itching and anal bleeding. In this text we will address the causes, symptoms and treatment of hemorrhoids.
What are hemorrhoids?
The terminal part of the digestive tract is composed of the rectum, the anal canal and the anus itself. As in any other part of our body, this region is vascularized by arteries and veins that are called hemorrhoidal arteries and veins.
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Most of our veins contain valves that help the blood to always follow in the same direction, preventing its return even when it is against the natural course of gravity. For example, the blood in the veins of the leg always runs against gravity; Thanks to the valves, it manages to climb without being stopped in the legs. When the veins get sick and their valves stop working, varicose veins appear, tortuous veins in which the blood becomes congested.
Unlike the veins of the rest of the body, the hemorrhoidal veins do not have valves to prevent stagnation of blood. Therefore, any increase in pressure in these veins leads to congestion. Hemorrhoids are like varices of hemorrhoidal veins. As in any varicose vein, the arrested blood increases the risk of thrombosis and inflammation of the veins.
Therefore, hemorrhoids are dilations of the veins of the rectum and anus, which can be accompanied by inflammation, thrombosis and bleeding.
Hemorrhoids are classified into:
- - Internal hemorrhoids : when they occur in the rectum.
- - External hemorrhoids : when they occur in the anus or at the end of the anal canal.
External and internal hemorrhoids
Internal hemorrhoids are classified into four grades:
- Hemorrhoids grade I: do not prolapse through the anus.
- Hemorrhoids grade II: prolapsed through the anus during the evacuation, but do not return to their original position spontaneously.
- Hemorrhoids grade III: prolapsan through the anus and its reduction is only achieved manually.
- Hemorrhoids grade IV: they are prolapsed through the anus and its reduction is not possible.
Internal grade I hemorrhoids are not visible and grade II hemorrhoids usually go unnoticed by patients, since no one can see the anus when defecating. As the rectum and anal canal have little enervation, this type of hemorrhoids usually does not cause pain.
External hemorrhoids are easily identified and often become inflamed causing pain and / or itching (itching).
Causes of hemorrhoids
Hemorrhoids are a very common disorder. It is estimated that more than half of the population over 50 years of age suffers from hemorrhoids in varying degrees.
The main risk factors are:
- Intestinal constipation (constipation)
- Effort to evacuate.
- Obesity.
- Chronic diarrhea.
- Hold stools often, avoiding defecation whenever there is desire.
- Diet poor in fibers.
- Pregnancy.
- Anal sex
- Family history of hemorrhoids.
- Smoking
- Cirrhosis and portal hypertension.
- To remain long periods seated in the toilet (there are those who think that the own design of the toilet propitiates the formation of hemorrhoids).
The habit of stooping crouching, very common in the Middle East and Asia, is associated with a lower incidence of hemorrhoids. Apparently, sitting down, as most of us usually do, can increase the incidence of hemorrhoids.
Regardless of the risk factors, hemorrhoids are formed when there is an increase in pressure in the hemorrhoidal veins or weakness in the tissues of the wall of the anus, responsible for supporting them.
Symptoms of hemorrhoids
Hemorrhoids can be symptomatic or not. As previously mentioned, inmates tend to be less symptomatic. The only indicative sign of its existence may be the presence of blood around the stool when evacuating.
Bleeding from hemorrhoids typically occurs as a small amount of living blood that remains around the stool. Sometimes, the patient may notice droplets of blood in the toilet after the evacuation is completed. It is common to have blood on the toilet paper after cleaning.
Internal hemorrhoids can cause pain if a thrombosis occurs or when the chronic effort to evacuate causes the prolapse of the hemorrhoid outward into the anal canal. Internal hemorrhoids grade III and IV may be associated with fecal incontinence and the presence of a mucous shift, which causes irritation and anal itching.
External hemorrhoids are usually symptomatic. They are associated with bleeding and pain when evacuating and when sitting. In cases of thrombosis of the hemorrhoid, the pain can be intense. Pruritus is another common symptom. External hemorrhoids are always visible and palpable.
Despite being a common cause of rectal bleeding, it is important not to assume that bleeding is due to hemorrhoids without first consulting a doctor. Several diseases, such as anal fissure, rectal cancer, diverticular disease and infections can also manifest with blood in the stool. In addition, nothing prevents the patient from having hemorrhoids and another disease that is also accompanied by anal bleeding, such as cancer, for example. Therefore, all anal bleeding should be evaluated by a doctor, preferably a proctologist.
Bleeding from hemorrhoids is usually mild, but, if frequent, can lead to anemia.
To see images of hemorrhoids, visit the following link: IMAGES OF HEMORRHOIDS .
Can hemorrhoids become cancer?
DO NOT. HEMORRHOIDS DO NOT BECOME CANCER. However, the symptoms can be similar to intestinal tumors, mainly in cancers of the rectum and anus. Therefore, it is important to establish the differential diagnosis, especially in people older than 50 years. Reinforcing the recommendation: all anal bleeding should be evaluated by a doctor.
Diagnosis of hemorrhoids
In external hemorrhoids, the physical examination is sufficient for the diagnosis. In the internal ones, it is necessary to perform the digital rectal examination and, in case of doubt, the anoscopy (a mini endoscopy where the rectum is visualized by video).
In long-term patients with bleeding from the rectum, although the presence of hemorrhoids has been identified, it is convenient to perform a colonoscopy to rule out other causes. Since hemorrhoids are very common at these ages, nothing prevents the patient from having a second cause for bleeding, such as a bowel cancer or a diverticulum.
Treatment of hemorrhoids
During crises, sitz baths with warm water can provide relief against acute symptoms. In pregnant women we suggest warm moist compresses. You should also avoid cleaning the anus with toilet paper, giving preference to the bidet or jets of warm water.
People with intestinal constipation (constipation) are prescribed laxatives to decrease the need to exercise strength when evacuating.
Ointments and creams can be used against hemorrhoids, since they serve as a lubricant for the passage of stool and, generally, they contain anesthetics in their formula. The relief is only temporary and these creams should not be used indefinitely without medical guidance. Suppositories with corticosteroids are another option when there is a lot of pain or itching, however it is a treatment that should not be used for more than a week due to possible side effects.
A diet rich in fiber decreases the incidence of bleeding and can also relieve itching.
Although avoiding spicy foods is a famous recommendation, there is no evidence that spicy worsens symptoms. This must be evaluated individually.
In small hemorrhoids with thrombi, treatment can be done in a doctor's office with a small incision, under local anesthesia, to remove clots. This is enough for the relief of symptoms.
In more severe cases, elastic ligature may be necessary. A gum is inserted into the base of the hemorrhoids, causing strangulation and necrosis of the hemorrhoids. After a few days, the hemorrhoid "falls", and exits itself by the anus next to the elastic. It is a technique that can be applied in the proctologist's own office. It is usually painless and often anesthesia is not even used.
Another option is sclerotherapy. It consists in the injection of a chemical solution that causes the necrosis of the hemorrhoids. A third option is laser coagulation. Of the three techniques, the elastic ligature is the one with the best results.
If the minimally invasive techniques have no effect, or if the hemorrhoid is very large, the treatment should be performed with traditional surgery, called hemorrhoidectomy.
A new treatment option for hemorrhoids is Doppler-guided transanal hemorrhoidal dearterialization (THD), a technique created in 1995 and perfected over the last few years. The technique involves inserting a small Doppler (ultrasound) device into the anus to identify the hemorrhoidal arteries; Through a small needle, these arteries are saturated so that they reduce the blood flow that reaches the regions where hemorrhoids exist. When less blood comes, the pressure inside the hemorrhoids decreases, so that they "dry up".
The THD technique has no cuts and the risk of bleeding is very low. The postoperative period is less painful than in the techniques with cuts, and there is a low rate of reoccurrence of hemorrhoids. The recovery time is shorter and the patient returns to normal activities in 48 hours. The procedure is carried out with local anesthesia and mild sedation.
THD is a relatively new method and there are still no studies comparing its long-term efficacy with older techniques, however, the trend is that it becomes the method of choice in the treatment of hemorrhoids.
