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

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

Why does hemorrhoids develop?

The rectum is abundantly supplied with blood; it is here that the arteriovenous plexuses are located - external and internal hemorrhoids. For various reasons, blood stagnation occurs in the area of ​​the hemorrhoidal plexus - in the anal canal and lower part of the rectum. The walls of the veins stretch, bulge in certain places, and a hemorrhoidal node is formed. It is believed that in the occurrence of internal hemorrhoids, a significant role is played by dystrophic processes in the connective tissue structures of the submucosal layer of the rectum and in the ligament, which to a certain extent holds the internal nodes inside the rectum, and when weakened, contributes to the prolapse of the nodes from the anal canal.

Provoking factors for hemorrhoids:

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

Symptoms of hemorrhoids

• Painful lumps in the form of lumps in the anus with external;
• Prolapse of hemorrhoids during bowel movements (with internal hemorrhoids), as well as in later stages - even when lifting heavy objects, coughing, sneezing;
• Bleeding that occurs during bowel movements (admixture of scarlet blood in the stool, discharge of blood in the form of drops or a thin stream);
• Pain in the anus, usually associated with node thrombosis;

Discomfort in the anus, heaviness associated with a feeling of incomplete bowel movement. The feeling of discomfort directly depends on the size of the hemorrhoids

• Bleeding develops when the mucous membrane of the node is injured, which is overstretched at the site of formation of the node and is easily vulnerable when passing dense stool. Diarrhea (diarrhea) can also provoke hemorrhoidal bleeding, irritating and damaging the mucous membrane in the area of ​​the hemorrhoid.

External and internal hemorrhoids

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

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

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

Hemorrhoids: clinical picture

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

Thrombosed hemorrhoids cause severe pain, aggravated by movement, coughing, and sneezing. The node itself is bluish in color, swollen, tense and sharply painful. Subsequently, inflammation may be associated with thrombosis involving subcutaneous tissue. The acute course of the disease also includes heavy bleeding from internal nodes, which requires urgent hospitalization.

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

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

Bleeds during bowel movements, nodes do not fall out of the rectum

The nodes fall out and subsequently move back into the anal canal on their own. With or without bleeding.

The nodes fall out and manual reduction into the anal canal is required. With or without bleeding.

The nodes constantly fall out and it is impossible to put them back into the anal canal. With or without bleeding.

Diagnosis of hemorrhoids

The diagnosis of external or internal hemorrhoids is made based on the patient’s complaints and the results of examination of the anus and anal canal. Sometimes the doctor may recommend performing a rectoscopy to diagnose concomitant diseases of the rectum and sigmoid colon or a colonoscopy if there is a suspicion that the patient has inflammatory diseases or neoplasms of the colon. Recommendations for colonoscopy for patients who complain of blood in the stool and discomfort in the anus are explained by the wariness of coloproctologists regarding cancer of the rectum and colon.

Treatment of hemorrhoids

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

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

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

Conservative treatment It is recommended at the initial stage, when symptoms of hemorrhoids (enlargement of nodes, bleeding during bowel movements) are disturbing for the first time, or if intensification of symptoms occurs rarely and their duration is short. But even if you have been suffering from hemorrhoids for several years, this does not mean that conservative treatment is not for you. Often, understanding the problem and the necessary correct recommendations on lifestyle, nutrition and preventive medications help to significantly reduce the number of exacerbations and slow down the development of the disease as much as possible. The European conservative treatment regimens that we use are quite effective in some cases.

Minimally invasive methods (outpatient surgery)– a mini-operation performed in a doctor’s office under anesthesia using the latest surgical techniques and instruments, after which the patient is sent home with recommendations for dressings (care of the wound for proper and rapid healing) and an appointment for a follow-up appointment with the doctor.

Surgical treatment– after a preliminary (preoperative) examination, the operation is performed in a hospital operating room, with mandatory anesthesia (pain relief), after which the patient spends one or several days in the ward under the supervision of a doctor. Usually one day is enough.

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

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

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

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

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

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

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

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

The advantages of the method are minor pain and rapid recovery of working capacity. The method has been very popular in the last 10 years, but accumulated data indicate almost 50% recurrence of the disease.

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

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

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

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

If the diagnosis is established based on classical and modern methods of functional diagnostics, remember that consent to surgery (as well as to any other treatment) is your voluntary decision. Do not agree to the proposed treatment if you have even the slightest doubt. To be completely sure, get

) is a very common disease that occurs as a result of enlargement of the anal canal. hemorrhoids. Under unfavorable conditions, blood stagnation occurs in hemorrhoidal tissues, which leads to an increase in the size of hemorrhoids and destruction of the ligaments and muscles that hold the nodes inside the anus.

Hemorrhoids consist of cavernous bodies , and are located in the form of 3 pads in the anus (these are internal nodes) and 3 pads inside the perineum near the anal canal (external nodes).

Highlight interior hemorrhoids, when only the internal hemorrhoids are enlarged, and outer , when the external nodes are enlarged. There is also an increase in both internal and external nodes at the same time, then we can talk about combined hemorrhoids.

In addition, there are two types of hemorrhoids - primary And secondary . Primary occurs due to an increase in intra-abdominal pressure, with heavy physical labor, sedentary work, frequent abuse of spicy, smoked foods. Secondary appears as a consequence of other diseases, for example, with cirrhosis of the liver, tumors leading to disruption of the venous outflow of blood from the pelvis and rectum. Also distinguished chronic And spicy haemorrhoids. The acute form is most often a complication chronic hemorrhoids. More than 10% of the adult population of the planet suffers from hemorrhoids.

Causes of hemorrhoids

Most experts agree that the main cause of hemorrhoids is dysfunction of the vessels of the lower rectum, which leads to an increase in blood flow and stagnation in the rectum, as a result of which the hemorrhoids increase in size. Another factor in the occurrence of hemorrhoids is the so-called mechanical factor . Under the influence of unfavorable factors and enlarged hemorrhoids, gradual destruction occurs ligamentous-muscular apparatus , which holds the nodes in the anus. Thus, as a result of an increase in hemorrhoids, as well as dystrophic changes in the ligaments and muscles that hold them inside, they begin to shift to the edge of the anal canal and fall out of the anus.

However, this is only one of the possible factors; in addition, the following causes of hemorrhoids are noted:

• hereditary predisposition to hemorrhoids;
• frequent constipation;
• sitting on the toilet for a long time, straining during bowel movements;
• pregnancy And ;
• excessive consumption of spicy, canned food, which causes irritation in the anal area;
• frequent consumption of strong coffee, tea, alcoholic beverages;
• sedentary, often sedentary lifestyle;
• strong physical activity;
• lifting weights;
• anal sex;
• stressful situations;
• diseases of the pelvic organs.

Symptoms of hemorrhoids

Typically, hemorrhoids develop gradually; at the initial stage, discomfort is felt only during intestinal disorders, after intense physical exertion, overheating or hypothermia. Most often, hemorrhoids occur in a chronic form with periodic exacerbations.

The first symptoms of hemorrhoids are manifested by a feeling of discomfort in the anus, lungs anal itching , burning, a feeling of heaviness, a sensation of a foreign body, discharge of bright red blood during bowel movements. Due to the expansion and thinning of the walls of the cavernous vessels, small tears are formed, as a result of which bleeding. These symptoms may bother a person for several years. Gradually, the symptoms intensify, pain appears during bowel movements, bleeding during bowel movements, pain when walking and while sitting, and blood stains may be observed in the stool. The gradual enlargement of hemorrhoids and the development of dystrophic processes in the musculo-ligamentous apparatus cause a displacement of the nodes towards the anus. This leads to their loss. Against this background, it can be observed anemia , general weakness, rapid heartbeat, decreased hemoglobin in the blood.

Chronic hemorrhoids are divided into four stages:

First stage characterized by the formation of hemorrhoids in the rectum that do not protrude from the anus. There may be discomfort during bowel movements, and there may also be bleeding. However, these symptoms of hemorrhoids may not always be observed.

On second stage hemorrhoids fall out of the anus during defecation, but are reduced on their own. The nodes increase in size, which leads to the thinning of the mucous membranes of the node and to constant bleeding during bowel movements. Patients often complain about burning in the anal area.

On third stage the muscular-ligamentous apparatus holds the nodes in the anal canal, but dystrophic changes prevent the normal contraction of this muscle, anal sphincter weakens, so the nodes that fall out during defecation need to be reset independently. There is severe itching and heavy bleeding. Blood loss can lead to a sharp decrease in hemoglobin levels in the blood.

Fourth stage characterized by the fact that hemorrhoids and the rectal mucosa fall out with the slightest physical effort. At this stage, the muscular-ligamentous apparatus of the anal canal, which held the nodes, is destroyed. Observed hemorrhoids , heavy bleeding, involuntary discharge of liquid feces and mucus.

Acute hemorrhoids are most often a complication of chronic hemorrhoids and occur with thrombosis of external and internal painfully swollen hemorrhoids. Highlight three stages of acute hemorrhoids.

On first patients feel a burning sensation in the anal area, especially after defecation; hemorrhoids are small in size and painful.

At second stage pain in the anus is observed constantly, intensifies when walking and sitting, palpation thickened inflamed hemorrhoids are very painful, body temperature rises.

For third stage swelling of the anus is characteristic, thrombosis spreads to the hemorrhoids, the nodes acquire a purple or dark cherry color, the pain is very intense.

For any form of the disease, timely treatment of hemorrhoids is required; in its absence, the nodes will gradually fall out become necrotic , the mucous membranes become ulcerated, which can lead to acute inflammation.

Diagnosis of hemorrhoids

Hemorrhoids are diagnosed by examining the patient's anus. External hemorrhoids are defined as fringes surrounding the anus. At the first stage of the disease, internal hemorrhoids are difficult to identify, and as the disease progresses, they begin to appear in the lumen of the anal canal; when straining, they can fall out. The main diagnosis of hemorrhoids includes:

• palpation rectum;
• sigmoidoscopy carried out to examine the mucous membrane of the rectum and lower sigmoid colon;
• colonoscopy carried out to determine the condition of the rectal mucosa;
• anoscopy carried out for hemorrhoids, makes it possible to assess the presence, location and degree of enlargement of internal nodes. Anoscopy is used to select a treatment method.

Such comprehensive studies also make it possible to identify concomitant diseases of the gastrointestinal tract and, if necessary, carry out treatment.

Treatment of hemorrhoids

Choice of treatment method hemorrhoids depends on the stage of the disease, the severity of symptoms, as well as the presence of concomitant diseases. To treat hemorrhoids, complex treatment is usually carried out.

At the initial stage chronic hemorrhoids (1st and 2nd stages) subject to conservative treatment, aimed at combating exacerbations accompanied by bleeding to eliminate pain. If you start treatment on time, it can greatly slow down the progression of the disease. It is very important to follow a special diet and proper nutrition, with regular bowel movements. Hot, spicy, fatty foods and alcohol should be excluded from the diet. You need to eat foods rich in plant fibers (fresh vegetables, grains, cereals), bran, drink more mineral water, exercise regularly, wash the anus with cool water after defecation. Without following these rules, exacerbations of the disease will recur more often.

Treatment of hemorrhoids successfully uses both general and local painkillers , ointment compresses, anti-inflammatory and phlebotonic drugs. Suppositories are mainly used for internal hemorrhoids, ointments for external hemorrhoids.

If there is itching and other painful sensations, it is recommended to use rectal suppositories with, , based cocoa butter or lanolin . In the treatment of chronic hemorrhoids, suppositories with thrombin . Pain syndromes associated with inflammatory processes in the thrombosed node or in surrounding tissues are relieved with the help of non-narcotic (,), as well as local combined painkillers in the form ointments And gels ( , ).

Apply to the tissue surrounding the node to relieve inflammation. ointment compresses( , ). For itching, you can make compresses from ointment with, suppositories with. Thrombosis of hemorrhoids is treated with the use of combination drugs with painkillers, anti-inflammatory and thrombolytic components that relieve inflammation in the nodes ( gelpan , venobene ).

For bleeding, hemostatic drugs are used, which dissolve when introduced into the anal canal, forming a film that blocks the bleeding areas of the nodes (sponges with adroxon , beriplast ). Doctors also prescribe phlebotonic drugs that increase vascular tone ().

To increase the effectiveness of local drugs, it is necessary to take drugs that improve the tone of venous vessels and prevent thrombus formation (, detralex , ). For chronic forms of hemorrhoids, the use of combination drug therapy can provide a positive temporary effect.

Are becoming more widespread minimally invasive methods hemorrhoid treatment performed on an outpatient basis. Surgery is necessary if the patient experiences prolapse of hemorrhoids that cannot be put back into place, severe rectal pain, itching, and bleeding. The following methods are used to treat patients with stages 1 and 2 of hemorrhoids:

• sclerotherapy (introduction of a sclerosing substance into the node causing flattening of the vessel);
• focal infrared coagulation (the effect of thermal energy on the node, causing gluing of the vessel due to the evaporation of intracellular water);
• ligation of hemorrhoids latex rings (a ring is placed on the base of the nodes, causing a disruption in the blood supply, as a result of which the nodes are rejected);
• cryotherapy (freezing the node for 2-3 minutes, after which the latter dies).

Another common treatment for hemorrhoids is Longo method(truncation of a section of the rectal mucosa above the hemorrhoid). Surgical removal of nodes ( hemorrhoidectomy ), is indicated in the 3rd and 4th stages of the disease, in the presence of large nodes, heavy bleeding, and concomitant diseases of the rectum. Recently started using stapler hemorrhoidectomy method(staples) – circular application of staples to protrusions of the anorectal mucosa using a stapler.

It should be noted that despite all their low-traumatic nature and minor pain (except for hemorrhoidectomy) of these manipulations, complications may develop after they are performed, namely: relapses of the disease, rectal bleeding, severe pain, paraproctitis.

It is important to remember that symptoms of hemorrhoids can be manifestations of other diseases, such as anorectal bleeding, tumors of the rectum and anal canal, , , rectal injuries, anal prolapse and many others. Therefore, at the first appearance of the above symptoms, do not delay visiting a doctor.

At home, to reduce swelling and pain for hemorrhoids, warm sitz baths for fifteen minutes are recommended 3 times a day after bowel movements. You can add a solution of potassium permanganate (), or a decoction of medicinal herbs - nettle, alder leaves, clover, pepper knotweed - to the water. You can buy a special one at the pharmacy antihemorrhoidal collection .

Folk remedies are often used in the treatment of hemorrhoids, but without consulting a doctor, self-medication can lead to undesirable consequences. Hemorrhoids in pregnant women are treated only under the supervision of a doctor; under no circumstances should traditional medicine be used during pregnancy.

The doctors

Medicines

Prevention of hemorrhoids

Prevention of the development of hemorrhoids, both before the development of the disease and after surgery, consists of normalizing the activity of the digestive tract, following a low-calorie diet, and treating constipation. To prevent the formation of hemorrhoids, you need to ensure the normal functioning of the intestines, fight stool disorders, and avoid overstraining during bowel movements.

You should also eat right, drink as much mineral water as possible, limit the consumption of hot, spicy and pickled foods, alcoholic beverages that cause blood flow to the pelvic area, observe good hygiene, wash the anus with cool water after bowel movements, and exercise regularly. Hypothermia should be avoided. When working sedentarily, every hour it is worth performing several physical exercises while standing for 10 minutes. Recommended for pregnant women gymnastics , hiking .

Hemorrhoids in pregnant women

Very often, hemorrhoids appear during childbirth. The cause of hemorrhoids is compression by an enlarged uterus intestinal veins , which leads to deterioration of blood flow from the intestines and from the perineum. Veins increase in diameter and change shape. Periodic constipation in pregnant women can also provoke the appearance of hemorrhoids.

However, for most women, the symptoms of hemorrhoids go away during the postpartum period, so it is believed that the causes of hemorrhoids may be hormonal changes . Hemorrhoids should be treated immediately after the first symptoms are detected. It is important to combat constipation, for example by taking medications for loose stool (, Laminaride, Methylcellulose), observe the rules of hygiene (washing the anus after defecation). Medicines for hemorrhoids (, etc.) are used mainly externally in the form of ointments and suppositories. Surgery is performed only in severe cases.

Prevention of hemorrhoids should be carried out from the first days of pregnancy - create a competent diet to prevent constipation, do not wear tight belts, spend more time in the fresh air, walking is useful.

Diet, nutrition for hemorrhoids

List of sources

• Vorobyov G.I. Hemorrhoids / G. I. Vorobyov, Yu. A. Shelygin, L. A. Blagodarny. - M.: Litterra, 2010.
• Rivkin, V. L. Hemorrhoids. Constipation / V. L. Rivkin, L. L. Kapuller, Constipation. - M.: Medpraktika, 2000.
• Fundamentals of coloproctology (edited by G.I. Vorobyov) MIA. 2006.

Education: Graduated from Vitebsk State Medical University with a degree in Surgery. At the university he headed the Council of the Student Scientific Society. Advanced training in 2010 - in the specialty "Oncology" and in 2011 - in the specialty "Mammology, visual forms of oncology".

Experience: Worked in a general medical network for 3 years as a surgeon (Vitebsk Emergency Hospital, Liozno Central District Hospital) and part-time as a district oncologist and traumatologist. Worked as a pharmaceutical representative for a year at the Rubicon company.

Presented 3 rationalization proposals on the topic “Optimization of antibiotic therapy depending on the species composition of microflora”, 2 works took prizes in the republican competition-review of student scientific works (categories 1 and 3).

Hemorrhoids are a rather delicate disease, so people often turn to a doctor at the final stages of its development, when even the right drug therapy does not give the desired result. Thus, hemorrhoids are most often found in men and women only after 40 years of age, although this disease develops much earlier. The following factors contribute to the occurrence of hemorrhoids:

• physical inactivity and sedentary work;
• alcohol abuse, eating a lot of spicy foods;
• constipation or, conversely, prolonged diarrhea;
• lifting weights;
• overweight;
• congestion in the veins in the pelvic area is provoked by taking medications and oral contraceptives;
• excessive use of laxatives;
• cycling or motorsports;
• hereditary predisposition.

Hemorrhoids often develop during pregnancy. This is due to the fact that due to the enlargement of the uterus, the vessels in the rectum dilate and lose tone. In addition, during pregnancy, a woman’s motor activity decreases; she is more likely to experience bowel movements in the form of constipation, which also provokes congestion in the vessels of the rectum.

Classification of hemorrhoids

Depending on the nature of the disease, this disease can be acute or chronic. Depending on the etiology, it is classified as primary and secondary hemorrhoids. The primary form of the disease develops under the influence of certain provoking factors. Secondary hemorrhoids are a consequence of other diseases (for example, severe cardiovascular lesions, cirrhosis of the liver, cancer pathologies in which normal blood flow in the veins is disrupted). Depending on the form, hemorrhoids can be internal, external, or combined.

External hemorrhoids are manifested by the location of hemorrhoids outside the intestine (they are grouped around the anus). Nodes arise due to the expansion of venous vessels that are located around the anus in the subcutaneous layer. Internal hemorrhoids are a form of the disease in which hemorrhoids are localized in the lumen of the rectum and remain invisible during remission. They are located under the mucous membrane and occur due to blood overflow.

Features of the clinical course

Hemorrhoids usually develop gradually. The main complaints of patients are discomfort and sensation of a foreign body, itching in the anal area. Such manifestations of the disease appear periodically and at first only bother you when you have problems with bowel movements, after taking a hot bath or breaking your diet (for example, after eating spicy foods or drinking too much alcohol). Subsequently, anal itching is combined with bleeding of varying intensity. It is worth noting that hemorrhoids are characterized by a chronic course with periodic exacerbations. The chronic form is characterized by the following:

• Bleeding. There is periodic appearance of blood from the anus. Most often, the appearance of scarlet blood during bowel movements is recorded. Less commonly, there may be some minor bleeding between bowel movements. Quite rarely, rectal bleeding occurs constantly. Also, when blood stagnates in the rectum, dark red blood clots may be recorded. If even a small amount of blood appears, you should consult a doctor, as this may be a manifestation of rectal cancer.
• Symptoms of hemorrhoids include prolapse of nodes. At the initial stages of the disease, they can be reduced on their own; in the later stages, manual reduction is required, or their constant loss is observed.
• Pain is not typical for chronic hemorrhoids. Only with a long-term course with frequent exacerbations can constant dull pain be observed.
• Discomfort and itching in the anus. Itching mainly appears as a result of irritation of the skin with mucus released when the nodes fall out.

Exacerbation period

Chronic hemorrhoids can be complicated by thrombosis of the hemorrhoidal veins. Acute thrombosis of internal nodes begins suddenly. Sharp pain appears and bleeding is possible. The development of such a complication is facilitated by spasm of the anal sphincter, which develops due to irritation of the anal canal. In turn, the spasm provokes circulatory problems in the nodes that have fallen out. They increase in size and swell, making it impossible to reduce them. Thrombosis develops. In addition, necrosis of the mucous membrane may form, followed by the appearance of ulcers and bleeding.

Acute hemorrhoids affecting the external nodes are manifested by constant pain, so effective treatment should be carried out as quickly as possible. Depending on the course, there are 3 degrees of severity.

• The first is characterized by the appearance of tight, painful formations. The perianal zone is hyperemic. Patients complain of moderate pain, itching and burning around the anus, which intensifies after sitting, defecation, or taking spicy foods.
• The second degree is characterized by increased hyperemia around the anus, spasm of the anal sphincter, hardening of hemorrhoids and the appearance of intense pain, which does not allow a rectal examination.
• In the third degree, the skin around the anus is hyperemic, the inflammatory process moves from the nodes to the tissues that are located nearby. Dense purple structures appear with areas of necrosis that cannot be moved into the anal canal. In this case, it is important to quickly carry out treatment measures. Otherwise, the nodes become necrotic, which leads to the development of acute paraproctitis with bleeding.

Treating hemorrhoids at home

Sitz baths are considered a safe and popular way to combat hemorrhoid pain. They can be cold or steam. Most people do not know whether thermal procedures can be performed during an exacerbation, so it is important to note that steam baths are used only in the remission stage of chronic hemorrhoids. In case of exacerbation, such procedures are prohibited.

To prepare a steam bath, you need to pour boiling water into a 10-liter container and close the lid, having previously made a hole in it with a diameter of about 5 cm. Before the procedure, the patient must have a cleansing enema, after which he should sit over the steam for 15 minutes twice a day.

A cold bath is used for acute inflammation to reduce pain. To prepare it, just take cold water and dissolve a small amount of potassium permanganate in it, then sit in the prepared bath for no more than 5 minutes.

You can treat hemorrhoids at home with ice suppositories. To make them, you should cool the chamomile decoction and freeze it in the fingertips of latex surgical gloves, and then insert the resulting suppositories into the anus overnight. Candles made from raw potatoes, which have an astringent and drying effect, are also considered effective.

How to treat itching with hemorrhoids? Ordinary mineral oils quite effectively eliminate this unpleasant symptom. So, applying glycerin, petroleum jelly or lanolin to dry and clean skin helps get rid of this manifestation of the disease.

To combat hemorrhoids, you can make your own special ointment. To do this, mix sea buckthorn oil with honey or propolis and lubricate the external nodes. For internal nodes, you can use gauze pads at night. Microenemas with sea buckthorn oil are also effective.

Therapy with folk remedies includes taking special infusions and decoctions orally. Thus, raspberry leaves steamed with boiling water have an anti-inflammatory effect. Beetroot juice has a hemostatic effect, which should be taken three times a day, 50 ml. To strengthen the vascular wall, it is recommended to drink rosehip infusion. To prepare it you need to take 1 tbsp. l. fruits, pour boiling water (0.5 l) over them and leave for 10 hours. When using, you can add honey. Such remedies cannot get rid of hemorrhoids forever, but their use significantly reduces the risk of exacerbation of the disease.

Traditional methods of treating hemorrhoids involve the use of lotions. The simplest is a lotion with cold water. You can also use decoctions of strawberry leaves or rowan berries. If you have external hemorrhoids, it is recommended to finely grate carrots or beets, wrap the resulting mass in gauze and apply to the nodes to reduce pain.

It is worth remembering that in case of severe pain and intense anal bleeding, home remedy therapy is unacceptable, since you should immediately seek help from a doctor. After the examination, he will prescribe appropriate drug treatment. As a rule, drugs are prescribed that:

• increase the tone of the venous wall (for example, Troxevasin);
• relieve inflammation and prevent the formation of blood clots (anticoagulants, such as Heparin);
• relieve spasms and reduce pain (suppositories with belladonna extract);
• eliminate inflammation, relieve swelling and itching (local anesthetics containing lidocaine, hydrocortisone).

How to treat hemorrhoids correctly? To determine the most optimal therapeutic tactics, you should undergo an examination, find out the reasons for the development of the disease and take into account the peculiarities of its course. Only then can you count on positive results.

Every person who is concerned about their own health should know how to treat bile in the stomach. Bile in the stomach is a very unpleasant condition, which is accompanied by a feeling of discomfort and bitterness in the mouth. Many people do not take the appearance of these unpleasant sensations very seriously. And this is a very big mistake, since bile in the stomach may indicate the presence of any serious complications in the body, including the development of gastritis and stomach ulcers. Therefore, at the first unpleasant symptoms, you should immediately contact a professional.

As you know, bile plays an important role in digestion. It is produced by the liver, after which it enters the gallbladder, from where it, if necessary, enters the duodenum and helps break down food. Normally, bile should not enter the stomach; this is prevented by sphincters that separate the esophagus from the stomach, and the stomach from the duodenum. But in some cases, reflux (backflow of bile into the stomach) may occur. This can happen if for some reason (serious illness, poor diet) the sphincters begin to do their job poorly.

Reasons for this condition

Doctors identify several reasons that can lead to the appearance of bile in the stomach:

1. Poor nutrition. Quite often, discomfort in the stomach occurs due to the fact that a person abuses salty, bitter, fatty and smoked foods. The thing is that, when these harmful products enter the body, they cause the liver to begin producing too much bile, which the gallbladder cannot hold. As a result, excess bile is released into the stomach.
2. Some medications can also cause bile to leak.
3. Often, bile entering the stomach is associated with the consumption of stale foods.
4. Another cause of stomach discomfort is constant smoking.
5. Doctors warn that constantly drinking water can lead to the appearance of bile in this organ.
6. Not many people know, but reflux can occur due to sleeping on a full stomach on the left side.
7. Heavy physical activity immediately after eating can cause stomach discomfort.

Correct treatment of the disease

If the reflux of bile into the stomach occurs quite rarely, then you can get rid of the unpleasant sensations on your own. To do this, you just need to drink at least 1 liter of clean water in small sips. Within a couple of minutes, the condition will noticeably improve, as the water will wash away the bile from the mucous membrane, which will reduce the pain and burning sensation.

However, if discomfort in the stomach appears too often, then this is a reason to sound the alarm and immediately consult a doctor. Since such symptoms can be caused by some serious disease.

If bile is detected in the stomach, treatment involves the use of the following medications:

1. Selective prokinetics - such drugs promote rapid gastric emptying and increase sphincter tone. It’s very simple: the faster the bile leaves the stomach, the faster the unpleasant symptoms will pass. Today, the most popular prokinetics are Cisapride and Motilium.
2. Antacids - these drugs affect the acidity in the stomach, namely they reduce it. A huge advantage of antacids is their low price. Most often, doctors prescribe Maalox and Almagel to the patient.
3. Proton pump inhibitors - these drugs act in the same way as antacids, so there is no point in combining these 2 drugs. Unlike antacids, these drugs last longer, but their price is much higher. Pariet and Nexium are considered the most effective representatives of this group of drugs.
4. Ursofalk - if the release of bile into the stomach has been diagnosed, then doctors often prescribe patients to take Ursofalk 2 times a day, 250 grams. This drug changes the form of bile acids to water-soluble. Ursofalk will help get rid of such unpleasant symptoms as heartburn, burning and bitter belching.

To relieve unpleasant symptoms, medications are most often used, but there are cases when the only way to cope with the disease is through surgery.

1. Laparoscopic correction of gastroduodenal reflux: this type of treatment involves surgical intervention in which the abdominal cavity is not opened. This is an ideal solution for pyloric sphincter insufficiency.
2. Surgery using laparotomy: In this case, during the operation, doctors make an incision in the abdominal wall.

To get rid of bile in the stomach, you need to adhere to a certain diet. The main principle of diet therapy is fractional nutrition: you need to eat often, but in small portions and at the same time. Doctors also recommend eliminating spicy seasonings, carbonated water, alcoholic beverages, fried, smoked and fatty foods from your diet.

The thing is that all these products can cause stomach spasms and lead to serious complications. In addition, people with this problem should limit their consumption of animal fats, vegetable oils and too rich soups.

Products such as oatmeal, kefir, and jelly are very useful.

They have a gentle effect on the walls of the stomach and do not cause a feeling of unpleasant heaviness after eating. Under no circumstances should you overeat; after each meal you should remain slightly hungry.

Traditional medicine: features

You can remove bile from the stomach using folk remedies. For example, to prevent the formation of sediment in the gallbladder and normalize intestinal function, it is recommended to consume food bran. A few spoons of bran per day will be enough.

The tincture of chicory and barberry is very popular.

To prepare this remedy, you will need to mix equal amounts of chicory herb, barberry root and dandelion root. 2 tablespoons of the resulting mixture should be poured into 1 liter of boiled water and left to infuse overnight. The prepared decoction should be taken several times a day, 1/3 cup, half an hour before meals. After 2-3 months, there will be no trace of unpleasant symptoms.

No less popular is a decoction of wormwood, yarrow, mint leaves, immortelle herb and the fruits of common fennel. First, mix 2 tablespoons of each ingredient. Next, the resulting mixture must be thoroughly ground and poured with 500 ml of boiling water. The product is infused all night, after which it can be consumed 1/3 cup half an hour before meals. If desired, you can add a spoonful of honey to the broth.

A decoction of rose hips and dandelion root has a beneficial effect on the stomach. To prepare this remedy, you will need to mix 3 spoons of corn stalks with stigmas and rose hips, 2 spoons of chamomile inflorescence and 1 spoon of birch leaves, dill fruits, dried cucumber and aspen bark. The resulting mixture must be crushed using a coffee grinder and poured with 1 liter of boiled water. The product must sit for at least 12 hours. Like previous tinctures, this remedy is taken several times a day before meals.

Among all rectal diseases, hemorrhoids are the most common. Every year, the number of people suffering from this disease is steadily growing, and people of working age are at risk. The appearance of hemorrhoids provokes a violation of the outflow of blood from the veins of the rectum. Those suffering from hemorrhoids experience discomfort in the anus and frequent bleeding from this area.

Symptoms of hemorrhoids

Hemorrhoids can be both acute and chronic, but any of its forms is a phase of the same process. The chronic form of hemorrhoids is characterized by the release of scarlet blood during bowel movements, prolapse of hemorrhoids, a feeling of dull, unremitting pain in the anus, and itching. During the acute phase of hemorrhoids, inflammation appears in the nodes, as a result of which the patient experiences sharp pain in the anus.

In the chronic phase of hemorrhoids, there are four stages:
1. at the first stage, during defecation, scarlet blood begins to be released, while prolapse of hemorrhoids does not occur;
2. at the second stage of chronic hemorrhoids, hemorrhoids fall out, but they are reduced on their own;
3. the third stage is characterized by prolapse of hemorrhoids, which must be manually pushed into the anal canal;
4. At the fourth stage, hemorrhoids prolapse and cannot be manually pushed into the anal canal.

In the acute stage of hemorrhoids there are three stages:
1. at the first stage, thrombosis of the hemorrhoids occurs, in which they do not become inflamed;
2. at the second stage, inflammation of hemorrhoids is added to thrombosis;
3. During the third stage, the surrounding tissue nodes become inflamed.

Causes of hemorrhoids

To understand why hemorrhoids occur, you need to understand a little about the anatomy of the anus. The point is that in its lower section the rectum is surrounded by a wide network of venous plexuses, the so-called. hemorrhoidal veins (corpus caverosa). These same hemorrhoidal veins are located along the entire circumference of the rectum. In the corresponding parts of the rectum, the lower corpus caverosum and the upper cavernous body are located, respectively. The cavernous bodies are supported by connective tissue: it is woven into the walls of the venous vessels, as a result of which they do not expand more than necessary. Inside, the cavernous bodies are filled with blood, so they help the muscle that closes the anus (the so-called sphincter) to retain feces.

Factors contributing to the development of hemorrhoids

Among the factors that provoke the development of hemorrhoids are:
Constipation, which leads to increased pressure in the rectum and provokes blood flow to the hemorrhoids. As a result, the nodes may enlarge and fall out.
Pregnancy, childbirth. In this case, hemorrhoids may appear as a result of increased pressure on the abdominal cavity.
Prolonged stay in a sitting position. In this position, the perineal muscles relax and the natural support of the hemorrhoids weakens.
Sedentary lifestyle. The enlargement of hemorrhoids in this case occurs due to stagnation of blood in the pelvic area.
Alcohol abuse. In this case, blood flow in the anal area is highly accelerated, which in some cases leads to bleeding.
Lifting weights, excessive physical activity - these factors contribute to an increase in intrauterine pressure, which can result in prolapse of nodes.
Consumption of spices and spicy foods, as this provokes irritation in the anal area.
Hereditary factors.

Types of hemorrhoids

Depending on which of the cavernous bodies is inflamed, they distinguish external, internal and combined hemorrhoids. External hemorrhoids are an inflammatory process in the lower cavernous body, which is located under the skin around the anal sphincter, in close proximity to the exit from the rectum. The term “internal hemorrhoids”, accordingly, refers to inflammation of the superior cavernous body. In most cases, inflammation occurs in both the external and internal cavernous nodes. Such hemorrhoids are called combined. If the anus is imagined as a watch dial, then hemorrhoids in most cases are located at the 3, 7 and 11 o'clock positions.

Prevention of hemorrhoids

1. If your job involves sitting for long periods of time, you must get distracted for 10-15 minutes every hour , walk, move actively.
2. Drivers are advised Do not drive for more than three hours. Periodically you need to get out of the vehicle and warm up.
3. Soft chairs at home and at work should be replaced with hard ones.
4. Include in your diet dishes that do not cause constipation (soups, cereals). In addition, you should avoid prolonged straining , since this often causes prolapse of nodes and bleeding.
5. It is necessary to take into account that frequent loose stools cause irritation of the anal area, so you should eat foods that are not capable of causing diarrhea.
6. Reduce consumption of alcohol, as well as salty and spicy foods.
7. After defecation, wash with cold water.
8. Women carrying a child are advised to do gymnastics and take daily walks.

Diagnosis of hemorrhoids

Diagnosing hemorrhoids is not difficult. Usually the diagnosis becomes clear already at the stage of interviewing the patient and during the initial outpatient examination. The examination determines the degree of prolapse of the nodes, as well as the likelihood of their reduction, the presence and degree of bleeding, and examines the skin in the anal area.

To exclude oncology, the mucous membrane of the sigmoid and rectum areas is examined (sigmoidoscopy procedure).

Differentiation of the disease:
with an anal fissure that can cause pain in the anus and bleeding
prolapse of the entire rectum or mucous membrane, the formation in this case has a cylindrical shape
with rectal cancer, which can also cause bleeding

Treatment of acute hemorrhoids

First of all, conservative therapy is recommended for acute hemorrhoids. Local and general painkillers, anti-inflammatory drugs, ointment applications, and cleansing enemas are used. In addition, phlebotonic drugs are used.

In the presence of pain, non-narcotic analgesics are prescribed ( Movalis, Voltaren, Diclofenac, Nise, Ketonal), as well as combined topical preparations ( Proctoglivenol, Ultraproct, Gepatrombin G, etc.). If inflammation spreads to the tissues surrounding the node and subcutaneous tissue, ointment applications are used, which have a strong anti-inflammatory effect ( Vishnevsky ointment, Levasin, Levomekol, etc.).

To get rid of acute and chronic hemorrhoids, today it is mandatory to use drugs that increase vascular tone (phlebotonic). The most effective of all is Detralex.

During bleeding, suppositories containing adrenaline and local hemostatic materials (adroxon, beriplast, spongostan) are used.

Conservative treatment brings only a temporary effect. Thus, after the acute inflammation has passed, it is necessary to begin minimally invasive treatment or, if necessary, undergo surgery. The choice of method depends on the stage of the disease.

Treatment of chronic hemorrhoids

Minimally invasive treatment methods are used for patients with the first and second stages of hemorrhoids. These methods are not recommended for use in the following cases:
anal fissure
thrombosis of hemorrhoids
paraproctitis (both acute and chronic) and other inflammatory diseases of the perineum and anal canal

Sclerotherapy is the introduction of a sclerosing substance (1.5-2 milliliters) into the hemorrhoidal node, which causes gluing and flattening of the vessels. It is recommended to inject a sclerosing substance into no more than two hemorrhoids, otherwise pain may develop. The sclerotherapy procedure can be repeated 12-14 days after the first session.

Ligation with latex rings used to treat internal hemorrhoids. A latex ring is placed on their base, which disrupts their nutrition. After 7-10 days, the nodes are rejected along with the rings. In some cases, it is necessary to carry out several similar procedures every 14-16 days.

Coagulation method consists in bringing the light guide to contact with the hemorrhoidal node. As a result, the node is affected by thermal energy, which leads to emptying and gluing of the vessels. During one procedure, the tip of the light guide is applied to the node 2 to 6 times.

When conducting cryotherapy the hemorrhoid is frozen for 2-3 minutes. After the node thaws, it dies and a wound appears in its place. In most cases, cryotherapy is performed under local anesthesia.

The main disadvantage of all minimally invasive methods is that they do not get rid of the true cause of hemorrhoids - excessive blood flow.

Surgical treatment of hemorrhoids

Today, the standard in the treatment of hemorrhoids is surgical intervention, which is used to treat hemorrhoids in the third and fourth stages. This method assumes excision of hemorrhoids and suturing of supply vessels (pedicle of the node). After the surgical procedure, the patient is left in the hospital for a period of one week to 9 days. In general, the patient remains incapacitated for two weeks.

For some time after the operation, the patient may experience discomfort in the anal area, pain, and suppuration of the scar may appear. In the long-term postoperative period, recurrence of the disease is not excluded, as well as a decrease in the compressive ability of the anus and impaired dilatation of the anus.

Traditional methods of treating hemorrhoids

Traditional methods in the treatment of hemorrhoids are used as additional measures to traditional treatment, applicable in the early stages of the disease.
1. Potato candles. A candle is cut out of a potato tuber and left in the anus overnight. In addition, you can make a tampon from potatoes, which is also left in the anus overnight: the grated potatoes are wrapped in gauze. Potato suppositories can stop bleeding from hemorrhoids, as well as relieve swelling and inflammation.
2. Honey. It has known anti-inflammatory, antimicrobial and healing effects. You can make a candle from solid honey, which is then inserted into the anus. In addition, you can soak a ready-made gauze swab rolled into a cylinder shape with honey.
3. Chamomile. Helps relieve inflammation and promotes the healing process. You can take chamomile baths every day: brew it for 20 minutes, and then sit in a basin with warm (but by no means hot) infusion.
4. Sea buckthorn oil. Lubricate the anus area (especially generously in areas of damage) up to four times a day. The oil can be purchased at a pharmacy or prepared independently at home from sea buckthorn berries.