Hemorrhoids , also called stacks , is a vascular structure in the anal canal. In their normal circumstances, they are pillows that help with the control of the stool. They become diseases when swollen or inflamed; the term "unqualified hemorrhoids" is often used to refer to illness. The signs and symptoms of hemorrhoids depend on the type. Internal hemorrhoids often cause painful bright red rectal bleeding during bowel movements. External hemorrhoids often cause pain and swelling in the anal area. If bleeding occurs usually darker. Symptoms often improve after a few days. Skin tags may remain after healing of external hemorrhoids.
While the exact cause of hemorrhoids remains unknown, a number of factors that increase pressure on the abdomen are believed to be involved. This may include constipation, diarrhea and sitting in the toilet for a long time. Hemorrhoids are also more common during pregnancy. Diagnosis is made by looking at the area. Many people incorrectly refer to any symptoms that occur around the anal area as "hemorrhoids" and the cause of serious symptoms should be ruled out. Colonoscopy or sigmoidoscopy makes sense to confirm the diagnosis and rule out more serious causes.
Often, no special care is required. The initial step consists of increasing fiber intake, drinking fluids to maintain hydration, NSAIDs to help with pain, and rest. Drug cream can be applied to the area, but its effectiveness is less supported by evidence. A number of minor procedures can be performed if symptoms are severe or not improved with conservative management. Surgery is reserved for those who fail to improve following these steps.
About 50% to 66% of people have problems with hemorrhoids at some point in their lives. Men and women are equally affected with the same frequency. Hemorrhoids affect people most often between 45 and 65 years. This is more common among the rich. The results are usually good. The first known mention of the disease is from Egyptian papyrus 1700 BC.
Video Hemorrhoid
Signs and symptoms
In about 40% of people with pathologic hemorrhoid there are no significant symptoms. Internal and external hemorrhoids can be present differently; However, many people may have a combination of both. Sufficient bleeding causes anemia rarely, and life-threatening bleeding is even more rare. Many people feel embarrassed when faced with problems and often seek medical treatment only when the case progresses.
External
If there is no thrombosis, external hemorrhoids can cause a little trouble. However, when thrombosed, hemorrhoids may be very painful. However, the pain usually goes away within two to three days. However, the swelling may take several weeks to disappear. The skin tag may remain after healing. If the hemorrhoids are large and cause problems with cleanliness, they can irritate the surrounding skin, and thus itch around the anus.
Internal
Internal hemorrhoids usually present with painless bright red rectal bleeding during or after bowel movements. Blood usually covers the stool (a condition known as hematochezia), is in toilet paper, or drips into a toilet bowl. The bench itself is normally normal. Other symptoms may include mucus mucus, perianal mass if they are prolapsed through anal, itching, and fecal incontinence. Internal hemorrhoids are usually only painful if they become thrombotic or necrotic.
Maps Hemorrhoid
Cause
The exact cause of symptomatic hemorrhoids is unknown. A number of factors are believed to play a role, including irregular bowel habits (constipation or diarrhea), lack of exercise, nutritional factors (low fiber diet), increased intra-abdominal pressure (prolonged strain, ascites, intra-abdominal mass, or pregnancy) genetics, absence of valves in the hemorrhoidal vein, and aging. Other factors that are believed to increase risk include obesity, long sitting, chronic cough, and pelvic floor dysfunction. Squatting during bowel movements may also increase the risk of severe hemorrhoids. The evidence for this association, however, is poor.
During pregnancy, pressure from the fetus in the stomach and hormonal changes causes the enlarged hemorrhoidal vessels. The birth of a baby also causes an increase in intra-abdominal pressure. Pregnant women rarely require surgical treatment, as symptoms usually improve after delivery.
Pathophysiology
The hemorrhoid pillows are part of a normal human anatomy and become pathological only when they experience abnormal changes. There are three main pillows in the normal anal canal. It lies classically in the lateral left, right anterior, and posterior right positions. They consist of arteries or veins, but blood vessels called sinusoids, connective tissue, and smooth muscle. Sinusoids do not have muscle tissue in their walls, just like veins. This collection of blood vessels is known as the hemorrhoids plexus.
The hemorrhoid pillows are important for the continence. They contribute 15-20% of the anal closing pressure at rest and protect the internal and external anal sphincter muscles during the fecal trip. When a person gives birth, intra-abdominal pressure grows, and the hemorrhoid cushion gets bigger, helping to maintain the anal closure. Hemorrhoid symptoms are believed to occur when these vascular structures slide down or when venous pressure increases excessively. Increased internal and external anal sphincter pressure may also be involved in the symptoms of hemorrhoids. Two types of hemorrhoids occur: internally from the superior and external hemorrhoid plexus of the inferior hemorrhoid plexus. Dentate lines divide the two regions.
Diagnosis
Hemorrhoids are usually diagnosed with a physical examination. Visual examination of the anus and surrounding areas can diagnose external hemorrhoids or prolapse. Rectal examination may be performed to detect possible rectal tumors, polyps, enlarged prostate, or abscess. This examination is not possible without proper sedation due to pain, although most internal hemorrhoids are not associated with pain. Visual confirmation of internal hemorrhoids may require anoscopy, insertion of a hollow tube tool with light attached at one end. Both types of hemorrhoids are external and internal. This is distinguished by their position with respect to the dentate line. Some people may have a symptomatic version of both. If pain is present, this condition is more likely to be an ani fissure or external hemorrhoids rather than internal hemorrhoids.
Internal
Internal hemorrhoids are derived above the dentate line. They are covered by columnar epithelium, which has no pain receptors. They were classified in 1985 into four classes based on the level of prolapse:
- Level I: No prolapse, only prominent blood vessels
- Level II: Prolapse while decreasing, but spontaneous reduction
- Grade III: Prolapse on downgrade requires manual reduction
- Level IV: Prolapse with inability to be reduced manually.
External
External hemorrhoids occur below the dentate or pectinate lines. They are covered proximal by the anoderm and distal by the skin, both sensitive to pain and temperature.
Differential
Many anorectal problems, including fissures, fistulas, abscesses, colorectal cancer, rectal varices, and itching have similar symptoms and may be mistaken for hemorrhoids. Rectal bleeding can also occur due to colorectal cancer, colitis including inflammatory bowel disease, diverticular disease, and angiodysplasia. If anemia is present, other potential causes should be considered.
Other conditions that produce rectal mass include skin tags, anal warts, rectal prolapse, polyps, and enlarged rectal papillae. Anorectal varicose veins due to an increase in portal hypertension (blood pressure in the portal venous system) may appear similar to hemorrhoids but are different conditions. Portal hypertension does not increase the risk of hemorrhoids.
Prevention
A number of precautions are recommended, including avoiding tension while trying to defecate, avoiding constipation and diarrhea either by eating a high-fiber diet and drinking plenty of fluids or by taking fiber supplements, and getting enough exercise. Spending less time on bowel movements, avoiding reading while in the toilet, and losing weight for overweight people and avoiding weight lifting is also recommended.
Management
Conservative
Conservative care usually consists of foods rich in dietary fiber, oral fluid intake to maintain hydration, nonsteroidal anti-inflammatory drugs, sitz baths, and rest. Increased fiber intake has been shown to improve yield and can be achieved with dietary changes or fiber supplement consumption. The evidence for the benefits of sitz bath for some point in the treatment, however, is less. If they are used, they should be limited to 15 minutes each time. Lowering the time spent in the toilet and not trying is also recommended.
While many topical agents and suppositories are available for the treatment of hemorrhoids, little evidence supports their use. Agents containing steroids should not be used for more than 14 days, as they may cause skin thinning. Most agents include a combination of active ingredients. These may include barrier creams such as petroleum jelly or zinc oxide, analgesic agents such as lidocaine, and vasoconstrictors such as epinephrine. Some contain Balsam from Peru that certain people may be allergic.
Flavonoids are a questionable benefit, with potential side effects. Symptoms usually disappear after pregnancy; thus active treatment is often delayed until after delivery. The evidence does not support the use of traditional Chinese herbal treatments.
Procedures
A number of office-based procedures can be performed. Although generally safe, rare side effects such as perianal sepsis may occur.
- Rubber tape ligation is usually recommended as a first-line treatment for those with levels 1 to 3. This is a procedure in which elastic bands are applied to the internal hemorrhoids at least 1 cm above the dentate line to cut off their blood supply. In 5-7 days, the hemorrhoid hemorrhoid falls. If the tape is placed too close to the dentate line, great pain will come soon after. Cure rate has been found around 87% with complication rate up to 3%.
- Sclerotherapy involves injection of sclerosis agents, such as phenol, into the hemorrhoids. This causes the vein wall to collapse and hemorrhoids to constrict. The success rate of four years after treatment is about 70%.
- A number of cauterization methods have proven effective for hemorrhoids, but are usually only used when other methods fail. This procedure can be performed using electrocautery, infrared radiation, laser surgery, or cryosurgery. Infrared cauterization may be an option for class 1 or 2 disease. In those with grade 3 or 4 disease, the reoccurrence rate is high.
Surgery
A number of surgical techniques can be used if conservative management and simple procedures fail. All surgical treatments are associated with several levels of complications including bleeding, infection, anal stricture and urinary retention, due to proximity of the rectum to the nerves supplying the bladder. Also, a small risk of fecal incontinence occurs, especially fluid, with levels reported between 0% and 28%. Ectropion mucosa is another condition that may occur after hemorrhoidectomy (often together with anal stenosis). This is where the anal mucosa is removed from the anus, similar to the mild form of rectal prolapse.
- Excisional hemorrhoidectomy is a surgical excision of a hemorrhoid used primarily in severe cases. It is associated with significant postoperative pain and usually takes 2-4 weeks for recovery. However, the longer-term benefits are greater in those with 3-degree hemorrhoids compared with rubber band ligation. This is the recommended treatment in those with external hemorrhoid thrombosis if done within 24-72 hours. The evidence for this support is weak. Glyceryl trinitrate ointment after the procedure helps with both pain and healing.
- Guided doppler, transanal hemorrhoidal dearterialization is minimally invasive treatment using ultrasound doppler to accurately locate arterial blood flow. The artery is then "strapped" and the prolapse tissue returns to its normal position. It has a slightly higher recurrence rate, but fewer complications than with hemorrhoidectomy.
- Stapled hemorrhoidectomy, also known as stapled hemorrhoidopexy, involves the removal of most abnormally enlarged hemorrhoid tissue, followed by repositioning of the remaining hemorrhoid tissue back into its normal anatomical position. It is generally less painful and associated with faster healing compared with hemorrhoid removal. However, the likelihood of symptomatic hemorrhoid is greater than conventional hemorroidectomy, so it is usually recommended only for class 2 or 3 diseases. Epidemiology
- Hemoroid in Curlie (based on DMOZ)
- Davis, BR; Lee-Kong, SA; Migaly, J; Feingold, DL; Steele, SR (March 2018). "American Society of Colon and Clinical Practice Guidelines for Rectal Surgery for Hemorrhoid Management". Diseases of the colon and rectum . 61 (3): 284-292. doi: 10.1097/DCR.0000000000001030. PMID 29420423. Source of the article : Wikipedia
It is difficult to determine how a common hemoroid is because many people with the condition do not see the health care provider. However, symptomatic hemorrhoids are thought to affect at least 50% of the US population at some time during their lifetime, and about 5% of the population is affected at any given time. Both sexes experience the same event of the condition, with peak levels between 45 and 65 years. They are more common in Caucasians and people of higher socioeconomic status.
Long-term outcome is generally good, although some people may have recurrent symptomatic episodes. Only a small percentage of people need surgery.
History
The first known mention of this disease is from Egyptian papyrus 1700 BC, which suggests: "... you have to prescribe, a great protective ointment, acacia leaves, ground, titurated and cooked together.. Smear strip of fine linen there with and placed on the anus, that he recovered immediately. "In 460 BC, the Hippocratic corpus discusses a treatment similar to that of modern rubber tape ligation:" And hemorrhoids in the same way you can treat it by massaging it with a needle and tying it with a very thick yarn and wool, for the application, and does not cause until they stop, and always leave one behind, and when the patient recovers, let him put into the Hellebore course. "Hemorrhoids may have been described in the Bible, with earlier English translations using" emerod "spelling which is now obsolete.
Celsus (25 BC - AD 14) describes ligation and excision procedures, and discusses possible complications. Galen suggests severing the arterial connection to the veins, claiming it reduces the pain and spread of gangrene. Susruta Samhita (4th to 5th century) is similar to Hippocrates' words, but emphasizes the cleanliness of the wound. In the 13th century, European surgeons such as Milan Lanfranc, Guy de Chauliac, Henri de Mondeville, and John of Ardene made great advances and the development of surgical techniques.
In medieval times, hemorrhoids were also known as the curse of Saint Fiacre after a sixth century saint who developed it after plowing the land. The first use of the word "hemorrhoids" in English took place in 1398, derived from the French "emorroides" of Ancient, from Latin hÃÆ'Â|morrhoida , in turn from the Greek ???????? ? ( haimorrhois ), "responsible for bleeding", from ???? ( haima ), "blood" and ???? ( rhoos ), "flow, flow, current", itself from ??? ( rheo ), "flowing, flowing".
Famous cases
Hall-of-Fame baseball player, George Brett, was ejected from a game in the 1980 World Series due to hemorrhoids. After a small operation, Brett returned to play in the next game, grumbling "... my problem is behind me." Brett underwent subsequent hemorrhoid surgery the following spring. Conservative political commentator Glenn Beck underwent surgery for hemorrhoids, then described his unhappy experience in the widely viewed YouTube 2008 video. Former US President Jimmy Carter underwent surgery for hemorrhoids in 1984. Cricketers Matthew Hayden and Viv Richards also experienced the condition.
References
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