By Dr Ahmed Nasr
Types of hemorrhoids
Depending on their location, hemorrhoids are classified into:
External hemorrhoids: they come from the inferior venous plexus. They appear in the form of small lumps, covered with skin, which become more prominent when defecating. The external veins are dilated - clots can occur inside them -, they become inflamed, they can thrombus, ulcerate and bleed, causing pain.
Internal hemorrhoids: they come from the superior venous plexus, are located above the anal canal and are covered by mucosa. According to the severity of internal hemorrhoids we find:
- First degree internal hemorrhoids:
They are small and generally asymptomatic, they usually present with itching.
- Second degree internal hemorrhoids:
They are medium and are usually accompanied by bleeding.
c) Third degree internal hemorrhoids:
This type of hemorrhoids descend from the inside of the anus, they come out having difficulty returning to their original position, this is known as prolapse (a lump appears in the anus accompanied by discomfort and pain). The patient can re-enter them manually.
- Fourth degree internal hemorrhoids:
They are large and protrude spontaneously. They are usually always prolapsed and present with ulcerations.
Etiology of the hemorrhoidal condition
The main causes of hemorrhoids are:
* The constipation. With this disorder, a vicious circle is established, since the efforts necessary for a defecation made difficult by intestinal laziness are painful and therefore many people stop regularly proceeding with the evacuation of feces, thus intensifying the problem.
* Hemorrhoids can be a sign or symptom of another disease. Like all veins, the venous capillaries in the rectal and anal region can dilate and form varicose veins, because the blood they carry is blocked at the bottom, that is, on its way back to the heart. There may be an obstruction due to heart conditions or liver cirrhosis (this disease should be treated and cured so that rectal or anal varicose veins disappear).
* Sedentary occupations, efforts during work or the need to stand for a long time influences its appearance. The drainage system in this area lacks valves, so the man's erect position increases the pressure inside the hemorrhoidal veins and predisposes to the disease.
* Obesity, sneezing and straining when defecating are other causes that produce an increase in pressure and can cause hemorrhoids.
* Bad habits when defecating, such as sitting on the toilet for a long time, exerting a lot of pressure on defecation.
* Diarrhea can cause irritation of the area and worsening of hemorrhoids.
* Frequent family history suggests a hereditary background or predisposition.
The most common symptoms of hemorrhoids are pain and the emission of red blood from the anus, either in the form of drops in the toilet bowl or on the toilet paper (bleeding is usually little). Itching and stinging are also common, although they are not specific symptoms of this problem.
In internal hemorrhoids, bleeding is not accompanied by pain, while in external hemorrhoids pain is very common.
Hemorrhoids that protrude from the anus can be inserted manually and sometimes by themselves. In the case of prolapsed hemorrhoids, hemorrhoidal ulcerations of the overlying mucosa may appear, which in turn are a potential source of local infections. Pain, as we have said, is not always present. A sharp pain when defecation occurs can indicate the presence of an anal fissure (tear in the skin of the anal canal). Another sign is mucus discharge and the feeling that the rectum is not completely empty.
The treatment consists of hygiene and lifestyle measures, dietary measures, pharmacotherapy and surgery.
Hygiene and lifestyle
In this section it is advisable to:
* Warm water baths (3-4 a day), for 10-15 minutes.
* The application of bags with ice also causes improvement.
* In defecation, it is very important to avoid repressing the desire to go to the bathroom; try to make a bowel movement a day, always avoiding diarrhea; avoid straining, as well as spending too long in the bathroom.
* If hemorrhoids prolapse (come out of the anus), it is best to try to return them to their original position by applying light pressure with your finger.
It is very important to correct the intestinal habit, especially constipation. In the event that this problem exists, it is important to offer the patient health education on diet and lifestyle, focused on restoring the normal function of bowel evacuation, without producing excessively soft stools or the very urgent need to evacuate.
Incorporating fiber in the diet is essential to avoid constipation. Fiber is a constitutive element of the cell walls and intercellular structures of plants. It is also one of the most abundant components of nature and although our digestive system does not have enzymes that can disintegrate it, it serves to give body and volume to the bolus and finally to the fecal matter, that is, it plays an important role as a regulator of intestinal activity.
The health benefits of fiber are many, although its excessive consumption can prevent the use of energy and minerals such as iron, zinc and calcium. It is also a notable cause of anemia, abdominal pain, nausea, gas, and even diarrhea.
It is best to gradually include fiber in our diet, until the natural bacteria in the digestive system get used to its presence. It is recommended to eat 15 to 20 g of fiber daily. In parallel to the increase in the fiber content of the diet, it is recommended that there be an increase in the amount of water ingested.
In the pharmacotherapeutic arsenal indicated in the symptomatic treatment of hemorrhoidal disease, laxatives are included, to address a possible underlying constipation, and topical antihaemorrhoids.
In the case of administering laxatives, it is advisable to first opt for a mass-forming laxative, which absorbs water and increases the size of the fecal bolus ( Plantago ovata , methylcellulose and bran). If there is no response from the patient, a lubricant or emollient laxative will be recommended, with anionic surfactants that soften the fecal bolus (docusates and paraffin oil).
The use of suppositories could be indicated for internal hemorrhoids, although their many disadvantages must be taken into account (in bedridden patients they can leave the affected region and ascend through the rectum and lower colon, have a slower onset of action, etc. .).
calamine, zinc oxide, cocoa butter, petroleum jelly, etc. They form a barrier on the skin's surface that helps prevent irritation and loss of moisture from the skin.
calamine, zinc oxide, witch hazel, etc. They produce protein precipitation when applied to mucous membrane or skin that has been eroded or damaged. They relieve irritation and inflammation.
* Anti-irritants or soothing:
menthol, chlorophyll, etc. They are those products that cause a sensation of freshness in the area, which alleviates the sensation of stimulation of the nerve endings, reducing the painful sensation.
* Healing agents:
cod liver oil, Peruvian balsam, vitamins A and D. They promote healing and regeneration of the damaged area.
Consult your GP first.
Sometimes surgery is necessary, although this option should only be used when pharmacotherapeutic treatment and health and food education have not been successful or if complications have already appeared. There are different techniques:
* Band ligation.
* Laser coagulation.
* Sclerosing through injections.