Hemorrhoids: What it is
Beneath the epithelial layer of the anal canal is a rich plexus of vascular tissue. These tortuous vessels are defined the cavernous body of the rectum. In this point the arterial vessels are connected directly to the veins without the presence of capillaries.
Vascular bearings are helped and kept in their physiological position, the upper half of the anal canal, the anus musculature.
There are three major vascular bearings (primary) in the anal canal, one left, one right rear and one front and it can also be other side.
When, for various reasons, are experiencing any bulging of the vessel walls of the hemorrhoidal plexus, then you can talk about the HEMORRHOID PATHOLOGY.
Hemorrhoids are classified as:
- First grade: They bearings inside the anal canal that can be bloody and are visible only to a anoscopy.
- Second degree: Hemorrhoids are visible outside the anus just under stress, and fall on their own when it ends.
- Third degree: The hemorrhoids protrude from the anus under stress and remain outside until it is provided manually to bring them back.
- Fourth grade: Hemorrhoids also emerge without effort and remain outside and not reducible.
Hemorrhoids: How does it manifest
The internal and external hemorrhoids may be in a different way. However, many people may have a combination of the two. A significant enough to cause bleeding anemia is rare, hemorrhage which could put in danger of life is even more rare.
Many people feel embarrassed about the condition, and often seek medical care only when the situation is now in an advanced stage.
If not thrombotic, the external hemorrhoids can cause a slight problem.However, when there is a thrombosis, they can be very painful with resolution that has typically in more than 2 or 3 days. The swelling may take a couple of weeks to disappear, and after an excrescence of skin healing may remain. If they are large and cause problems with hygiene, they can cause irritation of the surrounding skin and itching around the anus.
Internal hemorrhoids usually occur painless, bright red and rectal bleeding that occurs during bowel movements: a condition known as hematochezia. Feces, usually, they have a normal color. Other symptoms may include mucous discharge, a perianal mass if there is prolapse through the anus, itching and fecal incontinence. Internal hemorrhoids are usually only painful if they become thrombotic or necrotic.
The hemorroidal disorders can be treated at different levels, ranging from conservative treatment until any surgical treatment.
Conservative treatment typically consists in increasing the intake of dietary fiber and fluids to maintain hydration, to take non-steroidal (NSAID anti-inflammatory) and, in addition, is recommended the rest.
The increased fiber intake has been shown to improve outcomes and can be obtained by a change of diet or through the consumption of food supplements.
suppositories are also available for the treatment of hemorrhoids
- Outpatient procedures
A number of outpatient procedures may be practiced. They are generally considered safe, but very rarely can cause serious side effects, such as sepsis, perianal.
- Band ligation: is generally the first-line treatment recommended in patients with a grade between 1st and 3rd of the disease
- Sclerotherapy: involves the injection of a sclerosing agent in hemorrhoids, such as phenol;
- Selective Cryotherapy is an outpatient method that combines rubber band ligation of hemorrhoidal nodule with cryotherapy;
- Cauterization techniques: effective, but they are generally used only when other methods fail
There are several surgical techniques that can be used when conservative management and outpatient procedures are slow effects. All are associated with a certain degree of complications, including: bleeding, infection, anal stenosis and urinary retention due to the proximity of the rectum to the nerves that serve the bladder.
- Excisional hemorrhoidectomy is the surgical removal of hemorrhoids, and is mainly used only in severe cases;
- Dearterialization Doppler guided transanal haemorrhoidal: is a minimally invasive treatment that employs a Doppler signal to accurately detect the inflow of arterial blood.
- Stapled hemorrhoidectomy, also known as stapled hemorrhoidopexy is a surgical procedure used in particular for the treatment of 2nd or 3rd degree hemorrhoids;
- Dearterialization haemorrhoidal Doppler-guided laser: the operation is performed without any kind of anesthesia (only mild sedation) and consists in the closure, through the use of a 980 nm diode laser of wavelength, of the arterioles that irrigate directly venous hemorrhoidal plexus,