Hemorrhoids (piles) are swollen veins dilate the anus and rectum, which can cause pain, itching and bleeding anal. In this paper we will address the causes, symptoms and treatment of hemorrhoids.
What are hemorrhoids?
The end of the digestive tract consists of the rectum, anal canal and anus itself. As in any other part of our body, this region is vascularized by arteries and veins are called hemorrhoidal arteries and veins.
Most of our veins contain valves that help blood to always follow the same direction, preventing their return even when it is against the natural flow of gravity.
For example, blood in the veins of the leg against gravity always runs, thanks to the sleeves, get to go up without being detained in the legs.
When veins become ill and their valves fail, varicose veins arise, tortuous veins where the blood is congested. Unlike the rest of the body’s veins, the hemorrhoidal veins have no valves to prevent blood stagnation.
Therefore, any increase in pressure in the veins promotes their congestion. Hemorrhoids are like varicose veins of the hemorrhoidal veins. As in any varicose vein, the blood stopped increases the risk of thrombosis and inflammation of the veins.
Therefore, hemorrhoids are dilated veins of the rectum and anus, which can be accompanied by inflammation, thrombosis and bleeding.
Hemorrhoids are classified as:
- Internal hemorrhoids: they occur in the rectum.
- External hemorrhoids: they occur in the year or at the end of the anal canal.
Internal hemorrhoids are classified into four grades:
- Hemorrhoids grade I do not prolapse through the anus.
- Hemorrhoids Grade II prolapse through the anus during bowel movements, but do not return to its original position spontaneously.
- Grade III hemorrhoids: prolapse through the anus and its reduction can only be achieved manually.
- Hemorrhoids Grade IV are prolapsed through the anus and its reduction is not possible.
Internal hemorrhoids are not visible grade I 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, these hemorrhoids usually do not cause pain.
External hemorrhoids are easily identified and often inflamed causing pain and / or pruritus (itching).
Causes of hemorrhoids
Hemorrhoids are a very common disorder. It is estimated that more than half the population above the age of 50 suffer from hemorrhoids in varying degrees.
The main risk factors are:
- Intestinal constipation (constipation)
- Effort to evacuate
- Chronic diarrhea
- Hold the stool frequently, avoiding defecation whenever there is desire
- Diet low in fiber
- Family history of hemorrhoids
- Cirrhosis and portal hypertension
- Stay for long periods sitting on the toilet (some believe that the very design of the toilet causes the formation of hemorrhoids).
The habit of crouching evacuate, common in the Middle East and Asia, is associated with a lower incidence of hemorrhoids. Apparently, sitting evacuate, as most of us do regularly, can increase the incidence of hemorrhoids.
Regardless of the risk factors, hemorrhoids form when there is an increased pressure on the hemorrhoidal veins or weakness in the wall tissues of the anus, responsible for the support thereof.
Symptoms of hemorrhoids
Hemorrhoids can be symptomatic or not. As already stated above, the internal tend to be less symptomatic. The only signal indicative of its existence may be the presence of blood around the stool to evacuate.
Bleeding hemorrhoids are typically a small amount of blood that remains alive around the stool. Sometimes the patient may notice drops of blood on the toilet after completion of the evacuation. It is common to have blood on toilet paper after cleaning.
Internal hemorrhoids can cause pain if there is a thrombosis or when the effort to evacuate chronic causes the hemorrhoid prolapse out into the anal canal. Internal hemorrhoids grade III and IV may be associated with fecal incontinence and the presence of a shift mucus, causing anal irritation and itching.
External hemorrhoids are usually symptomatic. Are associated with bleeding and pain during bowel movements and when sitting. In cases of thrombosis of the hemorrhoid, the pain can be intense. Itching 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 the bleeding from hemorrhoids without consulting a doctor. Several diseases, such as anal fissure, rectal cancer, diverticular disease and infections may also present with blood in the stool.
Moreover, nothing prevents the patient has hemorrhoids and other disease that is also accompanied by anal bleeding, such as cancer, for example. Therefore, all anal bleeding should be evaluated by a physician, preferably proctologist.
Bleeding from hemorrhoids is usually mild, but, if frequent, can lead to anemia.
Do hemorrhoids can lead to cancer?
NO. Hemorrhoids NOT BECOME CANCER. However, the symptoms can be similar to intestinal tumors, particularly in cancers of the rectum and anus. It is therefore important to establish the differential diagnosis, especially in patients over 50 years. Reinforcing the recommendation: all anal bleeding should be evaluated by a doctor.
Diagnosis of Hemorrhoids
In the external hemorrhoids, physical examination is sufficient for diagnosis. In the internal, you need a digital rectal examination and, if in doubt, anoscopy (a mini endoscope where it displays the video straight).
In long-lived patients with rectal bleeding, although it has identified the presence of hemorrhoids, you should perform a colonoscopy to rule out other causes. Since hemorrhoids are very common in this age, nothing prevents the patient has a second cause for the bleeding, such as bowel cancer or a diverticulum.
Treatment of hemorrhoids
During crises, sitz baths with warm water can provide relief from acute symptoms. In pregnant women warm moist compresses suggest. They should also avoid cleaning the anus with toilet paper, giving preference to the bidet or a gush of warm water.
People with intestinal constipation (constipation) are shown laxatives to reduce the need for straining at stool.
You can use ointments and creams for hemorrhoids, since they serve as a lubricant for the passage of stool and usually contain anesthetics in its formula. The relief is only temporary and should not be using these creams indefinitely without medical guidance.
Corticosteroid suppositories are another option when there is much 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 high in fiber reduces the incidence of bleeding and can also relieve itching. While avoiding spicy foods is a popular recommendation, there is evidence that the sharp worsening of symptoms. This should be assessed individually.
In small thrombus hemorrhoids, treatment can be done in a doctor’s office with a small incision under local anesthesia to remove clots. This is sufficient for the relief of symptoms.
Treatment – Hemorrhoids
In more severe cases, it may be necessary rubber band ligation. Rubber is introduced at the base of the hemorrhoid, causing strangulation and necrosis of the same. After some days the hemorrhoid “falls” and itself comes from the anus along the elastic. This technique can be applied to the proctologist’s office itself. Usually painless and often not even use anesthesia.
Another option is sclerotherapy. Consists in injecting a chemical solution that causes necrosis of hemorrhoids. A third option is laser coagulation. Of the three techniques, rubber band ligation is the one with best results.
If minimally invasive techniques do not work, or if the hemorrhoid is very large, treatment should be done with traditional surgery, called hemorrhoidectomy.
Hemorrhoids Treatment – THD
THD – com Doppler probe and suture agulha
A new treatment option for hemorrhoids is guided transanal haemorrhoidal dearterialization Doppler (THD), a technique established in 1995 and perfected over the years.
The technique involves insertion of a small Doppler (ultrasound) in the year to identify hemorrhoidal arteries, through a small needle, these arteries are so saturated that reduce blood flow that reaches the regions where hemorrhoids . Upon reaching less blood, the pressure inside the hemorrhoids decreases, so that they are “dry”.
The technique THD has no cuts and bleeding risk is low. The postoperative pain is less technical than in court, and there is low rate of recurrence of hemorrhoids. Recovery time is shorter and the patient returns to normal activities within 48 hours. The procedure is performed under local anesthesia and mild sedation.
The THD is a relatively new and as yet no studies comparing long-term efficacy with older techniques, however, the tendency is to become the method of choice in the treatment of hemorrhoids.