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Hemorrhoids are one of those diseases that, while relatively easy to treat, are a huge problem. Suffering from ailments around the anus, many people are simply ashamed to talk about it. The intimate taboo of excretion is stronger than the pain and discomfort. Meanwhile, if we go to a doctor with the problem immediately, the chance of healing the hemorrhoids is very high. Unfortunately, in most cases, patients come to hospitals in an advanced stage of the disease. How to recognize it and how to react so that it is not too late?
What are hemorrhoids?
Hemorrhoids, or rather enlarged hemorrhoids, are densely intertwined structures of blood vessels in the rectum, and more specifically in the rectal mucosa. The term itself comes from Greek and literally means “bleeding”. This is also how hemorrhoidal ailments manifest themselves – the most common concern is the sight of bright red blood on toilet popes and around the stool, as well as eczema, burning sensation and the feeling of incomplete bowel movements. Although no official statistics are kept, specialists estimate that hemorrhoids at various stages of development may suffer from every second Pole after the age of 30.
Hemorrhoids play an important role in the excretion process, and the task of the vascular plexus is to seal both the rectum and the outer and inner walls of the anus as much as possible. Often in the literature, nodules are also referred to as pillows, which form an anastomosis of connective tissue, smooth muscles and blood vessels called sinusoids. In a healthy person, during pushing, or in women during childbirth, due to the pressure generated, they fill with blood, swelling accordingly and closing the anal canal. Hemorrhoids occur only when this process is disturbed and the oxygenated blood accumulated in the hemorrhoids does not find an outlet and pushes them out.
The causes of hemorrhoids
Although haemorrhoids are a disease occurring on a mass scale, its genesis has not been established so far. There is no doubt, however, that there are a number of factors that objectively increase the likelihood of malfunctioning of the lower excretory system.
First of all, hemorrhoids can occur regardless of the patient’s age and sex, and are mainly favored by a sedentary lifestyle, low-fiber diet, and pregnancy. The prolonged state of increased pressure in the abdominal cavity is caused by a pressure imbalance in the venous system caused by a lack of physical activity or an excess of activities that cause pressure around the anus. Hence, collages, drivers, horse riders and desk workers often struggle with hemorrhoids.
One of the hypotheses is also a genetic factor, namely the lack of valves in the rectal veins. Understandably, the risk of pathological changes in the haemorrhoids also increases with age (weaker muscle tone) and with the patient’s weight (pressure on the intestines). Very often, haemorrhoidal symptoms occur during the above-mentioned pregnancy and are the result of the increased pressure that the fetus exerts on the abdominal cavity of the woman. Fortunately, in most cases, the worsening of the disease occurs periodically and ends with the time of birth. Regardless of the age and condition of the body, it is also important to hydrate the body regularly, because too little fluid translates into constipation and additional stress on the intestines, which can stretch the rectal mucosa.
An additional factor that increases the risk of hemorrhoids is chronic diarrhea and anal sex.
Types of hemorrhoids and degrees of disease development
Due to the place of occurrence, hemorrhoids can be divided into internal and external. The former are less dangerous and their occurrence is related to the swelling of the soft tissue around the anus. If a blood clot occurs, there can be severe pain, usually lasting up to three weeks. Larger external hemorrhoids cause an unpleasant itching sensation around the anus, sometimes turning into a wart when healed. Increased mucus secretion is also observed at this stage. External hemorrhoids can turn into perianal eczema, which is an inflammatory skin disease, if not properly treated and the patient does not care for hygiene.
The second type of hemorrhoids is called internal and is most often characterized by painless rectal bleeding and blood around the stools (hematochezia). In the first stage of development, hemorrhoids are not visible externally, therefore the disease is often ignored as not very bothersome. This does not mean, however, that the haemorrhoids cannot be seen – if the first disturbing symptoms appear, the degree of their development is determined during a visit to a proctologist who performs an anoscopic examination, and, if necessary, a more detailed examination – with a rectoscope. In the second stage of development, haemorrhoids tend to fall out temporarily during pressure. It is accompanied by intense burning and a feeling of incomplete bowel movements. In the third stage, the cushions also fall out of the anus during increased physical activity, although they can still be inserted into the intestine with a finger. They are accompanied by increasing pain, they are also beginning to be felt on the outside. In the fourth and last stage of the disease, the nodules spontaneously fall outside the anus, without the possibility of introducing them inside. There is intense bleeding, uncontrolled defecation and itching. In this case, an operational intervention is necessary.
Examination of hemorrhoids
The development of hemorrhoids, which are easy to stop in the early stages of development, is caused not only by the “shame” of the problem, but also the fear of being examined. Completely wrong. Before starting the whole process, the doctor should give the patient a laxative or a bowel irrigation to avoid unnecessary pressure from the stool accumulated during the day. After returning to the office, the patient takes off the lower part of his clothes and is subjected to a finger exam by painless pressure on the external area of the anus and its canal. For the patient’s comfort, a lubricant is also given to minimize friction. If it is necessary to examine the inside of the intestine more thoroughly, the doctor uses an ano- and rectoscope, which are small speculae that allow for the expansion of the intestinal walls.
During the examination, the patient may assume one of the three positions – turned on his side with contracted knees, the «cycling» position – by squatting towards the doctor or sitting on the gynecological chair. Due to the comfort of patients, the most common position is currently lying on the side. During the examination, it should be remembered that for the doctor there is absolutely nothing embarrassing about it, and the rectal examination is one of the routine activities that allows to detect not only hemorrhoids, but also other, more dangerous forms of rectal diseases (e.g. colorectal cancer). As soon as we notice the first symptoms of hemorrhoids, there will be blood on the toilet paper and unpleasant itching during the expulsion – we should immediately refer to the family doctor who, if necessary, will write a referral to a specialist proctologist. This disease can be cured at an early stage without the need for surgical intervention, mainly by changing the diet, lifestyle and the use of appropriate ointments or suppositories. Let no shame be a factor for which we will pay with serious problems in old age.