Hemorrhoids – hemorrhoid disease
The hemorrhoid disease is as often and as old as the human race. The exact number of patients is not known. It is assumed that about 50% people have symptomatic hemorrhoids during some period of their life. The prevalence ( exact number of diseased persons in some population in a given time frame ) in the USA is between 4.4% and 39%. Although the young also suffer from this disease, most of the diseased are in the age group of 45-65 years. In our country there is no precise data, but it is assumed that there is no one older than 50 years that did not have at least once in their lifetime some kind of problems with hemorrhoids.
Hemorrhoids are a normal anatomic structure of the lower part of the colon. They consist of blood vessels, smooth muscle stacks and fibrose tissue. They have their function in the preservation of continence (keeping in gases and liquid stool ), and during the strain of defecation, they fill with blood and lower down into the upper part of the anal canal, thus protecting it from mechanical injuries. When dilatation of the blood vessels occurs and the muscle connections weaken, the symptoms occur. Then we say that someone has the hemorrhoid disease, and only then do we start the treatment.
The factors that lead to the disease are constipation, long term use of laxatives, sitting in the toilet for a long time, poor physical activity, obesity and bad eating habits. Heredity plays a great role – the weakness of the connective tissue in the walls of the veins. That is the reason that often someone has varicose veins and hemorrhoids.
Depending on the localization, hemorrhoids are divided into internal and external. The border between them is the so called zig-zag line 1,5 – 3cm from the anal edge. The internal hemorrhoids are above this line, and the external below. Depending on the localization we have different symptoms. The most common are itching, bleeding, pain and falling out of the hemorrhoid knots.
Depending of the intensity of the symptoms and clinical appearance of the disease, we have four stages. The first stage is characterized by itching and sporadic bleeding. The hemorrhoid pillows are in the anal canal in this stage, and can not be seen externally. To diagnose them, we must use an ano-scope. They are treated conservatively. In the second stage the hemorrhoid pillows fall out of the anal opening during defecation, and return spontaneously. There is almost always bleeding after defecation. In the third stage the symptoms are stronger because the hemorrhoid pillows do not return by themselves into the anal canal. Then the pain can occur. In the fourth stage the enlarged internal hemorrhoids are out of the anal canal all the time, the external hemorrhoids can enlarge, and the symptoms are greater. In this stage, the disease is treated surgically.
The treatments can be different and there are a number of them. Usually it begins conservatively. The goal is the diminishing of the symptoms, although it can be an integral part of other ways of treatment. Conservative methods of treatment are adequate eating habits, local application of creams and suppositories, and tablets. Meals rich in fibers, fruit, vegetables and fluids can significantly lessen the symptoms. But most of all, the stools must be regular and soft.. Fast food must be avoided, manufactured meat products, fatty food, spices, pepper, vinegar, mustard and hot food, as well as alcohol and carbonated beverages. The lack of physical activities, and sedentary habits are today blamed for the increased number of people with this disease. Physical activity has a stimulating influence on the regular defecation habits, and improves the blood circulation in the anal canal.
Creams and suppositories do not treat the disease, but decrease the symptoms. Progress in treatment was made in1925 when Diosmine was extracted from a plant. Diosmine increases the tonus of the veins, decreases capillary permeability, inhibits the aggregation of platelets, improves blood viscosity, eases lymph drainage and inhibits the anti-inflammatory answer, and thus diminishes the existing symptoms and lessens the possibility of their appearing again. There are a lot of different preparations of diosmine in the market which differ among themselves in the concentration of diosmine and the way it is made. The most comfortable therapy is with clean co-aggregated diosmine in the concentration of 600mg in one tablet.
When conservative methods do not help, other procedures are optional: sclerosation, placing of elastic ligatures by Baron, infra red coagulation and laser coagulation. Surgical method like the Doppler led binding of the arteries ( THD ), ligasure hemorrhoidectomy and stapler hemorrhoidectomy are usually reserved for the III stage of the disease. The classic surgery is reserved only for the IV, and sometimes for the III stage of the disease, as well as for those patients that do not respond to previous methods of treatment. Fortunately, only 10% of patient get treated in this way.
Most patients with bleeding or pain in the anus do not visit the doctor, but take different preparations for treating hemorrhoids. There are other benign diseases of the anus and rectum that have similar symptoms, but are treated differently, among which most common is the fissure We have to think of the cancer of the colon, so that we do not miss the right time for the right treatment. The biggest mistake is to label the symptoms to hemorrhoids without previously examining the patient. That is why a doctors examination is mandatory, and when older patients are concerned, colonoscopy is recommended.