What are hemorrhoids?
Hemorrhoids are the result of abnormal growth of the internal and external hemorrhoidal plexuses . Or what is the same, are varices of anorectal location.
The dilation is due to an increase in pressure, usually due to excessive effort when evacuating . However, situations such as pregnancy or aging can also cause its appearance.
Depending on the plexus from which they originate, they are classified as hemorrhoids:
- Mixed or interoperable
The separation between both is established by the dentate line . The internal hemorrhoids, located in the submucosal layer and covered with mucosa, are located above it. Below it, the outer ones, covered with perineal skin.
The appearance of hemorrhoids at the expense of the two vascular plexuses is possible thanks to the anastomoses that communicate them.
Hemorrhoids represent one of the most frequent pathologies in our environment. It is estimated that more than half of the population suffers at some point in their lives.
Classification of internal hemorrhoids
- First degree: it is located in the submucosa layer, introducing itself slightly in the channel (like a small bump).
- Second grade: they excel with defecation, but they reduce spontaneously when the effort ceases.
- Third degree: prolapse also occurs with the efforts, although in this case they do not reduce spontaneously. Manual reduction is necessary.
- Fourth degree: in this case, hemorrhoids can not be reduced.
How are hemorrhoids produced?
The growth and prolapse of hemorrhoids is a consequence of a series of factors that weaken their anchoring and increase the pressure inside the plexuses.
These factors are:
- Aging, which naturally weakens the supporting connective tissue.
- Diarrhea, since it can end up producing irritation.
- Professions that require the person to remain standing for very long periods of time.
The most frequent clinical manifestations of internal hemorrhoids are pain and the burning sensation when defecating. It is common that, in addition, there is bleeding (rectal bleeding) and small protuberances exit.
Bleeding can appear in any of the hemorrhoidal degrees, and is of variable intensity. If it becomes chronic, it can cause the appearance of a . The blood is red and glistening from the hemorrhoidal plexus itself.
Bleeding from internal hemorrhoids is the main cause of rectal bleeding. Even so, it should not be attributed to them until other more serious causes of rectal bleeding such as have been ruled out.
Large prolapsed hemorrhoids can become strangulated, with thrombosis, inflammation, and even ulceration and infections. In this case, the pain is especially intense.
In the most severe cases, bad odor, gaseous incontinence and even total incontinence may occur, although it is rare.
Its main clinical presentation is thrombosis. It is characterized by the appearance of intense and constant pain, which worsens with defecation. It disappears completely after a week.
The inspection looks like bluish and inflamed nodules, in many cases even ulcerated.
Usually the clinical history and physical examination are sufficient.
It is recommended to perform a colonoscopy to determine the origin of bleeding, and distinguish benign from malignant tumors.
- Avoid spicy, spicy and high-fat foods.
- Limit the consumption of stimulant drinks, such as tea and coffee, as well as alcohol consumption.
- Follow a to stimulate intestinal transit and combat constipation. The wholemeal flour, and abundant fruit (with skin) and vegetables are especially recommended.
- Wash the area with lukewarm water for about 15 minutes after defecating. The use of soaps or shampoos that may contain flavorings is discouraged, as they are irritating.
Surgical treatment is intended for cases in which hygienic – dietary measures do not improve the picture. Likewise, it is reserved for serious cases (grades 3 and 4) and cases in which complications appear.
Hemorrhoidectomy is the surgical technique used. Currently, this technique is performed with laser, which allows local anesthesia and faster recovery.
There are minimally invasive techniques for patients with grades 1 and 2. These patients are managed on an outpatient basis. Some of the techniques used are:
- Photocoagulation, either with laser, or with infrared.