RECTAL BLEEDING
The most common causes of rectal bleeding are problems related to the structures in the anal area.
In addition, diseases of the large intestine can also cause bleeding, but problems related to the anal area
are more common.
The most common conditions in this region are hemorrhoid disease and anal fissure.
The main complaint of both conditions in patients is bleeding. The type of bleeding may
vary. While relatively darker colored blood contaminated with the stool is observed in hemorrhoid disease, bright red colored bleeding in the form of drops after defecation is more typical in the anal fissure. In hemorrhoid disease, breast-shaped bumps appear on the patient's hand in the anal area. From time to time, these bumps can be hard and painful due to blood clotting in the hemorrhoid tissues. In anal fissure, difficulty in defecation and severe pain after defecation are observed.
Apart from hemorrhoid disease and anal fissure, tumoral conditions in the large intestine may
cause bleeding. Masses and blisters seen on the surface of the large intestine (colon) and the last part of the large intestine (rectum)
may indicate cancer or may first manifest itself with bleeding
. In addition, inflammatory diseases of the small and large intestines may also cause bleeding. In every patient with bleeding from the anal area, it should be ensured that this bleeding is not due to a disease originating from the large intestine. For this reason, colonoscopy is recommended for most of the patients who apply to the physician with the complaint of bleeding from the anus.
HEMORRHOID DISEASE
Hemorrhoid tissues are normal tissues found in every person and can be internal and external hemorrhoids
structures located under the skin around the anus. Internal hemorrhoids, which are the main cause of hemorrhoid disease that requires treatment, are a pillow filled with a bundle of veins, located approximately 1.5 - 2 cm from the entrance of the anus, on the intestinal wall all around and with 120 degree angles between them. They are structures in the form of br />. When viewed from the front of the anus, they are located at the 3, 7 and 11 o'clock positions.
Their function is to open the anus at rest. It is to ensure that the area around the anus remains dry by preventing the fluids inside from leaking out. They are one of the few mechanisms
that work for this purpose. As the blood vessels inside them fill, they swell like a pillow, expand into the intestine at 3 points and close the exit. Under normal conditions, internal hemorrhoid tissues are attached to the intestinal wall with suspensory ligaments and are not visible from the outside. As a result of the stretching of these ligaments by external forces
, internal hemorrhoids hang outward and sometimes become visible from the outside, causing bleeding as a result of irritation of the surface on them.
External forces:
a. The repulsive effect of stool on straining (Constipation)
b. Prolonged gravity effect (Professions that require standing for long periods of time)
c. Prolonged cough
d. It can be listed as external pressure on the venous system in the abdomen (Pregnancy).
External hemorrhoids can also expand with the same mechanisms as internal hemorrhoids, but they do not require as much treatment as the disease caused by internal
hemorrhoids.
TREATMENT
Treatment planning is made according to the degree of the disease. According to the patient's examination findings, hemorrhoid disease is staged from one to four. While drug treatment is at the forefront in the first two stages, surgical treatment comes to the fore in the third and fourth stages. In drug treatment
drugs are used to reduce the pressure in the vessels inside the hemorrhoid tissue, while stool softening drugs are recommended to reduce edema developed in the tissue and to prevent new irritations during defecation. There are multiple options for surgical treatment:
a. Removal of hemorrhoid tissue (Hemorrhoidectomy): The hemorrhoid
tissue whose structure is not damaged cannot function as it used to, so the diseased hemorrhoid tissue is removed. Although it seems to be a method that solves the problem completely, the hemorrhoid tissues
are completely removed. Since there are no functional tissues, some problems may occur due to their deficiencies.
b. Ligation/strangulation of hemorrhoids (THD/Band ligation): The vessels that provide blood flow to the hemorrhoid tissues are identified and ligated with special devices, and with this method
enlarged hemorrhoid tissues are removed. shrinkage is achieved (THD). In addition, by placing a rubber band on the roots of the hemorrhoid
tissues and squeezing it, it is aimed to suffocate and shrink the expanded hemorrhoid tissue
(band ligation).
c. Resuspension of hemorrhoid tissues (Hemoridopexy): As mentioned before, hemorrhoids hanging on the intestinal wall hang outwards as a result of the stretching of these ligaments. Hemorrhoids can be attached to the intestinal wall again using various methods. For this, special staples (Longo) or laser (Laser hemorrhoidopexy)
can be used.
In the surgical treatment of hemorrhoid disease, patients often stay in the hospital for one night,
and can go home the next day after the surgery.
POST-SURGERY PROBLEMS
One of the problems that patients who undergo surgery may experience is bleeding in the surgery area. This
bleeding can be controlled with supportive treatments, but sometimes it may need to be stopped surgically. In addition, postoperative pain may be one of the important problems
. The pain usually passes over time and is controlled with painkillers.
During surgeries where hemorrhoid tissue is removed, contamination of the laundry may occasionally occur,
This situation is treated with anal area exercises. In hemorrhoidopexy (Longo) surgeries
very rarely, stenosis in the anus may occur; this condition must be treated with surgery.
Read: 0
