Normally, in humans, there are spongy vascular networks in the last part of the large intestine that opens to the outside. Hemorrhoid disease occurs with the expansion of these structures, called hemorrhoidal veins, located in the anus (anus) and rectum (the last part of the large intestine).
Hemorrhoidal veins have important functions in the body:
- Normally, the blood accumulating in these vascular networks ensures complete closure of the anus. Thus, hemorrhoidal veins help to control defecation even if the person does not voluntarily contract the muscles that control the anus.
- It functions as a protective cushion layer on the muscle ring we call the sphincter surrounding the anus.
- Rest. and during sleep, it completely closes the anus (breech) and prevents feces from leaking out.
Hemorrhoidal veins are divided into two as external and internal according to their location. External hemorrhoids are located around the anus and are covered with thin skin. Internal hemorrhoids are located inside the anus and covered with mucosa.
WHAT IS HEMORRHOID DISEASE?
Excessive expansion of the spongy hemorrhoidal veins in the anus and rectum and sometimes protruding from the anus. Its overflow is called hemorrhoid disease. External and internal hemorrhoids may be separate hemorrhoidal diseases. If clotting (thrombosis) occurs in external hemorrhoids, the patient feels great pain. Internal hemorrhoids, on the other hand, manifest themselves with more bleeding.
CAUSES OF HEMORRHOIDAL DISEASE
One of the main causes of the disease is high pressure in this area due to the fact that people stand on two feet. It is filled with blood. Hemorrhoids are very rarely seen in creatures that live on four legs. When factors that increase intra-abdominal pressure are added to this situation, the likelihood of hemorrhoidal disease increases. Factors that transfer intra-abdominal pressure:
- Constipation
- Chronic cough
- Pregnancy
- Obesity
- Severe removal
- Prostate disease
WHAT ARE THE SYMPTOMS OF THE DISEASE?
- Bleeding during defecation
It is the most common symptom. It is bright red in color, often fresh in drops. on the stool and t Blood may be noticed during cleaning.
- Protrusion of the anus during defecation (defecation), palpable swelling.
The patient complains of a soft swelling protruding from the anus. , complains about the mass. Some patients may push this protruding swelling back into the anus.
- Itching in the anal area (anus)
The hygiene of the anal area is affected by the hemorrhoidal veins not being able to perform their normal functions. it breaks down. When the anus does not close completely, feces and discharge leakage occurs. Due to this, itching occurs.
- Pain
Patients cannot fully express these complaints. They may describe it as a feeling of pain, stinging or burning. Especially thrombosed external hemorrhoids (blood clot formation in the vein) cause severe pain.
- Swellings that constantly remain outside the anal canal (anus) and are painful to touch
It may develop as a result of internal hemorrhoids protruding from the anus, or it may occur when external hemorrhoids become thrombosed.
HEMORRHOID EXAMINATION
The anal area of the patient is in the side-lying position, standing or leaning forward on the knees. It is first examined visually, and then the examination is completed by inserting the finger into the anus. This examination is usually sufficient to diagnose hemorrhoids. However, since hemorrhoid-like complaints can also be seen in diseases such as colon cancer and there may be other diseases that cannot be detected during examination along with hemorrhoids, an endoscopic examination must be performed before starting the treatment.
Endoscopic examination is the process of direct visual examination of the layer covering the inside of the large intestine with the help of a camera. If this procedure is performed only for the anus, it is called anoscopy, if it is performed for the rectum and sigmoid colon, it is called rectosigmoidoscopy, and if it is performed for the entire large intestine, it is called colonoscopy.
In a patient complaining of blood in the stool, at least rectosigmoidoscopy should be performed for differential diagnosis. Otherwise, other diseases that may cause bleeding may be overlooked. For example, if an early stage colon cancer that causes bleeding during defecation is not noticed and is treated incorrectly as hemorrhoid disease, it can cause serious health problems in the future. It should not be forgotten that it may cause k problems. For this reason, endoscopic examinations should be used for differential diagnosis.
Many disorders may occur with bleeding during defecation as the first symptom. Large intestine cancer (colon and rectum cancer), large intestine polyps, anal fissure, inflammation (abscess), fistula formation, inflammatory bowel disease (ulcerative colitis and Crohn's Disease), intestinal prolapse (prolapse), fecal incontinence ( incontinence), itchy rectal disease, irritable bowel syndrome, sexually transmitted diseases and many other conditions can affect this area. Therefore, differential diagnosis is very important and should be made by a specialist doctor
DO HEMORRHOIDS CAUSE CANCER?
No. However, constipation caused by cancer may lead to hemorrhoids, or cancer may also be present along with hemorrhoids. For this reason, an endoscopic examination should be performed without wasting time.
HEMORRHOID TREATMENT
The treatment method and time should be decided by taking into account the area affected by the disease (internal or external hemorrhoidal disease), the stage of the disease and the severity of the complaints. .
Medical treatment
It is the elimination of hemorrhoid symptoms with some precautions and medications, without surgical intervention to the patient:
- Regulation of defecation habits.
Regular defecation habits are important for treatment. Avoiding sitting on the toilet for long periods of time (smoking, reading newspapers, etc.) and excessive straining reduces the tension and pressure on the hemorrhoidal veins, thus preventing hemorrhoids from coming out of the anus.
- Regulating the diet
Increasing the proportion of fiber (fibre) in meals and adopting regular defecation habits may help. Another important issue is drinking enough water. You should drink at least 10-12 large glasses of water a day. Fruit juice, coffee and tea do not replace water.
- Sitz bath
Sitting in warm water for 10 minutes several times a day reduces symptoms (symptoms, complaints). . After the sit bath, the anal area should not be left wet and should be kept dry. With this treatment, even the most severe hemorrhoids experience pain relief within 2-7 days. and hard swellings palpable around the anus regress within 4-6 weeks.
- Cream-Pomade applications
There are many pomades used in the treatment of hemorrhoidal disease. Your doctor may recommend you an ointment depending on the condition of the disease.
- Phlebotropic drugs
They control the blood flow of the veins in the anal area and prevent excessive swelling, making hemorrhoidal disease normal in a short time. There are medications that make it easier to return to normal. These drugs should be used under the supervision of a doctor
Surgical Treatment
Surgical treatment is required in hemorrhoids that do not respond to medical treatment or in advanced stage hemorrhoids.
- Ligation with Rubber Band Method (Band Ligation)
It is used in the treatment of internal hemorrhoids. It is applied to hemorrhoids that protrude and bleed.
- Injection (Sclerotherapy)
It is used in the treatment of internal hemorrhoids that do not come out from the anus and cause bleeding complaints. A liquid (phenol solution) is injected into the hemorrhoidal veins. In this way, bleeding can be prevented, as well as vascular expansion and prolapse.
- Heat Coagulation
Internal hemorrhoids that do not come out of the anus and cause bleeding complaints. It is used in the treatment. By applying heat on the hemorrhoidal vessels that cause the complaint with the help of a light source, bleeding is prevented and the hemorrhoidal pockets shrink.
- Hemorrhoidectomy
It is the process of removing hemorrhoidal pockets. This procedure can be done with classical methods as well as using tools such as ligasure, cautery, ultrasonic scalpel.
- Stapler (Longo) method
Fourth stage and prolapse in the anus. These are surgeries performed using disposable instruments called staplers in cases of hemorrhoids that have caused hemorrhoids. It is a less painful and effective method, but expensive due to the cost of the equipment.
- Laser method
Most of the methods popularly known as laser are actually heat coagulation methods. In real terms, laser treatment is a less painful and effective method if applied correctly to suitable hemorrhoids. However, it is more expensive than other methods.
RISKS AND COMPLICATIONS (SIDE EFFECTS) OF SURGICAL TREATMENT
- Surgical treatment can be performed safely in hemorrhoid disease. However, although rare, some risks and complications may occur:
- In the postoperative period, there may be pain and a stinging sensation while defecating for a while.
- There may be inflammatory discharge from the wound.
- Bleeding may occur during or after surgery. Re-operation may be required due to this bleeding.
- Rarely, stenosis may occur in the anal canal (anus) after surgery. In this case, the patient has difficulty defecating. Sometimes re-operation may be required.
- After surgery, there may be a change in defecation habits and deterioration in stool control mechanisms. Improvement is observed over time.
- Hemorrhoid disease may recur after surgical treatment. To prevent recurrence, a high fiber diet should be preferred.
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