HEMORRHOID DISEASE

What are hemorrhoids?

Hemorrhoids represent an anatomical element of the anal canal that ensures its tightness, that is, they are continuous for gases and liquids. They are made of blood vessels, mostly venous, smooth muscle and elastic fibers and connective tissue. They are located submucosally. We speak of hemorrhoidal disease when certain changes in this formation cause certain complaints, symptoms and signs of the disease. Depending on the position in relation to the serrated line, we distinguish between internal and external hemorrhoids.
Internal hemorrhoids are caused by the expansion of the terminal veins of three basic hemorrhoidal nodes in the submucosa of the lower third of the rectum. Over time, they increase in size, push down, losing elasticity.

Internal hemorrhoids

Internal hemorrhoids are located under the mucous membrane, above the tooth line. They are covered with transitional and columnar epithelium and according to their expression, we divide them into four grades. The first degree is slightly enlarged hemorrhoidal nodules without any complications. Second degree hemorrhoids prolapse during defecation, but then spontaneously return to their normal position. The third degree requires digital reposition of the prolapse after defecation. Fourth degree impossible reposition, constantly prolapse through the anal opening.

If microorganisms are found in the urine during the examination, and there are no complaints, it is considered that the infection does not require treatment, but that it is important to take preventive measures and regularly monitor the condition of the urinary system. However, if complaints occur, it is mandatory to visit a doctor and do a laboratory analysis of urine in order to determine adequate therapy.

External hemorrhoids

External hemorrhoids represent a varicosely expanded external hemorrhoid complex, below the level of the dentate line, they are covered by squamous epithelium with rich skin sensitive innervation (that is why thrombosis of external hemorrhoids is very painful).

Causes of hemorrhoids

The cause of hemorrhoidal disease is chronic constipation, obesity, hereditary predisposition, insufficient intake of fiber-rich food, pregnancy, prolonged sitting and standing, and the most common symptoms of the disease itself are pain, bleeding, itching, swelling, increased secretion of mucus.

Treatment of hemorrhoids

Hemorrhoids require treatment only in severe cases. It is necessary to rule out the existence of other diseases (carcinoma, polyps, fissures and inflammation) through a detailed and systematic endoscopic examination (anoscopy and colonoscopy). Treatment can be conservative (use of ointments, creams, drugs), reserved for the first and second stages, while the third and fourth stages require operative treatment. Operative treatment involves excision of enlarged nodes and connection of blood vessels. Operations are performed under general anesthesia, and the complications that occur are postoperative pain, urinary retention, fecal impaction, bleeding, infections and stenosis. In addition to classic resection methods, there is laser hemorrhoidoplasty (LHP), a method that uses a probe to apply heat energy that leads to sclerosing of blood vessels. It belongs to the group of minimally invasive procedures, the cut is millimeter, there is no removal of tissue from the anal canal, therefore complications are much less frequent, and there is almost no pain. The operation is performed as part of a one-day surgery (the patient goes home the same day).