Hemorrhoids (lat.noduli haemorrhoidales) are spongy cushions in the anal canal, filled with blood. They have a role of finely closing the anal canal, and alongside the inner sphincter, they help control defecation.
They are covered with mucous tissue that includes smooth tissue which enables us the differentiation between formed stool, liquid stool and gasses. They become pathological when they get swollen, become inflamed or thrombosed, which is called hemorrhoidal disease.
Causes – Risk factor
Hemorrhoidal disease is a modern age disease. Alongside genetic heredity, bad habits play an important role: bowel disorder (diarrhea/constipation), obesity, lack of physical activity, prolonged sitting, irregular and inadequate nutrition (spicy, fat, dry, without residue). Those are also states with elevated pelvic pressure and pressure in the abdomen; pregnancy and birth, chronic cough.
Hemorrhoidal cushions are not swollen veins – the cushions are made of connective and sinusoid vessels – a shunt between arteries and veins.
Mechanism of the formation of the disease is connected with insufficiency (weakened function) of the valve mechanism inside the arterial-venous shunt. Blood transported via arteries cannot be furtherly transported by the venous part of the shunt into venous bloodstream, which leads to the enlargement of the node. With time, elastic supportive and muscle tissue of the enlarged hemorrhoidal node weakens, and it gradually descends towards the external opening of the anus. Physiological function of hemorrhoids weakens and typical symptoms of the disease occur.
- itching, excessive moisture and perianal dermatitis
- pressure and stinging in the anus
- bleeding – fresh blood in the stool, on the toilet paper
- pain and swelling – due to inflammation and thrombosis
- prolapse of the nodes through anus
The only therapy that effectively treats enlarged hemorrhoids is surgical (surgery).
It is common in the first stage of the disease to start the treatment with conservative therapy. It consists of hygienic-dietary measures, regulation of stool and use of symptomatic medications (creams, suppositories, compresses, baths, teas).
It is important to emphasize that conservative treatment alleviates problems only for a short period of time, but does not solve the problem permanently.
Moreover, healing and postponing of the definitive steps can only worsen the basic disease!
Choice of surgical method depends on the stage of the disease and surgeon’s expertise.
Grade I – mildly enlarged hemorrhoidal node accompanied by some of the symptoms
Grade II – significantly enlarged hemorrhoidal node, no prolapse through anus
Grade III – enlarged hemorrhoidal node with prolapse, but can be repositioned
Grade IV – prolapse of hemorrhoids through the anus, without the possibility of repositioning