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 DEFINITION
The haemorrhoids is dilations of the veins of the venous plexuses of the mucous membrane of the rectum or of the year. If the affected ones are those of the top plexus it is called internal haemorrhoids, are located at the top of the anal conduit and are covered by mucous membrane. Those of the low venous plexus are placed below the union anorrectal and are covered by exterior skin.
The drainage system of this one area lacks valves, and for it the position erecta of the man increases the pressure inside the veins hemorroidales and therefore it predisposes to the illness hemorroidal.
CAUSES
Some causes that predispose to endure haemorrhoids are:
- Hereditary factors.
- Constipation that, on having forced the step of the dregs, compresses the veins hemorroidales.
- Diarrhea, which can produce annoyance.
- To be standing up or sat for the long time continued.
I embarrass, especially in the last weeks.
There are often familiar precedents that suggest a fund or hereditary predisposition. Also it is implied as it causes to certain anomalies of the microcirculation with communication arteriovenosa demonstrable.
The pregnancy is the most common cause of haemorrhoids in the young women. The increase of the frequency of the haemorrhoids during the pregnancy thinks that it should stem from the increase of the pressure exercised on the veins iliacas for the womb that it is increasing of size, which provokes elevation of the venous pressure inside the veins hemorroidales average and low, which must drain his blood to the veins iliacas internal. After the pregnancy, the haemorrhoids tends to disappear, although they can deteriorate in progressive form with subsequent pregnancies or with the age.
In general the haemorrhoids is primary to the constipation that is usually secondary to them and not vice versa.
The sedentary occupations, the efforts during the work or the sport, staying standing in long time, and certain food habits are the rest of the causes involved in the formation of haemorrhoids.
SYMPTOMS
The principal symptoms are the appearance of bled rectal scarcely and inconveniences on having defecated, with mucous secretion of the rectum. Sometimes it is possible to appreciate an anemia and especially the most typical thing the proper palpación of the haemorrhoids is in the year, which even can be reduced manually by the patient.
As complication of the haemorrhoids can produce a strangulation of the same ones to itself with appearance of an obscure color, due to the underlying thrombosis, and can deteriorate forming thin wrinkles in the mucous membrane, which loses his polish and turns out to be dead. The secondary intense anemia to abundant hemorrhages or to the persistence of the loss of small quantities of blood is another complication of the haemorrhoids.
DIAGNOSIS
For the haemorrhoids diagnosis we must have a few typical symptoms, of blood and secretions after it defecates, with an external anal examination or examination rectoscópico, that confirms the presence of the dilations in the rectum.
Analyses must be realized to verify the possible presence of anemia.
Since bled rectal is the most common symptom of the internal haemorrhoids, and appears also in diverse tumors of the colon and of the rectum it is advisable to realize one rectum - sigmoidoscopia, to be able to discard other illnesses.
TREATMENT
GENERAL MEASUREMENTS
- To support a good anal hygiene and to avoid to scratch or to rub the haemorrhoids to help to prepare the infections.
- To correct the constipation adding fibre to the diet: fruits, vegetables, wholemeal bread, abundant liquids.
- To correct the diarrheas.
- To avoid very seasoned meals and the alcohol consumption.
- To avoid efforts on having defecated. To reduce the defecation time. To use soft toilet paper or anal cleanliness by means of bath with lukewarm water
- To apply ice or cold compresses in the sharp phase of the disorder. The cold will make to diminish the distension.
- To give him then warm baths in the area two or three times a day. This sequence I fry - heat is a way of relieving temporarily the pain for external haemorrhoids.
The asymptomatic haemorrhoids does not need treatment. It must be avoided pushing during the defecation to diminish to the maximum the bled one and the prolapse. The suppositories and the rectal ointments are of scarce value in the treatment of internal haemorrhoids, only they have effects of transitory anesthesia.
If the haemorrhoids prolapsadas is reducible they will have to be pushed to the interior of the rectum by means of soft pressure, the patient must go to bed and reduce the protrusion whenever it is necessary.
After the reduction, the external inflammation will disappear.
When the haemorrhoids has been reduced, they will be able to be supported in his position by means of compresses. If the picture is very sharp frozen compresses soaked with water will be applied Later seat baths will be prescribed in lukewarm water (never warm).
The haemorrhoids that appear after the childbearing or in the puerperio they will not have to talk each other surgically but until sufficient time has happened to determine if they persist or not.
The haemorrhoids that stand out on the outside, irreducibles, trombosadas, inflamed or gangrenadas they will have to talk each other by means of surgery. The surgery offers a more rapid solution of the symptoms and the convalescence is short.
The treatment with injections esclerosantes is realized by means of the injection of irritating chemical substances (sometimes it is possible to realize for freezing) in the textile that surrounds the varicose veins hemorroidales internal. The healing resultant from the inflammatory reaction produces the fibrosis of the varicose veins hemorroidales. The recurrencias are 50 % of the patients. This treatment is indicated if the haemorrhoids is initial, not complicated and internal. The complications of the treatment of injections are the infection and prostatitis sharp.
The surgical treatment is realized by split of the whole mucous membrane that makes a detour to the haemorrhoids, producing a long-term excellent result. The recurrence is extremely rare, after a hemorroidectomia practised in suitable form.
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