Haemorrhoids

What are they

Hemorrhoids are pads of vascular tissue present in the canal. When, in certain circumstances, they undergo an oversized swelling and become inflamed, hemorrhoidal disease is triggered. In common parlance, however, the term hemorrhoids is used to designate both venous structures and their dysfunction.

In fact, the term hemorrhoids is used to refer to ectasias, that is, pathological dilatations of the veins of the rectum and anus (hemorrhoidal plexus). They are venous alterations similar to common varicose veins, and can easily become inflamed.

They are widespread in the adult population: it is estimated, in fact, that from 25 percent to half of the population over 30 years suffers or has suffered from a haemorrhoidal disease.

Men and women suffer equally. The latter are often found to have to deal with this problem during pregnancy, especially in the third trimester, or immediately after childbirth and during breastfeeding.

From the anatomical-pathological point of view, it is possible to distinguish hemorrhoids into internal and external. Internal hemorrhoids are located in the canal above that imaginary line, called the dentate line, which divides it into two parts, and are covered by the rectal mucosa. The external hemorrhoids are located lower, at the margins of the orifice, then inferior to the dentate line, and are covered with a squamous epithelial tissue.

The stages of hemorrhoidal disease

Hemorrhoids can be classified into four stages depending on the severity of the prolapse:

• Stage I: internal hemorrhoids that are not prolapsed, i.e. they do not come out during defecation. They are not visible during exertion, but are bleeding
• Stage II: prolapsed but spontaneously reducible hemorrhoids. During exertion, they become visible outside the area and immediately diminish when the effort ends.
• Stage III: prolapsed hemorrhoids requiring manual reduction. They come out of the anus during stress or defecation and remain outside until they are manually brought back inside the canal, until the next defecation
• Stage IV: hemorrhoids constantly prolapsed. They are always present outside the canal and cannot be reduced.

Onset and symptoms

The most frequent symptom is bleeding: in this case you will find bright red blood (since it has just leaked from the vessels) in the stool. Bleeding can range from a few drops to real bleeding, which in the long run can promote the development of anemia. The latter may be suspected when an unusual sense of tiredness arises. In addition, itching or pain are almost always present, due to inflammation of the affected vessels. However, pain can also be a sign of complications, both in the external and internal hemorrhoidal plexus, such as hemorrhoidal thrombosis, or other diseases such as fissures.

The symptomatic picture worsens when hemorrhoids prolapse through the anus: in this case we will have edema (swelling) and spasm of the sphincter. In addition, mucus leakage is possible, associated with an annoying feeling of wetness, and a sense of heaviness in the ano-rectal area.

To identify the most appropriate therapy and avoid further suffering, a specialist visit is indicated that includes digital rectal exploration. In this way it is possible to have more details, as well as exclude any other endorectal pathologies.

Unfortunately, we often tend to label many symptoms of relevance as hemorrhoids, when

In fact, they are not at all. In fact, in some cases they are a sign of other diseases, starting from fissures, perianal fistulas, signs of infection and abscesses in progress, warts up to rectal cancer.

Course and prognosis

The diagnosis is made by careful procotological medical examination, which involves inspection or palpation and, if necessary, the use of an anoscope, which allows to better control the hemorrhoids and the entire rectal cavity.

The course is manifested by high variability from subject to subject. However, the disorder generally presents symptomatic periods interspersed with more or less long periods without symptoms or apparent remissions.

With advancing age, the patient shows a greater tendency to worsen, due to the fact that the lesions at the base of the disease, if not properly identified and eliminated, tend to accumulate over time.

Causes

Hemorrhoidal disease is a dysfunction related to inflammation of the hemorrhoidal veins that slide outside their natural site due to the sagging of the rectal mucosa. In some cases, a blood clot (clot or thrombus) may form, which amplifies painful symptoms.

Although the true causes of hemorrhoids have not yet been well identified, predisposing or triggering factors are undoubtedly age, constipation or chronic diarrhea, obesity, pregnancy and excessive use of laxatives.

The hereditary factor, moreover, could have a certain importance. It should be emphasized that bad eating habits and sedentary life contribute to the appearance of a hemorrhoidal disease. Periods of stress and strong tension, interfering with bowel regularity, can also promote the development of hemorrhoids.

However, improper nutrition with a low intake of fiber and even more irregular defecation are probably the factors that most affect the development of hemorrhoids. Their development may depend on an increase in pressure inside the abdomen caused by efforts made during bowel evacuation rather than sitting on the toilet for a long time. Not surprisingly, those who suffer from it report having problems with chronic constipation, drinking little water, taking little fiber (fruits, vegetables, cereals and legumes) and consuming alcohol. The low intake of water makes the stool even harder and the effort necessary for their expulsion can promote hemorrhoids.

In particular, in those at risk it is necessary to avoid some foods and prefer others.

In addition, it is important to drink at least one and a half liters of water a day.

In this way the compactness of the stool and therefore constipation is reduced, facilitating defecation.

Care

According to international guidelines, the most suitable approach for the treatment of hemorrhoids should be chosen in relation to the symptoms felt by the patient. You can intervene with medical or surgical therapies, but it is also very important to act on lifestyle.

Local hygiene

In general, in the presence of hemorrhoids, the change in lifestyles, both dietary and behavioral, is the first therapeutic intervention. Local hygiene is also essential: it is advisable to bidet a few times a day with warm water and acid soap to soothe burning and itching, but without excesses. The excessive use of soaps removes the secretion of the sebaceous glands which has a protective effect on the skin and can therefore increase itching. In this case, it is advisable to replace the soap with less irritating preparations based on vegetable oils and almond oil.

Physical activity

A sedentary lifestyle can promote the development of hemorrhoids, while regular physical activity can help regularize the intestine, helping to prevent them and favoring a positive evolution if they have already occurred. Obviously in the acute phase it is better to avoid excessive efforts so as not to worsen the inflammation.

Feeding

The main recommendation on the diet plan is to increase the intake of fiber to counteract constipation, which as mentioned is one of the factors that favor hemorrhoids. Fibers make stools less hard, increase stool, accelerate intestinal transit and reduce evacuation efforts. Pepper, too many spices and spicy foods would seem to favor hemorrhoids: it is therefore necessary to limit their consumption especially if there is a predisposition to develop them.

Drug treatment

The most useful pharmacological treatments to relieve inflamed hemorrhoids are based on corticosteroids and painkillers. Some vasoprotective drugs such as flavonoids may also help. These products, to be taken by mouth, would seem to be able to increase venous tone, lymphatic drainage and capillary resistance. Often, when hemorrhoids are in the initial stage, topical preparations based on anti-inflammatories and steroids, local anesthetics or vasoactive molecules are used. The effectiveness of these ointments is however partial. Local anesthetics can control pain and itching, while creams containing steroids can exert a local anti-inflammatory action, but they do not work miracles and are generally not able to block the evolution of hemorrhoids.

Herbal remedies

As for phytotherapy, you can use remedies based on Zanthalene, an innovative active ingredient that guarantees an important soothing action, horse chestnut, which thanks to its content in escin acts as a powerful vasoconstrictor, licorice, which is considered the most effective corticoid-like of natural origin, the vine, whose active ingredients are able to collaborate in the protection of veins and capillaries.

Surgery

When the severity of the condition is such that it has a negative impact on normal daily activities, surgical treatment should be considered. There are numerous approaches, more or less invasive, which must be chosen according to the needs of the person concerned and his particular condition. In all cases they involve the removal of hemorrhoidal tissue.

There is also an outpatient approach with cryotherapy to allow healing of hemorrhoids. This method allows to select the lesions to be eliminated, both internal and external, and to isolate them from the surrounding healthy mucous membranes with a special ligature so as to act only in these areas without involving the entire wall of the rectum. With this technique you have the double advantage of being able to operate under local anesthesia and not to cause lesions to the anus.