Hemorrhoids

Definition

Hemorrhoids is a term for the dilated tissue that contain blood vessels and which is located in the anus and rectum. This disease is most common in men and women aged between 45 and 65. Hemorrhoids can be external ou internal, clots can form and may be hypertrophied.

Hemorrhoids are classified according to their degree, for optimization of treatment:

Grade 1 – The pacient presents an increase in the number and volume of hemorrhoids, without prolapse;

Grade 2 – The hemorrhoid becomes external to evacuate, but migrates to internal;

Grade 3 – The hemorrhoid becomes external but needs manual help for the ineer return;

Grade 4 – The hemorrhoidal prolapse is permanent, with no return to the interior.

Symptomatology

After evacuation, hemorrhoids tend to bleed. Usually they are painful when infected or not.

Less frequently feels an anal pruritus (itching). Alone it doesn’t mean the existence of hemorrhoids, but it’s common if the affected area is difficultto clean.

Causes

- Increase of boold pressure by evacuating with constipation;

- Hypertension can cause hemorrhoids. Any disease that increases the tension in the portal vein (cirrhosis, hepatitis, cholestasis) can be the cause of hypertension and therefore hemorrhoids;

- Obesity, increased pressure in the rectal vein;

- Pregnancy;

- Smoking;

- Excessive consumption of alcohol or caffeine. Alcohol increases the possibility of liver disease, caffeine increases the blood pressure;

- Stay standing or sitting for a long period of time;

- Hereditary predisposition.

Diagnosis

- Collect clinical anda historial information;

- Physical exam with simple procedures for classification (internal ou external degree);

- For the inconclusive cases, internal non-prolapsed hemorrhoids, it can be used rectoscopy, anoscopy  and sigmoidoscopy.

Treatment

For sclerotheraphy or by breakdown of tissue edema, that collapses veins. When there’s not an answer to sclerotheraphy it can be done a  ligation with elastic bands. With this ligation the haemorrhoid atrophy and disconnect. The laqueação is carried out each time a hemorrhoid, which make this method impratical if the paciente is suffering from several number of hemorrhoids.

The new methods for hemorrhoids destruction are: the laser, the infrared rays (photocoagulation iv) or the electrocoagulation (use of electric currents).

When all of the treatments mentioned aren’t adequate for the patient, it can be done a surgery. The hemorrhoidestomy (surgery) it the most effective treatment and the most used for achieve a long term cure.

At home the patient should have a diet without constipant food or diuretics and shouldn’t use rough toilet paper. It’s also advisable baths with warm water and the use of analgesic creams. In periods of most pain it can be used oral analgesics.