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Haemorrhoidal varices
Haemorrhoids are small anatomic structures inside the anal canal. Their name comes from a Greek word "hemorrhoides" which means the flow of blood. Their function is keeping the anus imperviousness, gasses in particular. They are in the form of bulges from mucous membrane directed to the inside, and contain numerous arteriovenous communications. The system of final arters directly becoming veins (without the presence of capillaries) produces variceal dialations in the upper part of anal canal just above anorectal line (pectinate line). They are surrounded by two circular muscles – anal contractors - inner and outer. These muscles remain tense through the most of the time. It causes the stasis of blood in haemorrhoids, their bulking, tight adherence to each other and maintaining the anus imperviousness. During the passage of the stool the contractor muscles lossen up and then blood gathered in the haemorrhoids outflows.
How does the illness appear?
The haemorrhoidal illnes developes in stages. At the begginning the arteriovenous communications grow bigger, the mucous membrane stretches, the engorgement appears, the haemorrhoids are getting bigger and are starting to bleed. The sustentacular connective tissue and Parks ligamentas are weakened which causes the fall out of haemorrhoids through the anal canal to the outside. There are 4 stages of this illness.
STAGE I
During the first stage of the ilness one can feel the pain whilst the passage of the stool. In such case we are dealing with internal haemorrhoids. The increase of vascular plexus is only temporary and the bleeding comes from the mucous membrane situated higher. They can be seen by anoscope in the shape of light convexities in the anal canal. In this stage, besides the seldom bright red bleedings, no other damage is made.
STAGE II
During the second stage blood vessels are damaged and replaced by connective tissue. The “tumours” appear, which while the passage of the stool are moved by the fecal mass downwards. That is why the bleeding is accompanied by pain. The haemorrhoids can fall out during tenesmus, but they go back by themselves. The process is accompanied by bleeding, itch and burning sensation. The patient has the impression of incomplete passage of stool which leads to a longer stay in the toilet and continous tenesmus, which increases the pain.
STAGE III
In the next stage (in cases of internal haemorrhoids) the vascular plexus loses its efficiency and tissues surrounding it are lesioned. The muscles’ contractors are weakened. In every passage of the stool the haemorrhoids fall out and sometimes they stay outside and are visible by the anal canal ostium. Usually it is possible to push them back by hand. Large haemorrhoids are pushing downwards the mucous membrane, which remaining in the outside of the intestine is liabled to constant stimulation and reacts with mucous secretion. The disease symptoms are: bleeding, the impression of engorgement and pressure, itching and soiling the underwear. The patient has problems with his personal hygene.
STAGE IV
Stage four haemorrhoids fall outside the anus and cannot be pushed back. The symptoms accompanying the process are: bleeding, itch, pain, filtration or anal incontinence.
The bleeding may appear in different ammount – from a trace one to an arterial one leading to an operative procedure.
What are the causes?
The causes of haemorrhoid disease are little known. It is not known, why in some cases the ailment does not progress, while in other cases there are some serious complications. There is also no proof for the family-related or hereditary prevalence of the disease. It is possible, though, to distinguish some of the factors conductive to the development of haemorrhoids, and to treat others as inducing.
These are:
- Bad eating habits and improper diet lacking in sufficient amounts of fibres of vegetable and fruit origin
- Insufficient amounts of liquids
- Too little exercise or lack of physical activity
- Remaining in a sitting or standing position for a long time
- A job requiring a great muscle effort
- Long-lasting and frequent obstructions (an increased effort during the pressure on the stool)
- Pregnancy and delivery
- Old age ( elastic elements of the connective tissue in a submucosa layer of rectum disappear at that time)
- Some disease changes, such as the presence of big tumours in abdominal cavity and pelvis minor, liver cirrhosis (30% of cases)
- Diarrhoeas
- Frequent vomiting
- Cardiac failure
- Arterial hypertension
- Rectum cancer
- hereditary enervation of musculus anal sphincter
What kind of examinations?
Bleeding from anus is an absolute indication to the full proctological examination. The doctor conducts a medical history, during which he obtains information on such things like, what is the amount of bleeding, if the patient feels any pain, what is the rhythm of defecation. The doctor looks at the area of anus and examines it manually. He usually does the endoscopic examination, anoscopy and/or rectoscopy. It is often necessary to do the colonoscopy, as it is essential to know that the bleeding from anus might not only be the symptom of a haemorrhoids disease but also one of the symptoms of large bowel cancer.
Treatment:
The treatment includes the conservative treatment of I and II degree, non-operative invasive methods of I, II and III degree, operative treatment of III and IV degree.
Conservative treatment
Conservative treatment can be used for about 30% of the patients. If the main symptoms are loose stools, anal itching and traces of blood on the toilet paper, the patient should, first of all, change the diet to a one rich in fibre, drink a lot of liquids, avoid the food causing diarrhoea, and perform gentle washing of anus after defecation. General and local vescular drugs which reduce the engorgement and local inflammatory reaction, often lead to the improvement of the condition.
Non-surgical invasive methods
They include a prevention of haemorrhoids loss through changing the structure of their excipient or preventing the engorgement and disorders in blood flow through tension. Sphincterocomy or cutting out of enlarged vascular cushions are also sometimes used.
In our surgery we use the Barron method.
This is the method of band ringing, which involves putting a special rubber band on the roots of the tumor, which cuts off the blood flow to it, which, in turn, causes the death and coming off of the tumour. One of the advantages of the method is not only the fact that it is painless and avoids an operation, but also the fact that the method is very convienient and time-saving. The procedure lasts about 10 minutes and after it is completed you can go back home and return to your everyday activities. The troublesome tumour comes off within about ten days. The research on the effectiveness of the method shows that, within several years after the procedure, over 90% of the treated did not have any discomforts or relapses.
An additional advantage is that this modern treatment saves the patient from pain, stress, staying in hospital and it also saves his precious time. There is no need to make a long break in you everyday duties or resign from your holidays because of the treatment.
Surgical methods
They are used in the treatment of about 10% of the patients with haemorrhoids disease. They are applied as the last resort in the treatment of haemorrhoids in a significant degree of advancement.
In the treatment of haemorrhoid disease, it is of great importance to suit the method of treatment to the individual state of the patient. Both the doctor and the patient must take into consideration the fact that you cannot treat everybody with the same method; which is a popular approach at the moment.
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