Hemorroides (of Greek haima: `blood' and rein: it is written with hews with an axe: “rhein”--> `to flow') is varices or inflammations of the veins in Straight and Anus . Also is known them with the name hemorrhoids. Anatomically they are plexos, bearings or pads of woven submucous where and are contained Vénulas superficial Arterioles of the anal conduit. Normally they are the three bearings, located in the left sidewall, sidewall derech and On guard mediates later and work in the mechanism of continencia of Lees .

Often, the inflammations of the hemorroides are consequence of the effort of I bid up to evacuate Internal, although they can be caused by other factors like Pregnancy, the aging and chronic Constipation or Diarrhea .

The main symptom of the hemorroides is Blood red brilliant in Lees, hygienic Paper or poseta. Other causes of anal or rectal bleeding include anal rectocolonic Cancer or . Because the hemorroides are normal part of anorrectal Anatomy, the treatment only indicates in symptomatic cases . He is recommendable that is treated by specialistic doctors in Coloproctología . The treatment usually includes lukewarm baths and a cream or another medicine. Perhaps the complicated hemorroides require surgery and other treatments.

Classification

The pathological hemorroides are divided in interns, if they are by above of the pectínea or indented line of the anal conduit, and external those that are distales or below the dentated line. The hemorroides interns classify themselves in four degrees.

to ) In first of them, the hemorroide is located in the submucous weave on the dentated line. It can defecate alive red blood.
b ) In the second degree, excels when defecating but they are reintroduced spontaneously, with the cease of the effort.
c ) Those of third degree, leaves when defecating and the patient must reintroduce them manually.
d ) In the fourth degree, the hemorroides is irreducible and is always prolapsadas.

The hemorroides also can be trombosar. The hemorroides interns originate from plexo hemorrhoidal superior and are covered by proximal mucosa to the dentated line. They can present/display rectorragia, protrusion, quemazón, prurito, pain and mucous unloading.

Etiology

Some causes that predispose to suffer hemorroides:

  • Hereditary factors .
  • Constipation that, when forcing the passage of lees, compresses the hemorrhoidal veins.
  • Diarrhea, that can produce irritation.
  • Occupational, to be standing up or seated during long followed time, examples: executives, drivers, pilots (by increase of pressure G, that is to say, the gravity).
  • Pregnancy, mainly in the last weeks.
  • Hypertension vestibule, increase of venous pressure concerning the system carries.
  • Obesity, by increase of the abdominal pressure on the pelvic floor.

Clinical picture

The annoyances that cause the hemorroides are easy to feel: sensation of ardor in the rectum, comezón, constant anal humidity, Pain, bleeding when evacuating (although not always it bleeds), stained of the underclothes and sensation of exit of some protuberance by the rectum.

Rectorragia and melenas

The most frequent cause of Rectorragia (bleeding by the anus) is by hemorrhoidal bleeding. Also it can be originated by fissures, the Rectitis and most serious, by polyps and/or tumors of the rectum and colon. Therefore, before a bleeding, either recent or chronic, an endoscopic study must always take place (rectoscopia or coloscopy) so that in case a tumor exists, Proctólogo can be diagnosed by the surgeon and to apply the sooner the opportune treatment.

Of equal way, the most frequent cause of one rectorragia is the hemorroides. One rectorragia produces relatively small bleeding, often as soon as they stain the bath paper. Nevertheless, if rectorragia is of an amount of moderate to severe, it is necessary to look for well-taken care of doctor immediately.

Sometimes, bleeding in the alimentary canal is not pronounced by red blood in lees, but by black and sticky blood ( melenas ). Although some meals ( Calamaries in their red, Spinach or medecines ( Iron, Bismuth ) can cause black lees . Nevertheless, if black lees of unknown cause are observed, a doctor is due to consult immediately.

Melenas is the rectal evacuation of black and stinking material, the result of the bacterial degradation of Hemoglobina of blood suspended in the intestinal light, indicative of bleeding from a proximal point to the ligament of Treitz . In patients with slow colónico transit, a bleeding concerning the proximal colon can appear like melena.

Diagnosis

The diagnosis is realized by means of a clinical examination of Straight and Anus . In order to discard the possibility of Cancer is recommended to practice a x-ray examination with opaque Enema and, possibly, one Sigmoidoscopia . In any case, before a picture of hemorroides small losses of blood can be observed, whereas before a cancer Hemorrhages usually are more abundant, persistent and, generally, associates with changes in the intestinal habit appear.

Endoscopy

Endoscopy is used mainly to see and to film the interior of the corporal cavities and to realize some procedures without needing resorting to the surgery. Different types from endoscopy exist and the anoscopia is one of them.

Rectoscopia is an artillery observation of the rectum and anus, by means of which the internal state of the same can be visualized. This way the origin of bleeding can be seen, the cause of the annoyance and in many occasions, Diagnosis can be taken one Biopsy and be clarified .

Coloscopy is an instrumental study, by means of a previous preparation of Purge and washed, with Colonoscopio, which allows, under anesthesia and lubricant, and nonpainful moderate distension, with air, to see all the digestive apparatus inferior.

In them we can observe the origin of bleeding, to take photographies, to recognize tumoraciones and ulcerations, to diagnose formation diverticular, its pathological state, just like Estenosis and a hasty reconnaissance of the benign tumoraciones ( Diverticula ) and malignant ( Cancers, etc.

Nowadays the techniques have changed much. They exist analgesic excellent for the handling of the postoperative annoyances pre-examination and. The patient must be taken care of by a rectocolonic surgeon. This he will have the up-to-date knowledge more with respect to these diseases.

Treatment

  • Mantener a good anal hygiene and to avoid to rascar or to rub the hemorroides, to help to prevent the infections

  • To correct the constipation adding fiber to Diet : Fruits Vegetables integral Bread, abundant liquids
  • To correct Diarrheas to *Evitar meals very ripened, sharp and greasy as well as the alcohol consumption
  • To avoid efforts when defecating
  • To reduce the time of defecation
  • To use smooth hygienic paper or anal cleaning by means of bath with lukewarm water
  • He is not advisable to apply cold gauzes or ice since, although this action alleviates the pain temporarily, the cold prevents that trombo dissolves that causes the hemorroides.

Surgical handling

The surgical treatment is due to realize whenever the improvement of habits and medical treatment is not sufficient or when or beginning of the complications and for hemorroides of third and fourth degree exists generally or even those of second degree that did not respond to other nonsurgical alternatives of handling. The hemorroidectomía is the used surgery to clear the veins that have been swollen or expanded around the anus.

For the intervention of hemorroides the patient can be put under general anesthesia or the premises (local anesthesia or spinal anesthesia) with sedation. The expanded veins (hemorroides) take off and a sterile gauze package is let in the zone to diminish the hemorrhage.

Several types of surgical procedures for the treatment of the hemorroides exist, can be divided in two:

1) one is the abierta technique, when resection is realized or extirpation of the hemorroides and lets the abierta wound to allow that it heals by second intention,
2) the other is the closed technique, where the hemorrhoidal weave retires and the mucosa of the anal conduit affected and the edges of the wound confront again to leave closed it. Other techniques are with the use of engrapadoras, these are introduced by the anus and engrapan and cut the superfluous weave realizing one hemorroidopexia.

The most novel treatment consists the hemorroidectomía with laser, that allows the operation or with local anesthesia or zonal and the patient can retake the normal life in one or two days.

Intratecal analgesia or AI is called when medicine by means of a needle in the space is introduced that surrounds the spinal marrow. This analgesia also is well-known like intramedullary opiate analgesia or rachidian analgesia opioide. Whereas the intratecal analgesia controls the pain, the ability is not affected to control muscles of the body. This means that the pain will be alleviated remaining the wide-awake patient and in capacity to move. The AI is used with several intentions like alleviating the pain after a surgery or during the work of childbirth. Also it can be used to control the permanent pains produced by some diseases, like the cancer.

During the convalecencia the patient can undergo a strong pain after the surgery when she contracts or she relaxes the anus, reason why must administer itself analgesic. In order to avoid the paper use on the anus he must be used washed in bidet after the defecation. In addition, the baths temperings will serve to diminish the painful contractions of the anus, and can calm the picor and quemazón of the zone. One complete recovery in two weeks can be hoped. The intratecal analgesia has demonstrated a significant reduction of the pain in the patient after the operation in the first 24 hours.

Prevention

Exercise is due to do at least three times to the week during half an hour (to walk, to run, or static bicycle) with the purpose of improving the general circulation of its body. The foods little recommended are irritating and condiments like chili peppers, spices and dressings, garlic, the parsley, the onion and the mustard, the sauce of tomato, the tomato, the vinegar, the coffee, the black chocolate, the black tea or the tea of cinnamon, the alcohol, all the nonmature or acid fruits (like the lemon, the mandarin, the orange, pineapple, the grapefruit), and those that have much bone (like the bigeye tuna, the strawberry or the guava).

The recommended foods are all those that have fiber, like the bread or tortilla done with integral flour, the vegetable or fruit that can be eaten with rind or bagasse (like the grape), with the purpose of to soften the fecal matter and to make its expulsion easier, to take much water (always boiled or purified).

Another type of nonsurgical treatment for the hemorroides is the use of fotocoagulación, criocirugía, radio frequency or tie with elastic band. These options are generally considered for the hemorroides of degree II and some of degree III.

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