causes, classification, diagnosis, therapies.
Definition of hemorrhoids:
Abnormally large of painful conglomerates of
blood vessels, supporting tissues and overlying mucus membrane or skin of the anorectal
Bright red bleeding on the surface of the
stool, on the toilet tissue and/or in the toilet bowl.
In the industrial countries, hemorrhoidal
disease is extremely common.
Although most individuals may begin to develop
hemorrhoids in their 20's, hemorrhoidal symptoms usually do not become evident until the
30's. Estimates have indicated that 50% per cent of men over 50 years of age have
symptomatic hemorrhoidal disease and up to 1/3 of the total US population have hemorrhoids
to some degree.
The causes of hemorrhoidal disease are similar
to those which cause varicose veins, i.e., genetic weakness of the veins, excessive venous
pressure, pregnancy, long periods of standing or sitting and heavy lifting are considered
the minor factors.
Because the venous system supplying the rectal
area contains no valves, factors which increase venous congestion in the region can
precipitate hemorrhoid formation. This includes increasing intra-abdominal pressure (e.g.,
defecation, pregnancy, coughing, sneezing, vomiting, physical exertion and portal
hypertension due to cirrhosis), a low fiber diet induced increase in straining during
excretion and standing or sitting for prolonged periods of time.
This increasingly common affliction is caused by stagnation
and coagulation of blood fibron in the tiny capillaries that feed the anus and lower
rectum; this is mainly the result of sticky toxic waste in the blood stream, owing to
excess consumption of refined starch, especially white bread and other flour
products; in addition to dietary adjustments, daily practice of the anal sphincter
exercise and defecation in the squatting position help correct and cure this condition.
Classification of hemorrhoids:
Hemorrhoids are typically classified according
to location and degree of severity.
External hemorrhoids occur below the anorectal
line, the point in the 3-cm-long anal canal at which the skin lining changes to mucous
membrane. They may be either full blood clots (thrombotic hemorrhoid) or connective tissue
(coetaneous hemorrhoid). A thrombotic hemorrhoid is produced when a hemorrhoidal vessel
has ruptured and formed a blood clot (thrombus), while a coetaneous hemorrhoid consists of
fibrous connective tissue covered by anal skin. Coetaneous hemorrhoids can be located at
any point on the circumference of the anus. Typically, they are caused by the resolution
of a thrombotic hemorrhoid, i.e., the thrombus becomes organized and replaced by
Internal hemorrhoids occur above the anorectal
line. Occasionally, an internal hemorrhoid will enlarge to such a degree that it will
prolapse and descend below the anal sphincter.
Internal-external, or mixed, hemorrhoids are a
combination of contiguous external and internal hemorrhoids that appear as baggy swelling.
The following types occur:
Without prolapse- bleeding may be present,
but there is no pain.
Prolapsed- characterized by pain and
Strangulated- the hemorrhoid has prolapsed
to such a degree and for so long that its blood supply is occluded by the anal sphincter's
constricting action. Strangulated hemorrhoids are very painful and usually become
The symptoms most often associated with
hemorrhoids include itching, burning, pain, inflammation, irritation, swelling, bleeding
and seepage. Itching is rarely due to hemorrhoids except when there is mucous discharge
from prolapsing internal hemorrhoids.
The common cause of anal itching include
tissue trauma secondary to excessive use of harsh toilet paper, is Candida
parasitic infection and allergies.
Pain does not occur unless there is acute
inflammation of external hemorrhoids. As there are no sensory nerves ending above the
anorectal line, uncomplicated internal hemorrhoids rarely cause pain.
Bleeding is almost associated with internal
hemorrhoids and may occur before, during or after excretion. When bleeding occurs from an
external hemorrhoid, it is due to rupture of an acute thrombotic hemorrhoid. Bleeding
hemorrhoids can produce severe anemia due to chronic blood loss.
In contrast to the westernized countries,
hemorrhoids are rarely seen in parts of the world where high fiber, unrefined diets are
consumed. A low fiber diet, high in refined foods, contributes greatly to the development
Individuals consuming a low fiber diet tend to
strain more during bowel movements since their smaller and harder stools are difficult to
pass. This straining increased the pressure in the abdomen which obstructs venous return.
The increased pressure will increase pelvic congestion and may significantly weaken the
veins, causing hemorrhoids to form.
A high fiber diet is perhaps the most
important component in the prevention of hemorrhoids. A diet rich in vegetables, fruits,
legumes and grains promotes peristalsis and many fiber components attract water and form a
gelatinous mass which keeps the feces soft, bulky and easy to pass. The net effect of a
high fiber diet is significantly less straining during defecation.
Natural bulking compounds can be used to
reduce fecal straining. They are the first basic step in your
preventative strategy. These fibrous substances, particularly Psyllium seed and guar
Guam, possess mild laxative action due to their ability to attract water and form a
gelatinous mass. They are generally less irritating than wheat bran or other cellulose
fiber products. Several double-blind clinical trials have demonstrated that supplementing
the diet with bulk-forming fibers can significantly reduce the symptoms of hemorrhoids
(bleeding, pain, pruritis and prolapse) and improve bowel habits.
The warm Sitz bath is an effective
non-invasive treatment for uncomplicated hemorrhoids. A Sitz bath is a partial immersion
bath of the pelvic region. The temperature of the water in the warm Sitz bath should be
between 100-105 F or 37.7-40.5 C.
Topical therapy, in most circumstances, will
only provide temporary relief. Topical treatment involve the use of suppositories,
ointments and anorectal pads. Many over the counter products for hemorrhoids contain
primarily natural ingredients, such as witch hazel, shark liver oil, cod oil, cocoa
butter, Peruvian balsam, zinc oxide, live yeast cell derivative and
Monopolar direct therapy
The Monopolar direct current technique is
purely an outpatient procedure. No anaesthetic is needed, except local anaesthetic for the
occasional hypersensitive or nervous patient. To date, there have been no reported cases
of adverse effects, which speaks well for the procedures safety.
The Monopolar direct current technique for
hemorrhoid management is fast becoming a treatment of choice in the United States.
According to an article in Gastrointestinal Endoscopy, "this painless outpatient
treatment of all grades of hemorrhoids is effective and safe. This methodology warrants
consideration as the treatment of choice of hemorrhoidal disease.
The first published work on Monopolar direct
current (also called inverse galvanism) was Obliteration of Hemorrhoids with Negative
Galvanism by Wilbur E. Keesey MD of Chicago. Dr. Keesey dated the first use of this
approach to 1897, although the technical problems (producing a smooth uninterrupted
galvanic current source) were not worked out until approximately 1925. The technique then
began to be used in general practice.
When indicated, the Monopolar direct current
method, specifically designed for hemorrhoid treatment, will give permanent results. This
technique is especially useful in advanced hemorrhoidal disease.
As with all diseases, the primary treatment of
hemorrhoids is prevention.
This involves reducing those factors which may
be responsible for increasing pelvic congestion- straining during defecation, sitting or
standing for prolonged periods or time or underlying liver disease. A high-fiber diet is
crucial for the maintenance of proper bowel activity, and nutrients and botanical
substances which enhance the integrity venous structures may also be of benefit.
A high carbohydrate diet rich in dietary fiber
is indicated. The diet should contain liberal amounts of
anthocyanidin foods such as blackberries, cherries, blueberries, etc., to strengthen vein
structure. Alcohol and spicy foods should be removed as much as possible, as evidence
indicates that continuous persistence of hemorrhoids when these two elements are present
in the diet. Squatting while defecating, plus fasting and internal cleansing therapies are
highly recommended in the long run, as is the external application of aloe vera in cases
of continuous bleeding or itching.
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