What Is Hemorrhoidal Disease?

Hemorrhoids (from the Greek haima -”blood”, roe – ”flow”) are enlarged (hypertrophied) arteriovenous cavernous tissue in the submucosal layer of the anal canal and the perirectal tissue.

Hemorrhoids are the most common proctological condition in both men and women. This condition not only causes physical discomfort but also affects patients’ emotional well-being, leading to various psychological disturbances. Insufficient public health education and the resulting delays in seeking medical care often lead to the condition being diagnosed at advanced stages, when conservative treatment is no longer effective and surgery is the only way to provide definitive treatment.

Depending on which component predominates, hemorrhoids are conventionally classified as:

• internal hemorrhoids;
• external hemorrhoids;
• combined hemorrhoids.

According to the severity of the inflammatory process, hemorrhoids are classified as:

• chronic hemorrhoids;
• acute hemorrhoids.

Chronic hemorrhoids progress through four stages:

I stage – primarily presents with hemorrhoidal bleeding;

II stage – prolapse of hemorrhoids during bowel movements, with or without bleeding, followed by spontaneous reduction into the anal canal;

     III stage – prolapse of hemorrhoids during bowel movements, with or without bleeding, requiring manual reduction;

IV stage – the hemorrhoids remain prolapsed, even when changing body position.

Factors contributing to the development of hemorrhoids:

• constipation.
• hereditary factors;
• pregnancy and childbirth.
• prolonged sitting;
• a sedentary lifestyle;
• alcohol misuse;
• excessive physical exertion;
• hot and spicy foods;
• impaired blood outflow from the rectum;
• frequent cycling or motorcycling;
• horseback riding;
• anal sex;
• inflammatory and neoplastic processes in the intestines and liver;
• infection.

Acute hemorrhoids (synonyms: thrombosed hemorrhoids, anorectal thrombosis, acute hemorrhoidal thrombophlebitis) occur due to thrombosis of the blood vessels within the hemorrhoids or prolapse and strangulation of the hemorrhoids.

Hemorrhoidal thrombosis may be external (thrombosis of external hemorrhoids), internal (thrombosis of internal hemorrhoids), or combined.

In most cases, acute hemorrhoids are preceded by a spasm of the anal sphincter. This occurs in response to painful irritation of the anal canal walls caused by constipation, diarrhea, excessive physical exertion, cryptitis, or an anal fissure. Strangulation of thrombosed hemorrhoids within the anal canal may also be secondary to inflammation, which presents clinically with pain and swelling. Factors that may trigger an exacerbation of hemorrhoids include alcohol consumption and spicy foods.

Chronic hemorrhoids with frequent bleeding. In this form of chronic hemorrhoids, the main symptom is frequent rectal bleeding, which generally occurs during or immediately after defecation. Bright red blood is passed in frequent drops or as a stream.

In most cases, the body compensates for blood loss caused by hemorrhoidal bleeding. However, some patients with chronic hemorrhoids and frequent bleeding develop chronic secondary posthemorrhagic iron-deficiency anemia due to the decompensation of blood-forming mechanisms.

The primary cause of bleeding is mechanical trauma to the hemorrhoids as stool passes through, particularly during straining in patients with constipation.

Chronic hemorrhoids with prolapse (grades II and III). The leading symptom of this form of the disease is progressively worsening hemorrhoidal prolapse. Usually, 5-7 years after the first symptoms of hemorrhoids appear, the hemorrhoids begin to prolapse from the anus during defecation, then during coughing or straining, and eventually even while walking.

Chronic hemorrhoids with pain. Pain occurs relatively rarely in chronic hemorrhoids. It is associated with the nerve endings in the thinned walls of the anal canal, which also form the medial walls of the hemorrhoids, becoming closer to the surface of the mucous membrane. These nerve endings are easily injured by stool or irritated due to sphincter spasm.

In summary, isolated forms of chronic hemorrhoids are extremely rare and generally occur only during the early stage of the disease. In everyday practice, physicians mainly encounter forms of the disease that combine varying degrees of the manifestations described above, with one form being relatively predominant. In addition, the clinical features of chronic hemorrhoids largely depend on the frequency of exacerbations and whether conservative treatment is successful or ineffective.

Diagnosing hemorrhoids is not difficult when their clinical symptoms are known; however, it requires a methodical approach and a physician skilled in specialized examination techniques. A patient with symptoms characteristic of hemorrhoids should undergo a proctological examination. If you have hemorrhoids and are wondering which doctor to consult, the answer is simple—you should schedule an appointment with a proctologist.

Modern, effective treatment of hemorrhoids includes systemic therapy combined with surgical and local treatment.

Treatment of chronic hemorrhoids, particularly in the early stages, should begin with conservative measures. The patient is advised to follow an appropriate diet and limit strenuous physical activity.

If comprehensive conservative treatment is unsuccessful and the condition progresses, surgical treatment is used.

Surgical techniques for treating chronic hemorrhoids are highly varied and have changed significantly over recent decades. All procedures for hemorrhoids can be divided into two main groups: the first includes palliative interventions, and the second includes radical surgery. The first group comprises procedures in which hemorrhoidectomy itself is not performed, including sclerotherapy, laser therapy, cryotherapy, and hemorrhoid ligation, including rubber band ligation. The second group includes radical hemorrhoidectomy in its various forms.

Prevention of hemorrhoids

Prevention of hemorrhoids primarily involves eliminating factors that contribute to their development and includes:

• a balanced diet (avoiding diarrhea and constipation and limiting unhealthy foods that are fatty, hot, or spicy);
• developing appropriate hygiene habits from childhood, including thoroughly cleaning the anal area after a bowel movement;
• sports and exercise that help normalize the motor and evacuation function of the colon and prevent blood from pooling in the pelvic organs.

To check your health, we recommend consulting a proctologist! Lviv Medical Center has experienced doctors with many years of clinical practice.