Conservative therapy

Conservative therapy in the liver of acute and chronic hemorrhoids is becoming increasingly important. This is due to the advent of the pharmaceutical market sufficiently effective pain medications, thrombolytic, and flebotonicheskih hemostatic agents.

Works of national and foreign scientists determined that the basis for hemorrhoids is pathology of the cavernous vascular structures embedded in the course of normal embryogenesis in the submucosal layer of distal colon. We conclude that, in addition to vascular, in the pathogenesis of hemorrhoids plays an important role and dystrophic muscle factor. At the heart dysfunction is the first vessel, resulting in increased inflow of arterial blood in the cavernous bodies and reduce the outflow of cavernous veins, which leads to an increase in their size and the development of hemorrhoids. The second leading factor is the degenerative processes in the longitudinal muscle, submucosal layer of the rectum, and bunch of Parkes, retaining hemorrhoids in the anal canal. Under the influence of unfavorable factors is an increase of hemorrhoids, their displacement in the distal direction, and ultimately - loss of the anal canal. Most of these violations occur in high-risk groups, which include seating people or professions involved in heavy physical labor, suffering from constipation.

Hemorrhoids can occur with chronic or acute course, which is phase one and the same process. For hemorrhoids typical two main symptoms - bleeding and prolapse of hemorrhoids. Note that the symptoms of diseases of the colon rather monotonous, and the bleeding is a symptom not only of hemorrhoids, but also diseases brand viagra such as cancer, polyps, hemangioma of the colon, ulcerative colitis. Prolapse hemorrhoids frequently should be differentiated from prolapse of the rectum, prolapse of villous tumor. Therefore, for correct diagnosis, it is mandatory to carry out not only the examination of the perianal region, but the research and digital rectal and sigmoidoscopy. At the slightest suspicion of neoplasm or detection of multiple polyps in the rectum is carried out columns or irrigoskopiyu.

Hemorrhoids rarely observed symptoms such as discomfort in the anal canal, anal itching, abnormal discharge, pain in the main characteristic of acute hemorrhoids. They tend to occur in response to spasm of the sphincter, irritating the walls of the anal canal and anal fissures.

We have proposed a classification of chronic hemorrhoids, divided the clinical course of 4 stages:

Stage 1 - selection of blood from the anal canal, without loss of hemorrhoids

Stage 2 - loss of hemorrhoids with an independent reduction in the anal canal (with or without bleeding)

Stage 3 - the need to manually reposition nodes on a roll (with or without bleeding)

Stage 4 - permanent loss of nodes and the inability to reposition the anal canal (with or without bleeding).

In our opinion, this classification makes it possible in practice to choose an adequate method of treatment.

The basis for the development of acute thrombosis of a hemorrhoid. Inflammatory process that develops at the site and surrounding tissues, is often its consequence.

Acute hemorrhoids on the clinical course, we share in 3 stages:

1. Thrombosis hemorrhoids without inflammation.

2. Thrombosis, complicated by inflammation of hemorrhoids.

3. Thrombosis, complicated by inflammation of the subcutaneous tissue and perianal skin.

The indications for conservative treatment are the initial stages of chronic hemorrhoids and severe disease course. This therapy consists of general and local treatment. Certainly, in acute hemorrhoids shown conservative treatment, but it should be noted that to prevent it in the need to normalize the activities of the digestive tract, the treatment of constipation, which occurs more than 75% of patients with hemorrhoids. We assign enzyme preparations, affecting flora, and peristalsis of small intestine and large intestine, hydrophilic colloids (dietary fiber) during the regular and adequate fluid intake. As a source of dietary fiber in our country has traditionally used wheat bran, sea kale and flax seed in their natural form or in the form of pharmaceutical preparations. Abroad often use the seeds and husk psyllium and flaxseed in the form of drugs such as agiolaks, fayberlaks, nutriklinz and others that have a high water-holding capacity. We will not be in this article, consider drug therapy of irritable bowel syndrome, but the consistency of the regulation of intestinal contents and its transit through the colon is a prerequisite not only prevention but also the successful treatment of hemorrhoids.

Local treatment

Local treatment is aimed at eliminating pain, thrombosis, or inflammation of hemorrhoids and bleeding. When selecting the topical treatment of acute hemorrhoids one must take into account the prevalence of symptoms (pain, thrombosis), the prevalence of inflammation and the presence of a destructive component. When bleeding should clearly estimate the blood loss, and its activity and severity of post-hemorrhagic anemia.

Pain syndrome with hemorrhoids often associated with infringement of a thrombosed haemorrhoid or the appearance of acute anal fissure. Most often in the mechanism of its formation is a spasm of the anal sphincter due to inflammation in the hemorrhoidal node. Therefore, to eliminate pain demonstrates the use of non-narcotic analgesics and local anesthetics combined. For the local treatment of hemorrhoids, we use drugs such as aurobin, ulraprokt, proktoglivenol and others from this group stands out for its efficacy new drug neflyuan containing high concentrations of lidocaine and neomycin.

Thrombosis hemorrhoids complicated by viagra the frequency of erections and orgasms their inflammation is an indication for the use of combined preparations containing analgesics, thrombolytic and anti-inflammatory components. This group of drugs includes Proctosedyl, nigepan (a combination of heparin and anestezina) and gepatrombin T, issued in the form of ointment, gel and suppositories bases. Action gepatrombina F lies in the fact that heparin and allantoin, linking pay attention plasma coagulation factors and exerting an inhibitory effect on hemostasis, causing thrombolytic effect, and panthenol stimulates metabolic processes, granulation tissue and epithelization. Preference for using this drug is that it has a strong thrombolytic and anti-inflammatory effect and does not contain glucocorticoids.

Thrombosis of hemorrhoids - Indications of anticoagulants local action. This group includes heparin and troksevazinovaya ointment nigepan, gepatrombin G. In 70-80% of cases, thrombosis of hemorrhoids complicated by inflammation of the transition to subcutaneous tissue and the perianal region. In this case, the above-mentioned drugs used in combination with water-based ointments, possessing potent anti-inflammatory action (levasin, levomekol, mafinid).

Bleeding - one of the main symptoms of hemorrhoids. Ongoing bleeding for 1 hour is a sign of an acute process. To eliminate it you can use candles containing epinephrine. In addition, use these local hemostatic materials, such as adrokson, beriplast, tahikomb, spongostan consisting of fibrinogen and thrombin. When introduced into the anal canal, they dissolve, forming a fibrin film.

General treatment

The basis of the general treatment is the use of flebotropnyh drugs that increase the tone of veins and improves microcirculation in the cavernous bodies. This group includes many products, but in our opinion, the most effective in this group is diosmin. Treatment with this drug was performed in 120 patients with acute hemorrhoids. Each group of patients was 60 people in the study group patients received diosmin, and in control - placebo. In the study group, pain decreased in 83% of cases, loss of nodes decreased by 91%, and bleeding hemorrhoids - in 91% and almost 2-fold decreased receiving non-narcotic analgesics. In 98% of treated patients had stihaniya inflammation and the rate of annual exacerbations decreased by 2,2 times. Treatment with these drugs allows more than 2-fold to reduce the length of exacerbations and in 1,5 times - their severity.

Conservative therapy is also carried out in conjunction with widespread invasive methods of treatment used primarily outpatient, and surgical interventions that are shown in the later stages of hemorrhoids.

Should indicate that the complex conservative treatment only temporarily causes a decrease in the inflammatory component and normalizes the function of arteriovenous shunts, thus only temporarily improve blood flow in the cavernous Pacinian rectum.

Despite the use of modern effective drugs conservative treatment in acute phase of illness, is still palliative measure, and gives only short-term positive effect. Resumption of constipation, the error in diet, increased physical activity leads to the next exacerbation, which required re-treatment. Therefore, the ineffectiveness of conservative treatment, especially in the later stages of the disease, there should be a combined treatment including conservative in conjunction with minimally invasive or surgical methods.

If conservative treatment of acute and chronic hemorrhoids can be done by general practitioners, the minimally invasive techniques should be performed by a doctor-Coloproctologists on an outpatient basis, or on the testimony - in steady-state. Surgery, hemorrhoidectomy should also be carried out in specialized clinics.

The correct choice of treatment of hemorrhoids, depending on its stage and severity of symptoms with medication, minimally invasive and surgical techniques both separately and in combination, can achieve good results in 99% of patients.

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