Recommendations for the treatment of hemorrhoids. Clinical guidelines: Hemorrhoids in adults

In the process of treating hemorrhoids, the patient is prescribed many recommendations: what medications to take, how to eat, which will help relieve unpleasant symptoms. However, in addition to this, you also need to know what not to do with hemorrhoids, so as not to aggravate the situation. Sometimes even competent and complex treatment does not give the desired result due to non-compliance with hygiene rules, gentle nutrition or prevention further development diseases.

To effectively fight it, you need to radically change your lifestyle and follow contraindications for hemorrhoids.

Existing restrictions during the treatment period should help the patient relieve the load on the gastrointestinal tract, primarily the large intestine. Therefore, the doctor’s prescriptions should concern not only taking the necessary medicines, but also taking into account what is prohibited for hemorrhoids.

The influence of the causes of hemorrhoids on the treatment process

Effective treatment of hemorrhoids is impossible without determining the causes that caused inflammation in the veins of the rectum. Therefore, in the process of fighting the disease, it is important to take into account the factors that provoked its development. Hemorrhoids are often caused by the following reasons:

• sedentary lifestyle, sedentary work;
• poor nutrition, fast food abuse;
• excessive physical activity, for example in athletes;
• persistent constipation or diarrhea, which increases the load on the anus and smooth muscles of the intestines;
• physiological characteristics of the large intestine;
• pregnancy and childbirth;
• heredity.

Most of these prerequisites can be eliminated and the development of hemorrhoids can be prevented by following preventive measures. But if the disease has already appeared, eliminating them can help in the treatment process. Contraindications for hemorrhoids include actions that exclude provoking factors.

Features of nutrition in the treatment of disease

The main prohibition for hemorrhoids is uncontrolled eating. To eliminate the disease, you will have to adhere to a special diet, the main purpose of which is to ease the functioning of the stomach and intestines. It is necessary to eat only food that is easily digested, does not cause constipation and is easily excreted from the body.

The basic rules of gentle nutrition include:

• Eliminate smoked, fried, spicy and salty foods from your diet. Any products that cause irritation to the mucous membrane of the stomach and intestines are prohibited.
• Limit the consumption of coffee and tea, completely eliminate carbonated and alcoholic drinks.
• It is better to eat steamed or boiled foods with a minimum amount of salt.
• Avoid legumes, sorrel, cabbage, radishes and other foods that increase fermentation in the stomach and intestines.
• Add fresh fruits and vegetables to your diet that are high in fiber, which enhances metabolism and activates intestinal motility. The exceptions are apples, grapes and potatoes -.
• Eat often, but in small portions. There should be 5-6 meals a day, varying in quality and calorie content.

By adhering to a diet, the patient will be able to normalize the functioning of the gastrointestinal tract, eliminate the occurrence of constipation or diarrhea, help his body fight hemorrhoids and avoid its aggravation.

Physical activity restrictions

Often hemorrhoidal cones appear due to constant stress on the pelvic area, for example, during work associated with lifting weights, or among professional athletes. Therefore, physical overload is also among the contraindications that must be taken into account during the treatment process for both men and women. Patients with hemorrhoids should not:

• Work out in gym, bodybuilding, cycling and horse riding.
• Lift heavy objects weighing more than 5 kg.
• Go on long hikes and mountaineering.
• Sitting for a long time, especially on uncomfortable chairs and armchairs. Even squats create additional stress on the perineal muscles.
• Lead a sedentary lifestyle.
• Do not sit and strain in the toilet.

It is important to understand that limiting activity does not mean giving it up completely. After all, lack of mobility and moderate training is also common cause hemorrhoidal disease. Therefore, in the matter of activity, one must observe a sense of proportion. There are ones that are aimed at strengthening the muscles in the lumbar and pelvic areas.

And an active lifestyle is the prevention of not only hemorrhoids, but also many other health disorders.

Rules of hygiene and choice of clothing for hemorrhoids

An important contraindication for hemorrhoids is the use of the same hygiene rules and procedures that were used before the onset of the disease. Ignoring principles proper care It will not allow you to completely cure the disease, but will only aggravate the situation. The following rules must be followed:

• The anus area should be washed with water at room temperature twice a day, and also after each bowel movement.
• Instead of water for washing, you can use decoctions of herbs that have anti-inflammatory and antiseptic effects - chamomile, string, oak bark, sage and others.
• Do not wear tight underwear made from synthetic fabrics that restrict air flow. In addition, you need to temporarily give up tight trousers and jeans that pinch blood vessels in the pelvic area.
• Loosening the belt on the belt or completely abandoning it for the period of treatment of hemorrhoids.

Nutrition for hemorrhoids

Sports for hemorrhoids

The right choice of clothing and compliance with hygiene requirements will help to avoid many unpleasant symptoms and complications of hemorrhoids.

What are hemorrhoids?

Hemorrhoids are pathological expansion of veins in the area of ​​the rectum and anus. Weakened vessels form nodes that cause discomfort during bowel movements or when playing sports. At the early stage, the manifestations of the disease are minor: itching and heaviness in the anus are mild and can be eliminated by using special suppositories for hemorrhoids.

In later stages, a person suffers from severe burning, heaviness and pain even at rest. Timely consultation with a doctor helps to cure the pathology at an early stage. However, in Russia, only a small part of the country's residents are ready to inform a specialist about the symptoms of the disease, undergo examination and receive medical care.

Hemorrhoids are an inflamed condition of the veins inside and/or outside the rectum, their varicose veins. The disease occurs as a result of an increase in the volume of “cavernous” tissues located around the exit from the rectum, and the ligaments that hold these tissues are subsequently destroyed. Hemorrhoids are a chronic, progressive disease with periodic exacerbations. Folk remedies for treating hemorrhoids stop the progression of the disease and allow you to avoid or minimize exacerbations.

Hemorrhoids are not dangerous disease, but before it can be treated, an accurate diagnosis must be made. Hemorrhoids are diagnosed in only 40% of patients with proctological diseases. Under the guise of hemorrhoids, colitis, polyps, and rectal tumors can be hidden. Causes of hemorrhoids: chronic constipation, sedentary lifestyle, obesity, pregnancy. The causes of hemorrhoids may be related to the profession - it can occur if you have to stand for a long time (salespeople, hairdressers), lift heavy objects (loaders, diggers), sit (drivers, operators) Symptoms and signs of hemorrhoids: itching, burning sensation, heat in the anus , pain during defecation, bleeding, traces of blood in the stool, prolapse of venous nodes from the anus, prolapse of part of the rectum with pinching.

For hemorrhoids, the following recommendations should be followed: constipation; alcoholic drinks and spicy, salty foods; hypothermia of the lower body, do not sit in the cold; heavy physical activity, strong tension;

Retracting the anus in a sitting and lying position, “Walking” on the buttocks Sitting on your heels, rock your torso from side to side for 2-5 minutes All abdominal exercises

Exercises should not be performed during the acute stage of illness

The disease hemorrhoids has been known since ancient times, so there are many folk remedies and methods of treating hemorrhoids.

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Scientists associate this disorder with the ability to walk upright. Nodes are formed under the influence of increased blood flow in the arteries and high blood pressure in the venous vessels of the rectum.

A number of factors lead to this:

• hereditary predisposition. The structural features of blood vessels and the degree of their strength are determined genetically in the body. In patients different generations with hemorrhoids, similar disorders may appear. The most common example is varicose veins of the lower extremities;
• constipation Straining during bowel movements leads to an increase in pressure in the intra-abdominal zone, because of this, nodular veins are pushed out;
• heavy physical work. Unregulated loads contribute to damage to the ligamentous apparatus of the pelvis and rectum, which leads to congestion, stretching of veins and twisting of vessels into knots;
• sedentary lifestyle. Sedentary work and hemorrhoids are concepts that are inextricably linked. If a person sits in one place for a long time, a “warming compress” acts on the perineal area. Under the influence elevated temperature the vessels are constantly expanding, and the blood stagnates;
• unhealthy diet. Abuse of smoked, salty, fatty and spicy foods stimulates increased blood flow and irritation of the rectal mucosa. As a result, the veins gradually dilate and become nodular;
• alcohol abuse. High content alcohol leads to reflex vasodilation, congestion and inflammation of hemorrhoids.

Irritation of the mucous membrane and severe diarrhea are additional factors leading to inflammation and prolapse of veins. An exacerbation of hemorrhoids during or after childbirth is often observed.

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Hemorrhoids - exclusively human disease, which scientists associate with the ability to walk upright. The formation of nodes occurs with increased pressure in the venous system of the rectum and local increase in arterial blood flow for a number of reasons.

• Heredity. The literature describes cases of hemorrhoids in five generations in a row. We are talking about the structure and strength of venous vessels and their walls. Often with hemorrhoids, other diseases associated with the pathology of the venous system are determined, for example Varicose veins.
• Constipation may be the main cause. Due to constipation, when straining, intra-abdominal pressure increases and hemorrhoids are pushed out of the anus.
• Pregnancy, childbirth. During pregnancy, as the fetus grows, intra-abdominal pressure increases, this impedes venous blood flow and increases pressure in the veins, which leads to venous congestion. At the time of birth, these factors can exceed critical values ​​and lead to the formation of irreducible nodes. After childbirth, hemorrhoidal veins narrow sharply, and the symptoms of the disease, if there are no other predisposing factors, often disappear.
• Heavy physical labor . Loads arising from lifting and carrying heavy objects, especially by an untrained person, can lead to damage to the ligamentous apparatus of the rectum and pelvis.
• Passive lifestyle. When sitting on something soft for a long time, the hemorrhoidal veins expand and blood stagnates in them. Heat acts on the perineal area as a kind of warming compress.
• Diet violation - abuse of spicy, fatty, salty and smoked foods, chronic overeating. Spicy seasonings irritate the mucous membrane of the gastrointestinal tract, which leads to increased blood flow, so long-term abuse of hot and spicy dishes contributes to excessive blood supply and irritation of the mucous membrane.
• Bad habits (tobacco, alcohol). High concentration of alcohol in gastrointestinal tract causes persistent reflex vasodilation, spreading to all parts of the digestive tract, including the rectum. In dilated vessels, blood flow slows down, and blood stagnation in the hemorrhoids and their inflammation occurs.
• Severe diarrhea. Direct damaging effect on tissue - frequent enemas, inaccurate spinning, suppositories, laxatives, anal sex, excessively intense anal hygiene.

Prohibited sports

And for those people who are professionally involved in sports, when this disease is detected, it is best to switch to a more gentle regime of exercise, so as not to lead to serious consequences and not to prolong the disease for a long time. Therefore, it is advisable to reduce the load - do not lift heavy objects, do not make sharp turns. So what should you not do if your hemorrhoids worsen? Participate in certain sports that can increase pressure in the pelvic area.

• hold your breath when performing physical activity;
• climb mountains, as well as hike into mountainous areas.

In addition, in no case should you wear tight underwear or clothes, tighten belts at the waist or sit long time on soft sofas, chairs and more.

Causes and risk factors for developing hemorrhoids

Basically, for physiological reasons, a disease occurs when the walls of blood vessels begin to lose their elasticity. And therefore, it is strictly forbidden to provoke any stagnation of blood.

This condition can also be caused by a body position that does not change for a long time. Therefore, people who stay in one position for a long time most often suffer from hemorrhoids. This category includes people of the following professions:

• truck drivers;
• scientists and people who give knowledge to others - teachers;
• hair stylists;
• people who work time carried out in the office;
• bartenders.

And for those who occupy such positions, it is advisable to change their position after a few hours, and it is best to do simple gymnastics. What should you not do if you have hemorrhoids? First of all, stay in one position for a long time. Therefore, you need to get up as often as possible, walk around, you can bend over, make circular movements of your hips.

Hemorrhoids: prevention in children

Prevention of disease in children is not fundamentally different from measures to prevent disease in adults. So that you do not have to start treating hemorrhoids at home in your baby, follow the basic recommendations:

• provide your child with high-quality and healthy nutrition;
• Do not allow your child to sit for a long time at a table or computer. Be sure to send your child for a walk or arrange outdoor games right at home;
• Do not leave small children in one position for a long time. Be sure to turn them over, pick them up, rock them to sleep.

Scheme for the prevention of hemorrhoids in men

For women, three risk factors are most relevant: a sedentary lifestyle, pregnancy and childbirth. Let's deal with each of them in turn. Most jobs offered to women involve sitting for 8 hours.

If we add travel time to these eight hours, we get 9-10 hours of sitting per day. In the absence of physical activity, this daily routine will sooner or later cause hemorrhoids. What to do?

Firstly, we cannot but rejoice at the trend towards regular visits to fitness centers. The benefits that can be gained from playing sports are invaluable. In addition to getting in shape, you are also taking measures to prevent hemorrhoids.

Secondly, very often, in addition to playing sports, women are addicted to diets and healthy eating. This is another important factor in how to avoid hemorrhoids when sedentary work. What should the diet be like?

The cause of hemorrhoids is constipation and problems with bowel movements. Therefore, it is worth adhering to a diet that promotes the formation of healthy stools.

The diet should contain fiber (cereals, vegetables, fruits), and also exclude bowel irritants products: alcohol, spicy foods, marinades.

Products in this category cause fermentation and putrefaction processes in the intestines. If you can’t afford a gym membership, you’ll do yourself a big favor by developing healthy habits like morning exercise or jogging.

The more active your lifestyle, the more successful will be the prevention of hemorrhoids at home.

Among the male half of humanity, the disease is even more common. Very often it is caused by poor nutrition or overeating, a sedentary lifestyle and unexpected strength loads.

If we have already examined the issue of nutrition in detail in the women's issue, then in the men's issue we will pay more attention to preventive exercises.

In general, the best prevention of hemorrhoids during sedentary work is sports. But on the way to sports, other health problems that are common among the population can become an obstacle. Therefore there is an easier way. To prevent hemorrhoids, there is physical prevention in the form of exercises:

1. Without changing the starting position, we move on to the second popular exercise - “bicycle”. We pedal alternately in both directions.
2. The last exercise in this position is as tight as possible press your knees to your stomach.
3. We turn over on our stomach and We stand firmly on our hands, elbows and knees. Then alternately rotate your pelvis so that your buttocks touch the floor.
4. We move to a chair. While sitting, cross your hands at the back of your head and tighten your anus, pulling it in slightly. It is enough to do 6-7 repetitions.

Such exercises for the prevention of hemorrhoids, when performed regularly, will help you forget about this disease for the rest of your life. At the same time, do not forget about personal hygiene and maintaining a balanced diet.

We also do not advise men to be too heroic with lifting weights. Know your limits and don't push too hard. Sticking to all these simple rules, you will see that sedentary work and hemorrhoids can be incompatible.

Among men, the disease is even more common. Very often it is caused by poor nutrition or overeating, a sedentary lifestyle and unexpected strength loads.

In general, the best prevention of hemorrhoids in men during sedentary work is sports. But on the way to sports, other health problems that are common among the population can become an obstacle. Therefore there is an easier way. To prevent hemorrhoids, there is physical prevention in the form of exercises that can be performed at home:

1. The first exercise that strengthens the muscles around the pelvis, as well as accelerates blood in the pelvic organs, is the well-known “scissors”. Lying on your back, alternately cross your straight legs.
2. Without changing the starting position, we move on to the second popular exercise - “bicycle”. We pedal alternately in both directions.
3. The last exercise in this position is to press your knees as tightly as possible to your stomach.
4. We roll over onto our stomachs and stand on our hands, elbows and knees. Then alternately rotate your pelvis so that your buttocks touch the floor.
5. We move to a chair. While sitting, cross your hands at the back of your head and tighten your anus, pulling it in slightly. It is enough to do 6-7 repetitions.

Prevention of hemorrhoids during pregnancy

Bearing a fetus, especially in the later stages, has Negative influence on blood circulation in the pelvic organs. Also during this period, the levels of estrogen and progesterone in the blood are increased, this can also affect the occurrence of hemorrhoids.

Statistics say that 50% of pregnant women exhibit symptoms of pathology in one way or another. To avoid this, prevention of hemorrhoids in pregnant women is necessary. The disease can behave cunningly, and a woman may sometimes not be aware of it until the first check with a doctor. Therefore, we advise you not to delay going to the clinic while you are pregnant.

Prevention of hemorrhoids in pregnant women is: proper nutrition and a specific set of exercises:

1. First exercise. In the starting position, your feet are shoulder-width apart and your arms are extended forward. Movement: turn the torso to the right, keeping the feet in place, and abduct as much as possible right hand back. This movement is done while inhaling. As you exhale, we return to the starting position. Five seconds are allocated for each movement.
2. The same starting position as in the first exercise, but the hands are clasped. Turn the body to different sides, with effort we move our arms back.
3. Starting position: sit on the floor and lean on your hands behind you. Without lifting your heels, bend your knees. As you exhale, return to the starting position. It is enough to do it five times.
4. In the starting position, sitting, spread your legs to the sides without bending. Then stretch your body toward each leg, trying to reach your feet. ATTENTION! Exercise is ONLY allowed in the first and second trimester.
5. Recommended for the third trimester the following exercise: Sit in your starting position on a chair. Move your right arm, with your left leg bent at the knee, try to reach the side of your abdomen, you can help yourself with your left hand. This movement is carried out as you exhale, and as you inhale, return to the starting position. Repeat the action for the right leg and five times for each.

These are so simple physical exercise for the prevention of hemorrhoids will help disperse the blood and strengthen the necessary muscles.

Prevention of hemorrhoids in women expecting a child involves doing aqua aerobics for pregnant women, daily walking, and performing specially designed gymnastics exercises. It is important to follow a diet and avoid excessive weight gain.

During rest, it is necessary to place a special pillow under the stomach, which reduces pressure on the pelvic organs and prevents the development of congestion.

During pregnancy, the risk of developing hemorrhoids increases many times over. This is due to excessive pressure from the uterus on the hemorrhoids. While carrying a child, you should refrain from using excessively tight, constricting belts and bandages, as well as wearing tight clothes and high heels.

During the period of bearing a child, enormous pressure is exerted on the pelvic vessels. This leads to blood flow, congestion and deformation of hemorrhoidal vessels. The situation becomes aggravated at the moment when a woman begins to give birth - extreme loads can lead to dilated veins falling out. The next day, the woman who gave birth will have great difficulty moving and going to the toilet.

Knowing this, expectant mothers often wonder how to avoid hemorrhoids after childbirth. Doctors recommend doing the following:

• to prevent unpleasant pathology during pregnancy or shortly before childbirth, a woman is prescribed special means: creams, ointments and suppositories for the prevention of hemorrhoids. In the first trimester, doctors prescribe the following medications to expectant mothers: Natalsid, propolis-based suppositories and ointments, Posterisan. In the second trimester: Neo-Anuzol, Ichthyol. In the last trimester: Hepatrombin, Posterizan forte, Sea buckthorn suppositories;
• The best prevention of hemorrhoids during childbirth is to trust the doctor receiving them and follow all his recommendations. Controlling your behavior and efforts during childbirth will help avoid the formation and rupture of hemorrhoids and cones;
• Prevention of hemorrhoids during pregnancy includes maintaining a normal weight. Contrary to popular belief that you need to eat for two, unhealthy eating and overeating are strictly contraindicated for pregnant women.

The occurrence of hemorrhoids during pregnancy and childbirth is an unpleasant process that aggravates the already difficult situation of a young mother. To avoid this, follow preventative procedures and closely monitor your health.

To avoid this, prevention of hemorrhoids in pregnant women is necessary. The disease can behave cunningly, and a woman may sometimes not be aware of it until the first check with a doctor. Therefore, we advise you not to delay going to the clinic while you are pregnant.

Symptoms and complications of hemorrhoids

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Manifestations of the disease depend on the stage. At first, you may experience a feeling of heaviness, itching, and burning in the anus. Unpleasant sensations intensify after drinking alcohol and excessive physical activity. As the disease progresses, the main symptom of chronic hemorrhoids appears - prolapse of hemorrhoids, often accompanied by the appearance of scarlet bloody discharge at the end of a bowel movement on stool or toilet paper.

In addition to discomfort, hemorrhoids lead to the development of dangerous complications. Hemorrhoids can become inflamed, leading to thrombophlebitis. This complication manifests itself in the form of sharp pain and swelling, the hemorrhoidal node thickens, and the temperature rises. The inflammatory process can spread to the fatty tissue surrounding the veins. No less dangerous are the loss and pinching of internal nodes, in which they become dense and very painful. In both cases, you should immediately contact a specialist.

Diagnosis of hemorrhoids

Diagnosing hemorrhoids is not difficult. This is a visual examination of the skin of the anal area, the presence of bleeding and its degree.

A digital rectal examination of the rectum is mandatory. However, with severe pain, this may not be possible. Then, while taking painkillers, an anoscopy is performed.

To examine the mucous membrane of the rectum and the lower part of the sigmoid colon, sigmoidoscopy is performed, which allows you to see the presence of even high-lying internal hemorrhoids and assess the condition of the internal nodes, or fibrocolonoscopy.

You should not sound the alarm ahead of time if you discover symptoms of this disease. The treatment is sold publicly in almost any pharmacies without a doctor's prescription. We are talking about a medicine for hemorrhoids, such as suppositories.

The active ingredients have healing anti-inflammatory, wound healing and analgesic properties. In addition to treatment, suppositories are used to prevent hemorrhoids. Therefore, suppositories should be present in any family medicine cabinet, because there is a reason for their use, and the product may be needed at any time.

Overall, preventative measures for hemorrhoids will have an overall positive effect on your body and health. It is difficult to overestimate the benefits of regular exercise and a balanced diet. General muscle tone, as well as specifically digestive system will not only protect you from the occurrence of unpleasant diseases, but will also let your general state to the optimal one.

Be healthy!

You should not sound the alarm ahead of time if you discover symptoms of this disease. The treatment is sold publicly in almost any pharmacies without a doctor's prescription. We are talking about a medicine for hemorrhoids, such as suppositories for men and women.

Overall, preventative measures for hemorrhoids will have an overall positive effect on your body and health.

It is difficult to overestimate the benefits of regular exercise and a balanced diet. The general tone of the muscles, as well as the digestive system specifically, will not only protect you from the occurrence of unpleasant diseases, but will also bring your general condition to optimal.

Be healthy!

Greetings, dear readers of my blog!

Despite great amount information about hemorrhoids and its treatment, there is very little information on the Internet about practical ways the fight against hemorrhoids from ordinary citizens.

Below I suggest you familiarize yourself with practical recommendations Evgenia about the prevention of hemorrhoids and the prevention of exacerbations of hemorrhoids. I quote the text of the letter verbatim, almost without editing, it is written well, one can feel the person’s experience in this matter. It's nice to receive such useful letters from readers.

Evgeniy wrote me a letter about his experience in treating hemorrhoids. With his consent, I decided to post this information on my blog, hoping that my readers will find it interesting and useful to study this letter.

The main thing that I was able to understand is that hemorrhoids are not a disease, but a symptom of an imbalance in the body.

How cystitis, for example, indicates an infection in genitourinary system, and hemorrhoids indicate problems in the gastrointestinal tract - gastrointestinal tract. Therefore, as I understand it, it is necessary to treat the stomach, intestines and other digestive organs.

My wife came up with a diet for me that does not contain fatty, fried, smoked, spicy or salty foods.

Porridge in the morning, cottage cheese in the afternoon, then steamed vegetables or boiled meat, and in the evening another meal of vegetables, for example. It turns out 4 times a day.

I noticed that it is important to eat only these four times, and in small portions, so that the stomach and intestines are not overloaded and do not put pressure on the rectum, and also so that the blood supply is not impaired due to intestinal overcrowding.

It is also important to chew your food very very very well so that it is easy for the stomach and intestines to cope with it. Enzymes, pancreatin and Creon (pharmacy, for example, contain enzymes) are also suitable for improving digestion.

In general, digestion must be dealt with first so that the gastrointestinal tract machine starts working well.

Treatment of hemorrhoids is prescribed depending on the stage of the disease. Accordingly, conservative or minimally invasive methods or surgical operations can be used...

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In the treatment of hemorrhoids, it can be used as a general remedy (herbal preparations with anti-inflammatory, analgesic, laxative, hemostatic, healing and anti-spasm effects)…

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What drugs can be used for prevention?

Excessive and regular use of laxatives can cause hemorrhoids. Frequent constipation must be treated by eliminating the cause of its occurrence in the first place. Laxatives cannot cure constipation but will only provide temporary relief.

For prevention purposes, various medicines, contributing to the provision of a venotonic effect. The selection of drugs should be carried out by a doctor. Can be used:

• Detralex tablets for internal use are used both for exacerbations and to prevent the development of the disease.
• Venarus is an analogue of Detralex, used in courses several times a year. Regular use of the medicine in combination with diet and physical activity gives excellent results.
• Homeopathic suppositories are widely used to prevent the development of inflammatory process and have a strengthening effect on the walls of blood vessels. Suppositories based on sea buckthorn or propolis can also be used.

Traditional methods are used in the treatment and prevention of chronic hemorrhoids.

1. In order to prevent exacerbation of the disease, it is recommended to insert candles made from raw potatoes into the area of ​​the posterior hole every day. The course of treatment ranges from 30 days and can be extended if the proper therapeutic effect is provided.
2. To prevent the external form of the disease, it is recommended to apply a compress of cinquefoil grass to hemorrhoids. To prepare the decoction, pour 3 tablespoons of raw materials cold water and bring to a boil. Then cool and use for the procedure. The course of treatment is 2-3 weeks, then you need to take a short break.
3. Good healing and preventive action have sitz baths with the addition of essential oils and decoctions medicinal plants. During treatment, you can use oak bark, St. John's wort, calendula and chamomile inflorescences, and lemon balm.

Facilities traditional medicine must be used for a long time: in some cases from several months to six months. It all depends on the degree of development of the disease and the tolerability of a particular drug.

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Treating hemorrhoids at home

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Be healthy!

It is very important to consult with your doctor about taking different medicinal herbs, both internally and externally (in the form of baths, compresses, etc.). After all, herbal treatment, if taken orally, affects the entire body as a whole. Therefore, it is necessary to take into account all the indications and contraindications of these medicinal plants. And those herbs that may have blood-stopping properties should be taken in certain doses and generally better limited. After all, with such a disease, blood clots can form. This ultimately leads to serious consequences.

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Bad habits

It is worth stopping smoking, because just an hour after smoking a cigarette, blood circulation in the capillaries worsens by 30%. If there is a tendency towards hemorrhoids, then this factor can provoke its development. And if the disease already exists, smoking promotes thrombosis.

It is recommended to drink alcohol rarely, and ideally to give it up. The fact is that the products of alcohol metabolism contribute to excess blood supply. This also applies to the vessels of the rectum. And red wine increases blood pressure so much that if you have hemorrhoids, it can even provoke real bleeding.

Prevention methods

It is quite difficult to take any measures during the birth itself. The best and most relieving remedy will be timely pushing and following the advice of the obstetrician. Much depends on how the last months of pregnancy proceeded, when the fetus weighs the most.

It puts pressure on the blood vessels, so in order to prevent the appearance or exacerbation of hemorrhoids during childbirth, you need to follow the rules throughout the entire period.

There are a lot of ways to treat varicose hemorrhoidal veins, and the sooner it starts, the sooner it ends. Treatment medications - ointments and suppositories for hemorrhoids - will help get rid of them during pregnancy.

People who lead a sedentary lifestyle are at risk. If you have to be in the same position for professional or other reasons, we recommend that you follow a few simple rules:

• While working, get up and stretch every 30-50 minutes. If possible, walk around the room or go outside;
• play sports. To keep the body and intestines in good shape, cardio exercises are suitable: aerobics, running, swimming and dancing. Lifting barbells, dumbbells and weights with heavy weights has the opposite effect: hemorrhoids form due to high pressure;
• When staying at home for a long time, do exercises and be active in performing classic household chores. Get a dog - once you have a pet, you won't have time to sit in front of the computer or TV in the evenings.

If you don’t have enough time for additional activity, combine your commute to work with walking. This is an excellent prevention of hemorrhoids during sedentary work, which does not take much time and is safe for health.

Nutrition

Patients with hemorrhoids suffer from frequent constipation; as a result, such women have to put in a lot of time and physical effort to defecate. Therefore, nutrition is an important part of preventing hemorrhoids; it is important to cope with constipation.

A special diet helps to structure the diet so that bowel movements occur regularly (daily, preferably at the same time), without much physical effort.

It is important to drink at least a couple of liters of water a day; mineral water, for example Essentuki, is especially good.

You will have to give up any smoked meats, spicy foods, any pickled foods and, of course, semi-finished products and fast food.

It is important to eat enough vegetables, fruits, and grains, because they are rich in fiber. You should also eat dried fruits dairy products. They have a beneficial effect on the gastric mucosa and also normalize intestinal function. Excellent mild laxatives:

• pumpkin;
• jelly made from rhubarb;
• beet;
• prunes;
• fermented milk products, namely kefir, yogurt.

It is also worth giving preference to rye or bran bread. If there is still not enough fiber in the diet, the proctologist will prescribe special medications containing it.

Hemorrhoids are varicose veins of the rectum and anus. The disease is associated with thrombosis, inflammation, pathological expansion and tortuosity of the hemorrhoidal veins that form nodes around the rectum.

Hemorrhoids are characterized by a pathological process in the anus, which brings a lot of inconvenience and significantly worsens the patient’s quality of life.
Suffering from hemorrhoids about 80% of the world's population, but only 1 in 4 sick people seek help from a doctor.
The real threat of developing hemorrhoids occurs after 25 years. Men are most susceptible to it, but hemorrhoids also cause a lot of trouble for women.
The disease is based on the anatomical features of the structure of the rectal wall.

In the area of ​​the anus there are so-called anal ridges, in the thickness of which there is a large number of tortuous blood vessels. In these vessels, blood pressure is constantly increased. Pineal nodes are swollen and dilated veins; blood is deposited in them. Depending on where the node protrudes, doctors talk about internal or external hemorrhoids.

Symptoms and complications of hemorrhoids

Manifestations of the disease depend on the stage. At first, you may experience a feeling of heaviness, itching, and burning in the anus. Unpleasant sensations intensify after drinking alcohol and excessive physical activity. As the disease progresses, the main symptom of chronic hemorrhoids appears - prolapse of hemorrhoids, often accompanied by the appearance of scarlet bloody discharge at the end of a bowel movement on stool or toilet paper.

In addition to discomfort, hemorrhoids lead to the development of dangerous complications. Hemorrhoids can become inflamed, leading to thrombophlebitis. This complication manifests itself in the form of sharp pain and swelling, the hemorrhoidal node thickens, and the temperature rises.
The inflammatory process can spread to the fatty tissue surrounding the veins.
No less dangerous are the loss and pinching of internal nodes, in which they become dense and very painful. In both cases, you should immediately contact a specialist.

Causes and risk factors for developing hemorrhoids

Hemorrhoids are an exclusively human disease that scientists associate with the ability to walk upright.
The formation of nodes occurs with increased pressure in the venous system of the rectum and local increase in arterial blood flow for a number of reasons.

• Heredity. The literature describes cases of hemorrhoids in five generations in a row. We are talking about the structure and strength of venous vessels and their walls. Often with hemorrhoids, other diseases associated with the pathology of the venous system are determined, for example, varicose veins of the lower extremities.
• Constipation may be the main reason. Due to constipation, when straining, intra-abdominal pressure increases and hemorrhoids are pushed out of the anus.
• Pregnancy, childbirth. During pregnancy, as the fetus grows, intra-abdominal pressure increases, this impedes venous blood flow and increases pressure in the veins, which leads to venous congestion. At the time of birth, these factors can exceed critical values ​​and lead to the formation of irreducible nodes. After childbirth, hemorrhoidal veins narrow sharply, and the symptoms of the disease, if there are no other predisposing factors, often disappear.
• Hard physical work. Loads arising from lifting and carrying heavy objects, especially by an untrained person, can lead to damage to the ligamentous apparatus of the rectum and pelvis.
• Passive lifestyle. When sitting on something soft for a long time, the hemorrhoidal veins expand and blood stagnates in them. Heat acts on the perineal area as a kind of warming compress.
• Diet violation - abuse of spicy, fatty, salty and smoked foods, chronic overeating. Spicy seasonings irritate the mucous membrane of the gastrointestinal tract, which leads to increased blood flow, so long-term abuse of hot and spicy dishes contributes to excessive blood supply and irritation of the mucous membrane.
• Bad habits (tobacco, alcohol). A high concentration of alcohol in the gastrointestinal tract causes a persistent reflex vasodilation, spreading to all parts of the digestive tract, including the rectum. In dilated vessels, blood flow slows down, and blood stagnation in the hemorrhoids and their inflammation occurs.
• Severe diarrhea. Direct damaging effect on tissue - frequent enemas, inaccurate spinning, suppositories, laxatives, anal sex, excessively intense anal hygiene.

Diagnosis of hemorrhoids

Diagnosing hemorrhoids is not difficult. This is a visual examination of the skin of the anal area, the presence of bleeding and its degree.

A digital rectal examination of the rectum is mandatory. However, with severe pain, this may not be possible. Then, while taking painkillers, an anoscopy is performed.

To examine the mucous membrane of the rectum and the lower part of the sigmoid colon, sigmoidoscopy is performed, which allows you to see the presence of even high-lying internal hemorrhoids and assess the condition of the internal nodes, or fibrocolonoscopy.

Recommendations for patients with hemorrhoids. What to do if you have hemorrhoids

This unpleasant disease requires special attention both from the doctor and from the patient. Treatment of uncomplicated hemorrhoids should begin with simple recommendations.

• Constipation leads to strained bowel movements, which in turn leads to hemorrhoids. This requires treatment, especially when there are symptoms - anal discomfort, discharge, itching, blood in the stool.
  Rely not on laxatives and enemas, but on a balanced diet: eat foods rich in fiber, cereals, fruits and vegetables; wheat bran, seaweed and flaxseed in them natural form or in the form of pharmacological drugs. The doctor may prescribe enzyme preparations, agents that affect the flora and peristalsis of the small and large intestines, dietary fiber against the background of regular and sufficient fluid intake.
• Untimely and delayed defecation. Stagnation in the rectum leads to hemorrhoids quite quickly. To prevent and treat hemorrhoids, you need to empty your bowels regularly.
• Try to set the same time of day to empty your bowels (to develop the reflex), preferably in the morning, after sleep, after drinking a large glass of water. Avoid spending long periods of time on the toilet, such as reading.
• In the evening, sit for 10–15 minutes in a cool bath, which naturally stimulates blood circulation, or make a local bath with chamomile infusion: pour 4 tbsp. spoons of herbs 1 liter of water, heat to a boil, cool and strain.
• Follow your diet. Avoid foods that can cause local irritation and dilation of blood vessels (spicy seasonings, alcoholic drinks, coffee).
  Your daily diet should include as much liquid as possible. During the day, drink at least 6–8 glasses of water, fruit juices, kvass, and fruit drinks. Normally, the contents of the large intestine are 78% water. If its quantity decreases, the movement of feces stops.
• Lose excess weight that contributes to the development of hemorrhoids. The danger increases many times over if your fat is deposited on the anterior abdominal wall. “Beer belly,” which can be caused by an addiction to beer and sweets and baked goods, puts pressure on the internal organs and disrupts venous outflow.
• Maintain personal hygiene. Hygiene of the anus is mandatory after each bowel movement; in other words, washing is necessary.
• Try not to lift heavy objects.
• Move more. If you have to sit a lot, choose a hard chair (wooden is best).
• Do physical exercises regularly, do gymnastics, swimming, walking; Avoid cycling and horse riding. Every 1.5–2 hours, perform special exercises that promote the outflow of venous blood. While standing or sitting, tense and relax the muscles of the anus 10-15 times. Circular movements of the pelvis and bending back and forth in the “feet shoulder-width apart” position are effective.
• Don't wear clothes that are too tight.
• Do not stay in a steam room for too long at high temperatures.




Hemorrhoids - treatment, tablets, suppositories, surgical methods

Treatment of hemorrhoids is prescribed depending on the stage of the disease. Accordingly, conservative or minimally invasive methods or surgical operations can be used...




Herbal treatment of hemorrhoids, herbal preparations

In the treatment of hemorrhoids, it can be used as a general remedy (herbal preparations with anti-inflammatory, analgesic, laxative, hemostatic, healing and anti-spasm effects)...

Attention! the information on the site does not constitute a medical diagnosis or a guide to action and is intended for informational purposes only.

Relevance of the problem

Although published data on the prevalence of hemorrhoidal disease in the population developed countries vary,1,2 we can say that it is one of the most common diseases in surgical practice. In the United States, more than 2.2 million new cases are diagnosed as outpatients each year3. There is a wide variety of clinical symptoms that can be misinterpreted by doctors and patients as a manifestation of hemorrhoidal disease. Thus, it is necessary to determine exactly what hemorrhoids are causing the symptoms before starting treatment for the disease. These recommendations cover both diagnostic methods and modern approaches for the treatment of hemorrhoids.

Diagnosis of hemorrhoidal disease

1. A history and physical examination should be performed, taking into account the extent and duration of symptoms and risk factors. Recommendation level 1C.

The diagnosis of hemorrhoids is confirmed clinically in most cases. The evaluation should begin with a medical history, paying close attention to symptoms that suggest hemorrhoids, as well as risk factors such as constipation,6 followed by a physical examination. Painless bleeding during bowel movements with periodic prolapse of nodes are key features internal hemorrhoids. It is necessary to pay special attention to the severity, severity and duration of symptoms, both with bleeding and prolapse of nodes, with perineal hygiene and the presence of pain.

The amount of fiber intake, the frequency and nature of stool, and difficulty with bowel movements should also be clarified, since constipation is one of the most important risk factors for hemorrhoids.4,5 The presence of symptoms of fecal incontinence may influence the choice of treatment. Physical examination should be performed in the knee-elbow or lateral decubitus position with visual inspection of the anus, as well as digital rectal examination to exclude other diseases and assess the integrity of the sphincter. In addition, performing a straining test can help diagnose prolapsed hemorrhoids and help rule out rectal prolapse. To assess the topography of the affected hemorrhoids, it is necessary to perform anoscopy.6 The classification of internal hemorrhoids located above the dentate line is presented in Table 1. This classification allows you to choose desired method treatment. Laboratory tests are most often not required to make a diagnosis.

Identifying the source of rectal bleeding

1. Endoscopic examination of the colon is indicated in selected patients with symptomatic hemorrhoids and rectal bleeding. Recommendation level IV.

Although hemorrhoidal disease is the most common cause of blood in the stool (hematochezia), there are many diseases, such as colorectal cancer, inflammatory bowel disease, different kinds colitis, diverticular disease and angiodysplasia, which can also cause bleeding.7 In most patients, colon cancer does not cause hematochezia, and many doctors neglect this symptom and miss the opportunity to diagnose the tumor.8

Personal and family history, as well as physical examination, which may include proctoscopy and/or flexible sigmoidoscopy, will identify high-risk patients who require a more thorough diagnostic search. Previous endoscopic records should be reviewed whenever possible. Table 2 outlines the criteria for patients who should undergo a full colon examination using colonoscopy or another method of screening for colorectal cancer.9 If colonoscopy is not possible for one reason or another, flexible sigmoidoscopy should be considered in combination with other diagnostic methods given in the recommendations on colorectal cancer screening.10

Treatment of hemorrhoids

1. Modification of diet with sufficient fluid intake and inclusion of dietary fiber, as well as the formation of a habit of regular bowel movements are all the main methods of treatment for patients with symptomatic hemorrhoids. Recommendation level IV.

Constipation and bad habits(eg, excessive straining, prolonged toileting, and frequent bowel movements) may play an important negative role in patients with symptomatic hemorrhoids.4,5 Increasing dietary fiber and fluid intake should be recommended in all patients to help reduce symptoms of prolapsed nodes and mild bleeding. and moderate severity. A review including 7 randomized trials (378 patients) demonstrated the superiority of a fiber-containing diet. It improved treatment outcomes for symptomatic hemorrhoids (HR = 0.47, 95% CI, 0.32–0.68), and the risk of bleeding was also reduced (HR = 0.50, 95% CI, 0.28–0.89), while the diet had no effect on the symptoms of prolapsed hemorrhoids, pain and itching.11

2. Conservative therapy for hemorrhoidal disease is represented by various groups of drugs that have a minimal risk of complications and are sufficiently effective. Recommendation level 2B.

Phlebotonics include various groups of drugs used to treat both acute and chronic hemorrhoids. The mechanism of their action is not completely clear, but it is assumed that it is associated with strengthening the walls of blood vessels, increasing the tone of the venous bed, normalizing lymphatic drainage and capillary permeability. A review of 24 randomized controlled trials (RCTs) that compared the effectiveness of drugs versus a control group demonstrated that phlebotonics significantly reduced pruritus (odds ratio (OR) = 0.23 (95% CI, 0.07-0.79) , p = 0.02), bleeding frequency (OR = 0.12 95% CI, 0.04-0.37, p = 0.0002), incontinence symptoms (OR = 0.12, 95% CI, 0. 04-0.42, p = 0.0008), and also contribute general decline symptoms (OR = 15.99, 95% CI 5.97-42.84, p<0,00001). Несмотря на это, степень болевого синдрома статистически не различалась по сравнению с контрольной группой (ОШ = 0,11 95% ДИ, 0,01-1,11, p = 0,06).14 Мета-анализ 14 РКИ, проводящий сравнение различных классов флавоноидов (диосмин, микронизированная фракция диосмина и рутозиды) выявил, что флавоноиды оказывают положительное влияние на симптомы зуда, а также на частоту кровотечений и рецидивов (СР= 0,53).15

Despite the routine use of ointments containing anesthetics, steroids, emollients, and/or antiseptics, their long-term use can lead to allergic reactions or sensitization, and there is insufficient evidence on the long-term outcomes of therapy.

Ambulatory treatment

1. In most patients with stages I and II, as well as some patients with stage III internal hemorrhoids, it is possible to perform ligation with latex rings, sclerotherapy, and infrared photocoagulation. Latex ring ligation is the most effective method. Recommendation level 1A.

The goal of outpatient surgery is to relieve symptoms by reducing the size or vascularization of the hemorrhoidal plexus and fixing the hemorrhoidal tissue to the rectal wall to reduce the risk of prolapse. These procedures are not accompanied by severe pain and are well tolerated by patients.

However, patients should be informed of the high likelihood of relapse, which may require repeated intervention.16,17

Ligation with latex rings

The most common and effective method of treating hemorrhoids is latex ring ligation (LLR), which is superior in effectiveness to sclerotherapy and infrared photocoagulation.18 Ligation of hemorrhoidal tissue leads to its ischemia and necrosis, followed by fixation of the necrotic area to the rectal wall. The technique is well tolerated by patients, since ligation is performed well above the dentate line, where there is no sensory innervation. In one study of 750 patients with stage II and III hemorrhoids, the effectiveness was 93% and the recurrence rate was 11% over 2 years, regardless of the stage of hemorrhoidal disease.17

In an RCT of patients with stage II and III hemorrhoidal disease treated with LLK, 49% of patients experienced disease recurrence at 1 year of follow-up, most of whom required religation.19 The review compared the effectiveness of LLK versus hemorrhoidectomy, taking into account stage of the disease. The results of the analysis demonstrated that hemorrhoidectomy was superior to LLK for stage III hemorrhoidal disease (2 studies, 116 patients, HR = 1.23, 95% CI, 1.04-1.45); p = 0.01). However, there was no significant difference in outcomes when treating stage II disease (1 study, 32 patients, HR = 1.07, 95% CI, 0.94-1.21; p = 0.32). However, after radical hemorrhoidectomy, fewer patients required reintervention (3 studies, HR = 0.20, 95% CI, 0.09-0.40; p< 0,00001).20 Несмотря на то, что имеются ограниченные данные относительно безопасности ЛЛК у пациентов, принимающих антикоагулянты, применение латексного лигирования у этой группы больных противопоказано. В крупном ретроспективном исследовании среди 805 пациентов, которым суммарно было выполнено 2114 процедур ЛЛК, кровотечение в послеоперационном периоде отмечалось у 25.0% больных, принимающих варфарин, и у 7,5% пациентов, принимающих аспирин или нестероидные противовоспалительные препараты. Следует отметить, что только в 2,9% случаев кровотечение встречалось среди пациентов, которые не принимали какую-либо антитромботическую терапию.21

Sclerotherapy

For the treatment of internal hemorrhoids of I-III degrees, various techniques and sclerosing agents are used. The most commonly used sclerosant is a 5% solution of phenol in almond oil and sodium tetradecyl sulfate, a sclerosant approved by the FDA only for the treatment of small varicose veins of the lower extremities (Sotradecol, Elkins-Sinn, NJ). The mechanism of action is sclerosis of the submucosal membrane with subsequent fixation of hemorrhoidal tissue to the wall of the rectum. The injection is carried out into the submucosa in the apical region of the hemorrhoid (0.5-2.0 ml of 1% sodium tetradecyl sulfate or 1.0-3.0 ml of 5% phenol oil solution). Complications of injections can include ulceration or necrosis of the mucous membrane, as well as more rare complications - prostate abscess and retroperitoneal sepsis.22 Transient bacteremia after sclerotherapy is observed in 8% of patients; the use of antibacterial therapy should be considered only for individuals with an increased risk of septic complications.23

In one study, the effectiveness of sclerotherapy in the treatment of stage III hemorrhoids after a year was only 20%.24 Better results were demonstrated for stage I hemorrhoids; in a study using polidocanol (FDA approved, registered in the Russian Federation), 88% of patients had no relapses disease after 12 weeks of follow-up.25 Although there are no RCTs evaluating the outcome of sclerotherapy in patients receiving anticoagulants, there are data from case-control studies of 37 patients. In this study, study participants received antiplatelet therapy (aspirin, ticlopidine, clopidogrel, and cilostazol (not registered in the Russian Federation), or anticoagulant therapy (warfarin), or combination therapy (antiplatelet + anticoagulant), and no differences were found among the three groups in frequency of postoperative bleeding.26 New sclerosing agents available in some countries of Asia and Europe (for example, the drug Ziohn, not registered in the USA and the Russian Federation) have higher effectiveness in the treatment of stage II-III hemorrhoids.27,28 Until no new data will be obtained, the role of sclerotherapy in the treatment of hemorrhoidal disease remains quite limited.

Infrared photocoagulation

In infrared photocoagulation (IPC), infrared waves lead to coagulation and necrosis of hemorrhoidal tissue. Most often, this technique is used for hemorrhoids of stages I and II. Despite the high recurrence rate in early studies, especially among patients with stages III and IV hemorrhoidal disease,29 recent data from RCTs suggest comparable outcomes between IFC and LLK.30,31 Among patients with stages I and II internal hemorrhoids at 6 months of follow-up efficacy was 81% after IFC, with 28% of patients requiring a repeat procedure.32

Complications of outpatient procedures

In general, serious complications are quite rare. However, when performing outpatient procedures or surgery on the rectum, it is necessary to remember such a life-threatening complication as perianal sepsis. Perianal sepsis may manifest as difficulty urinating, increasing pain or fever, which requires an urgent search for the cause of the symptoms.33 Bleeding is the most common complication of outpatient procedures, and is more common after LLK than with other types.

As a rule, these complications occur on the first day after the intervention, which may be associated with ulceration of the hemorrhoid. Accurate data on the prevalence of postoperative pain syndrome are currently lacking. In some patients after LLK, pain occurs as a result of displacement of the ligature below the dentate line, which may cause removal of the ligature. Patients should be informed of these rare complications.22,34,35

Thrombosis of external hemorrhoids

1. Some patients with thrombotic hemorrhoids benefit from early excision of the thrombosed nodes. Recommendation level 2C.

The limited data from studies on hemorrhoidal thrombosis do not allow for recommendations of a high level of evidence. Surgical treatment may be superior to nonoperative treatment, but the optimal duration of conservative therapy is uncertain.36 Excision of a thrombosed hemorrhoid results in faster symptom relief, fewer relapses, and longer remission periods. In a prospective study by Cavcic et al, 37 150 patients were randomized into 3 groups: topical 0.2% nitroglycerin ointment, thrombectomy, and hemorrhoidectomy. On the 4th day after the start of treatment, the most pronounced reduction in pain was observed in the hemorrhoidectomy group, then in the local treatment group; thrombectomy was the least effective method. However, the differences in pain intensity after a month were not significant. Greenspon et al38 retrospectively analyzed data from 231 patients with thrombosis of external hemorrhoids. Among them, 48.5% of patients underwent surgical intervention (in this group, 97.3% underwent local excision of the thrombosed node, the rest underwent thrombectomy).

Conservative treatment included dietary modification, stool softeners, oral and topical analgesics, and baths. Symptoms (pain, bleeding and/or sensation of a mass) completely resolved after an average of 24 days in the conservative treatment group compared to 3.9 days in the surgical group.

Surgical treatment of hemorrhoidal disease

1. Hemorrhoidectomy is the treatment of choice for patients with symptomatic external hemorrhoids or in cases of a combination of internal and external hemorrhoids with prolapse of nodes (stages III-IV). Recommendation level 1A.

Hemorrhoidethcomy

Hemorrhoidectomy remains the most effective treatment method among patients in whom outpatient interventions were ineffective or impossible, with stages III - IV of hemorrhoidal disease or in the presence of anal polyps. A meta-analysis of 18 randomized trials compared outpatient procedures with hemorrhoidectomy, with the latter demonstrating greater effectiveness in patients with stage III hemorrhoids. Moreover, after hemorrhoidectomy, severe pain was observed and complications were more common.18 Open, like closed hemorrhoidectomy, can be performed using various surgical techniques. In a meta-analysis of 11 RCTs (total number of patients 1326), closed hemorrhoidectomy showed better results in terms of postoperative pain, wound healing time, and risk of postoperative bleeding.39

The rates of all postoperative complications, hemorrhoid recurrences, and infectious complications were not statistically different. The use of a bipolar electrocoagulator reduces surgical time and has a positive effect on postoperative pain, as demonstrated by a meta-analysis of 5 studies in which this technique was compared with closed hemorrhoidectomy.40 Another meta-analysis of 8 studies (468 patients) showed that the use of an ultrasonic scalpel has a positive effect affected the duration of disability, pain, and postoperative complications when compared with the outcomes of hemorrhoidectomy.41 When directly comparing these two techniques with hemorrhoidectomy, no differences in outcomes were found.42 The possible increase in costs associated with surgery requires additional clinical and economic studies.

Stapled hemorrhoidopexy

Staple hemorrhoidopexy (Longo operation) is an operation in which a muco-submucosal anastomosis is created using a circular stapler with resection of the submucosal layer proximal to the dentate line. As a result, the blood supply is stopped and the hemorrhoidal plexuses lift. This technique is effective only for internal hemorrhoids. The first non-randomized studies of stapled hemorrhoidopexy demonstrated less pain and faster patient recovery compared with hemorrhoidectomy. In the study, Watson et al43 randomized 777 patients, with 389 patients undergoing stapled hemorrhoidopexy and 388 patients undergoing radical hemorrhoidectomy. In the early postoperative period after hemorrhoidopexy, less severe pain was observed, and the number of complications in the two groups was not statistically different. Moreover, the hemorrhoidectomy group had higher quality of life scores than the hemorrhoidopexy group.

The hemorrhoidopexy group had more recurrences 32% vs 14% (RR = 2.96, 95% CI 2.02 - 4.32; p< 0,0001), эта разница сохранялась на протяжении 24 месяцев наблюдения. Кроме того, у пациентов после операции Лонго чаще встречались симптомы выпадения (ОР = 2,65, 95% ДИ 1,45-4,85; p = 0,002).43 Мета-анализ 12 исследований (955 пациентов) продемонстрировал более высокий риск рецидива после проведения степлерной геморроидопексии по сравнению с геморроидэктомией на протяжении всего периода наблюдения (ОР = 3.22, 95% ДИ 1.59-6.51; p = 0.001). После операции Лонго чаще требовалось повторное вмешательство, по сравнению с геморроидэктомией (8 исследований, ОР = 2,75, 95% ДИ, 1,31-5,77; p = 0,008), послеоперационный период чаще протекал бессимптомно (12 исследований, ОР = 0,59, 95% ДИ, 0,40-0,88). Положительная тенденция после геморроидопексии отмечалась в отношении болевого синдрома, симптомов зуда и случаев внезапных позывов к дефекации. Все остальные показатели продемонстрировали преимущество геморроидэктомии.44 По результатам мета-анализа среди всех методов хирургического лечения геморроидальной болезни у степлерной геморроидопексии отмечался самый высокий показатель рецидивирования симптомов геморроя.45

Long's operation has several characteristic complications: the formation of a rectovaginal fistula, bleeding or stricture at the site of hemorrhoidopexy.

A systematic review of 784 articles (14,232 patients) found an average complication rate of 16.1%, with five patients dying.46 Between 2000 and 2009, 40 cases of rectal perforation after stapled hemorrhoidopexy were published. Thirty-five patients required laparotomy with fecal evacuation, and in one case a low anterior rectal resection was performed. Despite surgical treatment and intensive care, 4 patients died.47

Desarterization of hemorrhoids.

When ligating hemorrhoidal arteries under the control of Doppler ultrasound (hemorrhoidal disarterization, HAL), a special anoscope equipped with a Doppler sensor is used. It allows you to identify the arteries associated with the hemorrhoidal plexuses and perform their ligation. In this case, there is no need for tissue excision, and the pain syndrome is minimally expressed. In addition to ligation, hemorrhoidal plexus lifting may also be performed. In general, studies of this technique show positive short-term results.48 According to a systematic review of 28 studies (2904 patients with stage I-IV hemorrhoids), the effectiveness of a single procedure ranges from 3.0 to 60.0% (average 17.5%), with the highest recurrence rate occurs among patients with stage IV hemorrhoids. Pain relief was required in the postoperative period in 0-38% of patients. Complications were quite rare, bleeding was observed in 5.0% of patients, repeated interventions were required in 6.4% of cases. The average duration of surgery ranged from 19 to 35 minutes.49

In a randomized prospective study comparing LLK with HAL for the treatment of stage II and III hemorrhoidal disease, the relapse rate within 1 year after LLK was 49% (87/176) and 30% (48/161) in the desarterization group (RR = 2.23, 95 % CI, 1.42-3.51, p = 0.0005). The number of additional procedures required for complete resolution of symptoms (32% in the LLK group and 14% in the HAL group) is considered the main reason for more frequent disease relapses after LLK.

In another study, relapse and complication rates, symptom severity, EQ-5D quality of life, and incontinence scores did not differ between the LLC and HAL groups. Moreover, in the early postoperative period, HAL was accompanied by more severe pain. Based on the results of a clinical and economic assessment of additional costs adjusted for outcomes, HAL was found to be less effective than LLK.50

Complications of hemorrhoidectomy

The incidence of complications after hemorrhoidectomy according to the literature varies from 1% to 2%.39 Acute urinary retention occurs in 1-15%.51 This complication is more common when using spinal anesthesia and after the HAL procedure. Reducing the volume of fluid therapy and using local anesthesia can significantly reduce the risk of developing these complications.52

2. Multicomponent therapy for pain syndrome with minimal use of narcotic painkillers can speed up the recovery of patients after hemorrhoidectomy. Recommendation level IV.

In a review of 115,775 patients undergoing various surgical procedures, hemorrhoidectomy was ranked 23rd out of 529 in terms of severity of postoperative pain.53 Various modifications of surgery and postoperative management of patients can reduce the severity of pain.54 Topical use of 2% ointment containing Diltiazem , reduces pain and the need for narcotic analgesics after hemorrhoidectomy.55,56 A meta-analysis of 12 studies (1095 patients) demonstrated a significant reduction in pain with the use of nitroglycerin ointment after hemorrhoidectomy, as well as a reduction in patient recovery time.57

Surgical sphincterotomy (LIS) reduced pain and analgesic requirements after hemorrhoidectomy. LIS reduced the incidence of postoperative urinary retention and the risk of anal stenosis. However, when hemorrhoidectomy is used in combination with LIS, the risk of developing transient fecal incontinence increases.58 In 3 RCTs, the use of botulinum toxin after hemorrhoidectomy was associated with a decrease in pain in the early postoperative period (<1 недели), а частота недержания газов оказалась сопоставима с группой плацебо.59 По данным мета-анализа метронидазол не снижал степень болевого синдрома в плацебо-контролируемых исследованиях.60 Оценка эффективности липосомального бупивакаина (ЛБ) проводилась в 2 РКИ. В первом случае 189 пациентов после геморроидэктомии рандомизировались в группы ЛБ и плацебо. В группе ЛБ интенсивность боли отмечалась значительно ниже (141,8 против 202,5; р < 0,0001). В группе ЛБ через 12 часов после операции у 59% пациентов не требовалось дополнительного применения опиоидных анальгетиков и у 28% через 72 часа по сравнению с пациентами, получавшими плацебо (14% и 10%; р < 0,0008 для 72ч).61 В другом исследовании 100 пациентов случайно рандомизировались в группы, однократно получающие 175 мг 0,25% бупивакаина гидрохлорида или ЛБ в дозе 66 мг, 199 мг, или 266 мг после выполнения геморроидэктомии. ЛБ значительно превосходил бупивакаин гидрохлорид по степени снижения интенсивности болевого синдрома через 72 часа после операции независимо от дозы ЛБ (р < 0,05). В послеоперационном периоде (12-72 часа) в группе бупивакаина гидрохлорида опиоиды назначались чаще, чем в группе ЛБ 266 мг (p = 0,019). Среднее время до первого применения опиоидов составило 19 часов для ЛБ 266 мг против 8 часов для бупивакаина гидрохлорида (р = 0.005). В группах ЛБ 266 мг и бупивакаина гидрохлорида в 4% и 35% случаев соответственно отмечались побочные эффекты, связанные с использованием опиоидов (р = 0.007).62

Hemorrhoids are one of the most delicate human diseases, which not only causes discomfort and changes the usual way of life, but also leads to serious complications. Knowing what is not allowed in case of pathology and following all recommendations, you can eliminate pain, facilitate therapy and speed up recovery.

Contraindications for hemorrhoids are quite varied:

and inactive lifestyle

Often occur due to constant or excessive stress on the pelvic area, for example, during work involving heavy lifting or in professional athletes. Therefore, physical overload is a contraindication that must be taken into account during therapy for women and men.

If you have hemorrhoids, you should not:

• exercise in the gym with strength training, bodybuilding, and on exercise bikes;
• engage in horseback riding and cycling, it is strictly forbidden to do this with;
• lift weights weighing over 5 kilograms;
• go on long hikes and mountaineering.

Attention! The development of pathology is facilitated by a sedentary and sedentary lifestyle, so not only athletes, but also those who move little, for example, truck drivers, office workers, teachers, bartenders, hairdressers, doctors, are at risk.

• stand on your feet for a long time;
• sit in one position for a long time on soft chairs and armchairs (it is better to choose hard surfaces).

Food contraindications

In most cases, hemorrhoids appear due to poor nutrition, therefore, in the process of treatment and prevention of pathology, foods and dishes that cause constipation, increase the rate of putrefactive processes and lead to increased fermentation in the digestive tract, which provoke excess blood flow to the intestines, are excluded from the daily diet.

Prohibited products include:

• eggs;
• vegetables (potatoes, cabbage, turnips, radishes);
• fruits (apples, grapes);
• sorrel;
• jelly;
• semolina and rice cereals;
• milk and chocolate;
• pasta;
• white bread, products made from yeast dough;
• smoked sausages;
• mayonnaise and ketchup;
• conservation;
• sweets;
• kvass, coffee, strong tea.

In addition, it is necessary to give up fast food products - fast foods, snacks, dry snacks, frozen semi-finished products, packaged meals, and so on.

The consumption of fried, fatty, salty foods and spices is limited.

Uncomfortable clothes and shoes

Wearing tight underwear, tight jeans, trousers and shorts if you have hemorrhoids is strictly prohibited.

Women are not allowed to wear high-heeled shoes, thongs or tights.

Hypothermia and overheating

Hypothermia of the anal area and legs causes disruption of blood circulation, which provokes inflammation of the hemorrhoids.

If you have hemorrhoids, it is contraindicated to take. When overheated, blood vessels dilate, which causes acute pain in the anus and more.

Bad habits

It is also necessary to give up smoking. These bad habits have the most negative impact on the patient’s well-being and aggravate the course of the disease. In addition, with regular smoking and drinking alcohol, the risk of re-development of the pathology increases several times.

Self-medication

This is the main contraindication for pathology. Trying to cope with the disease on their own using traditional methods or traditional medicine, a person risks worsening his condition.

Hemorrhoids can ultimately provoke the development of rectal cancer, so timely seeking medical help is an important condition for recovery.

What do we have to do

Hygiene rules

Maintaining intimate hygiene is an essential part of the treatment and prevention of hemorrhoids. If you are ill, you should not use hard toilet paper, as it can damage hemorrhoids.

The anorectal area must be thoroughly cleaned after each bowel movement. To do this, use a soap solution with warm, or preferably cool, water, an antiseptic solution or wet wipes. Doctors recommend replacing plain water with herbal decoctions with antiseptic, anti-inflammatory and antispasmodic effects: oak bark, chamomile, yarrow, sage and others.

After defecation, it is useful to take short-term sitz baths in a warm solution of potassium permanganate.

Proper nutrition

A balanced diet with a high fiber content prevents constipation, which not only worsens the condition of external and internal lumps, but also causes bleeding fissures.

A large amount of fiber is found in:

• fruits (bananas, apricots, plums and others) and vegetables (carrots, cauliflower, garlic, zucchini, beets and so on);
• dried fruits (prunes, dried apricots, raisins);
• bran and rye bread;
• pearl barley, oatmeal, barley and buckwheat;

Useful products for hemorrhoids are:

• lean varieties of fish and meat;
• whey (it is recommended to drink 1-2 glasses on an empty stomach);
• seaweed;
• olive and linseed oils;
• fermented milk products (kefir, natural yoghurts) and so on.

Drinking regime

Daily consumption of a minimum amount of pure non-carbonated water (from 2 liters) helps soften the stool and improve the patient’s condition.

Moderate physical activity

Physical inactivity is a common cause of hemorrhoids, so without moderate physical activity, treatment of the pathology will be delayed.

A good option are cardio exercises - walking and running, which will promote the outflow of blood from the pelvic organs, for example, exercises “Birch”, “Bicycle”, “Vertical Scissors”, “Bending”, “Cutting Scissors” and so on.