What Is Hemorrhoidal Prolapse and How Is It Treated?: Elvira Klause, MD, FACS: General Surgeon

The pain. The itching. The burning. If you have hemorrhoids, you’re probably familiar with all of those symptoms. And you have a lot of company — about one of every 20 Americans has hemorrhoids, with prevalence increasing as you get older.

As a leading medical provider in San Clemente, California, Elvira Klause, MD, treats hemorrhoids, helping patients feel more comfortable and avoid more serious complications. Hemorrhoidal prolapse is a relatively common complication associated with internal hemorrhoids — and one you should know about if you’re plagued by hemorrhoid symptoms.

Why hemorrhoids happen

Hemorrhoids are swollen veins in or near your rectum. Several factors can increase the likelihood that you’ll develop hemorrhoids, including:

• Chronic constipation
• Chronic diarrhea
• Straining a lot during bowel movements
• Spending a lot of time sitting on a toilet
• Eating a diet low in fiber
• Pregnancy
• Obesity
• Standing or sitting for long periods
• Repetitive heavy lifting

Women are more likely to have hemorrhoids, and they’re also more common among people over age 50.

Internal vs. external hemorrhoids

Hemorrhoids can be either internal or external depending on where they form. Hemorrhoids located inside your rectum are internal, while those that form near the outside of your anus are external hemorrhoids.

External hemorrhoids typically feel like bumps or lumps near your anus, and they’re more likely to cause pain, itching, and burning. They’re also more likely to bleed when you have a bowel movement.

Internal hemorrhoids can bleed a bit if you’re constipated or pass a hard stool. But frequently, they cause no symptoms unless they prolapse, or push outward. 

Prolapsed hemorrhoids vs. external hemorrhoids

The main difference between a prolapsed internal hemorrhoid and an external hemorrhoid is simple: External hemorrhoids form on the outside of your anus, while a prolapsed hemorrhoid forms internally and extends outside the anus.

Internal hemorrhoids usually prolapse because of increased pressure on the rectum due to any of the risk factors listed above. When pressure increases, the vessels that comprise your hemorrhoids tend to swell and drop, pushing out of the anal sphincter.

Complications

If a prolapsed hemorrhoid swells, it can wind up blocking your anus and obstructing your bowel, preventing you from having bowel movements. Some prolapsed hemorrhoids bleed heavily, increasing the risk of life-threatening blood loss.

Prolapsed hemorrhoids are also more likely to form dangerous clots (thrombosis) or become strangulated, resulting in circulation problems that can lead to tissue death. For these reasons, it’s very important to seek medical care for hemorrhoids — even if they’re not prolapsed.

Find relief for symptomatic hemorrhoids

Dr. Klause offers several solutions for symptomatic hemorrhoids that don’t respond to over-the-counter ointments and other conservative options. These include:

• Rubber band ligation 
• Sclerotherapy injections
• Transanal hemorrhoidal dearterialization

These methods block circulation to the hemorrhoids, and they eventually die. In more severe cases, Dr. Klause suggests hemorrhoidectomy, a surgical procedure that removes hemorrhoid tissue.

If you have hemorrhoids, scheduling an evaluation with Dr. Klause is the best way to find relief from pain and other symptoms — and to prevent more serious problems from happening. To schedule your evaluation, call 949-393-2595 or book an appointment online today.

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4 Signs Your Hemorrhoids Require Medical Intervention: Betsy F. Clemens, M.D.: Board Certified Physician

You may, understandably, not like to talk about it, but hemorrhoids are pretty common. They affect about 10 million adults in the United States annually. It’s estimated, in fact, that as many as three in four adults will experience problems with hemorrhoids at some point in their lives.

Take a walk down the pharmacy aisle at your local grocery store and you’ll likely find plenty of treatments that promise to help. But what do you do when home remedies don’t work? Is there a medical treatment that will help heal your hemorrhoids and resolve your pain?

“Yes,” says Dr. Betsy Clemens. And the good news? Effective hemorrhoid treatment doesn’t always mean surgery. In fact, most of the time it does not.

Dr. Clemens leads our team here at Midwest Hemorrhoid Treatment Center in Creve Coeur, Missouri. She’s a specialist who is well known for her medical expertise as well as her passion for making her patients feel comfortable when addressing this sometimes embarrassing condition.

What are hemorrhoids?

Simply put, hemorrhoids are swollen and bulging veins that occur in your anorectal region. Hemorrhoids are similar to varicose veins and can occur anywhere from your lower rectum to just outside the anus. Internal hemorrhoids occur inside and external hemorrhoids form under the skin of the anal opening.

Depending on their location, hemorrhoids may cause excessive bleeding with little discomfort or become exquisitely painful. As with many medical conditions, early treatment for your hemorrhoids can often spare you needless pain and discomfort.

4 signs that hemorrhoids require medical intervention

Here are the four signs that Dr. Clemens says indicate your hemorrhoids require medical intervention and why early treatment matters.

1. Bleeding during bowel movements

There are many underlying causes of rectal bleeding, including hemorrhoids. Blood associated with internal hemorrhoids is typically bright red, causes no pain, occurs with bowel movements, and may be mild to moderate in amount.

You can’t assume, however, that your symptoms are due to hemorrhoids. If you’ve never been diagnosed with hemorrhoids or have noted a change in the characteristics of the bleeding you’ve associated with hemorrhoids, see a doctor for an accurate diagnosis.

2. A noticeable bulge at the anus that seems to retract following a bowel movement

Internal hemorrhoids can prolapse or fall outside of the anal opening during a bowel movement. Initially, the tissue may retract on its own or be easily pushed back inside. But prolapse can worsen over time and can eventually cause significant irritation, itching, bleeding, and pain as this internal tissue becomes trapped outside of the anus. Early treatment helps prevent the prolapse from worsening.

3. The sensation that you’re not emptying your stool completely

Prolapsing internal hemorrhoids can cause the feeling that your stool is stuck at the anus. Or you may note a mucous discharge and difficulty in cleaning yourself following a bowel movement because of the displaced tissue. We can remedy these symptoms by treating the hemorrhoid.

4. Discomfort, itching, and irritation in the anal region

There’s really no reason to try and live with your hemorrhoids until the pain becomes severe enough to disrupt your life. Many effective nonsurgical treatments exist that can resolve your hemorrhoids, including:

Infrared coagulation (IRC)

The highly effective IRC method utilizes infrared light delivered via a small probe to painlessly coagulate (clot) the blood vessels supplying your hemorrhoid. As the blood flow is blocked, the enlarged hemorrhoidal tissue shrinks and your symptoms resolve.

Rubber band ligation

This method also blocks blood flow to the hemorrhoidal tissue, which eventually causes the hemorrhoid to wither and “die.” It’s admittedly more painful overall than IRC and may cause bleeding, but it remains an effective, nonsurgical solution for treating hemorrhoids.

You can rely on Dr. Clemens to focus first on diagnosing your condition correctly and then recommending the most conservative and effective hemorrhoid treatment available, including tips that help prevent hemorrhoids from recurring. Schedule your appointment today at Midwest Hemorrhoid Treatment Center.

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relationship, causes and prevention

Constipation and hemorrhoids are very common problems, so one condition is often associated with another. At the same time, both constipation and hemorrhoids can occur independently of each other. We will talk about all the features of the development and course of these pathological conditions in this article.

What is constipation

With constipation, there is a violation of the defecation process. Usually patients complain of a decrease in the frequency of fecal discharge, slowing down or difficulty. The disease can be acute and chronic, although not all experts consider constipation to be a disease. Domestic doctors consider it only as a symptom of other pathological processes. If we turn to the international classification of diseases (ICD-10), then in it constipation is placed in a separate disease (code K59.0).

The causes of constipation can be very diverse. Among the most common predisposing factors are:

• Wrong diet.
• Sedentary lifestyle.
• Uncontrolled use of laxatives.
• Pregnancy.
• Diseases in which there is a decrease in intestinal motility.
• Spinal cord injury.
• Taking certain medications, etc.

In addition, the list of causes of constipation includes hemorrhoids. Discomfort and pain during bowel movements with hemorrhoids force the patient to postpone going to the toilet as long as possible. The psychological influence is sometimes very strong and leads to the development of constipation even with a normally functioning bowel. The disease can be chronic and manifest itself even after the treatment of hemorrhoids.

What are hemorrhoids

Hemorrhoids are called pathological expansion of hemorrhoidal veins, which is accompanied by inflammation, thrombosis, formation of nodes. Among the most common causes of the development of the disease are:

• Physical inactivity.
• Obesity (details).
• Improper nutrition (more).
• Hereditary predisposition.
• Circulatory disorders in the pelvic organs, etc.

As you can see, some predisposing factors are common to both diseases. With constipation, the patient is forced to push hard for a long time to empty the intestines, which leads to an increase in intra-abdominal pressure. At the same time, hard and dense feces injure the rectal mucosa, which also contributes to the development of hemorrhoids. Often in the practice of a proctologist there are cases when both diseases are detected simultaneously. In this case, before proceeding with the treatment of hemorrhoids, it is necessary to eliminate constipation, and for this it is necessary to normalize nutrition and adjust lifestyle. Additionally, the doctor may prescribe medications.

How to avoid constipation and hemorrhoids

Prevention of these diseases also has common features. First of all, you need to adjust your diet: it is necessary to exclude fatty, fried and smoked foods, as well as foods that have a fixing effect. The optimal amount of fluid to drink every day is at least 1.5 liters of ordinary clean water. Do not forget about components such as fiber and foods that support intestinal motility at the proper level (dried fruits, kefir, fermented baked milk, fresh vegetables, cereals, etc.). Read more about the diet for hemorrhoids here.

The second important rule concerns physical activity. It is especially true for people who are engaged in sedentary work. Every hour you need to take small breaks of 5-10 minutes, during which you need to perform simple physical exercises or just walk. Experts recommend keeping the whole body in good physical shape, which will reduce the risk of developing not only hemorrhoids and constipation, but also many other diseases.

It is equally important to choose the right laxatives and not to abuse drugs that can cause constipation. Any treatment, even the most harmless and simple, should be prescribed by a doctor and periodically monitor the patient’s condition. It is imperative to consult a doctor in cases where, along with indigestion, symptoms such as discomfort, itching and burning in the rectum, the appearance of blood in the feces, pain during bowel movements, etc. develop. In order to identify the cause of these manifestations, it is necessary undergo an examination and only then proceed to treatment. Uncontrolled intake of drugs can lead to the development of complications and deterioration of health.

The material was prepared by
specialist of the medical center “URO-PRO”
Sugak Tatyana Vladimirovna,
proctologist, experience 12 years

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Hemorrhoids: symptoms, causes, diagnosis and treatment

Attention!

The information in the article is for reference only and cannot be used for self-diagnosis and self-treatment.
If you have symptoms of the disease, contact your doctor.

Contents

• Symptoms of hemorrhoids
• Causes of hemorrhoids
• Types of hemorrhoids
• Internal hemorrhoids
• External hemorrhoids
• Hemorrhoids in women
• Hemorrhoids in men
• Stages of hemorrhoids
• Diagnosis of hemorrhoids
• Treatment of hemorrhoids
• Hemorrhoid suppositories
• Hemorrhoid ointment
• Hemorrhoid tablets
• Hemorrhoid surgery
• Hemorrhoid prophylaxis
• Output

Hemorrhoids are varicose veins of the rectum and anus. Dilated veins are deformed with the formation of hemorrhoids, their walls become thinner and become easily vulnerable.
Hemorrhoids can be both an independent disease and a manifestation of another pathology, for example, cirrhosis of the liver.

Symptoms of hemorrhoids

• discomfort and pain in the anus,
• bleeding – occurs or increases after a bowel movement and can lead to the development of anemia (anemia).
• prolapsed hemorrhoids.
• heavy physical activity,

Causes of hemorrhoids

• heredity,
• consumption of spicy food and alcohol,
• obesity,
• heavy physical activity,
• stress,
• pregnancy and childbirth in women,
• sedentary lifestyle,
• constipation.

Types of hemorrhoids

There are three types of pathology – external, internal and mixed hemorrhoids.

Internal

Internal hemorrhoids are the presence of varicose veins inside the ampoule. Knots are formed inside on its walls.
The formations lie in the thickness of the mucous ampulla of the rectum, located above the dentate zone.
Here is the internal venous plexus.

Inner bonds are rather insidious. They don’t show up for a long time. Small seals for a long time
asymptomatically located inside the intestine. Only later, with decompensation of the process, clinical manifestations become
obvious – discomfort, burning in the anus, swelling in this area, painful defecation, blood on toilet paper.

External

External hemorrhoids – a pathology that is formed when blood circulation is disturbed in the anal venous network.
There is an expansion of blood vessels in certain areas of the vessels – cavernous bodies with the subsequent formation of nodes.
They are located directly under the skin in the area below the rectal-anal line.

There are ordinary and complicated forms of the disease. With it, hemorrhoids bleed, fall out, are infringed and ulcerated.
This type of lesion of venous vessels in the anal area is manifested by vivid clinical manifestations.
External hemorrhoids almost immediately after the appearance brings discomfort to the patient’s habitual lifestyle.

The patient is concerned about soreness in the anal area, itching. They occur first during bowel emptying, and then are constantly present.
Symptoms are aggravated by physical exertion, sneezing, long sitting.

Hemorrhoids in women

Contrary to popular belief that men are more likely to suffer from hemorrhoids, they often occur in women. The predisposition to the disease is inherited,
also its occurrence is due to the lifestyle of the patient. It often occurs in female patients for the following reasons:

• constipation;
• sedentary lifestyle;
• pregnancy;
• as a complication of childbirth;
• due to vascular pathologies.

Hemorrhoids in women occur with pathologies in the pelvic cavity, digestive disorders and tumors.

Hemorrhoids in men

Hemorrhoids occur slightly more frequently in men than in women. The reason for this is the lack of attention on the part of the stronger sex to their health.
They turn to the doctor already in the later stages of the disease. Causes of hemorrhoids in men are as follows:

• work with a predominance of hard physical labor, heavy lifting;
• sedentary work;
• the presence of bad habits: alcohol abuse, smoking;
• alimentary obesity;
• neglect of the need to empty the bowels regularly;
• delaying the act of defecation;
• chronic stress.

The causes of secondary hemorrhoids are somatic diseases: oncological processes, portal hypertension, heart failure.

Hemorrhoid stages

Hemorrhoids go through several stages in their development. They are characterized by the following manifestations:

• First. At this stage, moderate bleeding from hemorrhoids in the anus area is detected. The patient notices him after the act of defecation on toilet paper.
  At other times, there is practically no bleeding. Sometimes bowel movements are accompanied by shooting pain. With an external form, a small formation appears,
  located at the anus. It’s painful. With an internal variety of the disease, minor bleeding is observed.
• Second. With this degree, a more pronounced clinic appears with a characteristic symptomatic complex. The venous nodes are already protruding, but also drawn into the rectum on their own.
  This process is accompanied by a slight release of blood. Among the typical clinical manifestations, prolapsed hemorrhoids are noted. Blood is released after the act of defecation or at rest.
  There is a release of mucus from the anus, burning, peeling around the anus and itching. It is possible for knots to fall out. This occurs after significant physical exertion, with constipation and sudden movements.
• Third. At this stage, nodes fall out. They can no longer retract on their own. For the reduction of formations, a special procedure must be carried out.
  You can make manual adjustment yourself. When prolapsed, bleeding begins. It occurs after intense physical exertion. The patient is bleeding as if at rest,
  and after a bowel movement. He has itching, peeling of the skin at the anus. Often the situation is complicated by the formation of anal fissures, wounds, as well as sphincter incontinence.
  The patient is worried about constant discomfort, as well as paroxysmal shooting pains. Mucus mixed with blood is often discharged from the anus. A small amount of it indicates thinning of the walls of the node.
  A large amount of blood indicates the release of a blood clot outside the node.
• Fourth. This stage significantly reduces the quality of life. The nodes fall out and are not set either manually or by special procedures for reduction. The patient is constantly shedding blood from the nodes. TO
  bleeding increases after defecation. The patient experiences discomfort due to rectal sphincter incontinence. The patient is periodically disturbed by acute pain. Numerous wounds and cracks around the anus are revealed.
  He constantly combs this area, a secondary infection joins. Formed blood clots can break off at any time and block blood flow through the vessels of the small pelvis.

The tactics of treating the patient depends on the identified stage of hemorrhoids. In the initial stages of the disease, conservative therapy is used. In the late stages of the inflammatory process
in the treatment of surgical techniques.

Diagnosis of hemorrhoids

Diagnosis of this disease is not difficult. It is carried out by a proctologist or surgeon. The doctor interrogates the patient, finds out his complaints and information about the course of the disease. Then it carries out the following activities:

• Inspection. Examine patients in a chair. To do this, bring the knees to the stomach as much as possible. In the absence of a chair, the examination is carried out in the knee-elbow position. The doctor examines the anus.
  Reveals his deformation of the anus. He evaluates the skin around it and examines the hemorrhoids.
• Finger examination. They study the state of the external and internal sphincters, as well as the mucous membrane. The doctor determines the location and size of hemorrhoids. He evaluates the possibility of their reduction.
• Anoscopy. This endoscopic method allows you to explore up to 12 cm of the anal canal. Patients easily tolerate this procedure. With its help determine the location of internal nodes.
• Sigmoidoscopy. It is prescribed to exclude the pathology of the upper intestine.

If it is necessary to identify complications and comorbidities, the patient is referred for other types of examination – ultrasound of the abdominal cavity and gastroscopy.

Treatment of hemorrhoids

The treatment of this pathology is determined by the stage of the disease, the presence of complications and the general condition of the patient.

Suppositories for hemorrhoids

Suppositories are quite effective in the treatment of the initial stage of internal hemorrhoids. They are used as the main method of therapy. They have the following advantages:

• the drug is applied locally to altered vessels and tissues, and is not absorbed into the general circulation;
• quickly remove pathological manifestations;
• no side effects;
• they are convenient to use;
• they have a minimum of contraindications.

In the later stages of the process, rectal suppositories are used as concomitant therapy for rehabilitation and aftercare. Candles from hemorrhoids are divided according to the effect that they have on the body:

• Painkillers. Pain relievers are present in the composition of suppositories for hemorrhoids.
• Anti-inflammatory. These drugs are used when there is inflammation in the nodes and adjacent tissues. They reduce the activity of the rectal mucosa and dilated veins.
• Anticoagulants. Medicines with these substances reduce blood clots. They stop the clotting of venous blood.
• Hemostatic. When bleeding from the nodes, candles with hemostatic agents are used.
• Immunomodulators. Normalize local immunity, increase the resistance of tissues to infection.

Their action is aimed at alleviating the exacerbation and slowing down the progression of hemorrhoids.

Hemorrhoid ointment

The preparations are used for external and internal hemorrhoids. The package contains special nozzles for administering the medicine into the rectum. They contain the following substances:

• anticoagulants;
• venotonics;
• hemostatics;
• anti-inflammatory;
• immunomodulators;
• hormonal;
• binders;
• antiseptics.

Ointments are used in the early stages of nodule formation. They remove the main symptoms that bother the patient at this stage – irritation of the skin and mucous membranes, itching and burning.

Tablets for hemorrhoids

For the treatment of the disease, the main tablets are drugs from the group of venotonics and angioprotectors. They strengthen the vascular wall, prevent the progression of hemorrhoids, increase the tone of the veins. With persistent severe pain syndrome, patients are prescribed painkillers.

Surgery to remove hemorrhoids

Classical and minimally invasive surgical techniques are now used in surgery to excise hemorrhoids. They are carried out at the third and fourth stages of the course of the pathological process.
The following minimally invasive interventions are used:

• desarterization – ligate the arteries that feed the node;
• latex ligation – a hemorrhoidal formation is excluded from the bloodstream by throwing a latex ring on its base;
• sclerosing – a special preparation is injected into the node, gluing its walls together;
• laser coagulation – laser coagulates on the entire venous formation;
• cryodestruction – the node is frozen with liquid nitrogen.

Classic surgery is now used only if a minor intervention has not achieved the desired result.

Prevention of hemorrhoids

• timely treat constipation and diarrhea
• observe good hygiene after defecation
• adhere to a proper diet with enough vegetable fiber.
• exercise, avoid heavy lifting

Terminal

Hemorrhoids may develop inflammation, thrombosis, strangulation and even necrosis of hemorrhoids. This leads to the development of symptoms of acute hemorrhoids – itching and severe pain in the anus,
redness, swelling, enlarged hemorrhoids.

In severe cases, acute hemorrhoids may have severe purulent complications, in particular paraproctitis.

Early diagnosis and timely adequate treatment can not only prevent the occurrence of acute hemorrhoids, but also significantly reduce
or completely eliminate the symptoms of the disease in most people.

A visit to a proctologist should
be as early as possible, and for people over 45 years of age, it is advisable to contact a specialist for preventive purposes, even in the absence of visible clinical manifestations of the disease.

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