Bleeding after stool and anal pain may indicate hemorrhoids
The hemorrhoidal disease affects about 800,000 people per year in Brazil. For the patient, usually any problem related to the anus is due to "hemorrhoids". Itching, nodulations, pain, swelling, bleeding, prolapses, etc. However, there are a number of other entities affecting the anal region other than hemorrhoids.
Hemorrhoids are vascular formations made up of veins and arteries that are part of the anatomy of the anus and are essential to protect the anal canal from trauma during evacuation . Symptoms arising from their complications reflect one of the most common grievances in Western civilization. It is estimated that around 50% of people over 50 have already been affected by hemorrhoid-related complaints at some point in their lives. It affects both sexes, at any age, with higher incidence in people of better socioeconomic standard. However, there is a slight predominance in women, with a peak of incidence between 45 and 65 years.
There are several factors that may contribute to the development of the disease, however, there are still controversies regarding these possible factors. In order of relevance, we can mention pregnancy, heredity, obesity, occupational occupation, evacuation effort, among others.
Regarding the diagnosis, attention should be paid to symptoms that indicate other possible diseases than hemorrhoids
As hemorrhoids can be internal or external. This differentiation is important in defining treatment. The internal ones tend to bleed and prolapsar, and the external ones tend to swell and obstruct by clots, which usually generates the pain of the so feared crisis? of hemorrhoids. Therefore, hemorrhoids do not always manifest on the outside of the anus, and may be internal and cause only discomfort and bleeding, without other manifestations.
The most common complaint is bleeding, which usually occurs during or after defecation. The pain usually only occurs when there is thrombosis ("crisis" due to clot obstruction). Prolapse (exteriorization) is also a common symptom.
Regarding diagnosis, one should be alert for symptoms that indicate other possible diseases than hemorrhoids. Frequent pain after bowel movements suggests anal fissure. Other causes of chronic rectal pain are inflammatory bowel diseases, tumors, anal fistulas. Acute nodulation pain is usually due to external hemorrhoidal thrombosis or abscess. The physical examination consists of anal inspection and rectal examination, which are usually very enlightening if performed well, and may be supplemented by exams such as sigmoidoscopy and colonoscopy, endoscopic examinations of the rectum, anal canal and large intestine, respectively. It is suggested that whenever there is bleeding, a specialist doctor should be sought, as early diagnosis is necessary in these cases, since more serious diseases can be manifested only by bleeding. In addition, acute pain of severe intensity urges an evaluation as soon as possible, especially if there is nodulation, which may be external hemorrhoidal thrombosis or abscess. In addition, chronic pain, prolapse, pruritus, secretion, swelling, or perceived touching abnormalities can be evaluated and treated appropriately by a good physician. Regarding treatment, high fiber and liquid diet and warm water. These measures, combined with local and oral medications, tend to improve the symptoms but do not eliminate hemorrhoids.
For internal hemorrhoids, when not yet exaggeratedly advanced, we chose elastic ligation, the main non-surgical treatment performed in Which proved to be more effective than other non-surgical methods. In large, prolapsed internal hemorrhoids, the techniques of PPH (hemorrhoid stapling) and THD (Doppler ultrasound guided de-arterialization) are less painful than conventional surgery. For external hemorrhoids, conventional surgery, provided well performed, gives better results, especially if there are large excesses of skin in the perianal region.
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