Internal hemorrhoids stage 2 how to treat. The use of minimally invasive techniques. Treatment methods for the disease
In most cases, hemorrhoids are diagnosed in patients when the disease reaches stage 2. This is explained by the fact that at the first stages the symptoms of the pathology are hardly noticeable or completely absent. Hemorrhoids of the 2nd degree are accompanied by pain, periodic prolapse of nodes during defecation, bleeding and some other manifestations. Treatment delicate issue depends on the type of disease and its course. More often it is possible to cope with pathology with the help of drug therapy and minimally invasive surgical techniques.
The nature of the development of the disease
Acute or chronic hemorrhoidal symptoms secondary to internal hemorrhoids can be treated with alternative therapies. Traditionally indicated for grade 1 and 2 hemorrhoids, but not for use with external hemorrhoids.
For the treatment of symptoms with grade 1 and 2 hemorrhoids, rubber ligation or elastic banding may be indicated. The literature supports one or more bands in a single treatment, and the band site may or may not be entered. Cryotherapy is most effective with the fewest side effects when it is directed at grade 1 and 2 hemorrhoids. It is not recommended for use with external hemorrhoids. We have not had good results with cryotherapy.
Why is this happening
Stage 2 hemorrhoids occur due to the lack of treatment of the disease at the initial stage. Many patients are in no hurry to seek the help of doctors when they discover the first manifestations of pathology. This attitude to one's health provokes the transition of hemorrhoids into chronic stage accompanied by periodic exacerbations.
Controlled trials show it is beneficial for grade 1 and 2 hemorrhoids; however, first and second degree hemorrhoids may require multiple treatments, and alternative methods may be more efficient. not recommended as alternative treatment internal hemorrhoids due to lack of controlled studies, ignorance of the technique in the United States, and significant risk of incontinence in published reports.
Laser proponents suggest that the critical advantage of using laser energy is the precise control of the depth of destruction. They say this results in the minimization of associated tissue damage, which in turn results in less scarring, faster healing, and possibly less pain for the patient. After extensive work and reports laser treatment hemorrhoids did not result in a reduction in pain or bleeding for the patient; so we used the laser all the time.
Many factors can provoke the progress of the disease:
- malnutrition;
- sedentary work and a sedentary lifestyle;
- pregnancy and childbirth;
- excess weight;
- fluid deficiency in the body;
- weight lifting;
- frequent constipation.
Due to the above reasons, pressure in the pelvic area increases. The walls of vessels overflowing with blood stretch, change shape, and the work of venous valves is disrupted. As a result, hemorrhoids are formed.
Bipolar diathermic coagulation. Alternative fixation procedure. Significant clinical data are not yet available. After treatment, attention should be paid to proper instructions regarding pain control, bowel movements, urination, and wound care to minimize therapy-related complications. The need for and timing of adequate follow-up examinations is at the discretion of the physician. Persistent heavy bleeding or delayed hemorrhage should be assessed promptly.
Postoperative sepsis is usually reported as intractable pain, fever, and urinary retention. Patients showing these symptoms should be seen by a doctor as soon as possible. Surgical treatment of hemorrhoids: a critical appraisal of current options.
Symptoms
Hemorrhoids of the second degree are accompanied by periodic prolapse of venous nodes to the outside and other symptoms. The pathology clinic includes the following features:
- minor bleeding, more common during bowel movements;
- itching, soreness;
- sensation of a foreign body in the anus;
- feeling of incompleteness of the act of defecation.
Manifestations of hemorrhoids of the second stage may differ depending on the form of the disease.
Surgical treatment of hemorrhoids is still a dilemma. New methods have been developed that lead to a decrease in speed postoperative pain; however, they are associated with a greater likelihood of recurrence. To study the current indications, as well as the results and complications of the main methods currently used in the surgical treatment of hemorrhoidal disease.
Currently, surgical treatment options include prolapse and hemorrhoid procedure, transanal hemorrhoidal deartherialization, and conventional hemorrhoidectomy techniques. The experimental methods showed similar results in terms of pain, time to return to normal activities, and complications.
Stage 2 hemorrhoids are accompanied by pain, burning and periodic prolapse of cavernous formations
chronic course
Without treatment of hemorrhoids of the 1st degree, the pathology passes into the second stage with a chronic course. This aggravates the symptoms of the disease. The amount of blood during a bowel movement increases. Despite the fact that the bleeding goes away on its own, this should not be ignored. alarm symptom. With a significant loss of blood, the patient may develop anemia. Discomfort and burning sensation in patients in stage 2 are tolerable, so most patients manage with suppositories or folk methods. Strong pain does not occur. Soreness is noted only during bowel movements.
Conventional surgical methods give the best long-term results. Hemorrhoidal disease is a common disease affecting 4% of the world's population. The most common theory attributes this disorder to anal pad prolapse. Hemorrhoids are not varicose veins, but vascular cushions, consisting of fibroelastic tissue, muscle fibers and vascular plexuses with arteriovenous anastomoses. Hemorrhoids can be internal, external or mixed. Internal hemorrhoids are classified according to the degree of prolapse of the anal canal.
Important! Even minor manifestations of the disease cannot be ignored, since in the absence of therapy there is a risk of the disease moving into an acute stage.
acute form
Exacerbation of hemorrhoids in the second stage is accompanied by severe pain during bowel movements, while walking and in a sitting position. The patient is diagnosed with thrombosis, develops severe inflammatory process extending to the surrounding tissues. Bleeding increases, may occur when walking, physical activity. If the patient is not given proper treatment, complications develop. These include anemia, tears of the anus, the appearance of cracks, infringement hemorrhoids followed by necrosis.
The appearance can be classified as either acute or chronic. Patients with hemorrhoids often seek treatment for painless bleeding, prolapse, pain associated with hemorrhoidal thrombosis, or itching. Conservative treatment, which is initially indicated in most cases, includes an increase in fiber and fluid intake and the use of topical agents. When there is no initial clinical improvement, more invasive therapies such as rubber band ligation, infrared photocoagulation, and sclerotherapy are required.
In the acute course of the pathology, drug therapy is used in combination with surgical treatment. More often, doctors resort to minimally invasive techniques that allow to stop the symptoms of the disease with minimal trauma to the tissues of the rectum.
Types of hemorrhoids
According to the location of the hemorrhoidal cones, 3 types of the disease are distinguished. These include:
Surgery is usually reserved for those patients who fail to respond to conservative measures, about 5-10% of patients. Surgery is the first option in the treatment of symptomatic grade 3 or 4 hemorrhoids, or in patients with acute hemorrhoids that have not improved with other treatments.
Hemorrhoidectomy is considered the gold standard, and the Milligan-Morgan and Ferguson procedures are the most widely used techniques worldwide. Although these methods have produced excellent results and low complication rates, they are commonly associated with postoperative pain. To reduce pain, new procedures have been introduced, including the prolapse and hemorrhoid procedure, and ligation of the hemorrhoidal artery using Doppler guidance.
- internal hemorrhoids- here cavernous formations are located above the dentate line under the mucous membrane of the rectum in the area of the internal venous plexus;
- external - bumps appear below the dentate line, are easily detected during external examination;
- combined - is a combination of internal and external forms of pathology.
There are internal, external and mixed hemorrhoids
This study was intended to review the current indications, as well as the results and complications of the main methods currently used in the surgical treatment of hemorrhoidal diseases. The search included, but was not limited to, review of articles, meta-analyses, clinical trials, multicenter studies, guidelines and guidance projects, among others, published in English, Portuguese and Spanish. There were no restrictions on the time of publication. The following keywords were used: hemorrhoids, hemorrhoidectomy, surgical procedures, pain, recurrence, bleeding, and hemorrhoid prolapse.
External and internal hemorrhoids of the 2nd degree are diagnosed in a hospital setting. A preliminary diagnosis is made by a doctor during a visual and digital examination. To obtain additional data, methods such as anoscopy, barium enema, sigmoidoscopy, x-rays and other types of examination may be needed.
Treatment methods for the disease
Treatment of hemorrhoids of the 2nd degree includes A complex approach with the use of drug therapy, auxiliary methods folk treatment, minimally invasive surgical techniques. In addition, the patient needs to adjust his lifestyle, adhere to a certain diet, perform physical exercise recommended by the attending physician. Therapy of the second stage is carried out more often at home after the diagnosis and choice of treatment for a particular patient.
Medicines for bleeding
Normal surgery. A typical operation mainly involves the removal of piles. In a meta-analysis of 18 prospective, randomized trials comparing conventional surgery with outpatient procedures, including rubber band ligation, sclerotherapy, and infrared coagulation, it was found that surgery is the most effective method treatment. The most common methods are open and closed hemorrhoidectomy. Complications associated with these procedures include urinary retention, postoperative bleeding, pain, anal stenosis, and incontinence.
The use of medicines
Treatment of stage 2 hemorrhoids with medication involves the use of suppositories, ointments and oral medications, the action of which is aimed at reducing the symptoms of the disease and preventing complications.
When choosing one or another remedy, the doctor is guided by which symptom prevails in the patient.
Although hemorrhoidectomy can be performed using a common scalpel, scissors, mono- or bipolar electrosurgery modes, ultrasonic scalpel, or laser, there is no clear advantage of one method over the other. It is the most commonly used surgical technique. An elliptical incision is made in the outer hemorrhoidal tissue extending proximally across the dentate line to upper bound hemorrhoids. Care must be taken to make a narrow ellipse and only remove excess anode and hemorrhoidal tissue.
Painkillers
With a pronounced pain syndrome, a person is prescribed painkillers in the form of suppositories, ointments and tablets. These include:
- candles Anestezol - well relieve pain, inflammation, promote healing of anal fissures;
- ointment Relief - the drug is based on shark liver oil, rarely causes side effects, copes well with most manifestations of hemorrhoids at all stages;
- candles Procto-Glivenol - the medicine relieves pain, promotes blood circulation in the pelvic organs, strengthens the walls of blood vessels, increases their elasticity. Candles are used in courses prescribed by a proctologist;
- suppositories with adrenaline - used in patients with an acute course of the disease, have a powerful analgesic effect;
- suppositories Neo-Anuzol - have a bactericidal, anti-inflammatory effect, relieve soreness, redness and swelling.
Procto-Glivenol perfectly eliminates the unpleasant symptoms of the disease
The wound is closed with a continuous absorbable suture. Usually three piles are cut. This method is effective in 95% of cases, and surgical wound infection is extremely rare. The open technique is widely used and is preferred by many surgeons. A study comparing open technique with modified closed hemorrhoidectomy showed that this modification was associated with faster healing and fewer postoperative complications. Typically, complications after conventional hemorrhoidectomy procedures include urinary retention, bleeding, anal stenosis, infection, and incontinence.
In addition to preparations in the form of rectal suppositories, ointments are very popular. The following medicines give a good effect:
- Heparin ointment - anesthetizes, relieves itching, redness, irritability;
- ointment Proctosan - contains bismuth, thanks to which the drug quickly eliminates pain syndrome and other manifestations of hemorrhoids;
- Levomekol - safe remedy given to patients for the treatment varicose veins veins in the rectum, including after surgical removal hemorrhoids.
Important! Painkillers for hemorrhoids should be used only on the recommendation of the attending physician, self-medication often causes serious consequences.
Lateral internal sphincterotomy with hemorrhoidectomy. Lateral internal sphincterotomy should not be regularly combined with hemorrhoidectomy as this combination can lead to serious complications such as varying degrees anal incontinence, without significant reduction in postoperative pain. In selected cases of patients with preoperative manometric indications high blood pressure resting sphincter, lateral internal sphincterotomy appears to be safe and is not associated with a significant increase in postoperative morbidity.
Medicines for bleeding
If the patient has such a sign of pathology as bleeding, the following medications can be prescribed to him:
- suppositories with propolis - stop bleeding due to the presence of propolis in its composition, which has a positive effect on blood clotting, preventing bleeding;
- Methyluracil ointment - the medicine stops the blood, promotes the healing of anal fissures;
- suppositories Natalsid - used for bleeding of mild or intense severity, help relieve the inflammatory process;
- suppositories with sea buckthorn oil - heal wounds and microdamages well, eliminate bleeding of a weak and medium nature.
To stop bleeding with hemorrhoids of the 2nd degree, Natalsid suppositories are often prescribed.
Treatment of combined hemorrhoids
Hemorrhoidectomy using energy sources. While the use of an electric scalpel may shorten procedure time and reduce blood loss during surgery, it does not provide benefits in terms of pain, healing time, and early or late complications. Similarly, the use of an ultrasonic scalpel has also not been shown to be superior to an electric scalpel.
Open hemorrhoidectomy using a bipolar electrosurgical scalpel is associated with the need to reduce the number of postoperative analgesics, more fast healing wounds and a faster return to work compared to the same procedure using an electric scalpel. However, it does not provide benefits in terms of postoperative pain, patient satisfaction, disease recurrence, or complication rates after surgery.
Among oral medications, Detralex, Phlebodia, Hemoroidin and other drugs are used to strengthen blood vessels, treat bleeding and other signs of illness.
Ventonics
To restore the walls of the affected vessels and reduce the permeability of veins in medical practice use venotonics. Thanks to them, it is possible to normalize blood microcirculation, reduce venous pressure, eliminate bleeding, strengthen the walls of capillaries and veins, stop pain, increase the elasticity of the smooth muscles of the anus.
However, there is significant heterogeneity in the analyzed studies. Non-surgical surgical methods. This method uses a specific stapler to cut an annular ring of mucosa over the dentate line. The main characteristic of this procedure is the absence of external surgical wounds, making this operation potentially less painful than a conventional procedure.
Despite these postoperative benefits, long-term results are not enough, especially with regard to residual skin tags and recurrent prolapse. Placement of a suture thread with a high or low level, with inaccurate depth, can lead to serious complications.
Venotonic drugs include:
- Venarus tablets - increase blood flow and lymph flow, improve the condition of the venous walls, reduce vein extensibility;
- Detralex is a drug based on active ingredient diosmin, which is widely used to treat all signs of hemorrhoids;
- Troxevasin ointment - has a powerful tonic effect on blood vessels and capillaries, increases the resistance of veins, reduces the risk of bleeding.
With hemorrhoids 2 degrees positive result can be achieved with treatment that includes several drug groups. If a therapeutic effect is absent and the patient's condition is deteriorating, minimally invasive surgical techniques can be prescribed.
Three systematic reviews concluded that stapled hemorrhoidopexy is less effective than the conventional procedure and is associated with a higher rate of recurrence and prolapse. Research has also shown more high level further surgery and tenesmus when using a stapler.
Although hemorrhoidopexy is associated with a high number of complications, the overall index is generally similar to conventional surgery. Transanal hemorrhoidal dearterialization. These vessels are ligated in the cranial-caudal direction to the lower limit of the Doppler signal, at a distance of 2 cm from the anal margin, above the dentate line. The lower part of the suture ligation is connected to the upper part performing the mucopexy, with a reduction in prolapse. The procedure may be indicated for patients with second, third, or fourth degree hemorrhoid bleeding, with or without hemorrhoidal prolapse, who have failed to respond to non-surgical procedures.
Surgery
Hemorrhoids of the 2nd degree can be cured using minimally invasive methods surgical intervention. Open operations at this stage of the disease are rarely used, as they involve severe trauma to the tissues of the rectum and anus, prolonged rehabilitation period. Less traumatic techniques include:
- ligation of cavernous formations with latex rings;
- sclerotherapy - the introduction of a special fluid that leads to adhesion of the vessels that feed the hemorrhoid;
- infrared coagulation;
- deserterization;
- cryodistruction - freezing of the affected vessels with liquid nitrogen;
- laser treatment and other techniques.
The main advantage of these methods is good efficiency, the possibility of carrying out on an outpatient basis, a small number side effects short recovery period.
Important! Recurrence after transferring the removal of hemorrhoids using minimally invasive techniques occurs in no more than 5% of patients.
Folk methods
How to treat hemorrhoids 2 degrees with traditional medicine? There are many methods that allow you to cope with the manifestations of pathology at home. Natural products help relieve pain, itching, a feeling of heaviness and other symptoms of the disease.
Alternative therapy includes the use of herbs and natural products to help cope with the signs of hemorrhoids.
Popular recipes include:
- candles with honey and sea buckthorn. To prepare suppositories, mix a tablespoon of honey with the same amount. sea buckthorn oil. The resulting mass is poured into molds made of paper or foil, sent to the freezer for solidification. To eliminate the symptoms of the disease, a candle is inserted into the anus 1-2 times a day;
- sitz bath with a decoction of herbs. Mix chamomile, calendula, St. John's wort, yarrow, mix 1 tablespoon each, pour 2 liters of boiling water, bring to a boil, leave for 30 - 40 minutes. The resulting decoction is used for a sitz bath;
- raw potato juice. To reduce the unpleasant symptoms of hemorrhoids, it is recommended to drink a glass of freshly squeezed potato juice twice a day before meals;
- nettle decoction. With pain and bleeding, nettle has a good effect. A decoction of the plant can be used for internal use and or lotions and microclysters;
- steam compress. For treatment, you need to boil 2 liters of milk, add 2 medium finely chopped onions to it, boil the medicine for 5-10 minutes. After that, put a board with a hole on the pan, sit down so that the steam enters the anus. The procedure is carried out 1 - 2 times a day.
Any folk recipes It is recommended to use only as prescribed by a specialist. Self-medication often causes undesirable consequences, aggravates the course of the disease. Compliance with doctor's recommendations Attentive attitude to your body will help maintain health for many years.
Hemorrhoids are an unpleasant pathology of the intestinal priming, which causes people not only physical, but also emotional discomfort.
Kinds
There are three main types of the disease.
Pathology of an external nature
In the case of the development of an external disease, knots form around the anus, from the outside. In this case, the nodes are usually clearly visible during visual examination.
Disease external character often manifests itself as a complication that causes during its progression.
External illness can be chronic or acute.
Pathology of an internal nature
Internal hemorrhoids are characterized by the fact that the nodes cannot be detected by a simple examination of the anus, since they are located inside the rectum. The internal nature of the disease is often long time has an asymptomatic course and develops as a chronic one.
Combined pathology
Combined disease develops when the patient has a combination of internal and external forms of the disease. Most often, this disease is already chronic.
Stages of the disease
The disease can become chronic at any stage, and then the main thing is not to start the disease and not give it the opportunity to progress.
First degree
The disease is not sharp look in the first phase of development, it usually quite rarely reminds of itself. The main symptoms are episodes of light bleeding and intermittent discomfort in the rectum.
If the disease is in remission, then its signs may be absent altogether.
Second degree
Combined hemorrhoids of the 2nd degree are diagnosed most often.
At this stage, bleeding develops more often, discomfort becomes more noticeable, pain may appear when trying to empty the intestines.
In general, patients go to the doctor if they notice bloody issues on toilet paper or in feces.
The chronic form of the disease of the second degree is generally diagnosed quite easily, and its treatment must be started as early as possible in order to avoid complications.
A characteristic feature of this degree is that on it a person first encounters a prolapse of hemorrhoids, which so far fall into place without his help.
Third degree
Combined hemorrhoids of the 3rd degree, which is chronic, develops when the patient ignores the symptoms of the pathology long time without seeking help from a doctor.
All symptoms at this stage become more acute:
- a pain symptom can now be present not only with prolonged sitting, but also with walking;
- discomfort in the rectal area and cause a lot of inconvenience;
- knots fall out and can no longer return to their original position without the use of hands.
fourth degree
Hemorrhoids of the fourth stage are considered the most severe of all possible.
In this case, even if a person regularly adjusts protruding hemorrhoidal bumps, they still do not stay in place under the influence of a minimal load.
The fourth stage of the pathology, which is of a chronic nature, is accompanied by the development of a number of serious complications, such as:
- thrombosis of hemorrhoids;
- infringement;
- trauma resulting in persistent bleeding.
Treatment of pathology
Since hemorrhoids are most often found in the second stage of the disease, it is necessary to know about approaches to the treatment of this pathology.
In the second stage, the fight against the disease is carried out without surgical intervention:
- sclerotherapy is performed, in which it is necessary to inject into the hemorrhoid cone special drug, under the influence of which the walls of the vessels supplying the node will coalesce, and the node will die;
- you can apply cryodestruction, the essence of which is the freezing of nodes, because of which they also die;
- another safe non-surgical method is laser coagulation;
- doping can be carried out using special latex rings that help eliminate large nodes, the bottom line is that a dressing is applied to the leg of the cone, which blocks the blood flow, and the node soon dies.
However, more often second-degree hemorrhoids are treated using conservative therapy.
Depending on the localization of the nodes, suppositories, ointments, lotions, and even traditional medicine can be used.
A particularly good effect is the combination of traditional therapy with traditional medicine.
If you managed to catch hemorrhoids at the second stage of its development, then it is necessary to start treating the pathology as soon as possible. This disease will not go away on its own, but it can progress and lead to the development of unpleasant complications very quickly.