What is Internal Hemorrhoids
Internal hemorrhoids the (intemal hemorrhoid) is a the anal cushions support structure, the vascular plexus and arteriovenous anastomotic branch occurred pathological hypertrophy or shift the clumps form. Chinese medicine called inside hemorrhoids, female hemorrhoid. Ancient Chinese medicine regardless of internal hemorrhoids, external hemorrhoids, reference to "Taiwan Miyao (752) until the Tang Dynasty, Wang Tao Xu Ren is" The disease has internal hemorrhoids external hemorrhoids, but within the regressing blood outside different excessive bleeding body no Scarlet ", was a clear distinction between internal hemorrhoids, external hemorrhoids. Incidence of internal hemorrhoids up, accounting for 52% to 64% of the hemorrhoids, hemorrhoids, in some literature often refers to internal hemorrhoids. Internal hemorrhoids often single, and more in the front right bits in the right front, right rear and left-bit multiple. Larger, such as strawberries, as the primary internal hemorrhoids (mother hemorrhoids), was born in the meantime the smaller ones, such as cherry, for a secondary internal hemorrhoids (sub hemorrhoids), sometimes multiple internal hemorrhoids along the anal canal, Zhou Liancheng ring, then cyclic internal hemorrhoids.
Symptoms of Internal Hemorrhoids
The staging of the internal hemorrhoids:
According to the development and changes of the internal hemorrhoids divided into four.
Phase I: blood in the stool or drip or shot, and after more than to stop on their own, the hemorrhoid body does not prolapse microscopy shows the dentate line mucosa uplift in the right front bit diameter of more than one orientation, the the mucosal surface color pink was strawberry-like, for vascular swollen type.
Phase Ⅱ: blood red, body prolapse defecation associated with hemorrhoids, internal hemorrhoids performance will itself also bit microscopy shows the dentate line mucosal bulge is often in the right front, right or left-bit (mother hemorrhoids) surface mucosa the tortuous vein group for intravenous tumor type.
Ⅲ stage: after or long, a long line, coughing, labor force, weight-bearing long journey hemorrhoid body prolapse increase in abdominal pressure, not white line bit, you need to rest or hand push to also bit. Prolapse mucosal surface dark red, hypertrophy, blood in the stool, reduce swelling type fiber.
Ⅳ: hemorrhoid body increases, continued to emerge, or also bit easy prolapse or blood in the stool.
Incarcerated internal hemorrhoids hemorrhoid body prolapse can not self back, provoked the sphincter spasm while incarcerated. Venous obstruction, arterial blood pressure, continue to enter the internal hemorrhoids, the congestion and swelling, anal margin edema, and ultimately stagnation of the blood line solidified Erzhi thrombosis, symptoms of internal hemorrhoids pain intensified, prolapse hemorrhoid body stiff, tenderness sensitive anal margin edema. Bit difficult, all available Takano simple reset method also bit anal hemorrhoids block residues.
Hemorrhoids incarcerated strangulated too long, the the stagnant blood line and thrombosis, necrosis due to ischemic the hemorrhoid body surface black, oozing more the last hemorrhoid All necrosis necrosis anal margin edema. Lockhart-Mummery and Joshi reported in 1915: internal hemorrhoids thrombosis extends upward, leading to the rectal wall necrosis, to cause pelvic severe sepsis. Necrosis after infection in the local cause tenesmus. Force also bit this time, infection easily spread, caused by anal or rectal mucosa ischial rectal space abscess, the carrier the embolus along the vein or even fall off upstream portal bacteremia or sepsis occurs, they can still form a liver abscess. 1934 Lockhart, Mummery, 1948 Gabriel respectively reported a strangulated hemorrhoid concurrency fatal portal sepsis. Although rare, but should pay attention to.
Internal hemorrhoids inflammation internal hemorrhoids symptoms usually lighter, reduced immunity hemorrhoids cell degeneration and edema organizations, often due to constipation, fatigue, irritation and friction and infection, throat burning, the the internal hemorrhoids performance stroke dynamic and foreign body tamponade sense of due dry oppression surface erosion bleeding will often tenesmus sense for one week treatment successfully implemented fading, swelling, and pain relief, hemorrhoid block softened reduced remission. Also known as hemorrhoid attack.
What Causes Internal Hemorrhoids
The etiology of hemorrhoids:
Still unclear, but there are many causes theory.
(A) varicose veins doctrine as early as the 18th century Huuter hemorrhoidal veins found in the autopsy showed a continuous expansion based on that the hemorrhoid vein dilation is the cause of internal hemorrhoids, hemorrhoids as a vein disease, but varicose veins reason Opinions vary.
1.1749 Morgam proposed varicose veins and human upright and walking related by gravity, the end of the portal vein branch vascular the downward suction enhance Erzhi vasodilation, tortuous and affect blood returning prone internal hemorrhoids. Limbs animals when standing and walking all fours, the hemorrhoid vein is positioned higher than the heart, it is not conducive to the backflow of blood born hemorrhoids. 1954 Taylor et upright when venous pressure is one of the causes of internal hemorrhoids. The 1959 Robert adult multi-Health hemorrhoid is rare in children is another proof of varicose veins doctrine. Boerhare forced defecation, increased abdominal pressure can be transmitted to the rectal veins, long-term increased venous pressure, so varicose veins.
The 2.1960 Jomes pointed from hemorrhoid vein to the portal vein between venous blood reflux difficulties because of the the hemorrhoid vein through the muscle at different heights, vulnerable feces oppression affect blood with flow that may cause congestion expanding Zhang Zesheng internal hemorrhoids . 1958 Hunt et al found that the incidence of portal hypertension in patients with internal hemorrhoids is not high, and the the rectal vein tumor caused by portal hypertension, the appearance of the real internal hemorrhoids, hemorrhoid venous hypertension born hemorrhoids argument no anatomy according .
3.1855 Verneuil anatomical observation did not find the traffic branch the hemorrhoid vein and anal vein between, he thinks varicose veins vein through the rectal wall muscle "buttonhole" at the returning blocked due. Button hole refers to the blood vessels in the rectal mucosa through the intestinal wall formed muscle gap Yu-dimensional tissue protection - expansion anal sphincter spasm or defecation, the cause of internal hemorrhoids is when the feces oppression intestinal wall can make button holes taut narrow, affect blood flow, the hemorrhoid venous congestion expansion and development into hemorrhoids. But between the portal vein and the vein of Thomson studies have shown that, through the sphincter or muscle beneath rich traffic branch, he that the Vemeuil say is wrong. Hiller used inserted into the rectum barrel vein pressure closed rectum and then slowly draw out the barrel to the rectum, visible internal hemorrhoids prominent reflux of blood filled immediately (clinical microscopic examination of this phenomenon can also be seen), so he thinks the blood reflux, hemorrhoid vein through the intestinal wall muscularis pressure; hemorrhoid vein venous valves, backflow due to blood easily. So he supports the the Verneuil argument.
4.1874 years Sappr 1877 Duret, 1899 Waldeyer has found that pediatric the hemorrhoid area of expansion vein, they have reason to believe that the hemorrhoid area vein dilation is a normal phenomenon, dilated blood vessels belong to the normal tissue structure, does not support the varicose veins doctrine. 1975 Thomson anal cushions theory raised objections.
In summary, the varicose veins doctrine widely circulated for nearly 200 years, the theoretical basis of the diagnosis and treatment of internal hemorrhoids, supported by the opposition will eventually become history said.
(B) bacterial infection doctrine
In 1895, Quenu proposed expansion defecation caused by the anorectal tiny planing injury caused phlebitis repeated inflammation leads to loss of elasticity of the vein wall damage. Hartman and he died Lieffring the extracted internal hemorrhoids blood line culture, showing E. coli growth. Surgery, internal hemorrhoids in thrombus extends upward to a higher position, and also the presence of bacteria. In 1923, Pernington think that the hemorrhoid vein abrasions and thrombosis conducive to bacterial invasion, and the release of toxins stimulus, leading to congestive heart, inflammation internal hemorrhoids vein dilation born. Later Nesslrod also pointed out that the cause of internal hemorrhoids infection through anal sinus catheter, anal gland and surrounding tissue lymphatic vein inflammation around the blood vessels into the hemorrhoid area caused these blood vessels into varicose veins made internal hemorrhoids embrittlement thinning, and pointed out that the excision The hemorrhoid tissue for a check to see inflammatory changes. Our ZHANG Qing-rong "anal infection in the new concept of" book also said: "anal gland and duct with the hemorrhoid static plexus communicates the spread of inflammation caused by inflammation of the veins around the vein wall thinning loses its elasticity, the gradual expansion into internal hemorrhoids."
The internal hemorrhoids specimens sent for culture and the growth of E. coli, Streptococcus, Staphylococcus, the same internal hemorrhoids stump or typical internal hemorrhoids symptoms corresponding part of the sampling train ibid. bacteria growth.
Gass and Adams continuous check 200 internal hemorrhoids specimens found no inflammation, 1985 Shartul Bao, Zhang Dongming hemorrhoid histological observation, no results are shown the vast majority of hemorrhoidal tissue inflammatory changes. Thus infection theory has not yet been recognized.
(C) angiogenesis doctrine
This doctrine was popular in the 19th century. 1826-1852 Velpeau European scholars believe metaplasia from internal hemorrhoids is an erectile tissue. The 1863 Virhow nature of Allingham thought hemorrhoid 1973 hemangioma, his argument is that both structural similarity of hemorrhoidal tissue and cavernous tissue.
1840 Bourgery anal canal submucosal tissue is very thick characteristics compared to the erectile tissue network with arteriovenous anastomosis, Tbomsor vascular sinus veins, small arteries and inject directly. Some people think that the more the antral vein wall glial fiber myometrial dysplasia, easy bruising, produce anatomical basis of internal hemorrhoids. In 1840 the Henrich these erectile tissue called the rectum cavernous, containing a large number of blood vessels, smooth muscle, elastic fibers and connective tissue, is an important part of anal homemade organ. He believes that such tissue and mast made of hemorrhoids. He also found that the the cavernous blood vessel but not intravenous expanding artery take Zhixue proved arterial blood gas analysis. Usually DRE in the right front, right rear, left bit palpable arterial pulse can confirm arterial. Thomson histological observation of 25 cases of hemorrhoidectomy specimens, see the vessel lumen there is no vascular proliferation phenomenon, hemorrhoid real deep capillary network of a large number of expansion between the mucosal epithelium and muscularis mucosa, can be clearly seen bleeding . Therefore, he believes hemorrhoid bleeding does not come from the antral veins and arteries, but from the the lamina propria expansion of capillaries, in short, from the histological analysis, vascular proliferation doctrine of insufficient evidence.
(D) the anal canal stenosis doctrine
Bmes, Miles, Slack raised this doctrine, that the cause of internal hemorrhoids anal canal stenosis can affect normal bowel movements, must increase in abdominal pressure to assist defecation asked ground rectal pressure increased, causing venous congestion, a long time with feces extrusion outside the anus to form internal hemorrhoids. 1969 Lord think the hemorrhoid vein dilation Chlamys film with contraction cause anal stenosis about his anal law damage the Chlamys film with, get good results. After many scholars also use this method to obtain good results. According to Hancock and Arabi research was mainly due to abnormal internal sphincter spasm born hemorrhoids. It was adopted internal sphincterotomy treatment of internal hemorrhoids, and also get a good effect. So The Alexan-William supports this doctrine, he pointed out that the sphincter hyperthyroidism, hinder the circulation of the hemorrhoid blood vessels, impairing blood reflux, resulting in venous congestion expansion and thrombosis and gradually generate prolapse through defecation, and eventually became III hemorrhoids.
But this doctrine to young people anal sphincter was significantly higher than that of the elderly, and why the internal hemorrhoids incidence rose rapidly after the age of 30 is difficult to explain. Ortiz made a histological and anal function observed in 1981, does not support this doctrine.
(E) the anal canal liner down doctrine
The anal canal, the liner also known as the anal canal vessel liner, referred to as the anal cushions. As early as the 19th century French Bemard noted that the the anal submucosa like a sponge-like structure. 1826-1852 years Velpeau many scholars had similar reports. 1960 German scholars believe that internal hemorrhoids is rectal cavernous hyperplasia due, it is proposed as the doctrine of angiogenesis. 1950 Cass and Adams observed 200 cases of internal hemorrhoids resected specimen fracture fragments internal hemorrhoids connective tissue, and the internal hemorrhoids and anal relaxation linked proposed hemorrhoids hernia formation doctrine the until 1957 Hugber and Paley still support this doctrine. The Gass and Adams study: Hemorrhoids are anal support tissue degeneration caused part of the mucosal and submucosal organization down the results, and for the first time proposed mucosa sliding doctrine. Parks and Thomson made a further study of this doctrine.
Thomson, on the basis of previous studies, but also through their own experimental research, to the master's thesis in 1975 published a the anal vascular liner pathological hypertrophy and Down the internal hemorrhoids reasons, referred to as the anal cushions doctrine. He checked with a proctoscope 42 cases of healthy people, and found the back mirror the intestinal wall mirror Week squeeze into the barrel to form a Y-shaped cracks mass prove thickening of the intestinal wall is not uniform, but in the right front, right rear, three thickened portions of the left position, he called three pad. Only 10.1% of the typical Y-shaped according to his statistics. He also checks the anorectal specimens hemorrhoidectomy specimens of 95 cadaver contrast, found the internal hemorrhoids specimens with anal cushions histologically basically the same, and are constituted by the blood vessels, Treitz muscle, elastic fibers and connective tissue. Therefore, he believes that internal hemorrhoids are anal cushions, normal tissue of the human body is not a disease. Only anal cushions disease hypertrophy rational, down prolapse and (or) bleeding is a disease, he called hemorrhoids. He also checked the 25 cases of adults and 10 infants specimens found Treitz muscle: (1) form a mesh wrapped around the hemorrhoid venous plexus; ② scattered to the perianal skin; ③ The bypass the lower edge of the internal sphincter or through the muscles most lower end of the longitudinal muscle and joint joint three ways again. Treitz muscle bundle to support a large number of elastic fibers in the anal cushions. Elastic fiber degeneration and rupture occurs anal cushions lost support, the defecation force under earn, aggravate the expansion venous congestion, to make the anal cushions swelling mast and down made hemorrhoid extrusion anal. The right front bit anal cushions pressure defecation pushdown greatest power, right front bit internal hemorrhoids more common.
This new Pathogenesis preliminary clarify the nature of the internal hemorrhoids from anal cushions anal cushions → internal hemorrhoids that by the attention and support of the people, become the most popular theory. But it was also proposed follows inadequacies.
1 so-called Y-shaped groove and pad theory, he said Y-shaped groove accounted for only 10.1% of Wang Yucheng statistics three pad by only 50%, and the other half only two pads, and even a pad, that showed that the number of internal hemorrhoids and arrangement, especially in terms of any law. This doctrine is difficult to explain the diversity of internal hemorrhoids.
He said the first symptom of internal hemorrhoids prolapse, defecation anal cushions down, gripping the internal sphincter contraction caused by blood in the stool. While of Wang Yucheng statistics starting prolapse by only 7.2%. Starting bleeding up to 93%, and multi-stage Ⅰ internal hemorrhoids do not prolapse.
The anal cushions Down and rectum Ⅰ degree prolapse how to distinguish.
4 right front bit internal hemorrhoids more common, he thinks the front right-bit the anal cushions compression pushdown greatest power about defecation, this is just a reasoned, further study confirmed.
The nature of internal hemorrhoids from anal cushions, in histologically approximate. From histologically internal hemorrhoids is anal cushions, not a disease, this understanding is one-sided, because the the resected specimen because disease before surgery to remove the resected specimen is pathological anal cushions. So say the hemorrhoids is not a disease, of course, by the clinical experts against on the anal cushions doctrine terms "anal cushions pathological hypertrophy down made internal hemorrhoids" of course, is a disease, there are pathological changes. Internal hemorrhoids is the pathological tissue, the anal cushions normal tissue, can not be confused.
These issues need to be further research to be perfect.
In addition, there are arterial distribution of the doctrine, the doctrine of the pressure gradient, sphincter function decline doctrine, the hemorrhoid venous pump function decreased doctrine, various theories have correct and inadequacies, are not conclusive of the etiology of internal hemorrhoids. Most scholars believe that the formation and development of internal hemorrhoids is caused by many factors.
Relevant factors, internal hemorrhoids formation
The internal hemorrhoids etiology Although there is no conclusive, but Chinese and Western scholars believe that the following factors.
An improper diet, overeating. "Su asked the angry sky theory" that: thus satiation, the tendons cross-solution, intestinal bleach for hemorrhoids. "Clear" Past and Integrated Medical Department recorded "Note to the cloud:
"Fresh air of lags, the damp heat of the gas accumulation in the Yangming large intestine and is a hemorrhoid." Satiation is the main factors of internal hemorrhoids, be explained on this basis, and the development of subsequent ancient physicians.
(1) too spicy food, unbridled eat fatty stomach injury, the transport of weakness, movements disorders, cause tendons and relaxation, vertical and horizontal expansion. Congestion as hemorrhoids. The many internal hemorrhoids patients in the clinical delicious chili born hemorrhoids.
(2) Drinking excessive wine sex is hot and humid, The alcohol poisoning stains in the organs, blood overflowing, the accumulated heat lingers attack obstruct the large intestine, resulting in an aggregate congestion flow Note anus. Therefore the order of blood fat as hemorrhoids. Clinically, many patients with internal hemorrhoids are intoxicated wine history, especially the regular consumption of hard liquor, to cause reflex hemorrhoid venous congestion.
(3) the satyric excessive, drunk himself into the room, saturation of yin and yang, essence de vent, tendons and horizontal solutions, toxic heat ChengXu bet red hair for hemorrhoids.
(4) hunger and satiety uneven, imbalanced diet. According to the the modern epidemiological investigation, residents of rural Africa suffering from hemorrhoids are less urban residents, living Westernizers high incidence of hemorrhoids, this difference is related to the diet. Rural residents staple food grain, soft stool volume. In the intestinal running time is short, the defecation fun. Urban residents cereals, meat and more, the lack of crude fiber, stool less hard intestinal residence time is long, hard, dry feces, increased pressure on the terminal rectum, easy Health hemorrhoid.
2 long forbearance stool, chronic constipation. Ancient physicians believe that this is an important cause of internal hemorrhoids, such as the Chu treat patients, "think long forbearance stool not cause internal hemorrhoids.
(1) modern medicine is also related to the occurrence of long-term constipation and bowel adverse manner with internal hemorrhoids. The former Soviet scholars Ami promise husband told 500 healthy subjects and patients with X-ray observation defecation, be intended as not timely discharge, fecal moisture absorption made of hard, dry fecal increased pressure and irritation of the terminal rectum major factor in the formation of internal hemorrhoids, he also observed that the number of bowel movements, once drained the best, while two defecation formation with internal hemorrhoids.
(2) Goligher that defecation reading a newspaper or reading, injury hemorrhoid vein 10 times higher than normal. Darck pointed to the end of the oppression of the rectum and anal canal upper the arteriovenous pressure hemorrhoid, these blood can only accumulate in the arteries around the venous plexus, can not back up, causing the vein dilation hard fecal prolonged pressure gradually formed in 1956 the small arteries the varicose veins clumps, the last increase made hemorrhoids, constipation is the cause of internal hemorrhoids is well recognized.
(3) China's Li Ruiji observed bowel habits of 892 people with internal hemorrhoids. Found 660 defecation time in 9min below, of which 382 (57.9%) suffering from hemorrhoids. Defecation time more than 10min 232 people, of which 168 (72.4%) suffering from hemorrhoids, the difference is significant. Long squat toilet bowel poor who suffer from hemorrhoids more.
3. Clear "Golden Mirror of Medicine said:" Jiuxie Jiu Li born hemorrhoids, the long illness cough infuse hemorrhoid. Chronic Diarrhea Jiu Li the virtual stomach, chronic cough hurt gas blood transport of weakness stagnation in the next made hemorrhoid. chronic cough, chronic colitis long-term efforts hip Jiuzhibuyu fall so that increased abdominal pressure, the hemorrhoid venous pressure and congestion born hemorrhoids or aggravate internal hemorrhoids, varicose cause. "
Sedentary for a long stand, weight far exercised anal stagnant qi and blood runs sluggish, knot poly anus made hemorrhoid. Clerk, barber, traffic police, prolonged standing, authority staff, typists, drivers sedentary for a long time, and foundry workers squatting, hemorrhoids higher incidence. In 1980 HE enforcement the mao investigation sedentary by 4885 people, 3539 (72.9%) suffering from hemorrhoids; the Jiuli by 5523 people suffering from hemorrhoids and 4058 (73.5%); among the regular activities of 5555, suffering from hemorrhoids, 2390 ( 43%). Suffering from hemorrhoids the mechanism further study, but most scholars believe that with the increase in abdominal and pelvic pressure.
5 surgical management cases: analysis of 3500 cases of "woman by cold injury, menstruation colds, more than blood the heart by the blood flow in the large intestine, who have postpartum force too much and suffer from hemorrhoids." Ruiz-Moreno after hemorrhoids aggravating that 80% of women related to pregnancy and delivery. ① uterus oppression can lead to hemorrhoids venous congestion. ② Schottlev pregnancy make artery blood flow increased by 25%. ③ increased sub-official oppression intestine lead to defecation disorders hardened feces, defecation increase. ④ pelvic organs organizations brittle or relaxation, and prone to injury infection. ⑤ progesterone vasodilation. ⑥ life changes due to pregnancy diet, lack of activity, lead to constipation and hemorrhoids venous congestion.
6. Genetic factors. The "sore experience Britannica says:" Some father to son, maternal blood parent refined made. "For the mother's womb by poison, Gaoliang food product or the mother eat Sunburn torch Atsumi due. The modern epidemiological survey in Japan reported that about 44% of patients with internal hemorrhoids internal hemorrhoids family history Iwadare Junichi. Gnnt, Turell, pointed out that some families have a tendency to suffer from hemorrhoids, This may be related to genetic and congenital factors with weak vein wall, presumably these family members, and systemic. In the same patient can often see the internal hemorrhoids and other parts of varicose veins. But Shackelford is no conclusive evidence that the internal hemorrhoids genetic.
7. Sedentary wetlands, living in the the Wulu wet place, wet and hot forged Note anus and hair internal hemorrhoids. According to the epidemiological investigation, living in the basin, heavy moisture, pepper spicy gourmand crystal were more likely to suffer from hemorrhoids.
8 modern science body trace elements and internal hemorrhoids. Yuyun Chang, Peng Xianguang reported that internal hemorrhoids patients serum zinc and serum alkaline phosphatase was significantly lower than normal, significant differences (P <0.01), to supplement internal hemorrhoids symptoms improved markedly and even internal hemorrhoids have subsided.
The pathology of internal hemorrhoids:
Regardless Pathogenesis and pathogenic factors, the pathological changes are basically the same, namely, the venous plexus expansion, congestion, thrombosis or machine, tissue edema, the so-called "anal cushions pathological hypertrophy" pathological changes. The anal cushions Is that anal vascular cushion, mainly antral venous vascular plexus arteriovenous anastomosis, and the Trietz muscular elastic fibers and connective tissue.
1. Congestion due to certain factors cause vascular plexus circulation disorders and the arteriovenous anastomosis dysregulation cause hemorrhoid venous plexus blood flow, dilatation and congestion, called venous congestive referred congestion. 1976 the Japanese officer Kawasaki Haruo considered the antral venous congestion anatomical basis for generating internal hemorrhoids. Chen Yun, 1992 with the rabbit experimental of internal hemorrhoids model and the internal hemorrhoids surgical resection specimens studied, the results showed that the two groups there are hemorrhoid veins and telangiectasia congestion, so, venous dilatation and congestion is internal hemorrhoids pathological change.
Pressure rise due to congestion, slow blood flow, reduced oxygen content, reduced hemoglobin increase, hemorrhoid venous congestion, increased volume, the texture of the real surface dark red or purple, blue mucosa, abrasions, bleeding bright red, because the anal cushions arteriovenous anastomosis dysregulation arterial blood through the arterial and venous anastomotic branch was blood flow directly into the vein. Due the small venous congestion pressure increases arterial blood is difficult to enter the secondary arteriolar hyperemia. Thus more severe hypoxia, stimulate local histamine secretion increased, the arteriovenous anastomosis branches open, lead to venous dilation, blood flow is slower, internal hemorrhoids more congestion and swelling, and a vicious circle has been increasing, resulting in internal hemorrhoids symptoms.
Internal hemorrhoids congestion is difficult natural lift, to continue swelling protruding into the intestine, known as hemorrhoids or a hemorrhoid block of the main signs of internal hemorrhoids. The initial hemorrhoidal veins and telangiectasia, bruising, hemorrhoids the mucosal hyperemia surface color red, and visible blood vessels swollen like change, not very smooth surface, called vascular swollen internal hemorrhoids. Sometimes oozing mucosal erosion, if congestion persists, the blood continues to grow, small veins dilated the anal cushions hypertrophy, smooth surface, dark red color, called venous aneurysm of internal hemorrhoids. Prolonged congestion, slow blood flow, hypoxia and the accumulation of metabolites can cause: ① parenchymal cells, degeneration, severe necrosis, function decreased immunity loss, easy to secondary infection (inflammation of internal hemorrhoids). ② interstitial reticular fibers into collagen fibers and connective tissue proliferation, that is, interstitial fibrosis, known as fiber swelling type internal hemorrhoids (discomfort injection or nailing). Severe hardening is called congestion sclerosis. (3) the capillary wall permeability, increased pressure in the small veins and capillaries, plasma leakage into the interstitial space causing edema, called of congestive edema (internal hemorrhoids edema). Severe red blood cell leakage, bleeding, called congestion bleeding (internal hemorrhoids).
Thrombosis due to congestion, the blood flow velocity is reduced, the viscosity increased coagulation and solidification process of the anorectal intravascular blood components known as internal hemorrhoids thrombosis, solidification solid substance called thrombosis.
The normal intimal smooth, white blood cells, red blood cells, platelets are concentrated in the blood flow in the central constitute Axial peripheral formation of the plasma edge flow. Axial within platelets rarely have the opportunity to contact with the vessel wall, and therefore does not occur clotting. Slow blood flow, blood viscosity increased axial disorder or disappeared, and even the formation of vortex favor platelet precipitation and deposition and thrombosis. Such as the internal hemorrhoids merger constipation, pressure on the hemorrhoid veins, intimal damage, slow blood flow, blood coagulation enhanced the formation of many small internal hemorrhoids thrombosis, surface color Black and Purple intravascular thrombus.
Bell confirmed by microscopic examination of internal hemorrhoids is a small group of expansion vein, a lot of the vessel lumen thrombosis. Moore pointed out that the pathological changes of internal hemorrhoids blood vessels to dilate and intraluminal thrombosis.
Internal hemorrhoids or mixed hemorrhoid thrombosis blocking the vessel lumen leading to ischemia and pain and burning. Incomplete obstruction causing the congestion to increase the development of internal hemorrhoids. The outcome of thrombosis below.
(1) was dissolved and absorbed: Thrombosis also activated plasmin system play degrade fibrin and thrombolytic effect. Newly formed near the fresh thrombus can be dissolved quickly absorbed by the small blood clots can be completely absorbed and disappear.
(2) machine: fiber protease plasmin system activity, thrombosis longer vitality of occurred five days after the thrombosis, medium-sized blood clots after 2 weeks completely machine. 1950 Gass, according to the inspection of the hemorrhoid tissue hemorrhoid intravascular thrombosis, and ultimately through the machine of the formation of scar tissue.
(3) recanalization: the thrombus machine, connective tissue contraction, the vessel lumen narrowing deformation, while generating fissures, the blood flow back through, formed on the basis of the small blood vessels, so that the original has been blocked blood vessels to restore blood The flow of the process is called recanalization.
(4) calcification: such as thrombosis does not soften and machine thrombus calcium calm into lumps called phleboliths vein.
Tissue edema retention excessive fluid in the tissue spaces called edema. Internal hemorrhoids formation process: (1) capillary hypertension, venous obstruction, congestion, pressure increases, body fluids flowing out from the capillaries to increase blood flow back into reducing internal hemorrhoids containing excessive tissue fluid and edema. ⑦ increased capillary permeability, normal water and crystal substances can pass freely through the capillary wall, plasma protein can not. Such as long-term congestion hypoxia, the accumulation of acidic products organization, increased capillary permeability, and cause edema fluid from the blood vessels leak into the organization. The characteristics of the organization of edema volume increases, reduce swelling, moist, pale, decreased elasticity, cut liquid outflow, edema tissue resistance, easy to secondary infection.
4. Internal hemorrhoids blood outflow from the intravascular to the extravascular called bleeding.
(L): hemorrhage outflow of blood from the vascular area within the body cavity and the organization. Anorectal disease without bleeding. The external bleeding blood flow to the body, such as postoperative bleeding anus. Polyps shed the hemorrhoid block shed and wound bleeding, sometimes reflux into the intestine and excreted after a certain period of time, the amount of bleeding and external bleeding.
Bleeding sites can be divided into the arterial bleeding (ejection), venous bleeding and capillary bleeding.
Bleeding causes and mechanisms can be divided into the integrity of the blood vessel wall damage and blood clotting disorder bleeding, anorectal little bleeding blood clotting disorder, according to their degree of vascular integrity failure can be divided into the following two.
1 ruptured haemorrhage: anal arteriovenous destruction occurred. Caused by friction, trauma, surgery, malignant tumor necrosis or invasion into blood vessels and cause bleeding.
(2) exudative bleeding: occurred in the capillaries due to the capillary endothelial cell basement membrane permeability increased. More common in hypoxia, infection, poisoning, allergies, radiation injury. Such as the Fumigation drugs, outside dressing allergies, radiation proctitis, rectal cancer, ulcerative colitis, hemorrhoids inflammation. Capillary walls severely damaged red blood cells can also be leakage from the blood vessels into the extravascular, is also exudative hemorrhage.
(2) the consequences of bleeding: due to the amount of bleeding, the speed and location of different results. Shock can occur in acute massive blood loss by up to 1/4 of the total blood volume of the body. 1/2 time and not timely rescue can be life threatening. Acute moderate amount of bleeding or chronic anemia can be caused by a small amount of bleeding hemorrhoids, intestinal polyps shedding or large amount of bleeding after surgery prone shock, the subcutaneous hemorrhage had no significant impact.
5. Internal hemorrhoids prolapse
The anal cushions supported by Treitz the muscular elastic fibers and connective tissue. First proposed in 1853 Preitz the anal submucosa with a smooth muscle layer, from the internal sphincter, part of the the joint longitudinal muscle from across the internal sphincter, the muscle called Treitz muscle. 1854 Korivauseh found this muscle known as the the mucosal suspensory ligament. The same year, Ellis and Ford also found that this muscle called the anal wrinkled muscle. 1940 Fine and Lawes this muscle called submucosal muscle, also called anal muscle. Treitz muscle bundles in a large number of elastic fibers. 1950 the Gass and Adams found the cause of internal hemorrhoids is hemorrhoid tissue glial connective tissue debris. They pointed out that: hemorrhoid is due to the anal canal support organizations degeneration, leading the organization down the part of the mucosal and submucosal results. The anal cushions pathological hypertrophy suddenly pulled down to the intestine, defecation pushing pressure down, of Treitz support structure produce force, causing the support structure fracture, the anal cushions lose support and down into hemorrhoids. Hass found in 1984 to 30 years old, connective tissue degradation, then the fiber fracture, so that the the hemorrhoid venous lost support deformation expansion, down defecation easily, causing internal hemorrhoids prolapse.
Tests and Diagnosis for Internal Hemorrhoids
The body check according to the four diagnostic and Wang, palpable, knock, listen to, and other special examinations, pay attention to the presence or absence of hypertension, heart disease, diabetes and blood diseases such as.
2 local checks in accordance with the steps, and can not be omitted, otherwise easily misdiagnosed.
(1) visual examination: Note whether abnormal anal shape, internal hemorrhoids check for bloodstains. If any, can not themselves also bit feasible squatting check prolapse shape, length, color, number, with or without erosion oozing after prolapse. As usual can not own prolapse, can be used to suck the anus is slowly sucked out checks outside the anus.
(2) DRE: Note intersphincteric groove shades into the rectal cavity with or without sphincter spasm, women with or without rectocele. Visible fingertips, if any, in the vaginal opening, lumps than other diseases. DRE internal hemorrhoids only touched the soft mass, removable, and can not distinguish between the number, location and size. So diagnosis are not allowed.
(3) microscopy: the selection of drum anal mirror slowly inserted the rectal cavity extraction obturator side lights to observe whether the bloodstains, the intestine is a perfect circle, the presence or absence of rectal mucosal prolapse broke into the intestine. Then retire microscope to the dentate line, the visible the hemorrhoid body from around broke into the intestine and anus barrel, identify the parts of number size, surface color, with or without erosion oozing. Patients with the cough increased abdominal pressure, forced efforts hip, whether the observed hemorrhoid body is increased, with or without congestive. Anal mirror can see the important basis for diagnosis of internal hemorrhoids. Anal mirror should not use two leaves, and burst pressure, to make the internal hemorrhoid shift and deformation inaccurate diagnosis. Necessary, feasible fiber microscopic examination to rule out polyps and polyposis.
According to the signs and symptoms of internal hemorrhoids, internal hemorrhoids diagnosis is not difficult, but it is not a look can be diagnosed, the need to identify other diseases.
Anal fissure will after bloody attached to the piece of paper does not drip does not shoot no prolapse, associated with periodic pain, the two hip retractor rip the lower end can be seen.
Rectal polyps painless they Scarlet darker, the pedicle low polyps may prolapse, was mulberry-like scarlet. High polyps can be touched, spherical soft mass, can swing. Glimpse anal visible single or multiple polyps, pedunculated more.
Rectal mucosal prolapse often by anal mouth outward radial groove or in the form of ring layered, smooth surface without varicose veins, hemorrhoids prolapse was sub granulated.
4. Rectal tumor shape is not sharp, often has cauliflower quality hard, it plays more often mucus bloody stool, initially often misdiagnosed as hemorrhoids, sometimes concurrent with internal hemorrhoids, see only the check of the internal hemorrhoids have internal hemorrhoids, not again refer to diagnosis and missed. When necessary for pathological examination.
Hypertrophy of anal papilla and anal papillomas dentate line to the anal papilla prominent off-white cone, no bleeding, the tenderness but very light, and for a long time it is a papilloma prolapse, hard, is not the whole shape.
Malignant melanoma often grown at the dentate line, multi-single, small tumor, the color black, some pedunculated prolapse outside the anus, if necessary, for pathological examination.
Of intestinal bleeding the various intestinal bleeding color deep purple, mixed with feces; internal hemorrhoids is bright red, multi-stool attached to the surface, often secondary to anemia.
Treatments of Internal Hemorrhoids
(A) The principle of treatment
Hemorrhoid is a college Anorectal disease, can not think hemorrhoids are mere minor ailments and neglect.
(B) Treatment method
Therapy and many have their own indications and contraindications, and can choose the best method of application.
General treatment is the basis of a variety of therapies, hemorrhoids are appropriate.
Diet: (1) improve the treatment of internal hemorrhoids eat more vegetables, fruits (persimmon can cause constipation, and should not eat) and sweet potatoes, and should not be used to not eat pepper, mustard, alcohol, tea, coffee. Staple thickness of the grain mix, the food digestible mixed food. Regular quantitative eating, not hunger and satiety uneven. Only meat and refined grains to poor bowel, eat only vegetables and whole grains feces increased.
(2) to maintain smooth stool: defecation to adjust through food is very important to develop regular bowel habits, each 1-2d discharge times soft stools, internal hemorrhoids less affected by friction and irritation. Defecation to go with the flow, should not be forced efforts hip, and after a hot water bath to dry, then the paper should be soft, clean, anal insulation should be soft cushion.
(3) should be the law of life: living to regular work and rest in conjunction with long established should not be sedentary, weight-bearing long journey. Especially heavy manual labor, you can not use too much force, increased abdominal pressure, in the middle to rest.
2. Drug therapy is an important method. Ⅰ ~ Ⅱ internal hemorrhoids should be the preferred treatment of Chinese and Western medicine can relieve and alleviate the symptoms and delay the development of internal hemorrhoids.
(L) medication: the internal hemorrhoids acute exacerbation of the clinical evidence of the emergence of syndrome differentiation, Herbal Prescription. Physician habits medication group parties, there is no unified fixed prescription. Internal hemorrhoids thrombosis and incarcerated, available the Decoction B word soup Maxinshigan to facilitate water swelling (the Japan TCM MD Yamamoto rock experience side) of clinical conventional effect. Internal hemorrhoids treatment can also be used intravenous enhancer (micronized purified flavonoid ingredients, the sweet clover streaming Extract Tablet, Ginkgo biloba extract), anti-inflammatory and analgesic drugs can alleviate internal hemorrhoids symptoms of the acute phase, and can effectively alleviate internal hemorrhoids thrombus The cause of the pain. Another the use commercially Huaijiao Burnet balls, all kinds of hemorrhoids piece served the.
(2) for external use to select external use: according to local symptoms and signs.
Methods of operation:
Methods of operation: