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Classification, symptoms and treatment of hemorrhoids | article abstract
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According to the condition and pathological characteristics, hemorrhoids can be divided into internal hemorrhoids, external hemorrhoids and mixed hemorrhoids.
The hemorrhoid core of internal hemorrhoids is on the tooth fairy. According to its prominence, it can be divided into four levels. Grade I hemorrhoids will not sag. Although grade 2 hemorrhoids sag, they can be reset by themselves. Grade I hemorrhoids prolapse needs manual reset, and grade I hemorrhoids prolapse cannot be reset manually.
The data quality is located far from the injury line and covered with squamous epithelium. Pain occurs only in acute thrombosis, but there is no pain in other aspects (Fig. 1).
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Figure 1 origin and location of internal and external hemorrhoids
Patients with external hemorrhoids and internal hemorrhoids are collectively referred to as mixed hemorrhoids.
Shame is mainly manifested as painful swelling. Anal skin is the excess skin left after inflammation and thrombosis in the past, painless. David assela, northern exposure (American TV Series), hengwenming dialect)
The main clinical manifestations of mixed hemorrhoids: local blood flow slows down, blood volume increases, resulting in congestion. Changes of vascular contents caused by thrombosis; Changes in vascular wall permeability cause edema and bleeding, showing typical symptoms of decline, swelling, pain and bleeding.
In October 2021, the American College of Gastroenterology (ACG) issued guidelines for the management of benign anorectal diseases, including hemorrhoids management methods. For hemorrhoids treatment, ACG's guidelines are as follows:
Symptomatic hemorrhoids can be treated conservatively, including intestinal care [it is recommended to increase fluid (6-8 cups per day) and dietary fiber intake (20-30g per day)] and not to sit in the bathroom for a long time (such as reading and using mobile phones). For patients who cannot increase dietary fiber, polyethylene glycol or dacoate sodium can be given.
In the case of symptomatic hemorrhoids, dietary control (including adequate intake of liquid and fiber) and minimizing defecation are recommended as first-line treatment (strongly recommended). Quality of evidence: medium). Agreement score: 29
For symptomatic grade I and II hemorrhoids with drug treatment failure, it is recommended to carry out effective treatment through outpatient surgery (such as glue lasso). Alternative procedures include infrared coagulation, sclerotherapy, bipolar electrocoagulation, etc. (highly recommended). Quality of evidence: medium). Agreement score: 28
Symptomatic hemorrhoids can be treated by Doppler induced hemorrhoid ligation for hemorrhoid fixation, mucosal fixation or stapler hemorrhoidectomy.
Doppler guided surgery (such as hemorrhoid artery ligation) is similar to hemorrhoidectomy in the treatment of symptomatic hemorrhoids (conditionally recommended). Quality of evidence: very low). Agreement score: 29
Thrombotic external hemorrhoids are called thrombotic external hemorrhoids, which are characterized by sudden onset of pain and swelling, and may be outside or within the defense. If the quality of thrombotic data is observed within 4 days, it can be treated surgically.
Surgery or thrombectomy may be helpful if patients with acute thrombotic data quality have been observed within the past 4 days (highly recommended). Evidence quality: low). Agreement score: 30
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[2] Total demand. Talk about the causes, treatment and prevention of hemorrhoids [J]. Chinese medical guidelines, 2014, 12 (25): 379-380.
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