Hemorrhoidal thrombosis
Hemorrhoidal thrombosis is a complication of hemorrhoids, which is characterized by the appearance of a blood clot in the vessels of the rectum. It develops against the background of impaired blood circulation in the cavernous plexuses of the organ. The acute stage of the disease continues for 5 days, after which the thrombus node will be replaced by connective tissue. At the same time, complications such as necrosis, the appearance of ulcers on the intestinal mucosa and even death cannot be ruled out. The risk of developing complications of the disease is quite high, they are observed in about 60% of patients with hemorrhoidal thrombosis.
The main symptoms of thrombosis of this localization are severe pain in the rectal area, sensation of a foreign body in the anus. Perhaps both conservative and surgical treatment of the disease.
Thrombosis of hemorrhoids in 82.3% is a consequence of chronic hemorrhoids, and in 17.7% develops during the acute stage of the disease. Despite the sufficient knowledge of the disease, it still presents a certain difficulty in treatment. The fact is that conservative therapy often allows only a temporary recovery to be achieved, and surgical interventions are often complicated by relapses of pathology. Therefore, for proctologists, hemorrhoidal thrombosis is a very urgent problem.
Content:
- Types and severity of hemorrhoidal thrombosis
- Causes of hemorrhoidal thrombosis
- Symptoms of hemorrhoidal thrombosis
- Diagnostics of the thrombosis of the hemorrhoidal node
- Hemorrhoidal thrombosis treatment
- Prevention of hemorrhoidal thrombosis
Types and severity of hemorrhoidal thrombosis
Depending on which hemorrhoidal node was affected, the following types of thrombosis are distinguished:
- Internal thrombosis. With internal thrombosis, blood clots can be located in several hemorrhoids at once.
- External thrombosis. In this case, blood clots are most often single, that is, they are located in one of the nodes. Therefore, the clinical picture of the disease will not be so vivid.
- Combined thrombosis.
There are three degrees of severity of the course of the disease:
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The first degree of severity is characterized by the presence of thrombosis in the internal and external hemorrhoids, but the disease is not complicated by an inflammatory reaction. The nodules themselves, although painful, do not reach impressive sizes. They are tight and elastic, can be located in the perianal region and in the anus. Areas of the dermis above the nodules are slightly reddened. The pain is moderate, present on an ongoing basis. In parallel, a person may experience itching and burning in the anal canal. These sensations tend to intensify when a person has consumed spicy food, alcoholic beverages, or spent a long time in a sitting position.
- Second degree of severity. The pain becomes more intense, the hemorrhoids thicken, the redness of the perianal skin increases. It is almost impossible to touch hemorrhoids, so the doctor will have to refuse a digital examination. The internal sphincter is tense all the time.
- Third degree of severity. Thrombosis is characterized by inflammation of not only the hemorrhoids themselves, but also the subcutaneous tissue. The perianal skin is red and swollen. The mucous membranes of hemorrhoids undergo necrosis. Around the anus there are blue formations, which are represented by areas of strangulated skin. If third-degree thrombosis is not treated, then there is a high probability of rupture of the hemorrhoid with further bleeding and the development of acute paraproctitis.
In acute hemorrhoids, blood clots are localized in the cavernous veins. Since these vessels are very small in size, as well as the thinnest branches that carry out the inflow and outflow of blood, the risk of thrombus embolism is excluded. Moreover, almost all blood from the hemorrhoid enters the portal vein.
Causes of hemorrhoidal thrombosis
Thrombosis of the hemorrhoid is formed under the influence of many factors. First of all, we are talking about errors in nutrition. The development of the disease is negatively affected by the intake of alcoholic beverages, the use of spicy foods, seasonings, salinity, and bitter foods. Such food helps to increase blood circulation in the pelvic organs, which naturally increases the pressure in the hemorrhoids.
Constipation and frequent diarrhea also negatively affect the state of the hemorrhoidal plexus. Such disturbances in the processes of food digestion are observed not only against the background of intestinal disorders, but also due to the predominance of dishes in the menu, which do not contain a sufficient amount of fiber.
Another reason that can lead to the development of the disease is a sedentary lifestyle. The more a person sits, the longer the blood stagnates in the pelvic organs.
The birth of a child can also be associated with the formation of thrombosis in the hemorrhoids. In general, any sharp increase in intra-abdominal pressure negatively affects the course of the disease. Therefore, a blood clot can form even with severe physical exertion.
Any trauma to hemorrhoids is associated with a high probability of a blood clot forming in it. Hypothermia is a risk factor.
Spasm of the anal sphincter against the background of painful sensations can also provoke the development of thrombosis.
Thus, the pathogenesis of hemorrhoidal thrombosis is reduced to trauma to the walls of the hemorrhoid itself, as well as to stagnation in the cavernous bodies of the intestine. Leukocytes and platelets, which produce fibrin fibers, begin to shrink to the place where there is tissue injury. It is they who later form a blood clot that fills the node. Gradually, the thrombus grows, the node ceases to receive the nutrition it needs, which leads to the death of its tissues.
Symptoms of hemorrhoidal thrombosis
Asymptomatic disease is very rare.
Its main features are:
- Painful sensations that intensify while walking, during bowel movement, with prolonged sitting.
- The patient will feel that there is a foreign body in his anus.
- Itching and burning are constantly present in the anus.
- The skin around the anus is swollen.
- Mucous-fibrous contents can be secreted from the rectum.
- Since thrombosis of the hemorrhoidal node is always associated with an inflammatory reaction, during an exacerbation of the disease in a person, the local and general body temperature rises, weakness and nausea occur.
The severity of symptoms depends on the stage of the pathological process.
Diagnostics of the thrombosis of the hemorrhoidal node
To make the correct diagnosis to the doctor, it is enough to have a standard examination of the patient and questioning his main complaints. During the appointment, the doctor visualizes and palpates moderately or severely painful hemorrhoids (the degree of pain depends on the stage of development of the pathology).
Hemorrhoids with a thrombus are located below the scallop line, when it comes to the external form of the disease. With internal thrombosis, a groove will be located between the prolapsed node and the skin of the perianal region. If the node is inside the rectum, then during a rectal examination, the doctor palpates painful formations that have a round shape.
The patient must be prescribed a blood coagulogram. According to its results, hemostasis disorders will be detected. In patients with acute thrombosis, hypercoagulability, inhibition of fibrinolytic activity, and retraction of the blood clot can be traced. The prothrombosed index is increased. The fibrinogen level is increased.
A general blood test picture shows an increase in the number of leukocytes.
To clarify the diagnosis and turn off other pathologies, the patient is prescribed rectoscopy, or examination of the rectum using a rectal mirror. This allows you to exclude rectal tumor, anal fissures, paraproctitis in the acute stage, rectal polyps.
Hemorrhoidal thrombosis treatment
Treatment of patients with hemorrhoidal thrombosis can be both conservative and surgical. Most proctologists are of the opinion that one should try to get rid of the disease with the help of medications. The operation can be performed exclusively in specialized proctological departments. It is imperative to send patients for emergency surgery who have severe bleeding from internal hemorrhoids.
Treatment with conservative methods begins with the elimination of pain experienced by the patient. It is also important to direct efforts to prevent the development of complications, to eliminate the inflammatory process and stop thrombosis. Therefore, in addition to systemic treatment, the patient should receive local therapy.
To accelerate the lymphatic outflow, improve blood microcirculation, reduce capillary permeability, it is necessary to take phlebotropic drugs. It can be Rutin, Escin, Tribenoside.
To reduce pain, patients are prescribed Detralex. Also, this drug acts as an anti-inflammatory agent. Detralex can be prescribed to treat women in position. Paracetamol and derivatives based on it have a good analgesic effect. Can also be used to relieve pain with NSAIDs, such as Ketorolac.
When choosing drugs for local treatment, one should take into account which symptom comes to the fore - thrombosis, painful sensations, the strength of inflammation, tissue necrosis. Dicaine and bupivacaine ointments can be used for pain relief. It is possible to use combined gels with glucocorticosteroids and astringent components, for example, Proctosedil, Aurobin, Heparin ointment, etc.
Ointments Levasin and Levomekol are prescribed in the case when thrombosis of hemorrhoids is complicated by inflammation of the subcutaneous tissue and the perianal region.
To stop bleeding, local hemostasis is most often enough, for which drugs such as Androxon, Spongostan, Tachocomb are used.
Suppositories are widely used to treat hemorrhoids. The combinations of active ingredients in them may be different. Popular drugs are: Relief, Posterisan, Proktosedil, Nigepan.
In the complex treatment of hemorrhoids complicated by thrombosis, low-intensity laser radiation is used. Shown carrying out 5-7 sessions, each of which lasts from 5 to 7 minutes. After the second procedure, the inflammation will decrease, the swelling from the perianal region will subside, the nodes will become softer and more painless.
The pain syndrome can be successfully stopped with the help of novocaine-alcohol blockades. They allow you to remove swelling from tissues and significantly improve the patient's condition.
Most often, it is possible to eliminate thrombosis of hemorrhoids with the help of conservative treatment methods. Moreover, it should not end after the symptoms of the disease subside. The main task of the doctor and the patient is to prevent recurrence of inflammation, which is possible thanks to competent prevention.
Prevention of hemorrhoidal thrombosis
First of all, a person must adjust his diet. You should stop taking laxatives, but at the same time increase the amount of vegetable fiber consumed, as well as liquid. The diet should be enriched with bran, seaweed, flaxseed. You can take the drug Macrogol 4000.
If a person suffers from diarrhea, then he is shown taking Loperamide, but with sufficient volumes of fluid.
You should completely abandon the use of coffee, tea, alcoholic beverages, spicy foods, seasonings and spices.
Any trauma to the anus is associated with a risk of recurrence of the disease, so it is necessary to strive for a gentle and regular bowel movement. In addition to proper nutrition, sufficient physical activity can help.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
