Haemorrhoids, in a broad sense, refer to anorectal diseases. The name comes from an anatomical term that denotes normal vascular formations — haemorrhoidal plexuses — with which a number of pathological changes occur.
The vascular plexus, surrounded by connective tissue and muscle fibers, is adjacent from the inside to the anal sphincter, where it forms internal haemorrhoidal cushions or nodes . They complement the closure of the anal sphincter during periods between bowel movements. The cushions ensure a tight closure of the anus, expanding immediately after bowel emptying due to blood flow into the cavernous tissue. Thanks to the fact that the sphincter and haemorrhoids work synchronously and tightly close the anal opening, gas and stool do not exit the rectum outside of defecation. Outside the sphincter are the external haemorrhoids, through which blood from the vascular plexus drains into the system of subcutaneous veins of the perineum.
In clinical practice, external and internal haemorrhoids do not always occur in isolation. In many patients, both forms are detected simultaneously during examination. In this case, it is referred to as combined haemorrhoids.
Symptoms of grade 2 combined haemorrhoids
External haemorrhoids are located below the dentate line and covered with flat skin epithelium. The area is richly innervated and contains a large number of pain receptors. External haemorrhoids are swellings that occur in the anus, are easily visible, and easily palpable.
Internal haemorrhoids They are located above the dentate line and are lined with the rectal mucosa, which does not contain pain receptors of nerve endings. Haemorrhoids usually occur in the right anterior, right posterior and left lateral zones. Pathologically dilated haemorrhoids occur in adults and children.
Clinical signs of combined haemorrhoids of the 2nd degree may manifest themselves differently in each case. In general, the clinical picture is determined by the symptoms of internal and external haemorrhoids.
Signs and symptoms of external haemorrhoids
While small internal haemorrhoids go completely unnoticed, even very small external haemorrhoids often cause a number of unpleasant symptoms. Patients complain of itching, burning and pain during physical activity, sitting or during bowel movements.
External haemorrhoids appear as a lump outside the anus. Thrombosed external haemorrhoids are characterized by constant, high-intensity pain. They are easy to recognize: a node with a blood clot is visible under the skin above the anus.
Signs and Symptoms of Internal Haemorrhoids
Internal haemorrhoids are located inside the rectum and usually resolve on their own. Due to their location in an area without pain receptors, the disease is often asymptomatic. In cases where patients experience discomfort from internal haemorrhoids, it occurs due to an increase in their size.
Prolapse
The exit, or protrusion, of internal haemorrhoids from the anus outward is called prolapse. Sometimes the prolapse is manually reduced, but this is not always safe. Only a doctor determines the best course of action in each specific clinical case.
Signs of prolapse
Internal haemorrhoids prolapse as they enlarge and form large bulges, which are clearly visible at the outer edge of the anus.
They are divided into four different types, depending on the degree of their prolapse. It matters how far they protrude beyond the anus and whether they are temporary or permanent.
Signs and symptoms of thrombosed haemorrhoids
Thrombosed haemorrhoid is an internal or external haemorrhoid in which a thrombus has formed — thrombosis has occurred. The symptoms accompanying a thrombosed haemorrhoid are often more severe than usual and include intense itching, burning, pain, redness, and swelling. The area around the haemorrhoidal node often takes on a bluish color. Prompt treatment of thrombosed haemorrhoids is necessary to prevent loss of blood supply and damage to surrounding tissues — necrosis.
Symptoms of second-degree combined haemorrhoids also depend on the location, size, and number of nodes involved in the pathological process, as well as its severity. There are a number of symptoms that may occur individually or in various combinations.
Bleeding
Usually, during defecation, there is slight bleeding or blood-streaked discharge. It can be noticed on hygiene wipes, on the surface of stool, and in the toilet. If it appears, you should definitely consult a doctor for examination, diagnosis, and to rule out other causes — anal fissures, polyps, colorectal cancer, and some others.
Itching
The most common symptom of haemorrhoids is itching. Haemorrhoidal discharge causes inflammation of the skin around the anus, leading to a burning sensation that turns into itching. It is more irritating than painful. It can be reduced or eliminated with over-the-counter or prescription medications.
Pain and Discomfort
These symptoms usually occur when:
- hard stool repeatedly rubs, scrapes the mucous membrane, and damages haemorrhoids, causing their inflammation;
- a person strains too much during bowel movements, which leads to swelling of the haemorrhoidal cushions, even causing tears in the mucous membrane covering them;
- haemorrhoids become thrombosed.
To relieve the condition, reduce pain and discomfort, it is recommended to wash with water and potassium permanganate and soap after bowel movements, and to use a soft cloth for wiping. If discomfort occurs when sitting on a hard surface, haemorrhoid air cushions can help.
Mucous discharge
This most uncomfortable and unpleasant symptom is a typical sign of haemorrhoids. If internal haemorrhoids become inflamed, they can release mucus. This is what causes the feeling of discomfort and moisture. Stains may appear on underwear. After examining the patient during a visit, doctors recommend appropriate remedies that help deal with anal discharge.
The disease is identified based on the patient’s medical history and examination results. To confirm the clinical diagnosis, they obtain laboratory data and conduct imaging studies, although these are not always mandatory.
The doctor performs a digital rectal exam on some patients: inserting a gloved finger into the anus, deep into the rectum. In some clinical cases, they also perform anoscopy. : The specialist inserts a short endoscope with lighting into the rectum and examines the inside of the anal canal. The doctor recommends a colonoscopy if a person with haemorrhoids has symptoms that occur not only with haemorrhoids but also with other digestive system diseases, or if they have risk factors for developing colorectal cancer.
Treatment of grade 2 combined haemorrhoids
Pharmacies offer a wide selection of pharmaceuticals with natural and synthetic ingredients. The drugs eliminate pain and other unpleasant symptoms of haemorrhoidal disease.
You should not self-medicate and choose remedies for haemorrhoids on your own, after consulting with family members, friends or a pharmacist. Only a doctor will correctly assess the patient’s complaints, conduct an examination, do the necessary research, make a diagnosis, on the basis of which he will prescribe a comprehensive treatment of haemorrhoids.
Pharmaceutical products of different groups, created to relieve haemorrhoidal symptoms, are intended for local and general action. Accordingly, medications come in different release forms.
suppositories, gels, ointments and creams
Rectal preparations are intended for local action in haemorrhoids. Depending on the composition, they have a different range of therapeutic effects.
To them, for example, related to:
- Relief — suppositories And ointments, containing phenylephrine, beeswax, common thyme oil, vitamin E, and other ingredients — relieves itching and swelling. It has dangerous side effects: causes allergic reactions, insomnia, tremors, anxiety, increases blood pressure, destabilizes heart rhythm, and more. Not recommended for patients with diabetes, hyperthyroidism, arterial hypertension; pregnant women and for prostate hypertrophy.
- Ultraproct — cream and suppositories, containing a hormone from the glucocorticoid group — fluocortolone, and a substance that has an anesthetic effect — cinchocaine. They eliminate inflammatory phenomena and pain during the exacerbation of chronic haemorrhoids.
- Aurobin — rectal ointment that eliminates inflammation due to prednisolone; has a healing effect provided by D-panthenol; contains lidocaine, which acts as an anesthetic.
- Proctoglyvenol — suppositories and cream. Contains tribenoside, which increases the tone of the venous vessels of the haemorrhoidal plexus. The composition also includes lidocaine — a local anesthetic. Relieves pain syndrome and normalizes venous blood flow.
Many other local medications are available in pharmacies that effectively relieve the unpleasant symptoms of the disease.
Detralex — tablets with angioprotective and venotonic effects
The drug improves blood circulation in the venous system, eliminates signs of venous and lymphatic congestion, and increases the resistance and permeability of capillaries. In a single daily dose of 1000 mg, Detralex restores the elasticity of venous walls, reduces their stretching, and decreases the volume of veins in varicose veins and haemorrhoids. It helps to relieve pain, a feeling of fullness, and itching. The drug causes side effects very rarely. They include mild dyspeptic symptoms.
Treatment of grade 2 combined haemorrhoids with home and folk remedies
With the abundance of high-quality, symptom-relieving, safe remedies produced by leading pharmaceutical companies, some people prefer to use folk, homemade, makeshift remedies. Without dwelling on various kinds of “rectal suppositories” made from purified raw potato tubers, frozen water, and pork lard, it is worth mentioning some medicinal herbs. Sage, celandine, and chamomile do no harm and reduce pain and inflammation if their decoctions are added to warm sitz baths for 20 minutes. The ideal option for severe inflammation is a bath with a weak potassium permanganate solution.
It is better to carry out therapeutic procedures three times a day:
- in the morning, immediately upon waking;
- after defecation;
- at night, before bedtime.
After each procedure, it is good to use a factory-made ointment or suppository. Lovers of natural products can easily choose preparations that contain only medicinal herbs, beeswax, propolis,
Helpful home remedies include:
- an active lifestyle;
- full night’s sleep;
- morning exercise;
- stress resistance training;
- walks in the fresh air;
- a healthy diet that includes plenty of plant fiber and sufficient daily drinking water.
All this will normalize mood, general well-being, eliminate constipation, diarrhea, venous congestion, and increase the intestinal resistance to harmful influences.
Oral agents
Several factors provoke haemorrhoidal disease in men and women of any age group.
Haemorrhoids appear if:
- Pushing hard during bowel movements.
- Suffer from chronic constipation or diarrhea.
- Sit on the toilet for a long time.
- Eat low fiber foods.
- Drink little water.
- Be in a sitting position for a long time – for example, driving a car, in the office, on the sofa watching TV.
- Lead a sedentary lifestyle.
- Lift heavy objects frequently.
- Have anal sex.
- Be overweight.
Haemorrhoids in women most often occur during pregnancy and childbirth. For most of them, after some time, the symptoms of acute haemorrhoids completely disappear and no longer bother you.
Young patients are more willing to come to the appointment and tell the attending physician about the suspected causes that could cause haemorrhoids. It is important for them to quickly get rid of serious problems that interfere with their usual way of life.
- To eliminate constipation, laxatives are used – Dulcolax, Frutoslabin, Duphalac and others.
- It is useful to include dietary supplements containing fiber in therapy – especially preparations with psyllium husks. At the same time, you need to drink more water, otherwise the fiber will have the opposite effect and worsen constipation. Add more liquid foods to your diet – soups, smoothies, slimy porridges.
- In case of thrombosis of the external haemorrhoid, the doctor chooses conservative care or intervention according to indications. Topical heparin preparations have limitations, especially for bleeding. Systemic anticoagulants and aspirin are not universal treatments for haemorrhoidal thrombosis; You can’t start them yourself. If such medications are already prescribed for another reason, a change in intake must be agreed upon with the attending physician.
- Haemorrhoids complicated by infection and inflammation are treated with antibiotics and NSAIDs, which also have an analgesic effect.
Despite the abundance of medications that help fight the symptoms of haemorrhoids, they all provide only temporary relief. Haemorrhoids altered by the pathological process do not restore their normal structure.
Conservative methods for combined haemorrhoids bring a small and short-term effect. The disease can worsen with renewed vigor at any time. Persistent symptoms may warrant an office procedure or surgery if indicated. No treatment guarantees that the condition will never recur.
Features of treatment of combined haemorrhoids of the 2nd degree in men
Haemorrhoids in men occur due to strain: when you have to lift and carry heavy objects, sit for long periods in an office, at a computer, behind the wheel of a car, or the controls of an airplane.
In addition, the problem is complicated by the close proximity of the prostate gland. The proximity of the prostate requires caution when a man is prescribed treatment. It is important to trust a good specialist so that neither the haemorrhoids nor their treatment affect the functional activity of the genitourinary system.
Men who love spicy food, often eat fast food, smoke a lot, and consume alcohol are at risk not only for haemorrhoidal disease but also for colorectal cancer.
To choose suitable treatment for haemorrhoids, you need to be examined by a proctologist surgeon, conduct a differential diagnosis, rule out accompanying malignant diseases, complete the prescribed course of treatment, and strictly follow the recommendations of the attending physician after therapeutic measures to control symptoms and reduce the risk of recurrence, which cannot be eliminated completely.
Features of treating second-degree combined haemorrhoids in women
The main causes of haemorrhoids in women are pregnancy and childbirth. This is related to:
- the hormonal background, which affects the walls of blood vessels and the properties of blood during pregnancy;
- high intra-abdominal pressure when a woman is carrying a growing fetus;
- weight gain if a woman does not follow a proper diet and exercise routine;
- the need to strain due to frequent constipation associated with pregnancy;
- straining during childbirth.
When combined haemorrhoids occurs during pregnancy, it is treated only conservatively. The attending physician prescribes laxatives, pain relievers, anti-inflammatory drugs, and local anal medications that are not contraindicated for pregnant women.
It is important for women during pregnancy:
- to eat properly;
- to add more fiber to the diet;
- to drink enough water;
- to spend more time walking outdoors;
- to get enough sleep at night;
- to avoid stress.
Under no circumstances should you self-medicate or follow the advice of people without special education — relatives, friends, acquaintances, colleagues, pharmacy workers. Only a doctor can correctly interpret complaints, determine the causes, assess all risks, and prescribe adequate, safe treatment for the mother and the fetus.
Effective and fast treatment of stage 2 combined haemorrhoids
Minimally invasive procedures may reduce tissue injury compared with some operations. However, pain, bleeding and other complications remain possible; wound size and recovery time depend on the technique and the patient’s condition. The indications for each type of treatment depend on the characteristic features of the type, stage, and location of haemorrhoids.
Laser Treatment
Second-degree combined haemorrhoids are treated with a laser. The treatment is performed by experienced colorectal surgeons and provides excellent results. The patient goes home on the same day, shortly after the procedure.
The method uses a focused laser beam. It is precisely directed at the enlarged haemorrhoids, which shrink. The lumen of the blood vessels damaged by the disease is sealed. The method fixes the haemorrhoids inside, and they no longer protrude from the anus.
The fundamental difference of laser therapy from other methods of haemorrhoid treatment:
Tissues are not cut or removed from the anus. All traditional methods aim at removing the nodes. In contrast, the laser simply returns them to their place and simultaneously compresses them painlessly.
Laser energy is delivered via a radial fiber directly to the haemorrhoids, and they are obliterated from the inside. This helps preserve the structure of the mucosa and sphincter with extremely high precision.
After treatment, the haemorrhoids are again able to perform an important function in the process of controlling defecation. This makes the method safe and effective.
Rubber band ligation
The principle of rubber band ligation consists in surrounding the base of the haemorrhoidal node with a tight rubber band. The tissue tied with the band dies off and is replaced by an ulcer, which heals with scarring.
Such a procedure was described in 460 BC by the Greek physician Hippocrates:
The most common complication is pain. One to two weeks after the procedure, bleeding or a bacterial infection may sometimes occur, which spreads to the tissues surrounding the haemorrhoid — phlegmon.
Ligation of haemorrhoidal arteries under Doppler guidance and rectal restoration procedures
The system (DG) HAL/RAR uses minimally invasive surgical methods to treat haemorrhoidal disease without surgical excision, stitching, or banding.
This is a single system that offers two procedure options:
- (DG) HAL – ligation of haemorrhoidal arteries under Doppler control.
- (DG) RAR – rectal-anal restorative proctoplasty under Doppler control.
The procedure takes twenty minutes and patients usually leave the same day. Most experience only minor discomfort and return to work the next day.
New surgical techniqueHAL–RAR, based on ligation of the terminal branches of the superior rectal arteries under Doppler control in combination with transanal mucopexy of the rectum, provides postoperative comfort with minimal pain and low risk of complications.
Advantages of minimally invasive surgery in the treatment of grade 2 combined haemorrhoids:
- There are no or minimal operational risks.
- Intervention takes little time.
- No need to stay in hospital.
- After treatment, the pain is almost not felt, and its mild manifestations are well relieved by NSAIDs, and completely disappear after a few days.
- The body recovers quickly after the procedure.
- Haemorrhoidal ridges continue to perform the function of sealing the anus.
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Identified medical inaccuracies are clarified in the material. Methods, contraindications and recovery depend on the individual situation; information helps you prepare for the consultation.
ASCRS Haemorrhoids Guidelines 2024 · NIDDK: Haemorrhoidal Disease