Anorectal Diseases
Anorectal diseases are diseases that affect the rectum, the last part of the anus (breech) and large intestine, which is about 10-12 centimeters long. Hemorrhoids, proctitis, anal fissures and pruritis are the most common anorectal diseases.
What is Hemorrhoids?
Hemorrhoidal disease is also known as “hemorrhoids arasında among people and is very common among adult individuals. Hemorrhoids are vascular tissues (also present in neonates) that are part of the normal anatomical structure of the anal canal.
It is thought that there are approximately 2.5 million hemorrhoid patients in our country. Approximately 45% of the population consult a doctor due to hemorrhoid disease at some point in their lives. Hemorrhoidal disease has been reported in 50% of the population over 50 years of age. According to many studies, the most common symptomatic age of the disease is between 45-65 years. Since this group of patients is considered private, confidential and even shameful by the patients, significant delays and errors occur in their diagnosis and treatment. Patients usually tend to pass and hide the event by asking for information from their ear and close surroundings1,2.
How Does Hemorrhoids Occur?
The anus (breech) and surrounding (perianal region) arteries are dilated by the dilation of the veins and the anal pillows. Hemorrhoids are associated with straining and irregular bowel habits. Stiff and thick stools due to strain and a constant feeling of strains due to diarrhea are more likely to push anal cushions out of the anal canal. Compression also causes swelling of the cushions during defecation, paving the way for them to lose their places. In hemorrhoidal patients, connective tissue on the anal cushions is disrupted and disrupted.
What are the types of hemorrhoids?
Internal and external hemorrhoids are divided into two.
Internal hemorrhoids
The anus is hemorrhoids that are not visible when viewed from the outside and are located inside the anus. According to the severity of internal hemorrhoids are classified as 4 degrees:
First degree hemorrhoids: It cannot be seen from the outside by the patient, it can only be seen with anoscope. May cause slight bleeding.
II. Grade hemorrhoids: They go out during defecation, but they come in spontaneously.
III. Grade hemorrhoids: they come out spontaneously or during defecation and must be pushed back by hand.
IV. Degree of hemorrhoids: hanging out, can not be pushed back by hand. Internal and external hemorrhoids are mixed at this stage.
External hemorrhoids
They can be seen from the outside and can be felt by hand hemorrhoids.
What are the symptoms of hemorrhoids?
Strain during straining, strain and trauma to the vessel wall (injury) and painless bleeding is seen. The blood seen in bleeding is bright red. it is usually expressed in the form of fresh red blood following defecation, handling when showering, contamination of toilet paper, hemorrhage after stool, or seeing blood in the toilet unnoticed when bleeding. Long-term and excessive bleeding can cause anemia (anemia), it is beneficial to consult a doctor immediately. Hemorrhoids that go out of the anal canal may be disrupted due to spasm, causing severe pain as well as redness, edema and swelling. In case of external hemorrhoids itching is also present. Even if one of these symptoms is present, a doctor should be consulted. Another main symptom is the hemorrhoid breasts that are present following defecation and which patients try to replace. With the recognition of these breasts, the stage of hemorrhoidal disease is directly related. Especially in the 3rd and 4th stage hemorrhoids, complaints of wetness and feeling of fullness and inadequate cleaning can occur.
What Causes Hemorrhoids?
Hemorrhoids may occur in cases of chronic diarrhea or constipation, straining habits, pregnancy, hereditary factors, long-standing occupational groups, nutritional habits and impaired anal anatomy. Hemorrhoidal disease is more common in patients with prolonged strains and irregular bowel movements. It is thought that more hemorrhoidal diseases develop in those dealing with sports such as weightlifting and bodybuilding as an example of chronic strain1,2.
How to Diagnose Hemorrhoids?
It should be noted that the examination is mandatory. For more detailed examination of patients with rectal bleeding and breech pain, the rectoscopy procedure is used to visualize the last part of the large intestine. Diagnosis and treatment of hemorrhoids without necessary and adequate examinations can mean skipping the early diagnosis of an underlying cancer.
What are the treatment options?
There are many treatment options for hemorrhoids such as suppositories, creams and herbs. However, none of them is capable of providing definitive treatment of the disease. Changes in daily life are beneficial in the treatment of hemorrhoids. Hemorrhoids can be treated by medication or surgical methods, depending on the stage of the hemorrhoid and its location in or out. A hot water bath is also a method to accelerate healing. Once symptoms begin to be observed, it should not be too late to see a doctor because the delay may cause the hemorrhoids to recover in a short period of time and become operable.
Constipation prevention is the first condition and proper diet, pulp foods, plenty of fruits and vegetables should be consumed. Medication is used for small hemorrhoids. The healing process varies from 4 to 6 weeks if it is done with medications and treatments recommended by the doctor (hot sitting bath).
Non-surgical treatment methods of hemorrhoids include the insertion of a rubber around the neck of the hemorrhoid nozzle according to the degree of hemorrhoids, and the rubber band ligation method that causes hemorrhoids to decompose. sclerotherapy methods.
Surgical methods include the removal of the hemorrhoid breast, which is the classic surgical method, the lateral internal sphincterotomy, which is the method of cutting the internal muscle of the breech with the aim of lowering the breech pressure, the laser method which closes the vessels by gluing the veins and the fixation of the sagging hemorrhoidal tissue by pulling up the longo method1. -3.
How to make a hot water sitting bath?
The hot-water sitting bath is designed to accelerate healing, reduce pain and provide mechanical cleaning. Water that does not burn the skin should be seated for 10-15 minutes until the hemorrhoids remain completely in water (until the water is warmed). If the sitting bath cannot be done, the shower sprinkler and the hot water retention in the squatting position also have the same function.
What is needed for a life without hemorrhoids?
· The diet should be rich in fruits and vegetables in general.
· Foods rich in fiber, cereals and bran will ensure regular functioning of the intestines. Spicy food, alcohol or foods that may cause bowel mobility should be avoided.
· Drink at least 1.5-2 liters of water per day.
· Personal toilet cleaning should be paid attention to and complete cleaning should be provided. Soap and similar products should be used for cleaning and very thin toilet paper should be preferred when drying.
· Be careful not to be constipated. Defecation once daily and regularly is the most normal and healthy style. Postponement of defecation causes constipation. Constipation causes hemorrhoids tears, bleeding and pain. Never be pushed during defecation1-3.
What is the probability of recurrence of hemorrhoids after treatment?
Traditional methods (sitting baths, faecal emollients, creams) provide relief, but symptoms may recur if inflammation of the vessels is involved. Pregnancy-related hemorrhoids usually heal spontaneously a few weeks after birth4.
While rubber band ligation improves 80-90%, symptoms may recur in 40% of patients within 5 years. The results obtained by coagulation methods are good but require several times of administration, 12-15% of patients are therefore not compatible with treatment4.
Between 5% and 10% of hemorrhoid cases require surgical procedures. Full recovery can be achieved between 2-4 weeks. Although it is less than non-operative methods, recurrence can be seen in 5-10% in 2% to 5% 4.
Fiber-weighted nutrition, regular defecation, fluid consumption and hygiene are the factors that should be considered to prevent recurrence of hemorrhoids.
What is Radiation Proctitis?
Radiation proctitis is the name given to inflammation changes in the last part of the large intestine (approximately 15 cm) due to radiation therapy.
How does radiation proctitis occur?
It develops when the mucous layer covering the inside of the rectum, the last part of the large intestine, is damaged by radiation therapy (radiotherapy) used for the treatment of cancers such as anus, rectum, cervix and prostate. It may develop short or long after radiotherapy5.
What are the symptoms of radiation proctitis?
Bleeding during abdominal defecation, abdominal pain, diarrhea, pain around the breech, itching are among the symptoms.
What are the treatment options in radiation proctitis?
Anti-inflammatory anti-inflammatory drugs can be administered as pills, suppositories or enemas, reducing bleeding and inflammation. Fecal emollients are useful in laser treatment to heal damaged tissue. Surgery may be applied if deemed necessary by the doctor.
What is Anal Fissure?
It is the name given to a small rupture of skin-like structure covering the anus. It can be seen at any age and is more common in young and middle age (30-40 years old). The incidence is equal in both sexes. It can also be seen in 6-24 months old babies6.
How does anal fissure occur?
It is thought to occur after a trauma. Generally, a hard and dry stool is forced to pass through the rectum, causing a crack in the rectum.
What are the types of anal fissures?
Anal fissure is divided into acute (newly formed) and chronic (chronic).
Acute Anal Fissure:
During a period of intense constipation or diarrhea, a small tear occurs on the breech inner surface. As long as this condition continues, the tear is renewed and causes pain in every defecation. The acute period covers the first 1-2 months. With appropriate treatment, it will heal in about 4-6 weeks7.
Chronic Anal Fissure:
After the diagnosis of fissure, the fissures that do not change with the treatment and feeding order become chronic after 4-6 weeks. Chronic anal fissure is deep and stubborn. There may be a raised image around the fissure due to inflammation and wound. It is a painful condition that lasts longer than 6-8 weeks2.
What are the symptoms of anal fissure?
It is characterized by severe pain in the breech, pain during defecation, pruritus, bright bleeding and burning that is seen on toilet paper or dripping.
What Causes Anal Fissure?
Intense constipation or diarrhea, dietary changes, buckling during defecation, birth, inflammation caused by various diseases in the region are among the most common causes. Because pain and pain are very severe, patients often avoid defecation. Irregular stooling may result in constipation and may result in delayed healing of the fissure. As long as this cycle continues, the anal fissure is likely to become chronic. Rare causes include inflammatory bowel diseases, syphilis, tuberculosis, Crohn's disease, AIDS and cancer.
How is Anal Fissure Diagnosed?
Anal fissure is diagnosed by the doctor by examining the anus and surrounding tissue. Since the patient with anal fissure has hypersensitivity and pain, the examination can be performed after local anesthetic pomades are applied or under general anesthesia7.
What are Anal Fissure Treatment Options?
Acute anal fissures usually heal in one or two weeks with appropriate medical treatment. The aim is to reduce or eliminate spasm in the anal sphincter (muscles surrounding the breech). Posaca rich nutrition, warm water sitting baths, local anesthetic pomades, stomatous or non-steroid pomades provide a great improvement.
In chronic anal fissure, non-surgical methods are less likely to heal. Injection of chemical solutions such as glyceryl trinitrate (GTN), botilinum toxin (botox), diltiazem (chemical sphincterotomy) can be performed. Surgical methods include anal dilatation (3-4 fingers enlargement), local lateral anesthesia, "lateral internal sphincterotomy" (subcutaneous astringent internal muscles).
What should be considered to prevent anal fissure?
Fiber-rich diet and autonomous fluid intake prevent constipation, soften the feces and accelerate the healing of the fissure3.
Regular exercise for 30 minutes or more regulates bowel movements and increases blood flow to every part of the body; Thus, the anal fissure is easier to heal3.
Stretching during defecation may result in increased pressure, which may result in new tears. Therefore, pushing must be avoided3.
What is Pruritis Sudden?
It occurs with an itch and burning sensation in and around the anus. In the face of this situation, which is quite distressing and uncomfortable, there is a desire for itching that is difficult to prevent. The incidence in the community is between 1% and 5% and is four times higher in men8.
How does pruritis occur suddenly?
Itching occurs in 50% -90% of patients with unknown cause. The underlying infection can be caused by many factors such as disease state, irritants and dermatological problems.
What Causes Pruritis Sudden?
· Infections caused by parasites, fungi, bacteria and viruses
· Alcohol, dairy products, tomatoes, spices, citrus fruits, chocolate, nuts etc. some food
· Anorectal diseases such as hemorrhoids and anal fissures
· Some skin diseases (dermatitis)
· Some soaps and products used in anal area cleaning
· Fecal contamination (fecal contamination of underwear)
· Sugar, liver, kidney diseases, iron deficiency anemia, etc. systemic diseases,
· Psychological factors such as anxiety, stress and depression can cause anal itching.
Continuous cleaning of that area to relieve itching, excessive use of toilet paper or handkerchiefs, nail scratching and creams may further increase itching3,8.
How is Pruritis Sudden Diagnosed?
The patient's history should be taken. Allergic diseases and other or existing diseases, cleaning and eating habits, whether itch seasonal or intermittent are questioned. Physical examination is not only limited to the anal region, but also body examination in general (especially the groin area, hand and foot nails).
What Are The Options Of Pruritis Sudden Treatment?
It should be aimed to eliminate the underlying causes. Avoiding irritating products such as soaps, shampoos, cosmetics, toilet papers, itching that may cause itching, keeping the area dry and clean, cleaning with hot water after defecation, daily changing of underwear, containing zinc creams, hydrocortisone containing The use of creams and allergy medicines at night, the consumption of fiber foods provide relief. Itching is alleviated by the elimination of diseases such as hemorrhoids, anal fissures, constipation or diarrhea.
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