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With the development of endoscopic minimally invasive technology, endoscopic minimally invasive treatment of gastrointestinal diseases is more and more popular with physicians and patients.
Hemorrhoids are common and frequently-occurring diseases of the anus.
There are many ways to treat hemorrhoids, each with its own advantages.
Endoscopic ligation and sclerotherapy of internal hemorrhoids are simple, minimally invasive, low-cost and effective.
It is a highly recommended surgical method and a hot spot in endoscopic treatment.
The theoretical knowledge of hemorrhoids will be introduced below in combination with clinical treatment.
A misunderstanding of the definition of hemorrhoids Hemorrhoids are soft venous clusters formed by the expansion of the venous plexus under the mucous membrane of the human rectum and under the skin of the anal canal, including the anastomosis of tiny arteries and veins, and spongy normal tissue structures such as connective tissue and nerve tissue.
It is pointed out that the term "internal hemorrhoids" in a strict sense does not indicate a disease state.
It is part of the normal anatomy of the rectum and anus, which assists defecation and controls defecation.
The normal internal hemorrhoid vascular plexus is composed of 3 soft hyperemia pads.
It is called anal cushion or "hemorrhoids".
In clinical practice, "internal hemorrhoids" is only used to describe diseases caused by abnormal enlargement of the anal cushion.
More precisely, this definition is limited to symptomatic hemorrhoid diseases: that is, the anal cushion is bleeding And/or prolapse is called "hemorrhoids" or "hemorrhoids" [1].
Therefore, when hemorrhoids are present, it can be manifested as bleeding, pain, prolapse of hemorrhoids, and even difficulty in defecation.
Therefore, the Chinese Clinical Guidelines for Diagnosis and Treatment of Hemorrhoids (2020) The principle of hemorrhoids treatment is to relieve symptoms, not to eliminate hemorrhoids[2] .
Anatomy of the second hemorrhoid 1.
Anal cushion is a part of the normal anatomy of the rectum and anus.
It is located above the dentate line of the anal canal with a 1.
0cm-1.
5cm annular tissue band, with 8-10 rectal columns arranged longitudinally inside.
3.
Pathophysiology of hemorrhoids.
Causes of hemorrhoids.
Historically, academic circles have put forward many theories, from the theory of varicose veins in the 18th to 20th centuries, the theory of anal mucosal sliding in 1950, and the theory of cavernous hemorrhoids in 1962, as well as the current relatively recognized theory.
The doctrine of anal cushion shifting down. The theory of anal cushion shifting down: It is known that there are tiny arteries and veins, connective tissue, nerve tissue and other spongy tissues in the anal cushion; the tiny arteries and veins inside are anastomosed with each other.
When the anus is closed, blood in these small arteries and veins is present.
In the full state, when defecation, the blood in the blood vessel is squeezed by the stool and expelled, and the anal cushion will be reduced to assist the discharge of the stool.
Some undesirable factors can damage and deteriorate the connective tissue of the cushion, which causes the anal cushion to move down and cause varicose veins, and then form hemorrhoids.
Four Epidemiology In 2015, the Anorectal Branch of the Chinese Society of Chinese Medicine led an epidemiological survey of anorectal diseases in 31 provinces, municipalities, and autonomous regions across the country.
The survey results showed that the anorectal diseases of urban and rural residents over 18 years old in my country The prevalence rate of diseases is as high as 50.
1%, among which hemorrhoids is the most common anorectal disease, with a prevalence rate of 49.
14%, and the number of patients suffering from hemorrhoids accounts for 98.
09% of all anorectal diseases.
Internal hemorrhoids accounted for 59.
86% of the incidence of hemorrhoids, 99.
47% of internal hemorrhoids were I-III degree, and in a colonoscopy hemorrhoid incidence survey, the incidence of hemorrhoids reached 38.
9%, of which 44.
7% had related symptoms.
The peak incidence of hemorrhoids is 45 to 65 years old, and the prevalence gradually decreases after 65 years of age.
Five factors affecting the occurrence of hemorrhoids There are many factors affecting the occurrence of hemorrhoids.
The most important risk factor is constipation.
Hard stools directly prevent venous return.
Strong anal internal force is applied to the anal cushion during defecation.
Prolonged defecation can cause repetitive and ineffective defecation.
Defecation, damage the anal pad tissue, hinder the venous return of hemorrhoids, and then form internal hemorrhoids, which will develop into mixed hemorrhoids over time.
Classification and classification of six hemorrhoids▌ Classification of hemorrhoids Hemorrhoids are classified into internal hemorrhoids, external hemorrhoids and mixed hemorrhoids according to the growth position.
Internal hemorrhoids are located on the dentate line (a jagged visible line at the junction of the anal canal skin and rectal mucosa), and the surface is covered with mucosa.
External hemorrhoids: skin covering the lower surface of the dentate line.
Mixed hemorrhoids: internal and external hemorrhoids exist at the same time and are connected together [3].
▌ Stages of hemorrhoids Seven clinical manifestations, blood supply and innervation of hemorrhoids need to be understood because the blood supply and innervation of hemorrhoids are different, and its clinical manifestations are also different; internal hemorrhoids: mainly manifested as bleeding and hemorrhoids prolapse, intermittent Blood after defecation is the most common and generally painless.
The blood is bright red, covering the surface of the stool at the end of the bowel movement, sometimes dripping.
In severe cases, it may manifest as jet-like bleeding.
Due to chronic blood loss, some patients will experience symptoms related to anemia, such as dizziness and fatigue.
External hemorrhoids: The main manifestations are anal discomfort, persistent dampness and uncleanness, sometimes itching, and exposed hemorrhoids.
If it is accompanied by inflammation, the perianal pain is obvious.
Sometimes blood pools under the skin and forms painful masses called "thrombotic hemorrhoids" or "coagulated hemorrhoids".
These hemorrhoids are prone to bleeding and are accompanied by severe pain.
Mixed hemorrhoids: The manifestations of internal hemorrhoids and external hemorrhoids exist at the same time.
Internal hemorrhoids are mostly mixed hemorrhoids when they develop to degree Ⅲ or higher.
Mixed hemorrhoids gradually worsen and protrude outside the anus in a ring shape, which is called "circular hemorrhoids".
If the prolapsed hemorrhoids cannot be restored to the anus in time, it can cause "strangulated hemorrhoids" or "incarcerated hemorrhoids", which may cause edema, blood stasis, and even necrosis, often accompanied by severe pain.
In addition to the above-mentioned symptoms directly caused by hemorrhoids, it may also be accompanied by perianal skin irritation, itching, discomfort, perianal fullness, and mild fecal incontinence.
Skin irritation and itching are caused by the mucous secretions of the hemorrhoids; discomfort, perianal fullness, and fecal incontinence are caused by the hemorrhoids of the anal canal, and may still have a bowel movement after defecation.
This article introduces the theoretical knowledge of hemorrhoids.
Only a solid mastery of these basic knowledge can avoid pitting in endoscopic treatment as much as possible.
In the next article, I will continue to introduce the treatment methods of hemorrhoids, the anatomical position of the dentate line, and the mother hemorrhoids.
The concept and the performance of hemorrhoids in the active stage under endoscopy, welcome to continue to pay attention. References: [1] CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2013;11:593–603 [2] Guidelines for the clinical diagnosis and treatment of hemorrhoids in China (2020) Colorectal and Anal Surgery, October 2020, Volume 26, Issue 5 [3]Annals of Gastroenterology (2019)32,264-272
With the development of endoscopic minimally invasive technology, endoscopic minimally invasive treatment of gastrointestinal diseases is more and more popular with physicians and patients.
Hemorrhoids are common and frequently-occurring diseases of the anus.
There are many ways to treat hemorrhoids, each with its own advantages.
Endoscopic ligation and sclerotherapy of internal hemorrhoids are simple, minimally invasive, low-cost and effective.
It is a highly recommended surgical method and a hot spot in endoscopic treatment.
The theoretical knowledge of hemorrhoids will be introduced below in combination with clinical treatment.
A misunderstanding of the definition of hemorrhoids Hemorrhoids are soft venous clusters formed by the expansion of the venous plexus under the mucous membrane of the human rectum and under the skin of the anal canal, including the anastomosis of tiny arteries and veins, and spongy normal tissue structures such as connective tissue and nerve tissue.
It is pointed out that the term "internal hemorrhoids" in a strict sense does not indicate a disease state.
It is part of the normal anatomy of the rectum and anus, which assists defecation and controls defecation.
The normal internal hemorrhoid vascular plexus is composed of 3 soft hyperemia pads.
It is called anal cushion or "hemorrhoids".
In clinical practice, "internal hemorrhoids" is only used to describe diseases caused by abnormal enlargement of the anal cushion.
More precisely, this definition is limited to symptomatic hemorrhoid diseases: that is, the anal cushion is bleeding And/or prolapse is called "hemorrhoids" or "hemorrhoids" [1].
Therefore, when hemorrhoids are present, it can be manifested as bleeding, pain, prolapse of hemorrhoids, and even difficulty in defecation.
Therefore, the Chinese Clinical Guidelines for Diagnosis and Treatment of Hemorrhoids (2020) The principle of hemorrhoids treatment is to relieve symptoms, not to eliminate hemorrhoids[2] .
Anatomy of the second hemorrhoid 1.
Anal cushion is a part of the normal anatomy of the rectum and anus.
It is located above the dentate line of the anal canal with a 1.
0cm-1.
5cm annular tissue band, with 8-10 rectal columns arranged longitudinally inside.
3.
Pathophysiology of hemorrhoids.
Causes of hemorrhoids.
Historically, academic circles have put forward many theories, from the theory of varicose veins in the 18th to 20th centuries, the theory of anal mucosal sliding in 1950, and the theory of cavernous hemorrhoids in 1962, as well as the current relatively recognized theory.
The doctrine of anal cushion shifting down. The theory of anal cushion shifting down: It is known that there are tiny arteries and veins, connective tissue, nerve tissue and other spongy tissues in the anal cushion; the tiny arteries and veins inside are anastomosed with each other.
When the anus is closed, blood in these small arteries and veins is present.
In the full state, when defecation, the blood in the blood vessel is squeezed by the stool and expelled, and the anal cushion will be reduced to assist the discharge of the stool.
Some undesirable factors can damage and deteriorate the connective tissue of the cushion, which causes the anal cushion to move down and cause varicose veins, and then form hemorrhoids.
Four Epidemiology In 2015, the Anorectal Branch of the Chinese Society of Chinese Medicine led an epidemiological survey of anorectal diseases in 31 provinces, municipalities, and autonomous regions across the country.
The survey results showed that the anorectal diseases of urban and rural residents over 18 years old in my country The prevalence rate of diseases is as high as 50.
1%, among which hemorrhoids is the most common anorectal disease, with a prevalence rate of 49.
14%, and the number of patients suffering from hemorrhoids accounts for 98.
09% of all anorectal diseases.
Internal hemorrhoids accounted for 59.
86% of the incidence of hemorrhoids, 99.
47% of internal hemorrhoids were I-III degree, and in a colonoscopy hemorrhoid incidence survey, the incidence of hemorrhoids reached 38.
9%, of which 44.
7% had related symptoms.
The peak incidence of hemorrhoids is 45 to 65 years old, and the prevalence gradually decreases after 65 years of age.
Five factors affecting the occurrence of hemorrhoids There are many factors affecting the occurrence of hemorrhoids.
The most important risk factor is constipation.
Hard stools directly prevent venous return.
Strong anal internal force is applied to the anal cushion during defecation.
Prolonged defecation can cause repetitive and ineffective defecation.
Defecation, damage the anal pad tissue, hinder the venous return of hemorrhoids, and then form internal hemorrhoids, which will develop into mixed hemorrhoids over time.
Classification and classification of six hemorrhoids▌ Classification of hemorrhoids Hemorrhoids are classified into internal hemorrhoids, external hemorrhoids and mixed hemorrhoids according to the growth position.
Internal hemorrhoids are located on the dentate line (a jagged visible line at the junction of the anal canal skin and rectal mucosa), and the surface is covered with mucosa.
External hemorrhoids: skin covering the lower surface of the dentate line.
Mixed hemorrhoids: internal and external hemorrhoids exist at the same time and are connected together [3].
▌ Stages of hemorrhoids Seven clinical manifestations, blood supply and innervation of hemorrhoids need to be understood because the blood supply and innervation of hemorrhoids are different, and its clinical manifestations are also different; internal hemorrhoids: mainly manifested as bleeding and hemorrhoids prolapse, intermittent Blood after defecation is the most common and generally painless.
The blood is bright red, covering the surface of the stool at the end of the bowel movement, sometimes dripping.
In severe cases, it may manifest as jet-like bleeding.
Due to chronic blood loss, some patients will experience symptoms related to anemia, such as dizziness and fatigue.
External hemorrhoids: The main manifestations are anal discomfort, persistent dampness and uncleanness, sometimes itching, and exposed hemorrhoids.
If it is accompanied by inflammation, the perianal pain is obvious.
Sometimes blood pools under the skin and forms painful masses called "thrombotic hemorrhoids" or "coagulated hemorrhoids".
These hemorrhoids are prone to bleeding and are accompanied by severe pain.
Mixed hemorrhoids: The manifestations of internal hemorrhoids and external hemorrhoids exist at the same time.
Internal hemorrhoids are mostly mixed hemorrhoids when they develop to degree Ⅲ or higher.
Mixed hemorrhoids gradually worsen and protrude outside the anus in a ring shape, which is called "circular hemorrhoids".
If the prolapsed hemorrhoids cannot be restored to the anus in time, it can cause "strangulated hemorrhoids" or "incarcerated hemorrhoids", which may cause edema, blood stasis, and even necrosis, often accompanied by severe pain.
In addition to the above-mentioned symptoms directly caused by hemorrhoids, it may also be accompanied by perianal skin irritation, itching, discomfort, perianal fullness, and mild fecal incontinence.
Skin irritation and itching are caused by the mucous secretions of the hemorrhoids; discomfort, perianal fullness, and fecal incontinence are caused by the hemorrhoids of the anal canal, and may still have a bowel movement after defecation.
This article introduces the theoretical knowledge of hemorrhoids.
Only a solid mastery of these basic knowledge can avoid pitting in endoscopic treatment as much as possible.
In the next article, I will continue to introduce the treatment methods of hemorrhoids, the anatomical position of the dentate line, and the mother hemorrhoids.
The concept and the performance of hemorrhoids in the active stage under endoscopy, welcome to continue to pay attention. References: [1] CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2013;11:593–603 [2] Guidelines for the clinical diagnosis and treatment of hemorrhoids in China (2020) Colorectal and Anal Surgery, October 2020, Volume 26, Issue 5 [3]Annals of Gastroenterology (2019)32,264-272
