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Hemorrhoids and fissures are treated in the outpatient clinic

hemorrhoids, anal fissureHemorrhoids and anal fissures? Treatment most often is outpatient. These are difficult times, we all know. The ongoing epidemic has forced all hospitals to suspend outpatient visits and surgical activity, except in emergencies, to make room for infected patients. However, life goes on for everyone, and the health problems that worried us before continue to worry us now.

Not everything can be treated in an outpatient setting; however, for several proctologic conditions, quite a bit can be done. For example, the hemorrhoids and anal fissures can be treated on an outpatient basis: the second- and third-degree hemorrhoids with the procedures of elastic ligation and sclerosis, and the anal fissures with topical nitroglycerin and lidocaine treatments and, possibly, after confirming the pressure values of the anal sphincter system with manometry, with infiltrations of botulinum toxin. These are painless, simple and inexpensive methods, which in most cases effectively resolve these bothersome problems.

Hemorrhoids and anal fissures are not serious health problems, but they certainly can worsen the quality of life. Treating them on an outpatient basis is possible, not dangerous and, in the hands of a good proctologist, simple and inexpensive. For this, we remain at your disposal at our office in Chivasso, De Medica, Corso Galileo Ferraris 12 F, telephone 01119903768 and inTurin, in the offices of Pinna Pintor Clinic, via Amerigo Vespucci 61, telephone 0115802100. To contact us, our Facebook page or the following contact form is also available:

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Dr. Salvatore Cuccomarino
Medical Surgeon Specialist in General Surgery
Coloproctology, Surgical gastroenterology, Abdominal wall surgery, Laparoscopic surgery
Corso Galileo Ferraris 12 F
Phone 0110438161
hemorrhoids, anal fissure
I have hemorrhoids - But WHY do I have them???

Two lines on the causes of internal hemorrhoids.

Obviously, all things (including the human organism) are made to perform a certain function or series of functions, and for this reason they have "limits" of functioning-limits that are determined precisely by how they are constructed and the work they do. Many diseases abide by this simple rule.
The rectum is a kind of container in which feces accumulate to undergo the very last transformations before being eliminated; the anus constitutes the "gateway to the outside world" in this elimination mechanism, and therefore its activity is closely coordinated with that of the rectum. But this is not enough, because the "third actor" participating in the game, namely the feces, must be taken into account.
causes of internal hemorrhoidsIn the rectum, feces are accumulated, further dehydrated and then expelled outward, subject to the opening of the anal sphincters (which are two, one internal and one external). We have already mentioned that Hemorrhoids are part of this mechanism, because on the one hand they contribute to the sphincter mechanism, and on the other hand they accompany the feces outward.
That is, constipation and diarrhea (both, of course, for prolonged periods of time) are the main culprits in the changes that lead to hemorrhoidal disease. Consequently, a DIET POOR IN FIBERS, LACK OF INHABITATION OF LIQUIDS, SEDENTARY LIFE (things that all concur to cause constipation) can cause the onset of hemorrhoidal pathology. And in fact they are its main cause, far more important than diarrhea, since the latter is usually episodic, while constipation, far more often, is chronic.
A very important chapter is that of occurrence of hemorrhoidal pathology due to INCREASE IN ADDOMINAL PRESSURE. A classic example is PREGNANCY. Increased abdominal pressure causes increased pressure at the rectal level, and therefore also at the hemorrhoidal level, causing all those alterations (rupture of the fibers of the hemorrhoidal pads, elongation and deformation of the hemorrhoidal venous plexuses, etc. etc.) that we have already discussed. Pregnancy is among the causes of internal hemorrhoids as it causes a major increase in abdominal pressure, and even more so does PARTITION. It is very common to see pregnant or postpartum women with massive hemorrhoidal prolapses. These women MUST BE FOLLOWED BY A COLOPROCTOLOGIST, and especially THE SIMPLE USE OF LOCAL MEDICATIONS (POMATES, VASOPROTECTORS, ETC.) IS ALMOST ENTIRELY USELESS IF NOT MONITORED AND/OR ASSOCIATED WITH OTHER PROVISIONS that only the Coloproctologist is able to prescribe.
It is not uncommon for hemorrhoidal prolapses to APPARENTLY disappear after childbirth: but in fact the machine has been set in motion, and in the end, in women, pregnancy is probably the most important cause of hemorrhoidal pathology.
There is also, among the vcauses of internal hemorrhoids, a FAMILY PREDICTION to the development of the disease: as is the case with leg varices, those who have one or both parents who have suffered from hemorrhoids have a higher risk of developing the disease. This is for complex reasons of biochemical alterations in the tissues that make up the vessel walls of the hemorrhoid pads, a subject too specialized to be of interest: suffice it to know that it exists... so, going back to what was said at the beginning, if the machine is built badly, sooner or later it will stop working properly.

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Anal pain, anal pain, anal fissure, hemorrhoids, anal fistula
Doctor, I have hemorrhoids!!!

It's true!!! we all have them!!!

Pathology is often confused with normal anatomy. Hemorrhoids are, indeed, normal, even quite complex, anatomical structures that we all possess and that play a fundamental role in anorectal physiology, particularly in the physiology of defecation.

What are hemorrhoids?

Hemorrhoids, mucous prolapse, hemorrhoidal prolapse, mucohemorrhoidal prolapse, what are hemorrhoidsThe popular vulgate, often fueled even by us physicians, is that they are VENE. THEY ARE NOT. Then, what are hemorrhoids? They are actually Functional complexes consisting of arteries, capillaries, veins, connective and muscle fibers, and mucosa. Conventionally, we say that there are Three major hemorrhoid plexuses (which I, following the Spanish school, call front right, back right and side left; others, especially in Italy, enumerate them according to a "clockwise" criterion: "at one o'clock - at five o'clock - at nine o'clock"; to me this seems a tad farrago...) - although in reality, located among the main plexuses ACCESSORIES, smaller but equally important.

What are hemorrhoids for and how do they work?

Once we understand what hemorrhoids are, let's explain what they are for. Each hemorrhoid plexus is made up of a series of ARTERO-VENOSIC SHUNTS, i.e., veins and arteries that join together and form veritable VASCULAR CUSHIONS, the size of which can vary depending on the amount of blood they contain-which is, in turn, determined by arterial inflow and venous outflow into the "pads." These pads are covered by the mucous membrane of the last part of the rectum, and are, shall we say, "held in place" by a complex of connective and muscular fibers that ensure, moreover, their elasticity - and thus their ability to fill and empty with blood; in short, ultimately, VOLUME.

Thanks to their PLASTICITY, the hemorrhoid pads are able to perform their functions perfectly: which are to ACCOMPANY the feces toward their elimination, preventing the passage into the last part of the anorectal canal from being painful, and to PERFECT THE CLOSURE of the mouth of the anal canal, thus participating in the sphincter mechanisms of the anus. Alas, when the magnificent and complex fibrous scaffolding of the hemorrhoids becomes altered (and we will see the reasons for this another time) the problems begin... The connective and muscular fibers that constitute the support for the veins and arteries in the hemorrhoid pads can undergo alterations, which eventually cause them tostretch and/or rupture. The venous structures that make up the hemorrhoids then begin to "slide" downward, which causes them to become truly "deformed" (especially at the expense of the veins, which have, in contrast to the arteries, very little elasticity): the end result of this "degenerative" process (which, however, generally takes YEARS to develop) is HEMORROID PROLASSE.

The consequences, clinically speaking, are obvious: that valuable mechanism of accompanying stool and closing the anus that was regulated by hemorrhoids is broken; in addition, the elongated and deformed veins become more fragile, dilate, and can no longer empty. BLOODING (generally not painful) is the most frequent manifestation of hemorrhoidal pathology; the blood is "bright red," precisely because of its arterial origin, and may be noticed on toilet paper or, less frequently, in the toilet. Alteration of the sphincter mechanism may result in filtration of fecal matter, especially liquid, which causes IRRITATION and ANAL PRURITATION; finally, in the most important cases, there may be SOILING (i.e., minor fecal incontinence) or even STIPSI (the so-called "obstructed defecation syndrome"... a very complicated thing); not to mention the actual PROLAPSE, i.e., the outflow from the anus of a "mucous cylinder," consisting of the rectal mucosa, which sometimes no longer re-enters, which can ulcerate and bleed, and which for patients (who are often elderly, and therefore struggling with a thousand other conditions) is a huge problem.

Well, now we understand what hemorrhoids are, what they are for, and how they work. In a future article, we will see why they, from the normal structures that they are, turn into pathological entities. Stay tuned!