Choroba hemoroidalna jest jednym z najczęściej występujących schorzeń proktologicznych i jest zaliczana do chorób cywilizacyjnych. Przyczyną dolegliwości są zmiany patologiczne hemoroidów – guzków krwawniczych odbytu. Jakie objawy świadczą o chorobie hemoroidalnej, jak wygląda diagnostyka i leczenie?
Hemoroidy są prawidłową strukturą anatomiczną w kanale odbytu, a więc sama ich obecność nie jest wskazaniem do leczenia. Guzki krwawnicze zlokalizowane w kanale odbytu wspomagają uszczelnienie odbytu i utrzymanie gazów. Interwencję należy podjąć w przypadku objawowej choroby hemoroidalnej, gdy aparat wieszadłowy ulega rozluźnieniu i wewnętrzny splot krwawniczy przemieszcza się dystalnie, hemoroidy wypadają poza odbyt lub dochodzi do krwawień.
Jakie czynniki wpływają na rozwój choroby hemoroidalnej?
Uważa się, że istnieje kilka czynników, które prowadzą do patologii hemoroidów. Na rozwój choroby mogą wpływać dieta, tryb życia, zawód, wysiłek fizyczny, a także czynniki anatomiczne (np. rozluźnienie więzadeł Parksa). Choroba hemoroidalna najczęściej występuje u osób powyżej 20.-25. roku życia, a ryzyko jej pojawienia się wzrasta z wiekiem. Grupą szczególnie narażoną na chorobę hemoroidalną są kobiety w ciąży, szczególnie rodzące więcej niż dwa razy. Ponadto choroba hemoroidalna częściej dotyka kobiety, zwłaszcza otyłe, dźwigające ciężary, długo siedzące, mające problemy z defekacją czy chorujące na schorzenia jelit.
W praktyce klinicznej wyróżnia się cztery stopnie choroby hemoroidalnej:
- powiększenie guzków bez ich wypadania na zewnątrz;
- guzki wypadające na zewnątrz w czasie defekacji, ale cofające się samoistnie;
- guzki wypadające w czasie defekacji z koniecznością ręcznego ich odprowadzania;
- guzki utrzymujące się na zewnątrz i nie dające się odprowadzić ręcznie.
Objawy i powikłania choroby hemoroidalnej
Najczęstszym objawem hemoroidów jest bolesne krwawienie z odbytu żywoczerwoną krwią w trakcie lub po defekacji. Schorzenie objawia się również wypadaniem guzków poza odbyt, świądem i pieczeniem w okolicy odbytu. Pacjentom mogą towarzyszyć także dolegliwości bólowe związane ze szczeliną, przetoką lub ropniem odbytu, a także ból krocza. Ból pojawia się również w przypadku powstania zakrzepu w uwięzionym guzku krwawniczym, zakrzepu brzeżnego w zewnętrznym splocie odbytniczym, powstaniu stanu zapalnego, obrzęku czy uwięźnięcia guzków krwawniczych. Schorzenie może również objawiać się niezamierzonym spadkiem masy ciała czy stanem podgorączkowym. Do nietypowych objawów choroby należą także: zgrubienia, narośle, uwypuklenia lub guzy w okolicy odbytu.
Do powikłań pojawiających się w wyniku nieleczenia choroby hemoroidalnej, nasilenia dolegliwości lub zaawansowania schorzenia, zaliczane są niedokrwistość związana z utratą krwi, anemia, a w kontekście osób starszych, które obciążone są innymi chorobami: zaburzenia rytmu serca czy niewydolność serca.
Rozpoznanie choroby i wykluczenie nowotworu
Choroba hemoroidalna nadal jest dla pacjentów schorzeniem wstydliwym. Dlatego często nie zgłaszają się oni do lekarzy i samodzielnie próbują pomóc sobie dostępnymi w aptekach środkami bez recepty. Tymczasem, ważne jest, by z objawami choroby hemoroidalnej zgłaszać się do specjalisty– chirurga-proktologa. Pozwoli to na skuteczną diagnozę i wdrożenie odpowiedniego leczenia.
Badanie proktologiczne, w tym wziernikowe – anoskopia lub rektoskopia – pozwala na rozpoznanie choroby. Do odbytnicy wprowadzany jest specjalny przyrząd oświetlający kanał odbytu i odbytnicę, co pozwala specjaliście na pełną wizualizację zmian. W wywiadzie z lekarzem ważne jest również wykluczenie krwawienia, a także raka jelita grubego. Choroba hemoroidalna może maskować nowotwór.
Metody leczenia choroby hemoroidalnej
W praktyce klinicznej stosuje się różne metody leczenia choroby hemoroidalnej. Decyzję o rodzaju leczenia każdorazowo podejmuje lekarz w oparciu o badania i zaawansowanie schorzenia.
Leczenie zachowawcze wskazane jest w każdym stadium choroby i polega na zapobieganiu zaparciom oraz wprowadzeniu leków zwiększających napięcie ścian naczyń żylnych i zmniejszających ich przepuszczalność, z zawartością diosminy, hesperydyny lub wyciągu z ruszczyka. Pacjentom zalecane są również maści i czopki doodbytnicze o działaniu przeciwzapalnym i miejscowo ochronnym zawierające m.in. leki znieczulające miejscowo.
W przypadku nawrotu choroby hemoroidalnej lekarz może podjąć decyzję o wdrożeniu leczenia mało inwazyjnego. Wiąże się ono z zakładaniem gumowych opasek sposobem Barrona, skleroterapią, zabiegami z użyciem generatora fali radiowej lub wiązki laserowej lub selektywnym podwiązaniem tętnic hemoroidalnych pod kontrolą USG z dopplerem.
Leczenie operacyjne może zostać wdrożone w przypadku zaawansowanego stadium choroby, gdy wyżej wymienione metody leczenia nie przyniosły rezultatów. Pacjenci poddawani są wówczas leczeniu chirurgicznemu polegającemu na wycięciu guzków krwawniczych lub operacji podciągnięcia szwami wypadających guzków. Na tym etapie choroby, w praktyce klinicznej, przeprowadza się również hemoroidopeksję staplerową, np. gdy guzki wypadają okrężnie lub równocześnie z nimi wypada błona śluzowa odbytnicy. W przypadku leczenia operacyjnego choroby hemoroidalnej mogą pojawić się powikłania wczesne, np. krwawienie, zakażenie, zatrzymanie moczu, lub późne – przetoki, nawrót choroby. Sporadycznie obserwuje się nietrzymanie gazów i stolca.
Źródła:
J. Michalak, A. Wolski, Choroba hemoroidalna, Borgis – Medycyna Rodzinna 2/2001, s. 61-64
mp.pl
klinikaflebologii.pl
hemoroidy.info.pl
Przeczytaj także: Powstał antybakteryjny nanoopatrunek do leczenia infekcji ran
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