To the pathogenetic factor because the disease manifests itself,
a series of predisposing or triggering factors must be added:
Constipation and socio-environmental, behavioral, individual, hormonal factors
1. Chronic constipation
2. Diarrhea
3. Low-fiber diet
4. Habit to pamping
5. Heavy work
6. Work that requires long periods in a sitting or standing position
7. Excessive sedentariness
8. Weight gain or obesity
9. Abuse of alcohol, tobacco, spices
10. Pregnancy
11. Cyclical hormonal influences in the female (acting on the tone of the venous
walls)
12. Traumatizing sports (motorcycling, cycling, riding, weightlifting)
Anatomically we distinguish:
Hemorrhoidal anatomy
- internal hemorrhoids
- external hemorrhoids.
The internal hemorrhoids are borne by the upper hemorrhoidal plexus, are
submucous, located across the anorectal line and up to the hairline, above the
semilunar valves (and the Parks ligament); external hemorrhoids are on the lower
hemorrhoidal plexus, are subcutaneous and are located below the comb line and
semilunar valves (and Parks ligaments).
The old classification is simply the punishment and prolapse of the anodermine
with the breaking of the bonds of parks as a cause and the risk of haemorrhoidal
prolapse as an effect.
Hemorrhoids are classified into four grades according to their size and their
prolapse.
1st degree: haemorrhoids increased in size, due to congestion, only during
defecation, internally, only visible with rectal examination or anoscopy;
internal mucosal prolapse. In this case the symptoms may be missing, they are
present, they are modest and precise of heaviness and annoyance in the anal
region; sometimes itching; rarely and sporadically can be a slight bleeding at
the end of defecation.
2nd degree: there is the progressive distension of the venous packets and the release of the submucosa with prolapse; the gremocci protrude during defecation, but are reduced spontaneously at the end of the same; external mucosal prolapse which can be reduced spontaneously. The symptomatology is present but of variable entity. Generally the symptoms are modest (tenor, tenority, persistent sense of weight and annoyance); more often the symptom is the bleeding that accompanies or follows the defecation and that can be of various entities: mostly it is modest and occasional; if chronic or intense it can lead to a framework of anemia; it can present itself as a real haemorrhage with consequent acute anemia. Compare initial sections of symptoms from ODS (obstructed defecation syndrome) that are represented by constipation or its appearance, if previously absent.
3rd degree: the size of the hemorrhoidal packets is always greater, the ligament
of parks is more and more relaxed and released, exacerbating the mucous prolapse;
the gremocci protrude outside during defecation and can be put back in place
only manually; external mucosal prolapse manually reducible.
The symptomatology is accentuated; worsen the tenesmus, the itching, the sense
of heaviness, can compare the lighter, more often stippling or burning; bleeding
is present more frequently; the appearance of "dirt" is possible; the bleeding
is almost constant. Compare or worsen if already present, including symptoms
from ODS: constipation, fragmented defecation, incontinence in faeces.
4th degree: there is complete unraveling of the bonds of Parks with prolapsed muco-cutaneous prolapse and of the gavoccioli which become increasingly large;
permanent external mucosal prolapse.
The symptoms are further aggravated; the pain is felt as puncture or burning or
occurs with spasms, more frequently nocturnal; there is intense itching,
tenesmus, a sense of tension due to edema and congestion, a sensation of a
foreign body, constant "soiling" can cause irritation and maceration of perianal
skin; the bleeding is almost constant. ODS symptoms are aggravated: constipation,
fragmented defecation, stool incontinence, excessive and prolonged exacerbations,
pain or rectal and perineal pain.
To this traditional and dated classification, recently a new, morphological one
has been added, which refers to the mucous prolapse:
TYPE 1: rectal mucous prolapse with anoderm in anatomical position
TYPE II: a) anoderm located in distal, soft and mobile position;
b) dislocated anoderm in distal, fibrotic and with plicomas (skin-tags)
This classification was also old compared to the new thrusts and the new studies
of the pelvic floor pathology. In two important forums and in the presence of
important international proctosurgery, we have come to a new and modern
classification that brought together the pathology of the prolapse of the rectum
and of the pelvic floor disorders in a complete and complete classification
below:
To deepen the proctological theme:
Il paziente proctologico con prurito anale
Anatomia della regione anale, le emorroidi
La classificazione in gradi del prolasso emorroidario
Vari tipi di cura delle emorroidi
Il trattamento chirurgico delle emorroidi
index topics on gastroenterology