Hemorrhoids in women is an expansion of the cavernous veins of the choroid plexus of the rectum (hemorrhoidal), accompanied by the formation of internal or external hemorrhoids, characteristic symptoms.

At the initial stage of acute hemorrhoids in women, internal hemorrhoids are involved in the inflammatory process, extremely rarely - external The disease has been known since ancient times, mentions of it are found in Babylonian and Assyrian manuscripts, the first attempts at drug treatment of hemorrhoids are described by the ancient Egyptians. The term " Hippocrates wrote: “Hemorrhoidal disease is formed like this: bile or mucus, lingering in the veins of the rectum, heats the blood that is in the veins. These veins, warmed up, draw blood from the neighboring small veins and, filling, form a tumor inside the rectum "

The rectum is a hollow tubular organ about 15-16 cm long, consisting of 3 layers (mucous, submucous and muscular) and surrounded on all sides by loose fatty tissue of the small pelvis and perineum. At a distance of approximately 2 cm from the anus, in the thickness of the rectum, there is a dentate line, above which the skin of the anorectal zone passes into the mucous membrane.

In the submucosal layer, a few centimeters above the dentate line, there are three hemorrhoidal vascular plexuses that lie along the left, anterior and posterior right walls of the rectum. The structure of the vessels resembles a sponge, due to which they are able to fill with blood in a short time and empty just as quickly. Features of the structure and hemodynamics of the vascular plexus provide additional sealing of the anus, contributing to the strong retention of gases and feces, when the blood-filled hemorrhoidal vessels act as a kind of plug for the lower rectum.

The disease is a serious medical and social problem, as it occurs, according to various sources, in every 4-10 inhabitants of the Earth, forming the vast majority of appeals in proctology (up to 40% of the total). Hemorrhoids in women are somewhat less common than in men; with age, the likelihood of the formation of the disease increases.

Causes of hemorrhoids in women and risk factors The main anatomical and physiological causes of hemorrhoids in women are:.

the predominance of arterial blood filling of the plexus vessels over the venous outflow, which creates the preconditions for the development of stagnation and deformation of the plexus;

dystrophic-degenerative changes in the longitudinal muscle of the submucosal layer of the rectum and Parks ligament, which act as a fibromuscular framework for hemorrhoidal vessels;

microthrombosis of the vascular plexus;

varicose disease of hemorrhoidal veins;

traumatic injury to anal muscles.

As a result of these reasons, deformation of the corpora cavernosa occurs, their expansion, protrusion into the lumen of the rectum or prolapse from the anus (depending on localization).

Factors contributing to the development of hemorrhoids in women:.

defecation disorders (constipation, excessively dense stool);

sedentary, sedentary lifestyle;

systematic long stay in a standing position (production necessity when working in non-mechanized production, in the service sector, in some areas of medicine, etc.).

overweight;

adhesive process in the pelvic cavity with involvement of the large intestine in the pathological process;

autonomic dysfunction;

hard physical work;

heart failure;

stagnation in the portal vein system, leading to an overload of the vessels of the lower body (after cirrhosis, hepatitis, against the background of acute infectious processes, taking certain medications, alcohol abuse, etc.).

chronic diseases of the pelvic organs (adnexitis, salpingo-oophoritis, cystitis).

Hemorrhoids in pregnant women The most common factor provoking the development or exacerbation of an existing hemorrhoid in women is pregnancy. According to some reports, the incidence of hemorrhoids in women who did not have a history of childbirth is approximately 5 times less than in those who have given birth.. The likelihood of developing hemorrhoids in this case also directly depends on age: pregnancy after 30 years is complicated by hemorrhoids in women on average 3 times more often than in pregnant women at 20 years. Approximately 50% of women who suffer from hemorrhoids during pregnancy have an exacerbation in the first few weeks of the postpartum period..

The most common cause of hemorrhoids in women is pregnancy During childbirth, the head of the fetus, passing through the birth canal, squeezes the vessels of the small pelvis, which leads to a violation of the venous outflow and the formation of stagnation in the bloodstream. The severity of these processes depends on the duration of labor: the longer it is, the more local blood circulation suffers. Hemorrhoids swell sharply, increase in size, become tightly dense, cyanotic. When the head erupts, internal hemorrhoids, with their significant severity, are squeezed out, their rupture is possible. After childbirth, with a gradual reduction of the sphincter of the anus, the internal nodes decrease and adjust on their own, but often, if the contraction of the sphincter passes quickly, these nodes are pinched, and acute hemorrhoids occur.

According to statistics, hemorrhoids are observed in 7.7% of non-pregnant women, more than 25% of pregnant women and almost half of all puerperas.

Forms of the disease Depending on the root cause of hemorrhoids in women, there are two forms:.

primary (inherited), developing without connection with the previous pathology;

secondary, which is a complication of any disease.

According to the duration of the process:.

acute (one-time episode of painful manifestations);

chronic (long-term, possibly lifelong, undulating course with periods of remission and exacerbations).

Depending on the clinical picture, hemorrhoids in women can be external (several characteristic swellings located under the skin in direct proximity to the anus) and internal (hemorrhoids are not visualized during external examination, located inside the lumen of the rectum). Internal nodes, if they are not detected during external examination of the anorectal zone, can be detected only by conducting a special examination of the rectum. As a rule, they have a rounded or spindle-shaped shape, are located on a wide base, with a smooth (in the later stages of the disease - bumpy) surface, when pressed, they are easily emptied.

According to various sources, hemorrhoids are found in every 4-10 inhabitants of the Earth, forming the vast majority of appeals in proctology (up to 40% of the total).

With the addition of a secondary infection, thrombosis of hemorrhoids, their infringement, etc.. talk about complicated hemorrhoids. In the absence of such conditions, hemorrhoids are classified as uncomplicated..

The severity of hemorrhoids in women The severity (or stage) of hemorrhoids in women is determined depending on the morphofunctional picture, in total there are 4 stages:.

Episodic discharge of scarlet blood from the anus without visible signs of prolapse of hemorrhoids, degenerative-dystrophic changes in the connective tissue-muscular frame are expressed slightly.

II. Hemorrhoids that have fallen out of the anus are visually determined (both with and without bleeding), easily self-adjusting. Dystrophic phenomena progress, but the elasticity of the muscle-fibrous frame is preserved.

III. Hemorrhoids that have fallen out of the anal canal require manual reduction, prolapse can be accompanied by bleeding, the muscular layer of the rectum largely loses its elasticity, the mucous membrane is thinned, there is a tendency to bleeding.

IV. The prolapse of hemorrhoids is permanent, their reduction is impossible, the supporting apparatus is unstable, muscle tissue is largely replaced by connective.

Stages of hemorrhoids in women The course of acute hemorrhoids in women is somewhat different from chronic and goes through 3 successive stages:.

Thrombosis of external and internal nodes without signs of inflammation.

II. Initial inflammatory changes in thrombosed hemorrhoids.

III. Thrombosis of nodes, accompanied by inflammation of the subcutaneous fatty tissue of the perianal zone.

Symptoms of hemorrhoids in women The main signs of hemorrhoids in women with a chronic course make up the characteristic clinical triad of the disease: pain syndrome, protrusion of inflamed hemorrhoids and bleeding, often associated with the act of defecation.

In the initial stages of the disease, painful symptoms are transient, occur after excessive physical exertion, errors in diet, taking a hot bath, etc..

Bleeding with hemorrhoids in women is the most common symptom of the disease, occurs in about half of patients. The amount of blood discharged from the anus varies widely: from minor smears on toilet paper to massive bleeding requiring urgent care. The color of the stool in this case is not changed, the blood can be smeared on its surface.

With internal hemorrhoids, patients often complain of blood splashing in a stream, the presence of drops of blood on the walls of the toilet. At the beginning of the act of defecation, blood can be released with coagulated clots, be dark in color if there has been a preliminary accumulation of it in the lumen of the intestine, although more often the color of the released blood is bright scarlet. Bleeding from the anus with hemorrhoids in women is noted in more than 75% of cases.

The prolapse of hemorrhoids (observed in 4 out of 10 patients) in the early stages of hemorrhoids in women is of an episodic nature, the prolapsed nodes are reduced on their own. As the disease progresses, reduction requires manual assistance, in some cases it is not possible to perform manipulation, the bulging of the elements of the hemorrhoidal plexus becomes permanent. As a rule, the prolapse of hemorrhoids occurs at characteristic points: in the projection of 3, 7 and 11 o'clock on the dial when the patient is supine.

Pain with hemorrhoids in women is constant, dull, aching in nature (in the later stages of the disease) or occurs periodically, due to bowel emptying. Pain syndrome may be accompanied by discomfort, a feeling of moisture due to excess mucus from the rectum, maceration and itching in the anorectal region. Discomfort is usually associated with a feeling of heaviness in the perineum, discomfort while sitting, unproductive urge to defecate. Perianal soft tissue edema is also characteristic of acute hemorrhoids in women..

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