The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2001.
In expanding cavernosal cells (venous plexuses) located in the rectum, stagnation occurs (the stasis) in the blood them, whereby the vessels become dilated and tortuous form hemorrhoids, which is called hemorrhoids.
Hemorrhoids are frequently diagnosed during pregnancy, and the probability of its occurrence depends on the number of births. So, in nulliparous women the disease is found only in 20% of cases, and multiparous its frequency increases to 40-50%, especially in the third trimester.
Kinds
Depending on the localization of hemorrhoids distinguish the outer, inner and mixed (combined) hemorrhoids.
For external hemorrhoids venous nodes are located in the lower part of the rectum, and at home in the upper part.
By course of the disease is isolated acute and chronic hemorrhoids, although this step is essentially the same process (e.g., chronic complications arise when hemorrhoids becomes acute). Also Hemorrhoids can be complicated and uncomplicated.
Causes of Pregnancy
The disease is caused by stagnation of blood in the veins due to an increase in intra-abdominal pressure. The first increase in intra-abdominal pressure contributes to the pregnancy itself.
The pregnant uterus as growth compresses large vessels, including the inferior vena cava, whereby impaired blood flow to the lower extremities and of the pelvic veins, which provokes stagnation of blood in the legs and in a straight line intestine.
In addition, as a result of hormonal changes during pregnancy (increased production progesterone) Myometrium and smooth muscles of the intestine are relaxed, causing constipation and helps create or aggravate (at available hemorrhoids before pregnancy) disease.
Also inhibit intestinal peristalsis contributes to a sedentary life. With increasing gestational age a woman can no longer maintain the same active way of life both before pregnancy or in early pregnancy, and most of the time at rest (lying or sitting).
Medical limitation of physical activity (threat of interruption, placenta previa) Also exacerbate physical inactivity. Parity is also important. The more there is a history of childbirth, the higher the percentage of acute hemorrhoids during gestation (multiple swings in intra-abdominal pressure during pregnancy and childbirth).
By the predisposing factors of the disease include:
- genetic predisposition;
- error in the diet (low amount of fiber in the diet, spicy food, a large amount of spices);
- urologic diseases (promote systematic rise in abdominal pressure);
- Education pelvic;
- intense exercise and heavy lifting.
symptoms of hemorrhoids
For external hemorrhoids, which flows gently in the anus appear units that look like warty formation or folds. They do not decrease in size with pressure and tight. Internal hemorrhoids are characterized by the formation of knots in the folds of the mucous membrane of the rectum. They are not visible, there are single or in the form of the corolla falls off when pressed, but filled again when coughing or straining. These nodes are painful and irritating to the skin of the anus mucus, which is isolated.
chronic hemorrhoids
Flowing either asymptomatic or with a minimum of complaints and has 4 steps:
Stage 1 - enlarged internal hemorrhoids, without departing from the rectum during defecation (complaints of feeling incomplete bowel emptying, an uncomfortable feeling in the anus area, a small amount of bright red blood in the end of the straight emptying intestine).
Stage 2 - units after defecation go outside (fall), but may have the right to own the rectum (more discomfort Significant, itching and burning occur after defecation, spotting large, the feeling of foreign body sensations in rectum).
Stage 3 - hemorrhoids do not reduce a self, but allowed them to manually reposition, having pain during and after each bowel movement.
Stage 4 - nodes can not be returned to the rectum but expressed pain appears incontinence gas and feces, mucus and profuse bleeding from the intestine.
acute hemorrhoids
There is nothing else like thrombosis hemorrhoids. It arises due to the formation of blood clots in the venous plexuses and is characterized by inflammation around the anus. Proceeds with symptomatic:
- Straining significant pain, increasing during defecation,
- enlargement and bulging of the rectum hemorrhoids,
- hyperemia in the perianal region,
- bleeding from the anus.
Acute Hemorrhoids has 3 degrees of severity of inflammation:
1 degree - thrombosis without inflammatory reaction (moderate pain in the anus, appear after emptying).
2nd stage - considerable pain due to inflammation in the vicinity of the enlarged hemorrhoids, the temperature rises, nodes go outside and deform the anus, difficult defecation, there outflow of mucus from the rectum, there is itching and burning.
Grade 3 - the inflammation extends deep, redness of the anus, buttocks and perineum, worse pain, they are permanent and are found in the area of the buttocks and perineum, the temperature rises to 39 ° C, foreign body sensation in the rectum permanently, there is a feeling of fullness and pressure (pain is so intense that the movement of the seat and impossible).
Diagnostics
Differential diagnosis of the disease is carried out:
- anal fissures (There bleeding and pain when defecating and after, but not palpable external or internal nodes);
- Rectal prolapse or mucosal (palpated education tsyafilindricheskoy form);
- with polyps of the rectum (is bleeding but no pain, palpable and education alone, without straining).
The diagnosis is established on the basis of specific complaints, inspection and digital examination of the rectum (of visible external hemorrhoids, having a blue-purple color in thrombosis and palpation of the internal nodes, visible when the patient straining, evaluation of their number, size and locations).
From laboratory diagnostic methods are assigned:
- complete blood count (decrease hemoglobin and hematocrit due to chronic post-hemorrhagic anemia, Increase of leukocytes during inflammation and ESR);
- general urine analysis (Detection or exclusion urological disease);
- coagulogram (Reduced clotting time and bleeding, increased prothrombin and prothrombin index);
- blood type and Rh factor;
- blood chemistry, including urea and creatinine (except urologic diseases);
- toal occult blood.
From instrumental diagnostic methods are applied:
- sigmoidoscopy (Study of the rectal mucosa);
- Ultrasound of the blood vessels and pelvic;
- US involved veins portion angioscanning when assigning angiohirurga;
- Ultrasound (sonography) of the lower extremities.
Treatment during pregnancy
Treatment of hemorrhoids in pregnant engaged obstetrician, vascular surgeon (coloproctologist) is connected if necessary.
Treatment of the disease begins with correction diet (Increase of fiber in the diet, the prohibition sharp, spicy and smoked products).
recommended
- daily walks,
- physiotherapy for pregnant women (in the absence of contraindications),
- establish periodicity emptying the rectum (in the same time)
- washing away after each defecation cold water.
For external hemorrhoids are appointed with warm baths furacillin, herbs, potassium permanganate, candles and ointments with novocaine or lidocaine to relieve itching and pain:
- Anestezol candles (conventionally recommended)
- venitan gel (recommended without restrictions).
In the case of acute hemorrhoid disease in combination with anal fissure hospitalized patients. Appointed by the lead lotion, lotion with furacillin, heparin and butanedioic ointment troksevazin gel, gepatrombin-g, proktoglivenol topically to relieve inflammation and normalization of blood flow in hemorrhoids.
To prevent complications of chronic hemorrhoids and acute process into the prescribers, strengthen the vascular wall and improving venous return and possessing anti-inflammatory activity:
- Aescusan (no safety data in pregnancy)
- venoruton (conventionally recommended with II trimester)
- detraleks (conventionally recommended)
- troksevazin (no safety data in I trimester, with II trimester conventionally recommended).
Treatment of acute hemorrhoids is 7-10 days.
Operation during pregnancy
Surgical treatment of hemorrhoids during pregnancy is carried out with periodic heavy bleeding, loss hemorrhoids and rectal mucosa, the presence of cracks and fistulas intestine (the decision is made in conjunction with a doctor pregnant).
During pregnancy as possible are carried out minor surgical operations:
- hardening of the nodes;
- ligation sites latex ring;
- Cryotherapy units;
- laser photocoagulation;
- infrared photocoagulation.
Radical surgery (excision of hemorrhoids) are plotted on the postpartum period.
Effect of hemorrhoids the course and outcome of pregnancy
Hemorrhoids during pregnancy are not serious and practically does not cause complications during pregnancy. But it does not exclude aggravation of anemia in pregnant women due to recurrent bleeding from the rectum, threatened miscarriage and preterm labor with emerging problems defecation.
The choice of method of delivery does not affect the disease, cesarean section is performed for obstetric indications.
Complications of the disease during pregnancy and childbirth are:
- thrombosis of hemorrhoids;
- pinching and necrosis haemorrhoid;
- paraproctitis;
- pronounced bleeding.
Section oversees Sozinova AV, obstetrician-gynecologist. Experience in the specialty since 2001.
Some studies in pregnancy
- Smears during pregnancy.
- Tests during pregnancy by trimester.
- Ultrasound during pregnancy.
- Urinalysis in pregnancy.
- Coagulation.
- Installing pessary.
- Glucose tolerance test.
- Homocysteine in pregnancy.
- Amniocentesis.
- Anesthesia during childbirth.
- Fetal CTG (cardiotocography)
- Cordocentesis.
- Epidural anesthesia during childbirth.
