With respect

Hemorrhoids for more than four millennia is one of the most common human diseases. Equally often met in men and women, children and adults, the disease brings a host of physical and mental suffering, deprives the ability to work, reduces the quality of life.

The ability to accurately determine what is hemorrhoids appeared in the XVIII century, when they brand viagra were discovered cavernous vascular plexus surrounding the anal canal. It was proved that in addition to veins and arteries, these vascular formations contain elastic connective tissue and smooth muscle cells. Regulating blood circulation in the area of the anal canal, hemorrhoidal plexus provide the basic functions of the rectum: retention of feces and defecation, maintenance of an effective immune barrier between the organism's internal environment and the world.

Anatomy and physiology of the internal hemorrhoidal plexus, located proximal to the dentate line anal canal and external, are distal to its varied considerably. Spike (or comb), the line is kozhnoslizistym compound area closure ectodermal (skin) and endodermic (rectum) tissues and forms the upper border of the anal canal. Inside the anal canal lined with anodermoy essentially a continuation of the skin and covered with stratified squamous epithelium. Anoderma and the surrounding skin is richly supplied with somatic sensory nerves and are highly sensitive to painful stimuli. The lining of the rectum is a mucous membrane covered with transitional and columnar epithelium. It is innervated by autonomic fibers and relatively insensitive to pain. Venous drainage from the areas located above the dentate line, is carried via the portal system. Outflow from the anal canal and the zone located below the dentate line going into the system of the inferior vena cava. Venous blood from the anorectal compounds can act as a portal, and in the caval system. Lymph flow from the rectum is sent to the inferior mesenteric and aortic nodes, whereas lymphatic vessels of the anal canal approach to the internal iliac and inguinal nodes, the rear wall of the vagina. Distribution of venous and lymphatic vessels anorectal zone causes a variety of pathways of infection, malignant lesions and drugs from the areas before and above the dentate line.

Despite the deep historical roots of the studies on anorectal pathology only in the middle of the XX century have become generally accepted idea that the normal physiological role of the hemorrhoidal plexus does not involve the development of a set of pathological symptoms, which are usually combined in a symptom of hemorrhoids. The appearance of hemorrhoids is the result of impaired hemodynamics and inflammation in the vessels of the hemorrhoidal plexus, often accompanied by thrombosis, varicose veins, and multiple sclerosis, hemorrhage.

Classification

Hemorrhoids are divided depending on the location of hemorrhoids with respect to the dentate line anal canal. When an internal hemorrhoid (SH) sites are located medially, while the outer (NG) of the distal dentate line. Usually distinguished IIV severity of decompensation SH. When the SH I found the degree of swelling and possibly bleeding, but the captive hemorrhoids. When the SH II degree nodes, and can Viagra a questionnaire international quality erection reduce a drop on their own. When the SH III degree nodes can be dropped right only instrumentally or through manipulation of his hands. And finally, when the SH IV degree nodes to the right did not succeed.

Typical locations of hemorrhoids (SU) is considered the left side, right front and right rear wall of the anal canal. Frequently used method for describing the localization of proctology PG with similar clock face (eg, large PG is located at 9 o'clock) often contributes to confusion in the medical records, as may be applied only if the examination is conducted in the patient kolennoloktevom position.

Etiology

By the etiologic factors of hemorrhoids include constipation traditional, long-term spastic state of the internal sphincter of the rectum, growing due to various reasons and leads to frequent straining, as well as pregnancy. Among the reasons for the SH occupies a special place chronic portal hypertension, as well as various genesis occurring subclinical portosystemic blood disorders (such as with overeating, drinking, taking anabolic steroids, contraceptives, other chronic drug intoxication). Development of HF, no doubt, contribute to chronic inflammatory diseases of the anorectal area and the pelvic organs, such as bacterial salpingo-oophoritis, prostatitis or cystitis, which lead to a breach of hemodynamics and lymphatic spread of infection in the hemorrhoidal plexus.

However, the etiology of hemorrhoids, in the opinion of most researchers problem has not been studied fully, and among the factors that could theoretically be associated with disease progression, most noteworthy study of hereditary, social and cultural aspects of the problem [1,2].

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