Hemorrhoids - a confidential illness of
during pregnancy the woman feels a number of feelings, at once to understand which is very difficult. Where normal manifestations of pregnancy and when it is necessary to see a doctor? There are problems with health about which it is not accepted to speak. Hemorrhoids belong to such diseases. Women hesitate to tell the doctor about displays of this illness and ask for medical care only as a last resort when there are complications as many consider that hemorrhoids during pregnancy are norm.
Hemorrhoids are an expansion of veins in the field of back pass (anus). Development of this disease is promoted by anatomic and physiological features of a rectum. Under her mucous membrane the numerous veins forming textures, walls at these veins very thin are located. Besides, in a submucous layer there is a kavernozny fabric with a large number of arteriovenozny soustiya, t. e. connections between arteries and veins. Physiological feature of a rectum is that at a defekation of its wall together with the vessels which are in them stretch that can lead to damage of walls of vessels and developing of hemorrhoids (the name of this disease in translation from Ancient Greek is not casual means “bleeding“).by
As shows hemorrhoids?
the Main symptoms of hemorrhoids are:
- bleeding at a defekation (blood impurity in Calais);
- an itch, burning in the field of back pass;
- feeling of a foreign matter, feeling of weight in the field of an anus;
- loss of knots from a rectum;
- rectum pain at a defekation, walking, in a sitting position.
At hemorrhoids bleeding arises in time, to or right after a defekation. As a rule, patients pay attention to blood spots to linen or toilet paper, blood can sometimes follow a stream at the end of a defekation. If bleeding long, then can arise the iron deficiency anemia resulting in the general weakness, an indisposition, dizzinesses. It is necessary to pay special attention that bleeding from a rectum - the dangerous symptom demanding the address to the doctor.
the Itch and burning in the field of back pass arise at damage of integrity of walls of the gemorroidalny knots located in a rectum gleam. The feeling of a foreign matter, feeling of weight in the field of an anus, rectum pains at a defekation, walking are connected with an inflammation and thrombosis of gemorroidalny veins. Thrombosis call formation of a blood clot - blood clot in a vessel gleam.
statistically, already in the first trimester of pregnancy (from conception to
of the Cause of illness
the Reason of frequent developing of hemorrhoids at pregnant women and the giving birth women is that during pregnancy at once several factors exert pathological impact on a gemorroidalny venous texture, leading to emergence or an exacerbation of a disease. Treat such factors:
- inactive way of life;
- chronic lock;
- increase in the sizes of a uterus.
Reduction of physical activity and an inactive way of life, especially in the second half of pregnancy, are characteristic of many women and result in stagnation of blood in the lower extremities and in an abdominal cavity owing to what there is an expansion of gemorroidalny veins.
One more factor promoting development of hemorrhoids are locks which are suffered by about 57% of future mothers. Such high frequency of locks at pregnant women is explained, in - the first, by effect of progesterone - the hormone “supporting“ pregnancy which, affecting an intestines wall, reduces its vermicular movement (reductions). This mechanism during pregnancy is protective: as the uterus and intestines have an identical innervation, the active vermicular movement of intestines can lead to increase of a tone of a uterus and threat of interruption of pregnancy.
In - the second, the growing uterus, since the second trimester of pregnancy, squeezes intestines and the vessels feeding it, weakening a vermicular movement even more. The increasing uterus together with a fruit squeezes not only intestines, but also large venous vessels, such as the lower hollow vein and a vorotny vein on which blood flows from a lower body. It results in stagnation of blood in a small pelvis, and in particular in gemorroidalny veins.
One more important factor promoting developing of hemorrhoids is childbirth. Passing through a cavity of a small pelvis, the head of a fruit squeezes a rectum and all vessels surrounding it, increasing risk of development of this disease.by
as a result of the listed mechanisms breaks a ratio between inflow and outflow of blood in gemorroidalny veins of a rectum. Travmatization of small veins of a mucous membrane leads to bleeding. Penetration of microbes through cracks in a rectum causes an inflammation and thromboses of gemorroidalny knots.
Types of gemorroidalny knots
Depending on localization gemorroidalny knots can be internal, i.e. located in a rectum gleam, and external - around back pass.knots in the form of warty educations or folds, dense to the touch, not decreasing in sizes when pressing by them are characteristic
Of external hemorrhoids. External gemorroidalny knots practically do not give trouble though sometimes they cause unpleasant feelings and an itch in the field of back pass. Bleeding from external knots happens extremely seldom, also seldom there is an inflammation in these knots - tromboflefit (so call an inflammation of veins with formation of blood clots - blood clots). At thrombosis (formation of blood clots) external gemorroidalny knots become sharply painful, very dense, increase in sizes, the defekation at the same time causes pain.
Internal hemorrhoids are characterized by the fact that knots are located between folds of a mucous membrane of a rectum, have the wide basis, are fallen down when pressing and increase in sizes at increase of intra belly pressure, for example at cough and a natuzhivaniye. Internal knots can be single and multiple, they can drop out at a defekation and be restrained in back pass that leads to thrombophlebitis of pryamokishechny veins.by
Diagnosis of hemorrhoids
For statement of the diagnosis “hemorrhoids“ the doctor the obstetrician - the gynecologist carefully collects the anamnesis, specifying symptoms and features of a course of a disease. Then inspection of area of back pass for the purpose of identification of external gemorroidalny knots, and after that - manual research of a rectum is performed.
At emergence of complications the patient goes for reception to the proctologist - the specialist in rectum diseases. The proctologist if necessary conducts special research - a rektoromanoskopiya at which the optical device is entered into a rectum that allows to examine all walls. This research at pregnant women is conducted seldom - as a rule, at difficulties directed by the diagnosis. That this procedure is painful and can promote interruption threat emergence (pregnancies; besides, carrying out following at future mother is technically complicated as the thick gut is squeezed by the uterus increased in volume).
Prevention of hemorrhoids
At hemorrhoids cannot self-medicate at all - corrected treatment only the doctor can appoint. As hemorrhoids often arise during pregnancy, already from the first trimester it is necessary to carry out prevention of a disease, without waiting for its manifestations.
the Main measures of prevention of hemorrhoids are elimination of locks, careful hygiene of a crotch and special gymnastics. It is necessary to empty intestines daily. Besides, it is necessary to use more products containing rough vegetable cellulose (vegetables, fruit, cereals, grain), at moderate amount of meat and carbohydrates. It is useful to eat beet, prunes, dried apricots, pumpkin, carrots, and also fermented milk products (kefir, curdled milk), black bread, bread with bran. It is necessary to limit reception of greasy food, hot spices, coffee.
Hygiene of a crotch - a necessary measure of prevention of hemorrhoids at pregnant women. After each depletion of intestines it is necessary to wash cool water area of a crotch and back pass.to
For prevention of hemorrhoids can carry out a set of exercises for pregnant women:
- Starting position (nominative) - standing, hands are extended before themselves, legs at shoulder length. Without tearing off foot from a floor, to execute turn of the case to the right, at the same time to take away the right hand back, to make a breath. Coming back to a starting position, to make an exhalation. To make turn to the left. To repeat 5 times in each party. - costing
- of Nominative, hands are raised before themselves, fingers are linked in the lock. To execute turns of a trunk to the right and to the left, taking away hands back. To repeat 5 times in each party.
- of Nominative - sitting on a floor, resting hands behind. To bend legs in knees, at the same time feet have to slide on a floor. To slowly extend legs, without tearing off a heel from a floor. To repeat 5 times.
- of Nominative - sitting, to part legs aside, without bending knees. To bend forward, to touch by hands of the right and left foot serially, then to become straight. To repeat
of 5 - 7 times.(Exercise can be carried out only in the first and second trimesters of pregnancy.)
- of Nominative - sitting, to part legs aside, without bending knees. To execute inclinations in the parties, holding hands on a belt. To repeat 5 times in each party. (This exercise is also carried out only in the first and second trimesters of pregnancy.)
- of Nominative - lying on a back, hands are extended along a body. To raise the legs bent in knees to a stomach and to return to a starting position. To repeat
of 7 - 10 times.(Exercise is carried out in the first and second trimesters.)
- of Nominative - sitting on a chair. To extend the right hand aside. To raise the left leg bent in a knee forward and to the left, leading it to a lateral surface of a stomach, helping itself the left hand. To return to a starting position, then to execute exercise in other party. (This exercise is recommended for the third trimester.)
Treatment of hemorrhoids
Initial asymptomatic stages of hemorrhoids which are usually found by the gynecologist or the woman, as a rule, do not demand medicamentous therapy, but at the same time observance of a diet, hygiene of a crotch and performance of a set of exercises is obligatory.by
At women with gemorroidalny bleedings, pains at a defekation, an itch in the field of back pass carries out conservative treatment by means of rectal candles (Anuzol, Anestezol, Prokto - glivenol, Repif, etc.) ; ointments (Posterizan Forta, Gepatrombin) - should pay attention that both of these ointments are contraindicated in the first trimester of pregnancy): heat sedentary baths with weak solution of permanganate of potassium, infusions of medicinal herbs; the preparations accepted inside (Ginkor Fort, Eskuzan, Detraleks). Treatment has to be individual and be carried out under control of the doctor.
Surgical treatment is appointed at long moderate bleedings or at the plentiful bleedings causing anemia. Operation is performed, as a rule, on early terms of pregnancy, at the same time the sparing methods are used. The emergency hospitalization in a hospital and surgical treatment during pregnancy are shown at plentiful gemorroidalny bleeding, at infringement and thrombosis of the dropped-out gemorroidalny knots. To surgical methods of treatment treat a gemorroidektomiya (excision of knots with the subsequent suture) and the low-invasive (sparing) treatment methods, such as sclerotherapy (introduction to knot of the special “sticking together“ preparation), an alloying (jamming of knot a latex ring), infrared photocoagulation (impact on knots high temperature) and laser coagulation. At low-invasive interventions healing happens during