Hemorrhoids
Disease information
Hemorrhoids
Hemorroides.
Introduction.
Venous
disease
of the inferior members.
The notion of venous
disease
of the inferior members expresses the set of hemodinámicas disturbances at sanguineous level that appears when an operation of the venous
system
takes place badly. This pathology, predominantly feminine (2 / 3 women in front of 1 / 3 men) is very frequent, since it reaches approximately to 40 % of the population of the developed countries.
Frequently it is pronounced with the appearance of discreet edema in the inferior members, accompanied by
a
sensation of slowness of legs. Also it can appear by
a
superficial
chronic
venous éstasis that can go of the simple varicosidad (arborescencia of very small
red
and blue intradérmicas veins) to the complex variz.
The complications of the venous
disease
can be of type:
•
Circulatory
: varicose trombosis or periplexia,
• Trófico:
angiodérmica and varicose ulcer.
1. The veins.
The veins are tubular structures that the return assures the blood to the heart. Like all the conductive
glasses
, they are protected by cells of endotelio,
but
they are different from other
glasses
in which they have, of
specific
form, you fold internal that corresponds to valves. These valves facilitate the circulation from the the most elevated most inferior zone to, preventing than the blood flows back towards the feet. The
system
to valvular allows the vein to fight against the hydrostatic pressure and the force of the gravity. The wall of
a
vein
has
a
thickness smaller twice than the one of the artery.
It is formed by
a
weave specialized in the containment and made up of:
• smooth
muscular
Cells,
• elastic Fibers,
• Fibers of colágeno and
specific
proteoglicanos.
2. The venous
system
.
The venous
system
of the inferior members contains two networks schematically:
• deep
a
venous network and
a
superficial venous network.
Deep the venous network is the one that surrounds to the arteries. It is surrounded by the
muscular
mass. This network drains 90 % of the venous blood of the inferior members.
The superficial venous network is visible under the skin, is bad prote'ge'e and outside the
muscle
. She does not assure the return the blood more than in 10 %, and is the cause of several venous
diseases
of the inferior members. This network is compound essentially of internal and external safenas veins. The superficial venous network is united to the deep veins by the armor - piercing veins that are in
charge
to drain the blood of the surface towards the deepest zones.
3. The venous circulation.
The venous circulation is governed by two types of mechanisms: the called mechanisms passive and, by the active opposition, mechanisms.
The passive mechanisms.
The return of the venous blood is determined by the pressure differential between the periphery and the heart (right auricle) The venous pressure depends on several factors:
The
arterial
pressure.
It is the impulse of the
arterial
blood that entails the mobilization of the venous blood. The
arterial
system
is bound to the venous
system
by the capillaries. When the degree of opening of the hair arterioles increases, the venous pressure increases vice versa and.
The hydrostatic pressure.
The passage of "knocked down"
position
, where the hydrostatic pressure is the same one in all the sides, to "the raised"
position
imposes to the veins of the inferior members great variations of pressure. The process is limited by two factors:
• the colágeno of the venous weave, that assures
a
structure to him maintenance,
• the capacity of the valves to close
itself
, and that divide the blood column. If it appears an excessive pressure, the valves end up losing their functionality. Before an
injury
to valvular, the process also worsens by the creation of
a
compensating superior pressure in the immediately inferior part to the damaged valve.
The
peripheral
tissue pressure.
This pressure is related to the contraction of muscles of the inferior members that, when compressing the deep veins, impel the blood towards the heart. The gradient of pressure between the surface and the depth explains the passage of the blood of the superficial veins towards the deep veins.
The venous aspiration.
The aspiration of the venous blood must to the conjunction of two processes:
• the contraction of the right ventricle that creates
a
depression
in the right auricle,
• the intratorácica negative pressure.
The active mechanisms.
The veins are not only
a
set of túbulos in
charge
to lead the blood towards the
cardiac
cavities. Also are walls equipped with contractibilidad. The venous weave contains active elements: smooth
muscular
fibers that allow the vein to reduce or to increase their caliber. These fibers are compound of smooth
muscular
cells regulated by adrenérgicas completions. These completions
release
noradrenaline that causes, by activation of the receivers,
a
contraction of the smooth
muscle
. Noradrenaline at venous level is
a
vasoconstrictor. Other transmitters can affect to the vasomotilidad inhibiting or stimulating the liberation of this noradrenaline by the
nervous
completion.
The serotonin, histamina, angiotensina II and prostaglandins
B1
and F2 have
a
vasoconstrictor effect. It agrees to consider that during
a
too important venous contraction, takes place an exudation of
liquid
at hair level due to the compensating vasodilatación of the arterioles. The prostaglandins present A1, A2, E2 and I2 in the inflammation, have an inhibiting effect on the venous smooth
muscle
and therefore, they cause
a
vasodilatación.
APPEARANCE MECHANISMS.
The organization of the venous
system
is, from
a
functional point of view, an adaptation model to fight against the force of the gravity. At the same time, he is one of the great weak points, since this complex and multifactorial regulation can be unbalanced easily.
We are going to see the different mechanisms that cause the appearance of the venous
disease
.
Position
.
The vertical
position
adopted by the human being makes undergo considerable pressures to the venous network of the inferior members. He is undeniable that remaining of immovable foot and during long time favors and aggravates the venous insufficiency. It is stated very frequently in people who work during all the day of foot.
On the other hand, some studies have returned to bring to light the relation between long permanence On guard seated and the presence from
varices
. In the third - world countries and East, it is stated that the varicosidad is rare. The western ones sleep an average of 8 hours, 8 hours of foot work or seated and 8 hours seated in
a
chair or
a
sofa relax. Therefore, during 16 hours it is in
a
position
that does not favor the correct venous circulation. The
Japanese
also relax 8 hours
but
walking, cycling or seated in the
ground
, he is to say that the
Japanese
are 16 hours On guard favorable. Therefore, the
position
seated in
a
doubled chair, legs, seems to favor the appearance of venous
diseases
.
Muscular
exercise.
To walk improvement the operation of the venous
system
of the inferior members. The frequent
muscular
contractions assure
a
better sanguineous drainage and in addition, they
develop
a
network of collateral veins apt to suplementar
a
deficient containment. To make physical exercise of continued form is
a
protective factor of the venous
disease
; on the contrary, the sedentarismo is an aggravating factor.
Temperature.
Thus, with the changes of temperature vasomotores phenomena are observed venous level. These variations of section of the vein must to the thermal sensitivity of the
nervous
completions of smooth the
muscular
cells. The cold causes
a
vasocontricción by increase of the affinity of noradrenaline by its receivers.
By an inverse process, during the exhibition to the heat,
a
vasodilatación takes place. The heating by the
ground
, sobrewarmed up means,
a
solar exhibition or too important thermal amplitude favor the sanguineous éstasis and the installation of the venous
disease
. The sensation of heavy legs, edema and the
varices
are agravated by the heat. The frequency of functional
problems
of the venous insufficiency is much greater in
summer
.
Hormonal factors.
The statistics are clear:
the venous
disease
in front of affects to two women
a
man. As it is obvious east done is in narrow relation with the hormonal phenomena. The estrogens or, more concretely, the variation of their levels can affect the venous wall, which explains that the puberty, the
menstrual
cycle, the
pregnancy
and the premenopause are responsible for an accentuation of the venous distension. In addition, the way of feminine life, normally more sedentary, often associated to
a
more
static
work, makes that the woman reunites enough more unfavorable elements, propitious to
develop
a
venous insufficiency.
Inheritance.
It seems to be that the hereditary factor also can influence in the appearance of venous
diseases
. He is dificil to attribute ésto to the inheritance in case single, since, often, individuals of
a
same
family
have nutritional habits and similar hygiene of life. If one were inheritance, the races and the ethnic groups would be due to mark to significant differences between.
Surveys epidemiologists have tried to demonstrate this, therefore
a
study made by Brizzio in an India community of
a
native town of
Argentina
, demonstrates affirmative results in that sense. In the group of pure Indians, no had
varices
. In the group of racially mixed Indians most presented / displayed pictures of venous
anomalies
. In this
specific
case, the mestization
has
been the person in
charge
of the appearance of the varicose
disease
.
It is possible to be spoken of
genetic
weakness of the conjuntivo weave or rather question is hereditary degenerations of endotelio? La is open still today.
Free radicals.
At the moment one knows that after
a
chronic
circulatory
insufficiency, the alterations produced at level of the venous weave can have to the action of free radicals. Let us remember that the free radicals are unstable molecules that have
a
free electron and that tend to become stabilized, mainly after numerous physiological oxidativas reactions.
The free radicals act on lipids causing their oxidation. The oxidativa alteration of nutritional lipids is well - known for
a
long time: it causes
a
modification of the scent and the
flavor
(rancid)
A
similar phenomenon takes place on lipids of the alive organisms, mainly on which they constitute biological membranes. The free radicals are the
origin
of
a
great number of structural and functional
attacks
of cellular membranes. At level of the endoteliales cells, these
anomalies
are translated, at
a
first moment,
problems
of the permeability, people in
charge
of the plasmática flight (edema
interstitial
) Later, the action repels on the valves, with increase of the fragility and destruction in case of elevation of the venous pressure.
The
muscular
cells of the venous wall, can present / display morphologic and physiological
anomalies
produced by the free radicals giving rise to an abnormal conjuntivo weave, that does not assure its mechanical properties correctly. The oxidation of lipids of membranes also can have consequences in other structures that are not the cellular membrane. Thus, the lipids of oxidized membranes form peroxides, being known the malonil - dialdehído one (M.
D
.
A
.
This M.
D
.
A
. carrier of two free radicals, is able to act on protéicas molecules and to modify their structures. It
has
the property to establish
a
cross - sectional bridge between proteins. This bridge affects so much to the
D
. N.
A
. as to colágeno and elastina fibers, being able to alter its functional characteristics. Thus, the different weaves implied in the venous return are disorganized of progressive form by the free radicals.
After this review, we see with greater thoroughness three clinical forms susceptible to be dealt with
Fitoterapia
:
Beginning of
a
venous insufficiency,
•
Varices
,
• Hemorroides.
Definition.
The hemorroides are pathological expansions of the anorrectal venous network. According to the affected veins, 3 locations are distinguished:
• Hemorroides internal.
• Hemorroides external.
• Hemorroides marginal.
The anorrectales veins constitute an anastomosis carry - digs. The hemorroidal pathology very is extended. Its frequency is explained by an anatomical particularitity: the
system
carries does not contain valves at level of the anorrectales veins.
In addition, these venous walls are frequently subject to inflammatory phenomena of the mucosa due to the great microbial load of the average fecal.
Predisponentes factors.
Specific
predisponentes factors of the hemorroidal pathology are:
• Any increase of the intra - abdominal pressure:
Defecación.
I sneeze.
Cough.
Pregnancy
.
• nutritional Excess, in individual eaten strongly condimentadas, spirit, strong
coffee
.
•
Problems
of transit that can cause continuous traumatismos of the venous walls: constipation or diarrea.
• Certain sports as it is the case of:
equitación, cycling, motociclismo.
• Long trips by car.
Also it is necessary to consider that, sometimes, the hemorroides also can be symptomatic manifestations of underlying pathologies like:
• pelvic Lesiones that forms an obstacle:
cancer
or
straight
- sigmoidal, utero -
ovarian
or
prostate
tumor.
•
Cirrhosis
, with
hypertension
vestibule.
When the expansion of the anal venous network is
moderate
, the hemorroides are generally asintomáticas. On the contrary, when this expansion is accentuated, the hemorroides are painful (congestivos accesses) and including complicated.
The complications of the hemorroidal
disease
are:
• local Hemorrhage.
• Prolapse of the varicose package.
• Trombosis.
• hemorroidal Polyp.
Treatment.
The treatment of the hemorroides only can be medicinal or
doctor
- surgical (
sclerosis
or surgery) In this chapter we will treat only the medical treatments.
1. Rules higieno -
dietetic
.
He is interesting to follow some
dietetic
measures simple to prevent the hemorroidales accesses:
• Eliminar the predisponentes foods, to suppress spices, the
alcohol
, the
coffee
or the
tea
in excess.
• Luchar against the constipation or the diarrea.
• Prohibir the irritating laxatives.
• local Hygiene with nonirritating soap.
• Aportar fiber to the diet, to avoid the constipation.
2. Local treatments.
Numerous preparations of local use exist, under form of pomadas for the hemorroidal access. These treatments are considered sólamente like helping.
3.
Fitoterapia
.
In the acute hemorroidal crisis we will essentially use plants with vitaminic
activity
P
and raninos, as it is the case of the
Cypress
,
Chestnut
tree of Indians and
red
Grapevine, already described in this volume.
Plants adapted for this
disease
.
Cypress
.
Chestnut
tree of Indians.
Red
grapevine.
Hamamelis
.
Rusco
.
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