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Treatment of combined hemorrhoids: symptoms, diagnosis, treatment

Combined hemorrhoids are observed in almost every third person after 40 years. With this disease, the existing external and internal hemorrhoidal nodes are damaged. In ICD 10 it has a code - I.84.2-I.84.5. Mixed hemorrhoids are not identified by a separate code: the codes indicated in the International Classification refer to the external and internal form of the disease. This is due to the course of the pathology: the phases of exacerbation and remission alternate unevenly. With an exacerbation of internal hemorrhoids, the external nodes are in remission. With inflammation of the external cones, the internal ones may not bother. Therefore, when encoding, it takes into account which form of pathology has aggravated. A severe course is rare with simultaneous inflammation of the external and internal varicose cones.

The onset of the disease is asymptomatic. For this reason, pathology is already diagnosed in a chronic form, with extensive clinical symptoms with a severe course.

What is mixed hemorrhoids?

With combined hemorrhoidal disease in the rectum, there are simultaneously enlarged internal and external varicose nodes. It occurs in cases where both forms of the disease have been ignored for a long time. But their development does not coincide in time: the first internal nodes appear, later the external ones develop. In the initial stages of the disease, nodes can only be seen with anoscopy.

The clinical picture of pathology

The combined form of hemorrhoidal disease according to clinical signs is more severe than its other types. This is due to the course of the pathology: the alternation of exacerbations and remissions of each form leads to the fact that the patient is always in the active phase. As soon as the external hemorrhoids can be stabilized, the internal nodes become inflamed. Therefore, the patient constantly suffers from the manifestations of the disease, which exhausts physically and leads to psychological problems. In the case of simultaneous inflammation of the external and internal varicose cones, the clinical picture consists of symptoms of both pathologies.

At the initial stage, changes in the vessels occur slowly and gradually. The patient during this period does not have any complaints and symptoms.

The first signs of combined hemorrhoids are discomfort or a feeling of a foreign object in the rectum. As the pathological changes progress, typical manifestations arise:

  1. Isolation of blood, which can be seen on feces, toilet paper and linen in the form of traces or drops. At the final stages, massive bleeding is possible when blood flows in a trickle during bowel movements.
  2. Itching and burning in the anus.
  3. Pain of varying intensity. In severe cases, it becomes constant, intensifies when walking, sitting, small loads (coughing, sneezing).
  4. Visible varicose cones: external or falling out internal.

External nodes are localized around the anal opening subcutaneously. Without exacerbation, they do not cause discomfort, look

like sleeping bags. With inflammation, they increase, become painful on palpation, the skin above them changes.

Internal hemorrhoids are located submucosally. Upon reaching large sizes begin to fall out. This process is accompanied by pain (especially with pinching), itching and burning, since mucus comes out with them, irritating to the skin around the anus. Dropped out internal nodes are tense, painful, purple-cyanotic.

Stages of mixed hemorrhoids

Mixed hemorrhoids, like other types of the disease, are acute or chronic. An acute course is thrombosis.

Chronic mixed hemorrhoids undergo 4 stages (degrees) of development, which have the following characteristics:

  1. The appearance of a small amount of blood during bowel movements. There are no other manifestations.
  2. The nodes fall out when straining, set spontaneously (with or without bleeding).
  3. Drop nodes are set by hand.
  4. Nodes constantly drop out spontaneously, redirection is impossible. If you managed to straighten them with your hands, they fall out again.

With combined hemorrhoids of the 2nd degree, varicose cones that have fallen during defecation are self-correcting. Blood does not always appear. All symptoms are caused by an increase in varicose nodes: when they are large, they fall out with the release of mucus, which irritates the skin around the anus. There are complaints of discomfort in the rectum, itching and transient dermatitis. Small amounts of feces can go without defecation when the muscles of the anus are weakened, settling on the crypts around the anus and causing a burning sensation.

Combined hemorrhoids of the 3rd degree are manifested:

  • loss of large nodes to the outside, occurring with any, even slight straining, with the need for manual benefits,
  • the release of a small amount of blood (it may not be),
  • dermatitis around the anus,
  • itching.

With mixed hemorrhoids of 4 degrees occurs:

  • constant loss of nodes, regardless of load,
  • the impossibility of their reduction, even manually
  • significant blood loss
  • spontaneous release of feces and mucus,
  • the development of perianal dermatitis, eczematization of the skin, severe itching.

With combined hemorrhoids, the appearance of blood in the feces is sometimes noted from the first stage. This indicates decompensation, observed in 81% of patients. It is considered the beginning of the disease, since before the appearance of blood, the pathology for many years and even decades can be in a compensated form.

The allocation of blood in different quantities occurs during emptying or immediately after it. Also, bleeding appears between bowel movements - this is fixed in 19% of patients in the form of often falling red drops with their spraying in the toilet, blood traces in the feces or dark clots. In 10%, its permanent loss occurs over many months or years with the development of severe anemia. With the release of blood by a pulsating stream, the patient may lose 80-100 ml of it per day. The hemoglobin level drops sharply to 30-60 g / l, which is a life-threatening condition and requires urgent surgery.

With the progression of the disease, the condition worsens due to increasing anemia and constantly falling nodes. If the pathology continues without treatment for more than 10 years, then the number of patients with prolapsed hemorrhoids exceeds the number of patients who have undergone bleeding by 2 times.

Pain symptom accompanying mixed hemorrhoids:

  • associated with the formation of a crack, acute sphincteritis, papillitis and other inflammatory phenomena,
  • appears with all complications of the disease (necrosis, acute thrombosis),
  • It is noted in 9% of cases.

Daily dull pain bothers with the long-term course of combined hemorrhoids. But in many cases, even at the last stage with constantly falling nodes, the pain symptom may be absent.

Anal itching and discomfort appear due to mucus secreted along with the nodes during prolapse. Irritation, maceration of the skin develops. Similar changes occur with a gaping or incomplete closure of the rectal opening, when fecal particles with toxic substances irritate the skin. Such a clinical picture is observed in the later stages of the disease. As the first signs, itching and discomfort are found in 8% and 4%, respectively.

Therefore, with suspected hemorrhoids of a mixed nature, two main symptoms are distinguished:

  • the appearance of red blood
  • an increase in venous nodes.

How to treat?

Given the established stages of the disease and the diversity of forms, its therapy requires an individual approach. Complex treatment is prescribed using the following methods:

  • conservative
  • minimally invasive
  • surgical.

Diet is a mandatory item that must be observed by all patients. Alternative methods are also used, exercise therapy.

Diet and exercise therapy

Diet and exercise therapy are aimed at the etiological factors of the disease. Improper nutrition, harmful taste addictions, lack of exercise are the main causes of hemorrhoids. In order to avoid this disease or prevent its exacerbation and the onset of complications, it is necessary to get rid of bad eating habits, and carry out a diet correction.

  • alcohol, carbonated sugary drinks, strong coffee,
  • spicy seasonings, fast food, fatty, fried, pickled foods.

Their use causes the expansion of the cavernous plexuses of the rectum and the formation of hemorrhoids.

  • light wines punch
  • mild sauces, small amounts of dill, basil, parsley, cilantro.

  • fresh pastry,
  • whole milk.

  • 2-3 liters of still water per day,
  • products that enhance intestinal motility (vegetables and fruits due to their fiber, black and bran bread, buckwheat, oatmeal, barley porridge),
  • fermented milk products with bifidumbacteria.

Intestinal activity increases with the use of mineral waters (Moscow, Essentuki). It is recommended to drink in a warm form, 200 ml three times a day.

In order to improve blood supply and prevent stagnation in the pelvis, complexes of therapeutic exercises have been developed. They strengthen the muscles of the abdominal press, perineum and buttocks, are designed to perform in different positions - sitting, lying or standing. Physical education classes are carried out during the period of remission of hemorrhoids twice a day for 15 minutes. Some of the exercises can be used during the working day: sitting or standing with legs crossed, tighten the muscles of the buttocks and anus (3-10 times). The remaining physical elements are made in a prone position. The doctor of the LFK cabinet will select an individual complex and teach how to do it correctly.

Folk recipes

The use of traditional medicine is acceptable for the treatment of mixed hemorrhoids. But they are used simultaneously with the main therapy, which the doctor will prescribe. Self-treatment is not recommended because of possible side effects.

Folk recipes can not completely cure the disease. Only a reduction in individual symptoms is possible.

An affordable home remedy is raw potatoes. It gives good results with internal nodes and external cones.

Candles that are inserted into the rectum for the whole day are cut out of thoroughly washed potatoes. After defecation, the used candle is replaced with a fresh one. Before the procedure, a warm half-hour bath is taken, a home-made candle is moistened in vegetable oil before use.

Grated raw peeled potatoes are used in the form of lotions, compresses. It has an antispasmodic effect, relieves inflammation, starts regenerative processes - accelerates healing. The course of treatment is 10 days.

Decoctions of medicinal herbs have a therapeutic effect when added to sessile baths. Effective collections of chamomile, oak bark, string, sage. Water should be at a comfortable temperature.

Juices are also recommended:

  • from the flesh of a melon
  • spinach, carrots, lettuce,
  • blackberry.

Drug therapy

Conservative treatment involves systemic and local effects. Pharmacotherapy is prescribed to:

  • stop acute manifestations,
  • prevent complications
  • prevent aggravation,
  • prepare for surgery
  • accelerate the rehabilitation period.

Pathogenetic systemic treatment includes the use of:

  • phlebotonics (Troxevasin, Detralex, Phlebodia, Venarus),
  • anti-inflammatory drugs (NSAIDs - Diclofenac, Xefocam, Indomethacin).

The correct use of medicines of these groups reduces the severity of exacerbations by 1.5 times, and their duration by 2.5 times.

In addition, the treatment of the pathology of the digestive tract in order to normalize the stool. To improve digestion processes are prescribed:

  • enzyme preparations (Creon, Pancreatin, Festal, Mezim-forte),
  • probiotics and prebiotics (Bactisubtil, Bifiform, Hilak-forte),
  • dietary fiber (flax seed, wheat bran).

It is necessary to monitor the stool: with a delay of more than 3 days, measures must be taken.

  • NSAIDs
  • glucocorticoids,
  • anticoagulants
  • anesthetics in the form of ointment, cream, gel, suppository.

Medicines for topical use are necessary for stopping:

  • pain symptom
  • bleeding
  • thrombosis
  • inflammatory process.

For pain, candles are prescribed:

  • with an anesthetic (Anestezin, Lidocaine, Novocaine),
  • with antispasmodic (Proctosan, Neoanusole),
  • with a combined composition (Posterisan forte - contains hydrocortisone, killed strains of E. coli and their metabolic products).

For thrombosis, suppositories and ointments with heparin are used (Heparoid, Lyoton gel, Heparin ointment).

With bleeding - Natalside, suppositories with adrenaline. At the same time, parenteral hemostatic drugs (Ethamsylate, Dicinon) are used.

If necessary, antibiotic therapy is prescribed.

Minimally Invasive Techniques

Less traumatic methods are selected for treatment if there are no results after a course of therapy. Convenient for use on an outpatient basis, rarely in a hospital. The indication for such an effect is hemorrhoids of the 2nd-3rd stage, separate methods are prescribed at the 4th stage.

Known minimally invasive interventions:

  1. Sclerosis of bleeding vessels.
  2. Ligation rings.
  3. Infrared photocoagulation.
  4. Laser, electro-, cryo- and radio-frequency coagulation.

There are certain contraindications to the treatment with their use. These include all complications of hemorrhoids, including thrombosis, paraproctitis, cracks.

The tactics of treatment are chosen by the doctor, taking into account the prevailing symptoms and stage of the disease.

Vascular sclerosis is carried out in the early stages of the development of pathology, when the nodes are still small and do not fall out, but blood is released. The technique is also used at higher stages if they are accompanied by bleeding. A sclerotic drug is injected into the bleeding veins with a special syringe through an anoscope. The vascular epithelium is replaced with connective tissue cells over time, blood circulation is disturbed, and eventually stops. The bump is reduced in size, subsides and stops bleeding. Typically, the method is used in combination with an infrared laser. This enhances the effect of the administered medicine, anesthetizes, and relieves inflammation.

Ligation with latex rings is a constriction of the base of the assembly with a ring of high-quality hypoallergenic elastic material. The ring is put on the knot in two ways, depending on the tools used: by vacuum retracting the knot or using forceps. The mechanism of action is to stop the blood supply to the node, its drying out, replacement with connective tissue and self-rejection. After a few days, the node with the ring comes out when the intestines are empty.

Photocoagulation is performed with the Infraton apparatus. Through a special tip, the light flux of infrared wavelengths is fed through the anoscope to the node. Coagulation of the vascular pedicle of the node and its sclerosis occur.

Similarly, the impact on the base of the node is carried out by super low temperatures (-198 ° С) of nitrogen. The technique is used in the second stage of the disease.

A device combining an anoscope with a duplex scanning device is used to dearterilize a varicose cone. A projection of the hemorrhoidal artery is detected, the found vessel is stitched above the base of the node, and then the cone itself with the long end of the ligature. Manipulation is performed on an outpatient basis, since it is less traumatic and does not cause pain. It is performed at all clinically relevant sites.

Surgical intervention

Surgical intervention is performed for hemorrhoids from stage 1 to 4 with the ineffectiveness of conservative therapy and minimally invasive treatment methods. Absolutely shown in advanced cases. Operation required:

  • with severe bleeding
  • with the loss and infringement of nodes.

Since hemorrhoids are a chronic disease, we are talking about conditionally radical surgical methods. Treatment is carried out in a phase of remission. In practice, this is performed in the first hours after the onset of inflammation, until the process has spread, or 5-7 days after a course of anti-inflammatory therapy.

A hemorrhoidectomy according to the Milligan-Morgan method (English surgeons who proposed the technique back in the 30s of the last century) is performed at stages 3-4 and has certain indications. The operation is necessary with constantly bleeding hemorrhoids complicated by anemia, and with chronic ongoing pain.

Removing nodes is carried out:

  • open
  • in a closed way
  • submucosal resection (by type of cosmetic surgery).

With the open method, no sutures are applied after the operation, the wound heals for a long time. A micropreparation prepared from a remote site is carefully studied for the purpose of conducting differential diagnostics.

Operation Longo was developed in 1993 by the Italian physician Antonio Longo. An effective non-traumatic operation to pull up the prolapsed internal nodes is mainly used to treat the third stage of the disease. A circular incision is made of the rectal mucosa above the dentate line, part of the mucous membrane is removed, the incision is sutured, varicose cones are pulled up. The blood supply to the nodes is disturbed, over time, they dry out and disappear. The operation is expensive compared to the Milligan-Morgan method because of the disposable tool kit used. In Russia, this technique is not common.

To avoid costly surgical intervention and prolonged medical treatment, you must consult a doctor at the first sign of illness. A regular examination by a coloproctologist will prevent the development of combined hemorrhoids with all its consequences.

Causes and symptoms of the disease

Some scientists believe that the cause of hemorrhoids is that a person learned to walk upright, but then this disease would manifest itself everywhere. Why do seals and hemorrhoids occur?

Regardless of the type of disease, there are a number of common reasons:

  • A specific lifestyle of a person (sedentary work or long walks, as well as the absence of a sufficient number of movements and loads, the presence of bad habits, poor diet and, as a result, constipation, anal sex, weight lifting, constant stress),
  • Pregnancy and childbirth
  • Hereditary predisposition and age-related characteristics of the body (varicose veins, poor blood circulation in the pelvis, etc.),
  • Infection as a result of not following commonplace hygiene measures. Also the presence of hepatitis C.

And if external hemorrhoids are usually self-diagnosing due to the appearance of tubercles under the skin near the anus, internal neoplasms can be recognized at a late stage - when they fall out, they have a mucous membrane.

If there is already external hemorrhoids, then the pain symptoms of the internal also will not help in the diagnosis, despite the fact that they are usually stronger.

A feature of this type of hemorrhoids is that the stages of remission and exacerbation can permanently overtake either all hemorrhoidal formations simultaneously, or only internal or external separately.

In this case, the symptoms for all types of hemorrhoids are the same:

  1. At an early stage, it may not appear or have a weak severity. For example, in the form of a feeling of incomplete bowel movement during bowel movements or slight pain during a visit to the toilet,
  2. Acute severity is manifested through burning, itching, bleeding, it seems to a person that a foreign body is present in the rectum, a fallen hemorrhoid can appear,
  3. Both acute and chronic forms of combined hemorrhoids are characterized by a feeling of heaviness in the lower abdomen, pain during bowel movements.

Identification of combined hemorrhoids

Combined hemorrhoids can be diagnosed independently by a patient or a doctor during examination only in case of a hemorrhoid cone. A qualified specialist in identifying external nodules will necessarily prescribe additional types of detection of hemorrhoids.

Among them are the following:

  • Sigmoidoscopy is a method for examining the rectum and lower part of the sigmoid colon, which at absolute price availability provides the most reliable information and practically has no contraindications,
  • Anoscopy is a study of anal feces up to 12 cm, which also includes the anorectal region.

The first method is the most common and allows you to inspect up to 35 cm from the anus. It is recommended for all after forty at least once a year. The advantages of sigmoidoscopy are its painlessness, safety and speed. The only caveat: a qualified proctologist should carry out the procedure, since negligence and inability in this matter can lead to intestinal perforation.

The method also has contraindications. For example, severe bleeding, anal fissure, pulmonary and heart failure, mental disorders, the patient's general serious condition.

Before the examination, two conditions must be met:

  • follow a strict diet for two days before sigmoidoscopy,
  • to cleanse the intestines. To do this, the day before the procedure, you can put an enema or drink a laxative.

Anoscopy is mainly used with obvious signs of the presence of internal hemorrhoidal nodes in order to recognize the stage of the disease. Therefore, the anoscope has the function of collecting material for examination to identify the size and inflammation of the hemorrhoids, anal fissures. Also, this procedure is prescribed for any other disorders in the intestines.

Anoscopy has no contraindications, however, if inflammation and cracks are suspected, anesthesia may be used, ointments and gels are also used to facilitate the administration of the device.

The choice of method depends on the qualifications of the doctor and the general condition of the patient.

Treatment of combined hemorrhoids

Treatment of mixed hemorrhoids can be carried out in several ways:

By an operative method, bleeding nodules are removed if there is a suspicion of thrombosis, the manifestation of severe pain with the loss of hemorrhoids. Apply hemorrhoidectomy according to Milligan-Morgan or Longo. As with any surgical intervention in the human body, a postoperative rehabilitation period is necessary. In this case, it is 2-3 months.

Conservative methods include the use of ointments, suppositories, medications that improve blood circulation, and in the presence of blood secretions and their infringements, hemostatic agents.

Also, in addition to the basic prescriptions of the doctor, alternative methods can be used to alleviate pain and relieve inflammation. These include herbs, baths, syringes.

At home, complex treatment can also be quite effective. It includes:

  • proper nutrition (exclusion of spicy and fatty foods), which will help get rid of constipation and diarrhea,
  • gymnastics and balanced physical activity,
  • herbal medicine.
  • However, it must be understood that the only correct treatment can be delivered only by a proctologist, who must be consulted when the first symptoms of the disease appear.
  • In measures to prevent the development of the disease in people older than 40 years, it is worthwhile to regularly undergo examination by a proctologist. But since hemorrhoids have virtually no age limits, only systematic prevention of the disease can significantly reduce the risk of hemorrhoids. The right way of life, giving up bad habits and getting rid of stress is the recipe for a long and healthy life.

Symptoms and stages of hemorrhoids

For a coloproctologist, who is faced with the task of curing hemorrhoids of a combined type, it is important to determine the degree of this disease, since treatment methods effective for stopping inflammation at different stages differ significantly.

Primary diagnosis is carried out according to the symptom complex, characteristic for each stage of the development of this disease.

1 stage

In the first period, hemorrhoids are almost asymptomatic. Nodes are not determined during examination, and only with a digital examination it is possible to detect minor seals inside and outside the anus. The development of the disease is evidenced by moderate anal itching and mucous discharge from the anal canal. After defecation, there may remain a feeling of incomplete bowel movement and the presence of a foreign body in the intestinal lumen.

The primary diagnosis of combined hemorrhoids is carried out according to the symptom complex characteristic for each stage of the development of this disease.

2 stages

Tangible discomfort appears at the 2nd degree of hemorrhoids of the combined type. It most often occurs during or after bowel movement. After defecation in the anal area, the internal nodes that go outside are probed, which after a while are spontaneously repaired. Due to internal micro-bursts, a few drops of blood may come out.

3 stages

A characteristic sign of grade 3 hemorrhoids is the exit of inflamed internal nodes and an increase in the size of external hemorrhoids.

Due to the excess blood filling, the nodes begin to bleed - both during bowel movement and outside of bowel movement.

Hemorrhoidal cones do not adjust, causing pain and discomfort when walking and being in an upright position.

4 stages

At the last stage, blood clots appear in the blood vessels of the inflamed nodes, the inflammatory process is complicated by thrombosis. Intensive bleeding that occurs in this period of the disease, leads to an anemic condition, the patient experiences constant weakness from blood loss. The act of defecation is accompanied by severe pain, fecal incontinence, flatulence develops.


Mixed hemorrhoids are diagnosed during examination, combined with a digital examination. In the framework of differential diagnosis and clarification of the volume of internal inflammation, additional laboratory and instrumental studies can be prescribed:

  1. General blood test - will determine the ESR, the content of leukocytes, red blood cells, hemoglobin.
  2. Coprogram - is carried out to detect blood impurities in the feces.
  3. Anoscopy is a study that can detect anal fissures or tumors.
  4. Sigmoidoscopy is a diagnostic technique that is more informative than examination with an anoscope, which allows you to identify deeply located focal inflammation.

As part of the differential diagnosis and clarification of the volume of internal inflammation, a general blood test can be prescribed.

Treatment of mixed hemorrhoids

Therapeutic courses are developed by proctologists on the basis of data obtained during the preliminary examination, taking into account:

  • degrees of hemorrhoids
  • age and immune status of the patient,
  • the actual condition of the mucous membranes of the lower calving of the intestine,
  • state of muscle tissue of the sphincter,
  • general history.

The initial stages of combined type hemorrhoids are amenable to conservative treatment; in the presence of multiple external and internal hemorrhoidal nodes, operations of varying degrees of invasiveness are recommended. Regardless of what methods hemorrhoids are treated with, conservative or operative, the course is carried out against the background of a sparing diet, which is recommended to adhere to when a stable remission of the disease is achieved.

Sclerotherapy is one of the minimally invasive treatments for small hemorrhoids.

Minimally invasive therapy

Minimally invasive procedures are recommended for small hemorrhoidal nodes if conservative therapy methods have not succeeded in regressing chronic combined type hemorrhoids. Non-surgical methods for treating hemorrhoids include:

  • sclerotherapy
  • coagulation (laser, infrared),
  • ligation (suture, latex rings),
  • cryotherapy.

In 80% of cases, the mixed form of hemorrhoids is completely eliminated by minimally invasive therapy methods.


Treatment with drugs intended for internal use, and local therapy with the use of suppositories, ointments and applications with analgesic and anti-inflammatory effects are highly effective only in the early stages of hemorrhoids. Drug therapy aimed at relieving symptoms is not able to help with advanced forms of the disease, and is prescribed as a supplement to minimally invasive therapeutic methods or radical surgical intervention.

Definition of combined hemorrhoids

Hemorrhoids occur due to venous dysfunction, deterioration of blood flow and stagnation of blood in the pelvic area. Veins in the rectum change shape, adhesions and blood clots form, with the further development of the disease, large nodes grow, which are injured at the slightest exertion.

The disease itself does not go away, the lack of treatment can transfer it from an acute form to a chronic one. For her alternating periods of remission with exacerbations are characteristic.

The main difference between external and internal hemorrhoids is the localization of nodes. In the external form, they are located directly under the skin in the anus and often protrude from it.

Internal hemorrhoids are characterized by cones located under the mucosa.

Combined hemorrhoids what is it? The combined form combines the internal and external form of the disease. Knots along the walls of the rectum and at the anus indicate that both large veins were affected.

For mixed hemorrhoids are characteristic:

  • small internal tears on the rectal mucosa,
  • anal fissures
  • damage to external hemorrhoids,
  • swelling of the anus,
  • frequent painful inflammation,
  • severe itching and burning,
  • pain during bowel movements and any tension.

Symptoms and manifestations

Patients often skip the initial form of combined hemorrhoids. For her typical problems with stools, alternating constipation and diarrhea.

There is a general deterioration in well-being, weakness, apathy, insomnia, and a deterioration in appetite. At this stage, vein dysfunction is almost invisible. Some patients note an unusual tuberosity in the anus, however, in a relaxed state, the sphincter looks quite normal.

Palpation also does not produce results. During bowel movements, bloody stains are found on paper, but patients do not feel pain and discomfort.

The doctor at the first stage is very rarely consulted, moreover even a detailed examination does not always show the onset of the disease. In the absence of help, hemorrhoids progresses.

Due to the proliferation of internal nodes, the lumen of the rectum narrows, the mucous membranes are often injured. Patients are increasingly finding drops of blood in the feces, on linen, on the walls of the toilet.

Defecation is accompanied by pain; at rest, the patient suffers from severe itching and burning in the anus. External edema, redness, cracks in the anus occur.

On palpation, mobile cones of different sizes, concentrated at the anus, are easily palpated. When energized, the nodes protrude and cause discomfort.

An ultrasound examination clearly shows changes in the rectum, nodes also appear under the mucosa. It is at this stage that patients go to the doctor and begin comprehensive treatment.

  • Detailed description of the various stages: first, second, third, fourth,
  • Features of the internal course of the disease and external manifestations,
  • The list of medicines, suppositories and ointments that are used in the treatment of this disease can be found here.

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Features of the course of the disease

In some cases the first stages proceed without visible symptoms. With increased elasticity of the venous walls, rectal bleeding is not observed, minor injuries quickly heal.

Patients solve the problem of constipation by laxative, and frequent ailments and a general deterioration in health are attributed to age or fatigue.

Without proper treatment, the development of hemorrhoids continues and gradually passes into the irreversible stage, which is especially dangerous when combined.

Hidden bleeding is fraught with anemia, the formation of internal adhesions and blood clots. Untreated wounds become a source of infections, tissue necrosis, purulent fistula occur.

Deep gaps do not lend themselves to conventional therapy, they cannot be cured by external means. A weakened body is not able to independently resist the disease, there are complications that require separate treatment and the use of potent drugs.

Now that you know a lot more about combined hemorrhoids, treatment is the next topic we would like to cover in this article.

Mixed Disease Treatment

The complexity of treating combined hemorrhoids is the need for simultaneous exposure to external and internal nodes. Different forms of medication are needed for therapy, they must be used simultaneously or alternated according to a specially developed scheme.

So, how to treat combined hemorrhoids? Usually, the doctor prescribes a complex of drugs, which includes:

    Painkillers. They stop strong attacks, soothe, relieve hypertonicity of the intestinal walls, improving stool separation.

Timely applied non-steroidal drugs eliminate itching and burning, improve the general well-being of the patient.

At an early stage, tablets, rectal suppositories and ointments are effective, with more advanced forms, novocaine or lidocaine blockades, hormonal injections and other potent drugs are used. Venotonics and anticoagulants. Particularly effective tablets and capsules taken orally.

Rectal suppositories and microclysters work well on internal injuries, external nodes and cracks are treated with ointments, creams, lotions and bathtubs. With extensive lesions of the skin and mucous membranes, antibiotic injections are used.

With hemorrhoids running, more effective measures have to be applied. Minimally invasive techniques, such as ligation of large knots or their ligation with latex rings.

External nodes can only be removed online. They are excised with a scalpel or laser, followed by suturing with or without it.

What to look for?

When treating mixed hemorrhoids, it is important not only to relieve the symptoms of the disease, but also to eliminate the cause of the disease. If this is not done, the disease will return in a few months.

Reducing pain and the disappearance of prominent protruding nodes does not mean that the problem is defeated. During therapy, the doctor should periodically conduct detailed examinations with a probe of the nodes and determination of their size, at least 1 time in 3 months, ultrasound examinations are needed.

With frequent bleeding and increased fragility of blood vessels, a general blood test should be done regularly to quickly diagnose anemia.

For a more effective treatment lifestyle adjustments needed. A gentle diet is recommended for the patient, helping to reduce weight and eliminate the problem of constipation.

Important is the complete rejection of nicotine and alcohol, a full night's sleep, and the absence of stress. It is necessary to increase motor activity, avoiding overstrain. Good habits will help to eliminate additional risk factors and guarantee a speedy recovery.


Combined hemorrhoids are a complex disease that requires complex treatment. The earlier the disease is diagnosed, the greater the chance of a complete cure without complications and relapses.

Therapy should be carried out by a doctor, in severe cases, surgery may be possible with a long recovery period.

Reasons for the appearance

  • pregnancy, childbirth,
  • increased physical activity,
  • overweight,
  • low mobility
  • inflammation of the rectum,
  • phlebeurysm,
  • pathological changes in the vessels of the anal canal,
  • violation of microcirculation in the pelvic organs,
  • stretching of the sphincter of the anal canal.

Features of mixed hemorrhoids of the second stage

Mixed hemorrhoids of the 2nd degree is characterized by the addition of new symptoms and a deterioration in overall well-being. If at first the disease proceeds almost imperceptibly, then the second and third stages of the disease are fraught with the appearance of bleeding and loss of internal hemorrhoids.

Mixed hemorrhoids of the second degree can have a chronic course and may worsen. Remission is the period of time when the hemorrhoids stop disturbing and causing discomfort. With exacerbation, a pronounced manifestation of the symptoms of the disease occurs - the inflammatory process is accompanied by pain, burning, swelling of hemorrhoidal formations.

After bowel movement, blood is observed on toilet paper, the bumps begin to bleed and anal fissures appear. At the second stage of the disease, hemorrhoidal nodes fall out, but they can be corrected independently.

Features of mixed stage 3 hemorrhoids

The weakness of the vascular walls leads to the fact that in the third stage of the disease, the hemorrhoidal nodes cease to settle on their own. Hemorrhoidal necrosis develops, pain, burning and itching in the anal canal intensify. Chronic disease is accompanied by anal bleeding, which leads to the development of anemia in the body. Blood clots and mucus are periodically released from the anus. Pain in the last stages of the disease can be ongoing and quite intense.

Diagnosis of mixed hemorrhoids includes methods such as anoscopy and sigmoidoscopy. Such examinations of the rectum allow you to clarify the location of hemorrhoidal formations, their structure and their condition. Sometimes the nodes can be located very high in the anal canal, therefore, they can only be detected using the appropriate examination using diagnostic methods.

In the case of refusal of drug therapy, the inflammatory process continues to actively develop. Sometimes the condition of a sick person requires urgent surgical intervention. Mixed hemorrhoids require proper and timely treatment. Medication in the initial stages will avoid the development of many serious complications.

Features of mixed stage 4 hemorrhoids

Doctors can prescribe a hemorrhoidectomy for a 4th degree disease. This is a rather serious operation, after which a long rehabilitation period is required. Hemorrhoidectomy involves the complete removal of hemorrhoidal nodes, however, intestinal tissue is not sutured.

Since the wounds heal independently, it is very important to take the prescribed medication after surgery.

Surgeons can perform closed hemorrhoidectomy, in which the tissues are sutured, which greatly facilitates the recovery period.

Further treatment with prescribed drugs allows you to completely restore the tissue of the anal canal and rectum, and also to avoid various complications after surgery.

Complications after surgery for combined hemorrhoids

Using tampons and drains, surgeons stop bleeding, but this can cause discomfort. If the inconvenience lasts more than 3 days, you should inform your doctors about this.

On the first day, it is best not to eat food. This is due to the fact that food can damage the seams. On the second day, you need to eat food fractionally, while you should not forget about the drinking regimen.

Unfortunately, in some cases, complications may appear after removal of combined hemorrhoids:

  • The psychological problem associated with the fear of defecation,
  • Bleeding. It can happen if the seams are open,
  • After an incorrect operation, the anal canal becomes narrow. In this case, you need a second intervention,
  • Inflammation. Occurs when hygiene rules are not followed.

It is important after surgical removal of cavernous cones to be under medical supervision for at least one week. If necessary, a photo is taken to compare the results.

Prevention of combined hemorrhoids

First of all, it is recommended to normalize your diet. To understand which foods are best suited, you should look at the group of chronic combined hemorrhoids.

Thanks to proper nutrition, the gastrointestinal tract function will be restored. The bowel movement normalizes, after which the patient will be able to normally use the toilet.

Hygiene measures play an important role. After visiting the toilet, it is recommended to use soft toilet paper or tissue. It will also be useful to rinse with chilled water to relieve swelling of the cavernous nodes and pain.

When the first symptoms of combined hemorrhoids appear, it is strictly forbidden to lift weights. It is also recommended to reduce physical activity.

It should be noted that chronic combined hemorrhoids can occur both in men and in the fairer sex. The only difference may be in therapy if the woman is pregnant. In this case, doctors should carefully plan the treatment regimen.

Most often, cavernous sac prolapse is the beginning of serious diseases such as cancer.

Combined (mixed) hemorrhoids: symptoms and treatment

A mixed type of hemorrhoids is a disease characterized by the appearance of external and internal hemorrhoid cones. At an early stage, it does not have specific symptoms, therefore it is found in a neglected form. Hemorrhoids are dangerous for the development of complications, so it must be eliminated in a timely manner.

A mixed type of hemorrhoids is a disease characterized by the appearance of external and internal hemorrhoid cones.

1 degree

At this stage, it is almost impossible to recognize the disease, because it has no specific manifestations. Perhaps the appearance of minor pain in the anus during the passage of solid feces. The asymptomatic course of the disease is quite common.Grade 1 hemorrhoids can be cured by conservative methods.

2 degree

Stage 2 hemorrhoids is characterized by an increase in the intensity of symptoms. Itching and burning occur after each bowel movement, pain develops during physical exertion, prolonged sitting, walking.

After visiting the toilet, there is a feeling of incomplete bowel movement.

Spotting from the anus becomes more profuse. Their nature depends on the degree of damage to the dilated vessel.

In the second stage of hemorrhoids, the pain syndrome develops with prolonged sitting.

3 degree

Pain in the anus at the 3 stages of hemorrhoids is constantly present. It is combined with persistent itching in the anus caused by leakage of the contents of the rectum.

Unpleasant sensations intensify after the act of defecation. Pain extends to the navel and lower back. Knots fall out when coughing, sneezing, weight lifting.

Spotting becomes abundant, which leads to the development of anemia.

4 degree

Stage 4 mixed hemorrhoids is characterized by the appearance of the following complications:

  • intense pain that prevents a person from sitting, walking and defecating,
  • heavy bleeding that threatens the patient’s life,
  • hemorrhoidal vein inflammation,
  • spasm of the anal sphincter,
  • intoxication of the body, accompanied by an increase in body temperature,
  • fecal delays,
  • pinched hemorrhoids,
  • blockages of the rectal veins.

Stage 4 mixed hemorrhoids is characterized by the appearance of elevated body temperature.

Internal and external hemorrhoids

Inflammation of the hemorrhoids can occur inside and outside the rectum. What are their differences, let's figure it out.

External hemorrhoids have a non-aesthetic appearance and are determined visually. May be under the skin or outside the anus. With exacerbation, severe pain and bleeding occur. It is treated conservatively and surgically.

Causes of combined hemorrhoids

A manifestation of hemorrhoids is the appearance of hemorrhoidal nodes, or rather, a significant increase in their size.

In this case, a person may experience unpleasant discomfort in the anus, as well as pain and bleeding during bowel movements.

Combined hemorrhoids appear for the same reasons as internal and external hemorrhoids, just with a combined form, the processes are parallel on both sides of the anus.

The main causes of hemorrhoids are usually attributed to:

  • Violation (for various reasons) of blood circulation in the pelvic area,
  • Pregnancy, as well as childbirth,
  • Excessive physical activity, most often associated with weight lifting,
  • Malnutrition, causing chronic constipation,
  • Hepatitis C
  • Overweight and obesity,
  • Low physical activity and a sedentary lifestyle,
  • Hereditary tendency to varicose veins,
  • Alcohol abuse
  • Addiction to anal sex.

Combined hemorrhoids appear in humans and for a long time they simply do not notice. However, over time, the disease gains strength and begins to bring a lot of trouble.

By the nature of the course, combined hemorrhoids are divided into chronic and acute forms.

In the acute phase, all symptoms appear with particular strength and frequency, however, over time, the disease can go into a less acute phase and even remission can be observed, but inevitably a new acute phase will come and everything will start again.

  1. First stage. Almost imperceptible and manifests itself only in a slight sensation of discomfort in the anus, especially discomfort is noticeable during bowel movements,
  2. Second stage. The appearance and prolapse of hemorrhoids begins. Not only itching and burning appear, but also a feeling of pain and even slight bleeding,
  3. In the third stage Hemorrhoidal diseases begin to fall out often, even with moderate physical exertion. The nodes are set, but the pain is no longer weak. Bleeding becomes more frequent and more severe
  4. Fourth stage characterized by prolapse of hemorrhoidal nodes and the impossibility of their reposition without assistance. Treatment in this case is possible only with the help of surgery.

Combined hemorrhoids of the 2nd degree

Often during defecation, blood or anemia appears, which literally plunges a person into shock, which is often replaced by panic. The first bumps appear in the area of ​​the anus. These are hemorrhoidal nodes, with combined hemorrhoids, exactly the same nodes, and sometimes more clearly expressed, also formed inside the rectum in the region of the anus. Constant burning and severe itching in the region of the anus, together with pain, do not allow the patient to move normally.

According to doctors, at this stage hemorrhoids are easiest to stop.

This will require conservative treatment and in 90% of cases it is enough that all the symptoms disappear and the person returns to normal life.

If we hope that everything will "resolve" by itself or hope for the effectiveness of self-medication, then combined hemorrhoids will necessarily go into their regular third stage of development.

Combined hemorrhoids of the 3rd degree

These bleeding are quite capable of provoking the development of anemia in the patient and thereby further aggravate the situation. Nodes can still be adjusted on their own or with a little help. At this stage, conservative treatment is not always effective. In most cases, surgery along with conservative treatment may well put a person on his feet and even forget about the nightmarish hemorrhoids over time. However, it is not worth delaying an appeal to a coloproctologist, since combined hemorrhoids quickly move to their fourth stage.

Developmental stages

Mixed hemorrhoids has the following stages of development:

  1. 1 degree. It is characterized by the absence of severe symptoms. Diagnosing it is quite difficult due to the lack of complaints in the patient. Inflamed nodes during the initial examination is not detected.
  2. 2 degree. A distinctive feature is the likelihood of a straight bump falling out during bowel movements and during increased physical exertion. At this stage, the patient begins to experience discomfort.
  3. 3 degree. Hemorrhoidal nodes fall out during the passage of feces, carrying weights and increasing intra-abdominal pressure. It is not possible to restore the dilated vessels to their previous position. Symptoms of hemorrhoids intensify, severe bleeding appears.
  4. 4 degree. External nodes are constantly present, signs of clogging and infringement appear, and health complications develop.

Combined hemorrhoids of the 4th degree

The fourth stage is the most neglected state. This stage is characterized by the fact that the remission phase is almost completely absent. The nodes fall out on their own, and it is impossible to insert them into their place without outside help. The nodes bleed constantly.

severe pain, and going to the toilet seems to the patient a real torture. Due to prolapse of nodes, numerous erosions appear.

In some cases, a person ceases to control gas evolution. Often, feces are also released spontaneously. A particular problem may be formed by blood clots, it is they that can lead to death at any time. It is simply impossible to delay the treatment of hemorrhoids in the fourth stage. This is not only a lot of inconvenience, but also a direct threat to health and even life.

Reasons for the development of pathology

Chronic combined hemorrhoids develop under the influence of the following factors:

  1. Frequent constipation. They contribute to stagnation of blood in the pelvis, which is why the veins of the rectum expand and begin to fall out.
  2. Sedentary lifestyle. The combined form of the disease is often diagnosed in people with sedentary work. The risk group includes adolescents spending most of the day at the computer.
  3. Excess weight. It provokes a violation of the functions of the digestive system, increases pressure on the walls of blood vessels.
  4. Excessive exercise. The loss of hemorrhoids contributes to the wearing of weights.
  5. Pregnancy. The growing uterus presses on the pelvic organs, because of which the blood in the vessels stagnates. Heavy labor is provoked by the formation of external hemorrhoid cones.
  6. Genetic predisposition. The hemorrhoids themselves are not inherited, but the structural features of the vessels that cause this disease.
  7. Improper nutrition. The flow of blood to the veins of the rectum contributes to the use of spicy food and alcoholic beverages.
  8. Anal sex.
  9. Psycho-emotional overload. It is proved that constant stress negatively affects the state of the whole organism. They suppress immunity, increase the risk of chronic diseases.

Manifestations of mixed hemorrhoids

Combined hemorrhoids appear in the patient imperceptibly. Therefore, patients are already seeking help with a chronic form. This ailment in its chronic form also has two phases - this:

Phases alternate, replacing each other.

Symptoms of the disease

The clinical picture of combined hemorrhoids largely depends on its phase - remission or exacerbation. In the acute period, the patient complains of:

  1. Itching and burning in the anus, which arise due to the constant allocation of intestinal contents against a background of decreased tone of the anal sphincter. Sometimes they become so intense that a person begins to experience inconvenience when walking and sitting on a hard surface.
  2. Bleeding. In the early stages, they are mild - the patient pays attention to the presence of blood marks on the toilet paper. With the further development of hemorrhoids, severe bleeding begins to occur regardless of bowel movements. If several nodes are damaged, they are plentiful.
  3. A feeling of heaviness in the lower abdomen.
  4. Foreign body sensation in the rectum. The appearance of this symptom is facilitated by increasing internal nodes.
  5. Prolapse of hemorrhoid cones. In the early stages are set in place manually. If the node went outside at least 1 time, a similar situation will be repeated constantly.
  6. Pain in the rectum. At first it intensifies during bowel movements, in the late stages of hemorrhoids it torments the patient constantly. Often gives to the abdominal organs.

During remission, the following symptoms are observed:

  • weak burning in the anus, which does not cause inconvenience,
  • the feeling of a foreign body in the rectum is less intense than during an exacerbation,
  • the presence of small hollow formations in the anus, remaining in place of inflamed hemorrhoid cones.

Patients do not pay attention to the first signs of hemorrhoids or get rid of them with folk remedies. This contributes to the transition of the disease into a neglected form, in which it is painful to sit and walk.

Therapeutic measures

Treatment of combined hemorrhoids can be carried out using:

  • medicines
  • minimally invasive techniques
  • folk remedies
  • surgical interventions.

The choice of therapeutic technique depends on the form and stage of hemorrhoids. The drug treatment regimen includes:

  1. Rectal suppositories (Natalsid, Relief, Proctogenesis). They have analgesic, anti-inflammatory and healing effects. They are administered 1 time per day before bedtime. The course of treatment is 10-14 days.
  2. Ointments (Proctosedyl, Ultra-proct). External hemorrhoidal nodes are being treated. The signs of inflammation are eliminated, the healing of anal fissures is accelerated.
  3. Venotonics (Troxevasin, Detralex).Regular intake of tablets helps strengthen the walls of blood vessels, prevents the expansion of the veins of the rectum.
  4. Anticoagulants. They prevent the appearance of blood clots, restore blood circulation in the pelvic organs.
  5. Hemostatic drugs (Vikasol, Ditsinon). Used to relieve persistent rectal bleeding.
  6. Antibacterial ointments. Prevent the attachment of secondary infections, accelerate the healing process.

Minimally invasive surgery is prescribed for the 2-3 stages of hemorrhoids, characterized by frequent prolapse of the nodes. The most effective are:

  1. Sclerosis. The method is used in the early stages of the disease. A drug is introduced into the cavity of the hemorrhoid that promotes the formation of connective tissue. Stopping blood supply helps to reduce the size of the cone.
  2. Ligation with latex rings. The procedure is prescribed for patients suffering from advanced mixed hemorrhoids. It is highly effective and has a short recovery period. The leg of the hemorrhoidal node is pinched by the ring, due to which the tissues die and are torn away.
  3. Infrared photocoagulation. It is indicated for heavy rectal bleeding in the early stages of hemorrhoids. During the procedure, the tissue dies, subsequently the node is rejected. For 1 session, you can get rid of 1-3 cones.
  4. Cryodestruction. Tissues are frozen with liquid nitrogen, as a result of which they die. The procedure is safe and painless, subsequent healing proceeds without scarring of tissues. It can be used at any stage of the disease.
  5. Electrocoagulation An electrode is applied to the leg of the hemorrhoidal node, which cauterizes tissue from 2 sides. The method does not exclude the repeated loss of a cone, therefore it is prescribed when it is impossible to use more effective methods.
  6. Radio wave exposure. The breakdown of tissues is achieved by increasing the temperature, while the device itself does not heat up, so the patient does not experience unpleasant sensations. The method has a low risk of developing complications.

Hemorrhoidectomy is used in 4 stages of hemorrhoids, complicated by pinching or thrombosis of the nodes. During the operation, a section of the rectal mucosa lying above the dilated vessel is dissected. Relapses of hemorrhoids after hemorrhoidectomy are rare.

Which doctor should I go to

In a clinic with hemorrhoids problems, they are referred to a coloproctologist.

As a rule, this doctor is one of the most qualified doctors working in the clinic, because in order to become a coloproctologist, the doctor must master surgery, anesthesia and therapy.

If there is no coloproctologist in the clinic (this may well be), then you should consult a physician or surgeon who will provide the necessary advice and prescribe treatment.

Folk methods

There are several folk recipes that can alleviate the condition of the patient with mixed hemorrhoids:

  1. Cold baths. Used for bleeding and severe pain. The basin is filled with cold water and sit in it for several minutes. The procedure is carried out 1-2 times a day.
  2. Compresses of red beets or potatoes. The vegetables are grated, the resulting slurry is laid out on cheesecloth. Compress hold 2-3 hours. It is not recommended to use in the presence of anal fissures due to possible infection.
  3. Chamomile candles. 1 tbsp. l herbs pour 200 ml of water, boil for 10 minutes, cool and filter. The broth is poured into molds resembling pharmacy suppositories in shape. Ready candles are inserted into the anus 1-2 times a day. The tool eliminates pain and swelling.
  4. Honey candles. They are made from candied honey and inserted into the rectum.

What is combined hemorrhoids

Depending on the location of hemorrhoidal nodes, external, internal and combined hemorrhoids are distinguished.

With the appearance of the disease, hemorrhoid plexuses are located under the skin near the anus. The internal type is characterized by the location of the nodes under the mucosa in the rectum. With the combined form of the disease, the cones are located in the lumen of the intestine and outside.

The course of combined hemorrhoids is practically more severe than with any other type of hemorrhoids. This is mainly due to the chronic nature of the disease and the spontaneous alternation of periods of exacerbation and remission. For example, internal hemorrhoids may be in remission, and external, on the contrary, become inflamed and cause discomfort.

Perhaps a one-time inflammation of the external and internal nodes. Symptoms in this case are complex. Exacerbations of the pathology can be detected by signs inherent in both types of disease.

  • In most cases, combined hemorrhoids develop in stages, which causes difficulties in detecting problems at the initial stage.

  • The first signs of combined hemorrhoids include a slight feeling of inconvenience in the rectum or a feeling of a foreign object in it. The main signs of this type of hemorrhoids include:
  1. Bleeding. Traces of blood are fixed on feces outside or on toilet paper after defecation. The intensity of bleeding increases in the last stages of the pathology.
  2. Itching and burning in the anus. The condition is fraught with the appearance of irritation around the anus, due to combing of itchy areas. Irritation and itching can also occur as a result of the release of mucous fluid from the anus.
  3. Pain sensations of different intensity. Pain appears mainly during an exacerbation of chronic combined hemorrhoids.
  4. The formation of hemorrhoidal nodes around the anal canal. The nodes can have different sizes, depending on the phase of the disease, they can be seen with the naked eye. The bumps are elastic to the touch. During remission, the nodes look like skin bags or deflated balls.

A patient with combined hemorrhoids constantly feels discomfort - due to a symptom. Pain and discomfort prevent him from living an everyday rhythm.

Diagnosis of ailment

For the diagnosis of combined hemorrhoids, a patient survey and an external examination of the anus are used. These are the same tools that doctors use to diagnose any type of hemorrhoids.

It is worth noting that a good specialist conducts differential diagnosis, given the fact that many of the symptoms may be similar to the symptoms of oncological diseases.

Also, an experienced proctologist can send for an additional examination to accurately diagnose the patient.

It should be remembered that it is necessary to contact the proctologist in time for help. This will help you overcome the disease with less effort and in a shorter time. Also be aware that chronic hemorrhoids can go from a common disease to cancer (colorectal cancer).

Combined hemorrhoids of the 2nd degree: course of the disease and symptoms

The older a person is, the higher the risk of getting hemorrhoids. A feature of intestinal varicose veins is that at first it practically does not cause discomfort, and a person may not pay attention to the disease for a long time.

  • Pain during bowel movements.
  • Isolation of blood or anemia from the anus.
  • Severe itching in the perineum, a burning sensation is possible.
  • A person may experience discomfort when walking or other physical activity.

The peculiarity of internal hemorrhoids is that it is more dangerous than external. A person for a long time may not notice problems, and thus, internal hemorrhoids can first develop into chronic, and after that into combined hemorrhoids. If the course of the disease is not stopped in time, then the next stage awaits the patient - combined hemorrhoids of the 3rd degree.

Combined hemorrhoids of the 3rd degree - symptoms of the disease, treatment

If at the second stage of hemorrhoids the patient still does not feel severe pain and discomfort, then the third stage is already making itself felt in all its glory. The constant itching in the perineum, the painful act of bowel movements, streaks of blood in the feces - all this suggests that the disease is progressing.

Hemorrhoidal nodes significantly increase in size, become inflamed and bleed. Often, under their pressure, they fall out, and you have to set them yourself. In connection with the constant bleeding of the patient, hemorrhoids can be accompanied by a serious complication - anemia. Therefore, it is not worth delaying - it is better to consult a doctor immediately.

Complications and Prevention

Combined hemorrhoids can be complicated by the following pathologies:

  1. Thrombosis of hemorrhoids. The patient experiences severe pain, the tissues of the rectum swell, hard bumps appear that cannot be repaired.
  2. Bacterial infections Mixed hemorrhoids are often accompanied by anal fissures, which are the entrance gate for pathogenic microorganisms. In this case, purulent discharge, itching and burning appear in the anus.
  3. Paraproctitis. With this disease, suppuration of the tissues surrounding the rectum is observed. The causative agents of infection are streptococci, staphylococci, E. coli.

With this disease, there is severe blood loss that occurs with heavy bleeding, which is difficult to stop.

Prevention of hemorrhoids is the exclusion of factors leading to circulatory disorders in the rectum. You need to eat right, timely eliminate constipation, lead an active lifestyle. After bowel movements, use soft toilet paper and wash thoroughly to prevent the possibility of infection of damaged tissues.

Symptoms and treatment features of combined hemorrhoids

Depending on where the inflamed hemorrhoids are located, the external, internal and combined hemorrhoids are secreted. In the first case, the plexuses are located under the skin around the anal canal, in the second - under the mucosa in the rectum. In the combined form of the disease, they are located in the lumen of the intestine and outside.

In the combined form of the disease, they are located in the lumen of the intestine and outside.

Chronic combined hemorrhoids - causes and period of remission

With the complete absence of treatment, hemorrhoids develop into a chronic form. Usually it is characterized by two stages that alternate with each other:

1. The period of exacerbation. The patient feels pain and discomfort in the anus, hemorrhoidal nodes become inflamed and can fall out.

2. The period of remission. Our body is able to repair itself, small cracks gradually heal, therefore, pain also passes. However, the problem itself does not disappear. In the absence of treatment, with an improper lifestyle and heavy physical exertion, a period of exacerbation begins again.

Important! The course of chronic hemorrhoids never ends in one stage. The disease progresses, therefore, each time the patient will feel only worse. Chronic combined hemorrhoids in the last stages can be cured in only one way - surgical intervention.

Combined hemorrhoids of the 4th degree - you can not do without the help of a doctor!

Consider the last, most advanced, stage of hemorrhoids. This is a pathological condition in which the patient no longer has periods of remission. It is not difficult to diagnose combined hemorrhoids of degree 4 - hemorrhoidal nodes fall out, while it is impossible to correct them yourself.

The patient is haunted by constant discomfort, the quality of life is significantly reduced.A person becomes apathetic and weak due to the fact that he is tormented by incessant pain and bleeding. Bowel movement turns into real torture.

In addition, numerous erosions in the anorectal region may appear - this is due to the loss of hemorrhoidal nodes.

Hemorrhoids of stage 4 may be accompanied by involuntary secretion of liquid feces, a person can not control the release of gases.

Due to the fact that the dropped nodes fall out, blood clots may appear. And if with stage 3 of mixed hemorrhoids such a condition is a complication, at the final stage of blood clots is a pathology.

Unfortunately, if the disease has reached a critical point, the patient has no chance to recover using conservative healing methods. Turning to the doctor, be prepared for the fact that you will be prescribed surgery.

And the sooner they conduct it, the better.

Treatment methods for the last stage of hemorrhoids

As a rule, with advanced cases, doctors consider a method of hemorrhoidectomy according to Milligan-Morgan or Longo. Both operations are quite complicated, and the rehabilitation period will take at least 2 months.

Hemorrhoidectomy is divided into two types - open and closed. In the first method, the nodes are removed, but the edges of the tissues are not sutured. They heal independently, and it is very important to use medication in order to avoid inflammation and infection of the wound. A significant drawback of open hemorrhoidectomy is soreness and frequent bleeding.

In addition, wounds may not heal for a long time. Currently, doctors prefer to use closed hemorrhoids; in this case, the edges of the wound are sutured.

The recovery period is significantly reduced, but, nevertheless, the patient is still prescribed concomitant medication to avoid complications.

After removal of the hemorrhoidal nodes and their complete healing, the disease, as a rule, passes without a trace.

Possible complications after surgery to remove hemorrhoids

The first days, almost immediately after the patient departs from anesthesia, severe pain will torment him. In order to stop them, doctors use potent analgesics. Also, tampons and drains that the doctor introduces after surgery to stop bleeding can cause some discomfort.

It is very important to follow a special diet.

On the first day, the patient is recommended starvation - due to the fact that immediately after surgery to empty the intestines is extremely undesirable - the edges of the wound are fresh, the sutures can separate, which will entail complications. On the second and third day, the patient is recommended to observe the drinking regimen, eat fractionally. Food must be thoroughly chopped.

If all the instructions of the doctor are not followed, the patient may experience the following complications:

  • Bleeding. As a rule, it occurs due to a violation of the integrity of the seams or slipping off the ligature.
  • Psychological problems - fear of bowel movements. In such cases, the patient is prescribed mild laxative drugs.
  • If the operation is not performed correctly, the anal canal may narrow. The problem is serious, sometimes it requires repeated surgery.
  • Inflammatory processes. Often develop in case of refusal of drug therapy and non-compliance with hygiene rules.
  • If the musculo-ligamentous apparatus was damaged during hemorrhoids, the patient may suffer from fecal and urine incontinence. This complication is extremely rare.

It is very important after surgery is under the supervision of a doctor. From the foregoing, only one conclusion can be drawn. Hemorrhoids are a disease that requires timely treatment!

Combined hemorrhoids (2, 3 degrees): chronic, treatment (surgery, removal), reviews

In total, there are three types of hemorrhoids - external, internal and combined. This disease is located in class IX according to ICD 10 and has a code of 184.

Internal hemorrhoids can be a harbinger of external hemorrhoids, its initial stage. It is located inside the rectum and is invisible during examination. Bleeding can occur with trauma to the nodes, which occur, as a rule, during bowel movements.

In total, there are three types of hemorrhoids - external, internal and combined.

The patient can not immediately determine what he is dealing with hemorrhoids: pain is present inside the rectum, but there are no external manifestations.

The patient can detect external hemorrhoids on his own, since the hemorrhoidal nodes have come out and are under the anus. In this case, the pains are unexpressed, and bleeding occurs more often with exacerbations, when there is an infringement of the nodes. In addition to pain, a person experiences a burning sensation and itching.

Stages of hemorrhoids

A total of 4 stages of hemorrhoids:

  1. At the first stage, hemorrhoids do not fall out, and although it can manifest itself as bleeding, often a person does not notice a problem.
  2. The second stage of hemorrhoids. Hemorrhoidal nodes fall out during bowel movements, with straining. Forwarded independently.
  3. The third stage is decisive. Nodes can only be set with your fingers.
  4. Nodes fall out at rest, it is practically impossible to shove them back, since they immediately fall back.

At the first stage, hemorrhoids do not fall out, but the disease can manifest itself as bleeding.

Chronic combined hemorrhoids of the 3rd degree are dangerous, but not only because if the disease is not cured in time, it will go into the last, serious form, but also because this stage has a number of complications.

For example, when the leg of the hemorrhoid is infringed, severe pain is felt. Hemorrhoidal vein thrombosis is generally an indication for hospitalization.

In case of infection, and this is very possible in the presence of nodes, anal fissures, fiber inflammation can occur, this disease is called paraproctitis.

Chronic combined hemorrhoids are treatable in the second stage. It is difficult not to notice it, because slight pain or a sensation of a foreign body in the rectum can already be felt. Itching and burning are also possible.

The most common mistake is that patients do not consider the problem serious, and believe that they can cope without a doctor. Often this results in the fact that combined hemorrhoids of the 2nd degree go into the third degree due to improper treatment.

After exacerbations of the disease, remission of hemorrhoids also occurs. The course of the disease at this moment slows down, the symptoms subside, and the feeling of pain, if it was, becomes dull or goes away altogether.

Remission is not a victory over the disease at all, therefore it is necessary to continue to stick to the diet, to abandon the habits and lifestyle that led to the disease itself.

Remission is not a victory over the disease at all, therefore it is necessary to continue on a diet.

Hemorrhoid treatment

Features of the treatment of hemorrhoids depend on the degree of the disease. Obviously, when the disease acquired a chronic nature and went into the 4th degree, treatment in a conservative way alone will not help.

Medicine does not stand still, and there are many ways to help the patient.

In our country, hemorrhoidal prolapse is treated with surgical treatment in 75% of cases, a frequent method is Milligan-Morgan surgery, which involves removing the nodes and is prescribed for chronic combined hemorrhoids, starting from grade 3 of the disease.

Hemorrhoidal prolapse is treated with surgical treatment in 75% of cases.

Two modern ways

Another common type of surgery for hemorrhoids is ligation of hemorrhoidal nodes with latex rings.Simply put, the ring is put on the leg of the node, and thereby the flow of blood and nutrients to the node is stopped.

Under such conditions, the nodule dies, after which the body rejects it along with the latex ring.

A method such as knockdown is also used. The essence is similar to the first method, but more technological. With the help of ultrasound, the doctor finds the artery, crosses it, after which the node ceases to receive food and dies.

The advantage of this method is that healing is faster. The entire process takes no more than 30 minutes, although the total number of arteries that feed the node can reach 6 or more.

  • lack of pain
  • after the procedure there are no wounds left,
  • can be used at any stage if the nodes have already climbed out,
  • there is no risk of relapse if the operation is performed correctly.

There are no contraindications to this procedure, it is more often prescribed if a patient has combined grade 3 hemorrhoids, however, she also has certain disadvantages. In particular, the price.

The advantage of the deserterization of hemorrhoids is that healing takes place fairly quickly.

The operation is technological and requires the work of a qualified doctor, therefore, the cost of work increases. After all, if the doctor makes a mistake, does not notice at least one artery and does not block it, then the nodule will continue to receive nutrition, as a result, a relapse occurs.

Whatever method of treatment you use, treatment of combined hemorrhoids can have a number of complications.

Even the most gentle methods do not guarantee the absence of side effects. Fear of proctologists cause bleeding, which is possible with any method of treatment. It is impossible to exclude that a wound infection will occur, therefore, after surgery, a course of antibiotics for hemorrhoids is sometimes prescribed.

But all these operations concern advanced cases. In the first two stages, hemorrhoids respond very well to conservative treatment.

Nevertheless, patients with chronic combined hemorrhoids, located at 2 degrees, only an integrated approach helps, so you need to start taking medications.

If the patient is very worried about itching, burning, then you should start using anti-inflammatory drugs, for example, suppositories Hepatrombin G, Prostopin or Relief Ultra, which, moreover, have anesthetic effect.

In addition to suppositories, ointments can be used, for example, Hepatrombin G, heparin ointment or Bezornil. All of them contain the substance heparin, which will help to cope with burning, swelling, blood clots.

Pregnant women should not use ointments, suppositories and other drugs containing heparin in the first trimester of pregnancy, as this can harm the fetus. Their use is possible starting from the second trimester of pregnancy.


The benefits of physiotherapy for patients with hemorrhoids have never been in doubt.

Restoring blood circulation, reducing stagnation of blood in the pelvic organs, strengthening intestinal motility, strengthening the muscles of the abdominal press, especially the pelvic diaphragm, improving the general condition of the patient, the disappearance of hemorrhoidal nodes and bleeding - all these are real results of correctly applied physiotherapy exercises for hemorrhoids.


A fairly popular and effective method that has proven effective. Use birch baths, smoke baths with onions and garlic, as well as with propolis.

Birch leaves have essential oils and tannins that help with wound healing, relieve inflammation and can even stop bleeding.

Propolis helps relieve pain, and if combined with birch baths, it can have a bactericidal effect and relieve itching.

Remember that the treatment of hemorrhoids with folk remedies can help at the initial stage only if it is combined with prescribed medications. Chronic hemorrhoids cannot be overcome by some folk remedies.

What does hemorrhoids of degree 3 look like?

The disease has several forms, the external symptoms are somewhat different in each of them.

  • Internal hemorrhoids is characterized by the development of pathology on the inner wall of the sphincter. Nodes gradually increase in size, but are not visible from the outside. They can be seen by a specialist during an instrumental examination, or by a person himself, when the nodes already begin to fall out. Internal hemorrhoids are accompanied by severe pain during bowel movements, bleeding, a sensation of a foreign body inside. Externally manifested by inflammation of the sphincter, deformation, discoloration, the presence of mucus.
  • External hemorrhoids of stage 3 can be seen with the naked eye. The anorectal region becomes inflamed, mucus appears, the sphincter increases in size, is deformed, and a cyanotic color appears. Inflamed hemorrhoidal nodes resembling bumps are visible.
  • Combined hemorrhoids are characterized by an increase in hemorrhoids outside, inside. The most severe form of the disease, requiring different approaches to the treatment of pathology.

The presence of hemorrhoids of stage 3 can be determined by a specialist during a visual examination. But to assess the severity of the disease, an instrumental examination is required.

Is treatment possible without surgery?

The treatment methods for the late stages of hemorrhoids are somewhat different from the first two. External means in the form of a cream, ointment, lotion, suppository are ineffective. They are used only as concomitant drugs on the path to recovery. They relieve the external manifestations of the disease - itching, burning, pain, stop bleeding, but enlarged nodes do not disappear.

However, the operation does not guarantee complete recovery, the absence of relapse. Treatment should be comprehensive.

Enlarged nodes are removed by minimally invasive methods, continue treatment with medicines, folk remedies. In parallel with this, adjustments are made to the lifestyle, nutrition, and normalize the intestines.

Only if there is maximum effort on the part of man can a positive result be achieved.

At home, you can reduce the size of hemorrhoidal nodes in the first stages of the disease. Therapy of more severe forms involves the use of minimally invasive methods, which, in general, can hardly be called an operation.

The procedure is carried out for several minutes under local anesthesia. A person goes home to continue treatment, having received specialist advice.

Therefore, if there is a question about classical surgery with a scalpel, general anesthesia, you can do without it at the 3 stages of hemorrhoids.

Home treatment

It is strictly forbidden to carry out therapy for hemorrhoids at home if the disease has already reached 3 degrees. Hemorrhoids have no particularities to disappear on their own, the lack of qualified treatment leads to a transition to a more severe form of the disease, serious complications.

You can temporarily use medications to stop pain, stop bleeding, and relieve other painful symptoms.

However, a temporary improvement in well-being does not guarantee recovery, it is impossible to postpone with the operation.

Due to some circumstances, minimally invasive methods are not carried out in all cities, a certain amount needs to be collected, it is possible to treat grade 3 hemorrhoids temporarily at home.

The most convenient and effective means for treating internal, external, combined hemorrhoids are candles. In this case, it is necessary to select drugs with anesthetic, hemostatic effect, anti-inflammatory. Preparations on a natural basis in the form of candles from sea buckthorn, calendula will not give the desired result.

We need strong medicines with painkillers, anti-inflammatory, regenerative, astringent effects. These are:

  1. Anuzol
  2. Relief Ultra, Advance,
  3. Proctosed,
  4. Hepatrombin,
  5. Procto-glivenol,
  6. Aurobin.

Suppositories are administered twice a day after bowel movement. The maximum course of therapy is 14 days.

Additionally, you can use funds for external use - cream, gel, ointment. Especially if the increase in hemorrhoids is external.

Most manufacturers produce products for the treatment of hemorrhoids in two forms. Must be combined to obtain a greater effect.

The ointment is applied up to 3 times a day with increased painful symptoms, or after bowel movement with preliminary washing.

Folk remedies

Such drugs cannot relieve stage 3 hemorrhoids, but they relieve the patient of pain, discomfort, facilitate the bowel movement, stop bleeding, and prevent the secondary infection from joining.


The most common treatments for any form of hemorrhoids are sedentary baths. Cold is preferably done in the morning.

Cold stops bleeding, eliminates pain, increases the elasticity of the sphincter muscles. Warm baths are done before bedtime or, if it is impossible, goes to the toilet. Warm water relaxes muscles, normalizes blood circulation.

The procedure must be carried out 20 minutes daily for 14 days.


In second place lotions. Put cheesecloth in several layers, moisten in a decoction of medicinal herbs, or apply oils and grated vegetables. Apply to a sore spot, on top of the cling film, fix with underwear or a plaster. It is preferable to leave overnight. You can apply pharmacy ointment on gauze, then its effect will last as long as possible.

Effective Recipes

In the people there are many remedies for the treatment of hemorrhoids. You can use any.

  • Dissolve potassium permanganate in water, so that the solution turns out a light pink color. Water is used for washing, compresses, sitting baths.
  • Cut a candle from raw potatoes, grease with medical vaseline, insert into the rectum. Grate potatoes on a fine grater, put on cheesecloth, attach to a sore spot in the form of a compress. You can use fresh juice. Also, carrots, beets, viburnum have a healing property.
  • Freeze ice cubes in the form of candles, use to stop pain, stop bleeding.
  • Mix in equal proportions chamomile, calendula, St. John's wort, nettle, thyme, oak bark. Pour boiling water, insist in a closed container for half an hour. The broth is used for sedentary baths, lotions, frozen in molds.
  • Several times a day, lubricate the anus with oil from calendula, sea buckthorn.
  • Mix honey with cinnamon, lubricate the problem area several times a day. Ointment relieves painful symptoms, improves blood circulation.

Alternative drugs as an independent therapeutic agent give a good result only in the first stages of the disease, in this case they are used additionally.

What will happen if you do not consult a doctor on time?

The third stage of hemorrhoids is a serious disease that requires immediate help from specialists. The lack of qualified treatment leads to complications, the transition to the most complex, life-threatening form - the fourth. The last stage of hemorrhoids is treated exclusively by surgery.

  1. The presence of cracks in the anus opens the way for pathogens to enter the intestines. Inflammation progresses, mucus, pus secretion begins, accompanied by an unpleasant odor.
  2. Loss of elasticity of the sphincter leads to uncontrolled excretion of feces. There is irritation of the rectal mucosa, ulcers, erosion, and wounds appear.The passage of feces during bowel movements provokes bleeding of different intensities.
  3. Loss of nodes is dangerous by pinching, thrombosis, tissue necrosis. This situation requires emergency surgical intervention.

Proper nutrition and diet

Bowel disease is becoming one of the most important provocateurs of hemorrhoids. Recurrence of stool disorders, in particular, constipation. To ease the course of the disease, prevent relapse, you must constantly adhere to a diet, eat right.

Products can enhance pain, weaken. You just need to choose the right diet:

  • Exclude fried, spicy, salty, greasy dishes.
  • Eat small meals 6 times a day. Dinner should be no later than 2 hours before bedtime.
  • Refuse alcoholic drinks, carbonated, coffee.
  • Do not eat legumes, cabbage, beer, sweets. These products cause fermentation, bloating.
  • Eat more porridge, vegetables, fruits, drink still mineral water, green tea, dried fruit compote.
  • Sour-milk products improve intestinal function, normalize microflora, and eliminate constipation.

Nutrition plays a very important role in the treatment of hemorrhoids, preventing relapse, and recovering from surgery.

Characteristic symptoms

Combined hemorrhoids begin unnoticed - the chronic form is usually diagnosed, which, in turn, is divided into the acute phase and remission.

In the acute phase, both internal and external nodes become inflamed. Aggravation may not apply to all nodes.

The chronic phase is characterized by mild symptoms or their complete absence. With combined hemorrhoids, thrombosis is a common occurrence.

  • Combined hemorrhoids of the 1st degree are characterized by mild itching and mucus secretion. Patients may complain of insufficient bowel movement and a foreign body sensation.
  • Painful and unpleasant sensations, small traces of blood on toilet paper are characteristic for combined hemorrhoids of stage 2. There is a burning sensation, discomfort during bowel movements.
  • In the third stage, the nodes increase significantly, bleed, which can lead to complications and anemia. Over time, they begin to fall out and it is impossible to manually return them to their normal state.

Patients' reviews of combined hemorrhoids of stage 4 indicate that the disease brings constant discomfort, a feeling of weakness, pain and bleeding, a very painful act of defecation, involuntary discharge of liquid feces, uncontrolled release of gases.

Some signs of combined hemorrhoids are similar to other diseases and pathologies: polyps, cracks, oncological diseases.

Operational and minimally invasive

In the case when conservative treatment does not bring the expected results, modern minimally invasive procedures are prescribed, as a result of which recovery is guaranteed in 80%.

Recommended treatments:

Degree of Disease
Combined hemorrhoids stage 1Vascular strengthening conservative treatment is prescribed, anti-inflammatory drugs, cryodestruction is sometimes prescribed - treatment with the help of cold. Usually the course lasts from one to one and a half months.
Combined hemorrhoids 2 stagesThe nodes are frozen - cryodestruction. If the nodes are small, ligation with latex rings is prescribed.
Combined hemorrhoids 3 degreesFor large cones, the method of thromboectomy or excision by the Longo method is used. Conservative treatment at this stage is ineffective or ineffective.
Combined hemorrhoids of 4 degreesIt is only treated surgically - hemorrhoidectomy or transanal resection is performed.

Symptoms of combined hemorrhoids involving surgery:

  • Heavy bleeding
  • Pinched hemorrhoidal internal nodes,
  • Prolapse of the rectum.

Surgical treatment includes:

  • Freezing cones with nitrogen - when thawing, all plexuses die, and a small wound heals with drugs. In time, the procedure lasts about 5 minutes.
  • Ligation - latex rings are put on the nodes, as a result of a gradual tissue rejection, the process usually lasts 10-15 days. The effectiveness of the method is 90%.
  • Hemorrhoidectomy - removal of combined hemorrhoids by partial excision of the peranal skin and intestinal membrane. After ligation of the cones. Post-treatment relapses are very rare.
  • Transanal resection - stretching up during the operation of hemorrhoids, as a result of a decrease in size, due to a sharp decrease in blood flow. Not indicated for large external cones.

Concomitant decompression diseases (in the final stage of development) found in humans are often considered contraindications for surgical intervention.

Chronic combined hemorrhoids: treatment, symptoms, causes

Treatment of chronic combined hemorrhoids is a whole range of methods to eliminate the causes and symptoms of the inflammatory process.

The disease can be internal or external, but it happens all together

Hemorrhoidal pathology is the most common reason for men and women to consult a specialist - a colopractologist. With such a disease, a change (transformation) of hemorrhoidal nodes occurs.

If the initial stage is easily amenable to medical treatment, then hemorrhoids of the 2nd and 3rd degree often have to be operated on.

Alternative treatment

Folk remedies for hemorrhoids are used in combination with surgical and medical methods. To alleviate the symptoms, sitz baths with a decoction of chamomile, string or oak bark are used. 1 tbsp. l

raw materials are boiled in 1 liter of water, the prepared broth is poured into a basin with 5 liters of warm water, a bath is taken 10-15 minutes. No less effective are candles and compresses from potatoes. The peeled vegetable is rubbed and spread on cheesecloth.

The compress is kept for an hour, after which they are washed with cool water.

Forms and stages of the disease

Distinguish between internal and external hemorrhoids. They differ in the location of the inflammation on the walls of the anus. A combined option is also possible. In this case, inflamed nodes appear both inside the walls of the rectum and outside, around the anus.

The disease can occur in various degrees of severity. More often develops without symptoms, which is dangerous for lost time.

Stages of the disease
Symptoms of the disease
First degreeThere are bleeding, hemorrhoids do not fall out
Second degreeNodes begin to fall out, bleeding is also present. Inflamed nodes themselves are set into the anus.
Third degreeSevere inflammation, bleeding. Hemorrhoidal nodes fall out of the anus, you can remove them only on your own - with your hands.
Chronic stageThe loss of internal nodes without the possibility of their reduction back. Severe inflammation, manifestations of acute thrombosis of blood vessels of the rectum.

How to quickly get rid of external hemorrhoids?

Hemorrhoids are characterized by a gradual development, so its first signs are often ignored. The patient does not pay attention to the primary symptoms, and doctors have to deal with an already developed disease.

The development of chronic combined hemorrhoids can take place with more severe painful sensations than when it occurs only in external or internal form.

This is associated with an uneven alternation of the phases of remission and exacerbation of each type of pathology. For example, a person may aggravate the painful symptoms of internal hemorrhoids, and external at this time will be in remission. After passing through the period of exacerbation of one, the second passes from the calm phase to the exacerbated. As a result, a person feels pain constantly.

This type of disease is characterized by a concentrated formation of blood clots, this leads to a serious deterioration of the human condition.

Mixed (combined) hemorrhoids

Any of the symptoms of hemorrhoids at least once in a lifetime showed up in everyone. Fortunately, this disease can be noticed in time and cured without complications. But when the disease progresses, its course, symptoms, features of diagnosis and treatment largely depend on the location of the hemorrhoidal nodes.

The most difficult of all forms is combined hemorrhoids.

With it, inflamed hemorrhoidal nodes are located both inside the rectum and outside.

Constipation, prolonged overstrain of the abdominal wall lead to the development of this form of the disease. This can occur gradually or rapidly, accompanied by symptoms or their complete absence. The difficulty is that outside hemorrhoids are easily diagnosed by the presence of cones. At the same time, the internal course of the disease remains invisible, due to the absence of pronounced symptoms.

In patients with mixed hemorrhoids uneven periods of remission and exacerbations. Because of this, they constantly experience discomfort. Pain, burning, itching, bleeding after bowel movements and other symptoms are strongly reflected in normal life.

The main methods of treatment

How to treat the disease if they have signs of internal and external inflammation of hemorrhoids? Treatment of combined hemorrhoids goes in several directions. A patient is usually prescribed a suppository or ointment to treat inflamed areas.

Medications stop symptoms and prevent complications

When observing bleeding, they take special medications that stop it. Also, a person needs to follow a certain diet. Doctors advise eating sparing foods to make the stool softer. This reduces the injury to the inflamed nodes during the passage of feces through the rectum.

In the treatment of a disease of the 1st degree, alternative methods are also used. As a rule, these are lotions of grated raw potatoes, pots of potassium permanganate or herbal decoctions. All these funds work well on the sore spot and have both therapeutic and prophylactic effects.

For the treatment of the chronic combined form of the disease, painkillers, phlebotropic, hemostatic and anti-inflammatory drugs are prescribed. Their use can be both general and local.

In the acute course of pathology, topical agents are used:

They relieve pain, have an anti-inflammatory and tonic effect on blood vessels. Reduce stagnation in the veins and have a beneficial effect on blood circulation.

To localize and reduce thrombosis of hemorrhoidal nodes, means of mixed therapy are used, namely Pentoxifyline or Paracetamol. Combined phlebotonic medications are also used, most often Detralex. To improve blood flow, a patient may be prescribed medications containing benzopyrones. These include: glivenol, troxevasin, vazobral.

Clinical recommendations for the treatment of chronic combined hemorrhoids

First aid productsMinimally invasive surgerySurgery 6 knot removal
  • Anti-inflammatory drugs (Levomekol, Mesalazine),
  • · Hemostatic drugs
  • Dietary fiber (Psillium),
  • Anticoagulants (Heparin),
  • Venotonics (Diosmin).
  1. · Operation - Ligation with latex rings,
  2. Photocoagulation
  3. · The procedure of skeleton therapy.
· Transanal resection of the mucosa by Longo,
Hemorrhoidectomy (closed or open).

With an integrated approach, treatment passes favorably and over time allows you to completely get rid of hemorrhoids.

First, the patient is credited with medication. If it does not bring the desired effect, then proceed to minimally invasive operations.In the most extreme case, surgery is performed. Removal of hemorrhoids is justified only in cases where there is no effect of conservative therapy and severe grade 4 disease.

Effective treatment of internal hemorrhoids

The course of the disease and diagnosis

There are acute and chronic combined hemorrhoids. In the first case, internal or external nodes become inflamed, while others remain in remission. Because of this, they are not given proper medical attention, which means that the treatment is ineffective.

When the disease develops over a long period, the patient complains of manifestations of both internal and external hemorrhoids, then it is advisable to talk about advanced pathology.

To make a diagnosis, the doctor will conduct an examination using palpation and an anoscope.

So you can detect inflamed hemorrhoidal nodes, clearly indicate the localization of combined hemorrhoids, the stage, the exacerbation of which brings such discomfort.

If complications have already developed, proctologist “LeoMed” may be prescribed additional diagnostic measures, for example:

Timeliness of diagnosis greatly affects the accuracy of the diagnosis and the final prognosis.

Ideally, it should be carried out even before the disease passes to the second stage. Then, in addition to pain, itching, burning, the patient already notices bleeding, prolapse of hemorrhoids.

At the same time, anal fissures appear. At the third stage, the nodes no longer resolve independently, the symptoms intensify, and necrosis develops. Mucus and blood clots are released from the anus.

The pain does not bother periodically; it accompanies the patient constantly.

At the fourth stage, blood clots appear, indicating a critical condition. Fecal masses at this time can no longer be controlled, they stand out involuntarily. The only way to get rid of mixed hemorrhoids in the fourth stage is surgery.

Will folk remedies help

Treatment of a combined form of hemorrhoidal pathology with folk remedies should not be considered as an independent method of therapy. Such funds used at home, serve only to relieve the inflammatory process and symptoms of the disease.

Apply baths, tinctures, decoctions, rectal suppositories from raw vegetables.

Chronic combined hemorrhoids: what is it?

Many people wonder what combined hemorrhoids are. Combined hemorrhoids are a form of ailment in which both internal and external nodules are affected.

Symptoms in this disease are not much different from symptoms of external or internal hemorrhoids. But the course of the disease is different in that the disease often worsens.

Chronic combined hemorrhoids are usually treated with the help of certain medications. But if the therapy is ineffective, then surgical and minimally invasive methods of treatment are used.

Disease prevention

The basic principles of disease prevention are moderate physical activity every day, a healthy lifestyle and proper nutrition. Compliance with these rules will help to avoid this delicate disease.

For people predisposed to hemorrhoidal disease, it is recommended to take venotonic drugs. But the most important thing is the change in lifestyle and lifestyle.

It is necessary to leave the previous preferences and begin to develop new positive habits. People who have already undergone the disease should completely abandon alcohol and lifting heavy objects.

It is worth paying attention to your nutrition. If the diet is dominated by fatty and heavy foods, and urge to the toilet is a rare occurrence, then it is necessary to add plant components or sour-milk products to the meal.After all, combined hemorrhoids are better to prevent than subsequently subject themselves to prolonged and painful treatment.


Red beetroot

The juice of this wonderful vegetable can be used inside (200 ml per day, in three divided doses). Beetroot juice is also used for lotions. Red beets have anti-inflammatory, antibacterial and wound healing properties. Lotions of vegetable juice help relieve severe pain in the anus.

Sedentary baths with a decoction of herbs (chamomile, St. John's wort, oak bark, sage) are useful.

The main signs of the disease

Chronic combined hemorrhoids occur in some cases harder than a disease of any one type. First of all, this is due to the uneven alternation of the phases of remission and exacerbation. For example, external hemorrhoids can remain in a quiet period, and internal, at this time, on the contrary, become inflamed. Thus, the patient can almost constantly suffer from unpleasant symptoms.

Probably the simultaneous inflammation of the external and internal nodes. In such cases, the symptoms of the disease will also manifest in a complex manner. In other words, the aggravation of the process may be accompanied by signs characteristic of both forms of the disease.

The first symptoms of combined hemorrhoids are a little discomfort in the rectum.

Most often, this type of hemorrhoids develops gradually, in connection with this it can be difficult to recognize at the very initial stages. During this period, the disease usually does not manifest itself and does not cause discomfort. As a rule, the first symptoms of combined hemorrhoids are a little discomfort in the rectum or a feeling that a foreign body is present in it. Other signs of the disease include:

  • Bleeding. Blood can be seen on feces or toilet paper. More intense bleeding is characteristic of the last stages of hemorrhoids.
  • Itching and burning in the anal area. Due to combing of itchy areas, irritation often occurs on the skin.
  • Pain of varying intensity and character in the region of the rectum and anus. Pain usually occurs with exacerbation of chronic combined hemorrhoids.
  • Visible hemorrhoids around the anus. Depending on the degree of the disease, they can have different sizes. Such nodes are elastic to the touch. During remission, they look like bags made of leather, somewhat reminiscent of deflated balls.

Which doctor should I go to?

With hemorrhoids, for the purpose of examination and treatment, you need to contact a proctologist or coloproctologist. The proctologist deals with rectal problems. He is a therapist, anesthetist, and surgeon all rolled into one.

A coloproctologist is a specialist who uses conservative and surgical methods for treatment, dealing simultaneously with colon problems. Hemorrhoids are a disease of venous vessels, and, in connection with this, a coloproctologist may appoint a consultation with a phlebologist - a specialist treating vessels.

Combined form hemorrhoids are a serious pathology, fraught with various life-threatening complications. Correctly, at the very first symptoms of the disease, consult a doctor and cure the pathology. Modern medicine has effective treatment methods at hand, and timely treatment will help to forget about hemorrhoids forever and live a full life.

How to treat combined hemorrhoids

Combined hemorrhoids can be treated with both conservative techniques and minimally invasive interventions, as well as radical surgeries. Choosing the right treatment tactics is always individual.

More intense bleeding is characteristic of the last stages of hemorrhoids.

Combined hemorrhoids, its symptoms and methods of treatment

Combined hemorrhoids is a disease in which the inflammatory process affects the internal and external hemorrhoids.

This type of disease is characterized by a severe course and complications in the form of purulent inflammation of the intestine and infection of the abdominal cavity.

At the beginning of the development of pathological processes, there are no symptoms, so the diagnosis is often made when the hemorrhoids become chronic.

With combined hemorrhoids, both internal and external hemorrhoidal nodes suffer

Conservative treatment

In the initial stages of the disease, conservative therapy is more often prescribed. Usually it includes:

  1. Drug treatment. In order to strengthen the venous walls and prevent the formation of new nodes, phlebotonic agents are used (Troxerutin, Detralex, Phlebodia). In addition to them, topical preparations are prescribed (suppositories, ointments, gels), which help eliminate pain, burning and itching, reduce inflammation and swelling, and accelerate healing. Often, specialists recommend such drugs as Relief, Procto-Glivenol, Proctosan, Hepatrombin G. If necessary, laxatives, antibiotics, antispasmodics, hemostatic can be prescribed.
  2. Diet therapy. Regardless of the stage of combined hemorrhoids, the process of its treatment always implies the need for a sparing diet. Its main tasks are softening feces, prevention or combating constipation, and prevention of vein expansion. Thanks to such measures, the risk of injury to nodes and mucous feces, as it passes through the intestines, is significantly reduced. In addition, the correct diet eliminates the main factors leading to the emergence and exacerbation of pathology. The diet for combined hemorrhoids is the same as for other forms of the disease. Its essence is the rejection of alcohol, fatty, salty, spicy, spicy foods, the restriction of sweets, starchy foods, coffee and the increase in the amount of food, vegetable origin in the diet.

Features of the diagnosis and treatment of combined hemorrhoids

The cause of hemorrhoids can be a hereditary predisposition, obesity, constipation, a sedentary lifestyle, and with a dozen other factors. Equally diverse are the forms of this disease.

Hemorrhoids can be internal and external, and a combined form is often found, which is considered especially complex and dangerous. With its treatment, it will be necessary to combine various drugs and be sure to make adjustments to the lifestyle.

Causes of combined hemorrhoids

Mixed hemorrhoids develop for the following reasons:

  • As a result of stagnant processes in the abdominal cavity.
  • With frequent constipation, which disrupt blood circulation in the veins of the rectum.
  • If a person does not move much, he sits a lot.
  • In the presence of excess weight, which contributes to increased pressure on the vessels.
  • Excessive physical exertion, forcing a person to often strain.
  • The period of bearing a child. During this period, women are often worried about constipation. Hemorrhoids can also be caused by squeezing organs with an enlarged uterus and a difficult birth.
  • Pathological processes in the vessels.
  • Liver disease.
  • Infectious diseases.

Overweight is one of the risk factors for hemorrhoids

Specialists managed to identify certain categories of people in whom hemorrhoids occur more often than others. These include:

  • those whose professional activities are associated with prolonged sitting at the computer,
  • constipated
  • lovers of oily, spicy food,
  • alcohol abusers
  • people who often have anal sex.

The problem of hemorrhoids is known to many people, but few people pay attention to the reasons for its development and try to avoid them. As a rule, they begin to take measures when the disease has already caused significant discomfort.

Eating fatty foods slows down the intestines

How is the pathology manifested?

Symptoms of hemorrhoids may vary depending on the stage of development. There are such degrees of combined form:

  • The first stage of hemorrhoids. At the same time, it is very difficult to diagnose the disease, since on examination it is impossible to notice inflammation of the hemorrhoids and the patient does not experience any unpleasant sensations.
  • The second one. It can be detected by prolapse of nodes during bowel movements. In other cases, they are inside. This is accompanied by pain.
  • The third. Hemorrhoidal prolapse occurs not only during bowel movement, but also when lifting weights.
  • Combined hemorrhoids of the 4th degree are accompanied by severe complications such as pinched nodes and venous thrombosis.

There are acute stages of symptoms and a period of remission. In the first case, they worry:

  • a feeling of itching and burning in the anus, which can be very strong,

Combined hemorrhoids develop in stage 4

  • the presence of bleeding and bleeding from the anus,
  • a feeling of heaviness and the presence of a foreign object in the anus,
  • prolapse of hemorrhoid cones,
  • painful sensations that arise not only during bowel movements, but also do not leave a person all the time.

The stage of remission is accompanied by:

  • a small burning sensation in the anus, which can easily be sustained,
  • the feeling that there is a foreign object in the anus,
  • the presence of small bumps around the anus.

With remission, there are no such unpleasant sensations as in the acute stage, but the patient will constantly feel discomfort.

To avoid the development of a chronic form, treatment of combined hemorrhoids should be started at the first symptoms.

Burning in the anus is felt both in remission and during exacerbation

General characteristics

Hemorrhoids are characterized by the appearance of hemorrhoids, which are also called cones. With a combined form of pathology, such nodes are located both inside and out. Cones can be invisible, but with an exacerbation of the disease, they swell and cause a lot of trouble.

Hemorrhoids, including combined, can occur for various reasons. Pathology can be triggered by the following factors:

  • constipation
  • a sedentary lifestyle
  • improper diet (spicy, fatty foods),
  • a tendency to varicose veins,
  • pregnancy
  • congestion in the pelvic organs,
  • inflammatory process in the intestinal mucosa,
  • pathologies of the gastrointestinal tract,
  • strong prolonged straining during childbirth,
  • heavy physical exertion (often the reason is weight lifting),
  • anal sex.

Symptoms of combined hemorrhoids

The disease develops gradually. There are 4 degrees of severity of the pathology, each of which corresponds to certain signs:

  • The disease of the first degree is accompanied by unpleasant sensations. Bleeding at this stage may not occur.
  • The second degree is characterized by the loss of nodes, which are set independently. Injury to nodes can lead to bleeding. Usually, blood traces are first noticed on paper after defecation; later on, the problem may worsen.
  • With pathology of the third degree, severe inflammation is observed. Drop nodes can be adjusted only by hand.
  • The last stage of hemorrhoids is chronic. The dropped hemorrhoid cones cannot be straightened back. The inflammatory process continues, often acute thrombosis manifests itself.

With remission, the disease may not show any signs. During an exacerbation, the symptoms are quite bright and usually manifests itself:

  • itching and burning
  • a feeling of heaviness
  • spotting
  • the sensation of a foreign body in the anus,
  • painful bowel movements
  • unpleasant sensations in a sitting position.

As the disease progresses, the pain intensifies and may become permanent. In some cases, pain radiates to the abdominal organs.

An important factor is a psychological barrier. Patients are embarrassed to contact a proctologist, so they go for examination already when the pathology is started and brings significant discomfort.

Drug therapy

Conservative treatment includes the use of various local ointments, gels, suppositories. Such drugs usually provide a comprehensive effect, relieving swelling, inflammation and pain.

The following remedies are effective:

  • Relief
  • Nigepan
  • Proctosed,
  • Procto-glivenol,
  • Hepatrombin G.

With combined hemorrhoids, it is necessary to strengthen the venous walls. For this purpose, venotonics such as Troxerutin are prescribed. For internal use, Detralex and Phlebodia are intended.

If constipation occurs with hemorrhoids, it is necessary to use laxatives. They soften feces, which facilitates their release and reduces the risk of injury to hemorrhoids. Laxatives should be used only when necessary and for a short time. Otherwise, the natural intestinal motility may be impaired, which will significantly complicate the patient's life in the future.

With a pronounced inflammatory process, a specialist can prescribe antibacterial therapy. If the bleeding is severe, then you may need to take hemostatic drugs. In this case, it is also important to prevent anemia.


Alternative methods are appropriate in cases where hemorrhoids have not yet passed into an advanced stage. You can use the following recipes:

  • Sea buckthorn oil. This remedy is known for its healing properties. Oil should be impregnated with a sterile napkin and applied to the affected area overnight. In the afternoon, such a lotion should be changed every 3-4 hours. It is useful to take the product inside - a tablespoon on an empty stomach in the morning.
  • Aspen leaves. Raw materials must be used fresh, after having mash it. Leaves are applied to the nodes for an hour. The procedure is repeated three times a day.
  • Chamomile broth. With external nodes, you can make a compress, with internal nodes - ice candles. The strained broth is poured into molds and frozen.
  • Candles can also be made from candied honey. Such a tool effectively fights inflammation.

Diet and lifestyle

With combined hemorrhoids, you need to change your lifestyle. It is important to perform special exercises, combine dosed physical activity and good rest.

Physical activity should be moderate. You can’t lift weights, squat deeply. It is useful to do swimming and yoga.

When sedentary work, you need to take breaks of 5-10 minutes. At this time, it is useful to walk or perform special gymnastics. To reduce discomfort during sitting, it is effective to use a special pillow, which reduces the load on the affected area.

It is useful to refuse to use toilet paper. Instead, wash with cool water. It is more hygienic and less traumatic for hemorrhoids.

An important role in the treatment of combined hemorrhoids is played by the diet. One of its goals is to normalize bowel function and provide softening of feces. To do this, you need to base your diet on products of plant origin, eliminate fatty, salty and spicy dishes, spices. Refusal of alcohol is obligatory. Coffee, caffeinated drinks, and sweets should be limited, or eliminated altogether.

Surgical intervention is usually required when the pathology has reached stage 3-4. In this case, conservative treatment no longer helps.

If the hemorrhoidal nodes are not greatly enlarged, it is enough to put latex rings on their legs. This operation is called ligation. When squeezed with a latex ring, the hemorrhoidal node ceases to receive food, therefore it dies. At this point, a scar is formed.

Another technique is transanal resection. The size of hemorrhoidal nodes is reduced by reducing the flow of blood to them. This is achieved by pulling education up.

With a strong increase in hemorrhoidal nodes, their complete removal is required. In this case, resort to hemorrhoidectomy.

In the first three stages of hemorrhoids, it is possible to use cryodestruction. Hemorrhoidal nodes are exposed to low temperature (up to -200 ° C), which leads to their destruction.

Prognosis, complications

Combined hemorrhoids can cause various complications. The most unpleasant of them usually occur against the background of the internal form of the disease:

  • Anal fissures, swelling. Such complications are characteristic of advanced hemorrhoids and manifest themselves quite often. Against the background of a long inflammatory process, a caustic secret is released that irritates the anus. In this case, the patient suffers from burning and itching.

The concept of combined hemorrhoids and its proper treatment

Today, many people suffer from a pathological condition such as hemorrhoids. At the initial stage of the disease, discomfort is almost not observed, however, with an untimely start of treatment, the disease starts and leads to a deterioration in overall health. There are several forms of the course of this disease, but combined hemorrhoids are considered the most severe.

Main aspects

Combined hemorrhoids appear when internal and external hemorrhoids are combined. It leads to a loss of ability to lead a normal life.

If you touch on the anatomical features of the structure of the human body, then there are internal and external hemorrhoidal nodes that are not noticeable during normal functioning of the body. As soon as any malfunction occurs in his work, venous blood stagnation, swelling and lowering of these nodes are observed.

Over 30 years of my practice have shown that there are no miracles in the treatment of hemorrhoids, and at the same time, there are tools that can help a lot of people with this delicate problem.

Combined hemorrhoids can be found infrequently, because the cause of the appearance is usually the lack of treatment of its other form. But it is impossible not to notice that there are cases when such a formation of the disease occurs without the presence of symptoms, and therefore its diagnosis for a person becomes an extremely unpleasant surprise.

As for the treatment, with combined hemorrhoids it is severe and prolonged, because the intensity and severity of symptoms will be observed at a high level.

Help for traditional medicine recipes

The effect of treatment can be better if, along with traditional medicine, we use the advice of our ancestors. But usually the use of any prescriptions from folk sources should be agreed with the attending physician, because not in all cases it can be beneficial.

The most popular recommendations of traditional medicine in order to cure combined hemorrhoids are the following.

  1. Seated baths using cold water. Most often, they are recommended to be used if it is necessary to stop bleeding or reduce the intensity of pain. To do this, type cold water into the basin and sit in it for several minutes. Such baths can be carried out at most twice a day.
  2. The use of red beets. You need to grate the beets, put them in gauze and apply to the affected area. This method helps relieve pain.
  3. Suppositories made from chamomile. For their preparation, you need to take 1 tbsp. l chamomile and pour 250 ml of water, put on fire and boil for 10 minutes.When the broth cools down, it must be filtered and poured into specially prepared molds, the appearance of which will resemble the shape of pharmacy candles. These molds must be put in the freezer. After they freeze, they can be inserted into the anus. Treatment with such suppositories eliminates pain and inflammation.

So, despite the delicacy of the disease, you should not hesitate to consult a doctor and treatment. After all, human health is worth its weight in gold, and it must be appreciated.

What are the causes of combined hemorrhoids?

The most common cause of the onset of the disease is persistent constipation. Violations of the stool lead to damage to the mucous membrane of the rectum and small vascular plexuses. As a result of these factors, favorable conditions are created for the progression of inflammatory processes in hemorrhoids.

Also predisposing factors include:

  1. Hypodynamia. A mixed form of hemorrhoids very often becomes a consequence of a sedentary lifestyle. This is due to the fact that when in a static position, the hemorrhoidal veins are compressed, and high pressure is applied to the rectum.
  2. Pregnancy. In the process of bearing a child in the body of a woman, numerous changes occur, in particular, the uterus increases in size. This leads to the fact that this organ presses on the hemorrhoidal veins and rectum, thereby creating favorable conditions for the progression of the disease.
  3. Childbirth. During labor, intra-abdominal pressure rises and hemorrhoidal veins are compressed. As a result, the likelihood of hemorrhoids increases.
  4. Obesity. When overweight, pressure is applied to the hemorrhoidal veins, and blood flow in the pelvic organs is disturbed.
  5. Abuse of fatty, spicy, spicy and sweet foods. Also a predisposing factor is alcohol abuse, smoking, drug use.
  6. Hereditary predisposition.
  7. Age-related changes.

Constant diarrhea and chronic bowel disease can also lead to the appearance of combined hemorrhoids.

Surgical treatment of hemorrhoids combined

With hemorrhoids of 2-3 severity, a radical excision of the inflamed nodule is not necessary. Nowadays, there are minimally invasive procedures that, in conjunction with drug therapy, give an amazing effect. The best minimally invasive procedures are:

  1. Cryodestruction. This method consists in freezing the inflamed area with liquid nitrogen.
  2. Laser hemorrhoid removal. How hemorrhoids are removed with a laser, photo and thematic videos can demonstrate. This procedure is very effective, the percentage of relapse after it is low.

When the disease passes to a 3-4 degree of severity, and is accompanied by prolapse of hemorrhoids outward, only radical surgical manipulation will help. Commonly used Longo surgery or hemorrhoidectomy

Of course, it is easier to avoid the progression of the disease than to treat it with surgical methods. How to stop inflammatory processes and permanently get rid of hemorrhoids? Innovative dietary supplements will help in this, in particular, the Chinese anti-hemorrhoids hemorrhoids patch and Healthy cream wax.

Mixed hemorrhoids - causes and treatment methods

The cause of hemorrhoids is affected by defecation, sedentary work, inflammatory processes of the pelvic organs, pregnancy and other factors of the external and internal environment. At the beginning of the disease, the patient does not feel significant discomfort, but over time, the disease progresses and goes into more complex stages, sometimes provoking complications in the form of thrombosis or colon cancer.

Hemorrhoids are divided into two forms of the disease: acute and chronic, also distinguish its classification - internal, external and mixed (combined).

The classification of the disease depends on the location of the hemorrhoidal nodes.

The most complex course of the disease is observed with a mixed form of hemorrhoids, when pathological changes in hemorrhoidal nodes combine the internal and external course of the disease with more expressive symptoms.

The causes of the disease

Chronic mixed hemorrhoids are manifested by periodic exacerbations and a chronic course, which during treatment change the stage of remission. Sometimes only inflammation of the internal or external hemorrhoids is observed separately, which makes the symptoms less expressive.

The cause that causes combined hemorrhoids often become:

Treatment features

Treatment of mixed hemorrhoids is prescribed depending on the stage of development of the disease:

  • At the initial stage, conservative methods are used. The patient is prescribed drugs that improve the blood circulation process, strengthen the vascular walls and eliminate unpleasant manifestations of pathology.
  • Hemorrhoids of the second degree are eliminated by cryodestruction. During the procedure, hemorrhoidal nodes are exposed to low temperatures, which contributes to their freezing and dying. Cones can also be pulled using latex rings.
  • If the treatment was not carried out on time and allowed the development of the third degree, then one can not do with medications alone. The dimensions of the internal and external nodes in this case are quite large. Therefore, the treatment of combined hemorrhoids of the 3rd degree is carried out with the help of surgical intervention. This method involves pulling the nodes up with special titanium plates.
  • At the last stage, hemorrhoids must be removed surgically. Other therapeutic methods will not bring results.

In the initial stages of the disease, the doctor prescribes drugs

At the beginning of the development of pathology, you can save a person from torment. The main thing is that the patient follows all the recommendations of the doctor, even after the condition has improved.

How to cure a running combined hemorrhoids?

It is generally accepted that hemorrhoids is associated with diseases of the rectum, but the main reason can be hidden remotely from this organ. Weak immunity, mental illness, and even heredity - all this can trigger the development of hemorrhoids. The cause of the disease should be given the most attention, because only then can it be completely cured and prevent relapse.

Some patients turn to a proctologist with complaints of itching in the anus, burning, pain during a bowel movement, but outwardly no changes appear. This is internal hemorrhoids.

For others, on the contrary, there is an increase in hemorrhoidal nodes with an exit to the outside, but there are no symptoms. In this case, we can talk about chronic external hemorrhoids.

But there is a type of disease in which both the internal part of the intestine and the external one are affected - this is combined hemorrhoids.

Removal of launched hemorrhoids of a combined form

If everything is simple with the first stage of combined inflammation of the nodes and it can be eliminated without surgery, then with the subsequent stages everything is much more serious. It is possible to eliminate combined hemorrhoids of the 2nd degree using surgery according to the Longo method or Milligan-Morgan method. Longo's method involves the complete removal of inflamed internal and external nodes.

When carrying out the operation according to the Milligan-Morgan method, the nodes do not touch, but remove part of the mucous membrane. The bottom line is that after such an operation, the nodes independently pull up and pass over time. This process is accelerated by various medications.

But, unfortunately, the operation is not for everyone brings only positive results.Any treatment can lead to complications, regardless of the professionalism of the doctor. Even an insignificant factor can affect this. For example, temperature deviations or allergies.

  • bleeding is the result of rupture of sutures,
  • inflammation is a consequence of accidental infection
  • narrowing of the anal canal - happens when choosing the wrong method of surgery, the cause may be an incorrect diagnosis or a sharp transition of the disease to the next stage
  • psychological disorders - depends on the state of mind of an individual patient, a common deviation is a fear of bowel movement.

The combined form of hemorrhoids does not pose a serious danger to the patient in the case of adequate and timely treatment. Proper nutrition, hygiene, medication and surgery are all standard measures to restore rectal function.

Internal and external nodes

External hemorrhoids can be determined only visually. Inflammation of the hemorrhoids can occur under the skin or near the anus outside. During the period of exacerbation, the patient feels severe pain, heavy bleeding appears.

For treatment, conservative or surgical methods may be used.

Causes of the disease

The development of chronic mixed hemorrhoids is caused by the same factors as in the case of ordinary hemorrhoids. The same causes that cause the initial formation of the disease lead to exacerbations. The main adverse factors are:

  • circulatory disorders in the pelvis,
  • hepatitis C
  • pregnancy and childbirth
  • excess weight,
  • increased physical activity,
  • constipation
  • inflammatory processes on the mucosa inside the rectum,
  • diseases of the vascular system,
  • sedentary lifestyle,
  • stretching of the anal sphincter (as a result of frequent classes in anal sex, including).

External and internal hemorrhoids (similarities and differences)

External hemorrhoidsInternal hemorrhoids
LocalizationOutside of the anus under the skinInside the rectum
AppearanceOutward nodes are visibleNot noticeable externally
PainSlight painAccompanied by severe pain
BleedingOccur due to infringement of nodes during the exacerbationOccur as a result of damage to internal nodes during bowel movements
InterconnectionOften a late stage of internal hemorrhoidsIt happens as an early stage of external hemorrhoids

Watch the video: Hemorrhoids: Symptoms, Diagnosis, and Treatment Options - St. Mark's Hospital (April 2020).

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