Arsenal

In acute thrombosed hemorrhoids are widely used topical agent, whose composition in addition to the components listed above, included heparin (Gepatrombin F Nigepan). Included in the Gepatrombina T heparin and allantoin cause thrombolytic effect, and panthenol promotes epithelization of damaged tissues. Joint application anestezina and heparin in suppositories Nigepan causes analgesic, anti-inflammatory, and antithrombotic effects antispasticheskoe. Preparations containing heparin, of course, are the means of choice for acute thrombosis of hemorrhoids, but no less effective in any form or hemorrhoids, and in the postoperative period, providing a powerful and physiological anti-inflammatory, anti-and kapillyaroprotektivnoe action. In appointing mestnodeystvuyuschih geparinsoderzhaschih preparations complete resorption of thrombotic masses should be expected no earlier than 48 weeks of regular use.

A special place in the arsenal of tools for the conservative treatment of hemorrhoids brand viagra take drugs used to reduce straining and facilitate defecation. For this purpose, appropriate laxative emollient and osmotic action: drugs psiliuma, lactulose and macrogol. Means of reducing the tone of the internal sphincter of the rectum, mainly used in the early postoperative period, although their use is fully justified and in the provision of urgent assistance with complicated forms of hemorrhoids. For this purpose, use of ointments and creams containing nitroglycerine, isosorbide dinitrate, nifedipine, as well as candles, comprising an extract of belladonna [11-14].

With planned conservative treatment of hemorrhoids is now widely used kapillyarostabiliziruschie (rutin) and venotonic means (bioflavonoids diosmin, estsin). During the course assignment, these drugs may be used or given by mouth [4].

Surgical hemorrhoidectomy and minimally invasive tool treatments

The effectiveness of conservative treatment of hemorrhoids as an independent method of treatment is generally not highly valued, as the disease continues to progress and degenerative changes of hemorrhoids and anorectal zone with time is also growing [3,5]. However, the experts unanimously believe, an active conservative therapy, a necessary stage in preparation for the radical cure of the disease and at the same time a means of reducing the number of emergency hemorrhoidectomy, 25% of cases involving the early postoperative complications [6,7]. Moreover, according to a retrospective European study, conducted in 2000, about 10% of patients after emergency resection of nodes in need of re-operation, and an equal number of cases in the late period developed stenosis of the anal canal [7]. Nevertheless, the indications for emergency operative hemorrhoidectomy continue to believe acute thrombosed, or strangulated ulcerated NG, as well as massive hemorrhoidal bleeding in portal hypertension.

Elective surgical hemorrhoidectomy is shown 10-30% of all patients suffering from hemorrhoids IIIIV severity [5,8]. Hemorrhoids I, - II severity, as well as a substantial proportion of patients with III degree, complete cure can be achieved by using a minimally invasive tool allowances, which are also held outside the exacerbation of the disease [3]. Common and least expensive method of minimally invasive care is ligation haemorrhoid rubber ligature. Method is used to treat large internal and external hemorrhoids, and it is to capture and drag a node rubber loop diameter of 6 mm in area, is insensitive to the pain of the mucous membrane, which leads to necrosis and subsequent rejection. Every 14 days, ligated at viagra erection enhances one site, for 3-6 procedures. Ligation can be complicated by perineal sepsis. Sclerotherapy is also indicated for patients with hemorrhoids I and II severity, but little is used less frequently in connection with a high risk of serious complications developing in dystopia sclerosing agent (impotence, neurogenic bladder, liver abscesses) [9,10]. Among the safest and most effective today include infrared light, radiovysokochastotnuyu and laser coagulation of hemorrhoids. The procedures are outpatient, with exposure to one haemorrhoidal node during a single visit to a specialist. Coagulation is not accompanied by systemic complications, however, in 10-20% of cases the effectiveness of treatment is substantially lower than expected [1,3].

Course of the disease and its prevention

In most cases, hemorrhoids develops relatively benign with periodic "unmotivated" exacerbations, leading to a brief loss of earning capacity. Often the disease is primarily chronically without causing clinically significant pathological symptoms. However, the steady increase in proportion to the frequency of exacerbations of symptoms and over time leads to a widespread desire among doctors for a radical cure of hemorrhoids with the first treatment a patient for medical attention. On the other hand, among patients with widespread reluctance to undergo surgery on the matter. The situation is illustrated by reports of epidemiological studies performed annually in the U.S., which showed progressive reduction in the number of radical surgical operations for hemorrhoids. Since the number of surgical hemorrhoidectomy in the United States declined from 165,000 in 1982 to 30,000 in 1994 [5]. Apparently, there are several reasons for such a dramatic decrease in the number of surgical hemorrhoidectomy. And it is not the most consequential of these reluctant patients undergo expensive operation, move the painful post-operative period and the associated long-term disablement [17]. By reducing the need for radical surgery in recent decades has significantly improved the quality of conservative and minimally invasive therapy to be undertaken in the early stages of the disease and the consequent reduction in the number of emergency surgeries. Trends towards non-invasive treatment helps a lot the development and implementation in practice of family medicine and prehospital thesis of "the best strategy for treatment of hemorrhoids its prevention" [1.15]. One of the most important places in the system Prevention is the correction of constipation diet enriched with fiber, use enough water and food osmotically active substances, such as juices, increasing physical activity of patients. Prevention of hemorrhoids also involves ensuring the normal activity of the internal sphincter of the rectum, coordinated with the propulsive function of the colon, which is achieved by correction of emotional disorders, smoking cessation and substance use [16].

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Cerebral cortex