External hemorrhoids in women and men

Hemorrhoids are a common pathology that can cause symptoms, ranging from minimal discomfort or inconvenience to painful pain and significant psychosocial consequences. [1]

When there is varicose veins of the anal exit and rectum, with the formation of twisting formations - nodes - then they talk about a disease such as external hemorrhoids. Unlike the internal type, external pathology develops in the zone of transition of the anus into the rectum, not in its depth.

The sooner you start treatment, the faster and easier you can get rid of suffering. If you try to treat the problem yourself, or even completely ignore it, the disease will take a chronic course and will remind you of itself with regular exacerbations of the process. At the same time, exacerbation at a late stage is no longer being treated medically: you have to resort to the help of a surgeon. Therefore, a visit to the doctor to postpone is strongly discouraged.

Epidemiology

People with hemorrhoids and those who mistakenly thought they had hemorrhoids tended to use self-medication rather than seek proper medical help. [2] According to the 2012 Google Zeitgeist annual survey, hemorrhoids were the most common health problem in the United States, ahead of gastroesophageal reflux disease and sexually transmitted diseases. Unfortunately, the quality of information on the treatment of hemorrhoids on the Internet is now very different, almost 50% of poor quality websites. [3] Therefore, clinicians should advise and treat patients with hemorrhoids using evidence-based medicine and standards of care. 

Almost any of us can get external hemorrhoids: those who often sit for long periods of time, for example, in the office or driving a car, are most affected by this disease. People with bad habits and unhealthy diet who suffer from constipation and other digestive disorders also fall under the "sight". Hard physical work is another prerequisite for the appearance of a problem, so often loaders and even weightlifting athletes become patients of proctologists.

Hemorrhoids are a common anorectal disease that affects millions of people in the United States, and the most common cause of rectal bleeding. It is believed that hemorrhoids are equally found in both men and women. It is rarely seen before the age of 20 years, and the incidence rate reaches a peak between the ages of 45 and 65. The prevalence of hemorrhoids in pregnant women varies up to 35%. [4]

About 10% of patients in the proctology office turn to the doctor precisely for the external form of hemorrhoids.

Causes of the external hemorrhoids

Experts are still silent about the exact causes of the appearance of external hemorrhoids, but there are basic theories about this. So, most often the reasons may be as follows:

• daily insufficient physical activity, long standing or sitting, leading to stagnation of blood in the pelvic area;
• excessive physical activity associated with lifting and carrying weights, with the creation of increased intra-abdominal pressure;
• problems with bowel movements, stool instability;
• eating disorders, including abuse of alcohol and spicy foods;
• deterioration of blood flow in the pelvic area, which may be associated with overheating or hypothermia of the specified area;
• pregnancy, natural childbirth, when there is a strong increase in intra-abdominal pressure against a background of impaired venous outflow; 
• excess weight, localized mainly in the waist;
• regular anal intercourse;
• pathologies that are accompanied by a violation of the venous outflow (liver, bladder, prostate, intestines, and also tumors in the pelvic area);
• congenital malformations of connective tissue, venous vessels.

Sometimes it may seem that there are no predisposing factors - and, nevertheless, external hemorrhoids crawled out. This happens if a person is subjected to constant stress, or suffers from emotional imbalance, which leads to a prolonged spasm of smooth muscle fibers of the vascular walls. This factor is often not given much importance, and in vain. In addition, there are hereditary reasons: if one of the parents is ill with external hemorrhoids, then the risk of developing the disease is also increased in children.

Risk factors

Factors contributing to the development of external hemorrhoids are conventionally divided into two categories:

• The following factors belong to internal factors:

1. congenital vascular defects;
2. systemic disorders affecting the vascular network (for example, vasculitis);
3. digestive disorders, which are often accompanied by constipation, stool tightening, etc.;
4. aging, obesity, abdominal obesity, depressive mood and pregnancy; [5]
5. other reasons for creating high intra-abdominal pressure.  [6]

• External factors include:

1. traumatic injuries of the anal zone (for example, during childbirth, during anal sex, etc.);
2. regular lifting-carrying heavy objects;
3. lack of exercise, prolonged sitting position, lack of physical activity.
4. It has been reported that certain types of foods and lifestyles, including a low-fiber diet, spicy foods and alcohol consumption, are associated with the development of hemorrhoids and exacerbation of acute symptoms of hemorrhoids.  [7]

Pathogenesis

The exact pathophysiology of symptomatic hemorrhoids is poorly understood. Previous theories of hemorrhoids as varicose veins are now outdated - as studies by Goenka et al. Have shown. Patients with portal hypertension and varicose veins do not have an increased frequency of hemorrhoids. [8]

Currently, the theory of the sliding mucous membrane of the anal canal is more widespread, which suggests that hemorrhoids occur when the supporting tissues of the anal nodes are destroyed. It is believed that age and such heavy physical activity, straining during bowel movements and prolonged sitting, contribute to this process. Therefore, hemorrhoids is a pathological term for describing the abnormal displacement of the anal nodes down, causing the expansion of veins. [9]

In a histopathological study, changes observed in the anal nodes include abnormal venous dilatation, vascular thrombosis, a degenerative process in collagen fibers and fibroelastic tissues, as well as deformation and rupture of the anal subepithelial muscle. In severe cases, a marked inflammatory reaction involving the vascular wall and surrounding connective tissue was associated with ulceration of the mucous membrane, ischemia, and thrombosis. [10]

External hemorrhoids are accompanied by the expansion of hemorrhoidal nodes that have formed in the lower venous plexus. Such nodes are located directly at the anus. Since the inflammatory process does not occur in depth, but outside the intestine, in most cases the problem can be seen with the naked eye.

The final segment of the intestinal tract, which ends in the large intestine, is called the rectum. Its beginning approximately corresponds to the level III of the sacral vertebra, and the anal opening becomes the final element.

Five arterial vessels are responsible for the blood supply to this site, one of them being called the “hemorrhoidal artery”. Blood flows through the extensive venous network, which is located in the rectal submucosal layer.

With weakness of the connective tissue and vascular walls, blood flow is present, and the outflow is disrupted, which leads to swelling of the veins, overflowing of the cavernous bodies with blood. In some cases, the “culprits” are mechanical factors that lead to stretching and weakening of the rectum muscles, which contributes to the movement of hemorrhoidal nodes to the anal area and loss from it.

Symptoms of the external hemorrhoids

A total of 40% of people with hemorrhoids are asymptomatic. [11]

External hemorrhoids do not appear immediately: its development with an increase in symptoms occurs gradually. A person does not immediately notice a violation, and only with time begins to pay attention to uncomfortable, pulling, itching or painful sensations in the anus, especially with prolonged sitting or after an act of defecation.

The first signs can be seen with a detailed examination of the anus: it is often edematous, with noticeable swollen veins. Sometimes discharge is found - for example, spots of blood appear on toilet paper or linen. If there is at least one of these signs, then you need to go to an appointment with a doctor.

External hemorrhoids are accompanied by the expansion of hemorrhoidal venous vessels: nodes are formed from the lower plexus of veins, which are located in close proximity to the anus. Since the inflammatory process is present not in the rectum, but outside it, the main role in the diagnosis is played by visual examination of the problem and digital (rectal) examination.

Bleeding does not become a typical sign, but external nodular formations are often subject to inflammation and damage, which can be seen with the naked eye.

It must be borne in mind that external hemorrhoids relatively rarely happen on their own. The problem is often combined, internal-external, with the deformation of the cavernous bodies of the rectum and subcutaneous venous plexus of the anus.

Psychosomatics for hemorrhoids

Psychological problems are rarely considered by doctors as the main causes of the development of a disease such as hemorrhoids. However, it has been scientifically proven that prolonged stress, anxiety, and fear can cause serious health problems.

The state of physical discomfort should always alert both the patient and the doctor. If you timely reconsider your own attitude to problems and to life in general, you can significantly improve your own health and prevent the development of many diseases. Experts point out that psychosomatics for hemorrhoids are not difficult: it is only important to pay attention to certain life aspects.

Scientists explain the appearance of external hemorrhoids by the reluctance of people to recognize their own miscalculations and mistakes, to point out the problems of others, without noticing their own. The inflammatory process is the result of individual insecurity, hemorrhoidal bleeding is the result of evil feelings associated with the impossibility of fulfilling one's plans, and the enlarged venous nodes are the result of constant procrastination, lack of organization and regular postponement of affairs for later.

In addition, excessive "looping" on something leads to energy, and then to blood stasis. Additional “provocateurs” are constant tension, lack of satisfaction in everything, suppression of their own emotional impulses.

External bump for hemorrhoids

What is a bump with external hemorrhoids? This is a dense painful nodule (often one or two) in the anus, sensitive enough when touched, and especially sensitive when pressed. Such nodes are located around the anus, and even in the depths of the anal canal. From patients, you can hear different terms regarding the hemorrhoidal nodule - this is not only a "bump", but also a "tumor", "compaction", "prolapse".

Why is the appearance of a lump accompanied by pain? Blood clots inside the venous extensions stretch the walls of the vessel, affecting the nerve endings, which causes pain.

Patients turn to the doctor mainly with complaints of a foreign body sensation and pain. Unpleasant symptoms intensify during bowel movements, with physical activity, with prolonged sitting. In this case, "cones" may have a reddish or bluish tint, depending on the stage of the painful process. When anal fissures appear, blood is released.

External hemorrhoids in women

External manifestations of hemorrhoids can bother any person, regardless of gender. But the course of the disease in men and women is slightly different. What is the matter?

Hormonal cyclical fluctuations associated with periods of menstruation and ovulation can provoke an exacerbation in the chronic form of external hemorrhoids in women. It is with such fluctuations that the appearance of discomfort, a feeling of heaviness, pain in the anus region is associated. To some extent, these signs are natural and easily explainable: with the beginning of a new monthly cycle, blood rushes intensely to the pelvic organs, veins overflow, which becomes a factor in the exacerbation of the disease.

To reduce the likelihood of relapse, a few days before the onset of menstruation, you should stop using salt, sugar, spicy seasonings. With an increased risk of exacerbation against the urge to defecate, it is recommended to introduce a rectal suppository with belladonna into the rectum, which will help relieve spasm, ease the load and relax the rectal sphincter.

External hemorrhoids during pregnancy occur in women most often, especially in the third trimester. [12] A growing uterus makes it difficult to empty the intestines, an altered hormonal background contributes to the appearance of constipation. A large amount of feces accumulates in the intestines, squeezing the blood vessels and worsening the outflow of blood from the veins. Stagnation occurs, contributing to the expansion of the vascular walls.

Natural childbirth is another provoking factor for exacerbation of hemorrhoids, because heavy attempts are accompanied by tremendous tension of the abdominal muscles with impaired vascular circulation. As a result - dilated venous nodes, pain and swelling.

External hemorrhoids in men

In representatives of a strong half of humanity, external hemorrhoids are often combined with other pathologies - for example, with internal hemorrhoids, prostatitis, etc. And a male problem appears under the influence of such factors:

• mainly sedentary work (drivers, programmers, etc.);
• abuse of alcohol, nicotine (the digestive system is disrupted, chronic intoxication occurs);
• massive eating disorders (fast food, convenience foods, chips, snacks, “dry” snacks;
• obesity, extra pounds in the abdomen;
• lifting and carrying heavy objects (causes tension and even spasm of the annular muscles of the anus, as well as an increase in intra-abdominal pressure).

It is characteristic that in most cases, men turn to the doctor about a delicate problem - hemorrhoids, already in advanced cases, because they tolerate and “delay" a visit to the doctor for as long as possible. But in the later stages, the risk of developing adverse effects is significantly increased, and the disease is already treated more complicated, often surgery is required.

So that the problem does not bother or overshadow the man’s existence, the specialist recommends visiting a doctor regularly for a routine examination, eating properly, giving up all kinds of “harmfulness” and alcoholic beverages, and practicing all possible physical labor, avoiding both excessive workloads and sedentary pastimes. It is necessary to maintain intimate hygiene and do not be shy to contact a doctor at the first sign of discomfort.

Stages

• Stage 1 of external hemorrhoids rarely causes concern on the part of the patient, since the signs of the disease are not yet sufficiently expressed. A slight discomfort manifests itself against the background of intestinal disorders, after physical overload, prolonged sitting, or after a sharp temperature drop. Slight itching and burning after the act of defecation passes independently and relatively quickly. This stage is easier to treat than others, but at this stage, doctors are consulted least often.
• Stage 2 of external hemorrhoids is characterized by an increase in enlarged nodes, thinning of their walls, and the formation of cracks. After physical overload, severe straining, bleeding and slight soreness can be observed. A long stay in a sitting position is accompanied by pain.
• Stage 3 of external hemorrhoids is characterized by dystrophic changes and weakness of the walls of the vessels. The patient complains of constant discomfort, itching, pain, decreased sphincter tone. It becomes impossible to sit and work physically.
• Stage 4: hemorrhoids, which are always outside the anus and can no longer be moved inward. Typically, a small portion of the anal mucus comes out of the anus. This degree is also known as  rectal prolapse . [13]

Forms

In general, hemorrhoids can be not only external, but also internal, and mixed (combined internal with external). The external variant is characterized in that hemorrhoidal extensions are formed in the lower venous plexus and are located directly near the anus. External hemorrhoids are located below the dentate line and are drained through the lower rectal veins into the genital vessels, and then into the internal iliac vein. These vessels are covered by the anoderm, which consists of squamous epithelium. [14]

Also distinguish between acute and chronic course of the disease.

Acute external hemorrhoids occur sharply, symptoms increase in a short period of time. The inflammatory process quickly spreads to nearby tissues, severe pain worries.

Chronic external hemorrhoids is characterized by a gradual increase in symptoms with periodic exacerbations. The disease lasts for a long time, for many months and even years.

Exacerbation of external hemorrhoids makes itself felt by bleeding, pain and severe discomfort. The nodes are enlarged, there is a sharp soreness when touched. During periods of subsidence of symptoms, the patient almost does not complain about anything, but soon the disease again reminds of itself.

Complications and consequences

If you do not seek medical help on time, then external hemorrhoids can be complicated by more painful conditions:

• bleeding, bleeding - both after the act of defecation, and against the background of a crack, or even without a specific reason;
• prolapse of the enlarged venous node - more often observed in the chronic course of the disease, against the background of prolonged constipation;
• mechanical injuries of the inflamed hanging node;
• thrombosis of the dilated vein, which is accompanied by edema, severe pain, inflammatory and necrotic processes. [15]

Permanent mechanical damage to the dilated veins can cause malignant tissue degeneration: this happens in about 10% of cases.

However, most often the disease is complicated by acute hemorrhoidal thrombosis, or the development of posthemorrhagic anemia. To prevent such adverse effects, it is recommended that phlebotonics be taken periodically, following a diet, and eliminating bad habits.

A severe consequence of advanced forms of hemorrhoids can be a necrotic process in the tissues of the hemorrhoidal extended segment. The beginning of such a process is characterized by blackening of the nodes, the pain may become dull or disappear altogether. Eliminate a similar problem only in a hospital: the help of a surgeon is required to remove areas of necrosis.

How many days goes through external hemorrhoids? The healing period depends on several factors - first of all, on what stage the disease is at. Therefore, there can be no clear answer to this question. For example, the first stage can be cured within a week. But with stage II or III, the treatment is definitely longer: from several weeks or more. If surgical intervention is used, then the healing period depends on how invasive and traumatic the intervention was.

What to do if external hemorrhoids do not pass? The disease itself cannot pass: it needs to be treated. Therefore, a visit to a doctor should be mandatory, and there is nothing to be shy and afraid of. The sooner medical care comes, the better the prognosis, and the faster the long-awaited relief. We must not forget that running external hemorrhoids is much more difficult to treat: at the late stage, drug therapy, as a rule, is already ineffective, therefore, surgical removal of dilated venous nodes is required.

External hemorrhoids are sore during an exacerbation, or against the background of the appearance of an anal fissure, which behind the external hemorrhoidal tubercles can become completely invisible and is detected only during a diagnostic examination.

But blood and bleeding with external hemorrhoids is an infrequent phenomenon. Although, if there is one, then another complication may arise: posthemorrhagic anemia. Regular bleeding imperceptibly leads to a fairly pronounced loss of blood, which can subsequently be noticed when considering the results of laboratory tests. In turn, anemia becomes the cause of other ailments: the patient feels constant weakness, dizziness, nausea, dark circles appear under his eyes, sleep and appetite are disturbed.

Thrombosis with external hemorrhoids is considered a formidable complication, which is accompanied by severe pain, and tissue failure can begin if tissue is not provided with relief. Prevention of this trouble may be taking venotonics and anticoagulants, correction of food and drinking regimen. [16]

Can an expanded segment of a venous vessel break through? Maybe, however, it rarely happens when external hemorrhoids burst - more often such a complication catches up with internal vascular damage. The likelihood of a problem increases if the vein is thrombosed or overflows with blood - for example, this happens with strong and prolonged constipation.

But the inflammation of the external hemorrhoids can develop into acute paraproctitis - this is a painful process that affects pararectal fiber. Pathology is characterized by signs of pararectal suppuration: edema, pain, central fluctuation, fever to subfebrile indicators. Further signs of general intoxication appear. The help of a doctor in such a situation should be urgent.

When such an unpleasant consequence as the perianal form of itchy dermatitis develops, the patient notes that external hemorrhoids itch. This happens infrequently, and the cause usually becomes improper hygiene of the perineum, non-compliance with the bowel movement. If the itching is persistent, then the doctor may recommend the use of antipruritic drugs, as well as ointment preparations with glucocorticoid components. [17],  [18], [19]

Diagnostics of the external hemorrhoids

A standard diagnosis by a proctologist involves collecting an anamnesis (interviewing a patient) and a digital examination. If a finger procedure is not possible to do - for example, with severe pain - then treatment is prescribed immediately, and the diagnosis is continued after the disappearance of the painful symptoms. [20]

In general, the diagnosis of external hemorrhoids includes:

• Finger palpation, which determines the type of disease.
• Instrumental diagnostics:

1. anoscopy, which is the introduction of a special device into the cavity of the rectum to a depth of 140 mm;
2. rectoscopy involves the introduction of a rectoscope equipped with an optical system and displaying an image on a computer monitor;
3. irrigoscopy is an x-ray using contrast.

• Laboratory tests:

1. analysis of feces (coprogram, feces for the presence of occult blood);
2. general clinical tests of blood and urinary fluid.

Differential diagnosis

Differential diagnosis is carried out with anal fissures, malignant or benign rectal tumors, ulcerative colitis, traumatic injury, solitary ulcerative lesion, Crohn's disease,  [21] with rectal prolapse, submucosal hemangioma. In the presence of severe pain, it is important to differentiate with an acute form of venous expansion thrombosis, with exacerbation of paraproctitis, anal tumor processes, proctalgia, Crohn's disease. With itching of the anus, it is necessary to exclude insufficient function of the anus sphincter, villous rectal tumor formation, chronic form of paraproctitis, diabetes mellitus, fungal infection, helminthiasis, perianal condyloma. Sometimes, such symptoms are present with the banal non-observance of hygiene of the perineum and genitals.

Contrary to previous studies, the frequency of hemorrhoids in patients with portal hypertension does not differ from the general population. [22] Varicose veins resulting from port-systemic communication through hemorrhoidal veins are commonly found in patients with portal hypertension. However, bleeding from varicose veins of the rectum is rare, which is less than 1% of massive bleeding with portal hypertension. [23]

How to understand external hemorrhoids or internal?

External hemorrhoids are nodal expansion of venous vessels located near the anus. In most cases, the problem is visible with the naked eye, because the inflammatory process takes place outside, and not in the rectum. But bleeding during the external process is not always worrying: the main symptom is still pain. [24]

Internal pathology is localized in the submucosal tissue of the rectum. It is difficult to see such hemorrhoids, but you can notice the presence of blood - for example, it can be blood in the stool, or red spots on toilet paper or underwear. At a late stage of the disease, the enlarged nodes slip out of the anus.

Internal and external hemorrhoids are often found together, in combination with each other: in this situation they talk about a combined form of the disease. Such a pathology is characterized by deformation of the cavernous bodies of the rectum and subcutaneous venous network of the anal zone.

Treatment of the external hemorrhoids

Therapeutic measures for hemorrhoids are prescribed in a complex, since it will not be possible to cure the disease with any single medication or procedure. In the early stages, conservative methods are used, which include changes in nutrition and lifestyle, as well as the use of systemic drugs and external agents (ointments, creams, etc.). 

For symptomatic treatment, topical preparations are available containing various local anesthetics, corticosteroids or anti-inflammatory active ingredients. Well-known topical preparations include 0.2% glyceryl trinitrate, which has been studied to relieve hemorrhoids of the 1st or 2nd degree. [25] Patients also usually self-medicate with phenylephrine, mineral oils, and shark liver oils (which have vasoconstrictor and protective properties) that provide temporary relief from acute symptoms of hemorrhoids, such as bleeding and pain during bowel movements. [26] Local corticosteroids are often used as part of creams or ointments, but their effectiveness remains unproven.

Oral preparations containing flavonoids are the most common phlebotonic agent used to treat hemorrhoids. It is obvious that flavonoids can increase vascular tone, reduce venous capacity, reduce capillary permeability, improve lymphatic drainage and have anti-inflammatory effects. [27] A large meta-analysis of the use of phlebotonics for hemorrhoids in 2012 showed that phlebotonics had a significant beneficial effect on bleeding, pruritus, discharge, and overall symptom improvement. Phlebotonic drugs also eased symptoms after hemorrhoidectomy. [28]

Calcium oral dobesylate is another venotonic drug commonly used in diabetic retinopathy and chronic venous insufficiency, as well as in the treatment of acute symptoms of hemorrhoids. [29] It has been shown that calcium dobsylate reduces capillary permeability, inhibits platelet aggregation and improves blood viscosity; which leads to a decrease in tissue edema. [30] A clinical study of the treatment of hemorrhoids showed that calcium dobesilate in combination with fiber supplements provided effective symptomatic relief in acute bleeding, and this was associated with a significant decrease in the inflammatory response in hemorrhoids. [31]

With the exception of cases of thrombosis, both internal and external hemorrhoids are easily amenable to conservative drug therapy. 

Surgical treatment is spoken about when routine interventions are not effective enough. For patients with thrombosis of external hemorrhoids, surgical examination and intervention within 72 hours after thrombosis can lead to significant relief, since pain and swelling reach a maximum after 48 hours. [32] However, after 48-72 hours most often they do not resort to surgery, since there is a thrombus organization and a decrease in symptoms. At this point, the pain from excising hemorrhoids will exceed the pain from thrombosis itself.

In addition to anti-inflammatory, analgesic, antibacterial, venotonic and anticoagulant drugs, special attention is paid to the diet:

• at least 500 g of plant foods should be consumed daily;
• it is useful to add bran to the diet;
• choosing bread, you need to dwell on products from wholemeal flour;
• it is important to exclude spicy seasonings, fried and smoked products, alcoholic drinks from the menu, as well as stop smoking;
• It is not recommended to suppress bowel movements.

In a meta-analysis of seven randomized trials comparing fiber to other fibers, fiber supplementation (7–20 g / day) reduced the risk of symptoms and bleeding by 50% for hemorrhoids. However, fiber intake did not reduce the symptoms of prolapse, pain, and itching. [33]

Thus, fiber supplements are considered effective in the treatment of hemorrhoids; however, significant improvement in symptoms may take up to 6 weeks. [34] Since dietary supplements with fiber are safe and cheap, they remain an integral part of both the initial treatment and the treatment regimen after other treatments for hemorrhoids.

In addition, special attention is paid to physical activity.

Sports with external hemorrhoids

Hemorrhoids and sports are often incompatible concepts, especially when it comes to professional sports activities. However, some types of physical activity are even welcome: the main thing is not to forget that excessive exercise will only aggravate the course of the disease.

The types of physical culture allowed for external hemorrhoids should contribute to the normalization of blood flow in the pelvic area, and the load on already existing affected veins should be moderate. Ideal for patients to engage in swimming, athletic or Nordic walking, practice yoga.

Regarding other sports, here recommendations should be obtained from the attending physician, since in each case they may be different. In general, the following principles are important:

• during periods of exacerbation, any load should be excluded altogether;
• You can not engage in sports immediately after surgery to remove hemorrhoids;
• You can not self-medicate and ignore the prescription and advice of a doctor.

The following are considered extremely undesirable, and even unsafe sports for patients with external hemorrhoids:

• power sports, power triathlon;
• weightlifting, bodybuilding;
• cycling, horse riding;
• all kinds of martial arts.

Exercises for external hemorrhoids

There are a number of options for physical activity that are allowed and even recommended for people suffering from external hemorrhoids. For example, to stimulate blood flow and ease the load on the anus, it is advised to do the following exercises:

• The well-known "birch": stacked on your back, raise your legs with the pelvis in an upright posture, fix it for several minutes, take its original position.
• “Scissors”: stacked on the back, raise straight legs at a slight angle from the floor, make crossing movements by the type of cutting with scissors.
• “Half-bridge”: lying on your back, extremely raise the pelvis up, squeezing the gluteal muscles (without focusing on the hands).

Squatting with hemorrhoids is undesirable, as well as the usual "swing of the press", because these exercises create high pressure on the hemorrhoidal veins. But walking is a great way to keep yourself in good shape and at the same time not harm your health. Classes should begin about two hours after the meal, choosing a comfortable speed for yourself.

There is another simple and inconspicuous exercise that can be performed for therapeutic and prophylactic purposes. Its essence is this: they strain the muscles of the anus, as if drawing it deeper. Fix this position for a few seconds, and then relax. Repeat up to ten times. Such an exercise, invisible to prying eyes, helps eliminate blood stasis in the rectal area.

Prevention

The best treatment is prevention. In the preventive plan, special attention should be paid to nutrition and lifestyle. [35]The main points should be remembered and always followed:

• Especially desirable foods with a tendency to hemorrhoids are fruits and vegetables, herbs and berries, bran, dairy products (kefir or fermented baked milk, natural yogurt, yogurt and cottage cheese), as well as cereals - in particular, buckwheat, oatmeal, barley groats.
• You should not drink whole milk, alcohol, consume sausages and smoked meats, sweets and pastries, spicy, fatty and too salty foods.
• With certain manifestations of discomfort in the anus, you should not take any actions yourself, it is better to consult a doctor immediately.
• After each act of defecation, it is advisable to wash, or wipe the anus with a damp cloth.
• Constipation should not be allowed, but leaning on laxatives is also not recommended. For the health of the rectum, both constipation and frequent loose stools are dangerous.
• With a tendency to external hemorrhoids, it is undesirable to visit the bath, take a hot bath, sit on hot and cold surfaces.
• Excessive straining during the bowel movement should be avoided.
• It is important to be active, to walk often, to lift weights less.

Forecast

The ability to forecast external hemorrhoids is determined by the neglect of the disease, the timeliness of seeking medical help. The prescribed drug therapy will not bring effect if it is not combined with the correction of nutrition and lifestyle, with the establishment of physical activity.

Unfortunately, in most patients, conservative treatment can only “muffle” painful symptoms, and it cannot cure external hemorrhoids. Therefore, it is often necessary to apply surgical methods of exposure - minimally invasive and traditional.