HEMOROİD NEDİR ? SAĞLIKLI BİREYLERDEKİ İŞLEVİ NEDİR ?


Normalde doğan her canlıda kalın bağırsağın dışarı açılan en son kısmında damar ağları mevcuttur. Anüs (makat) ve rektumda (kalın bağırsağın en son bölümü) bulunan ve hemoroidal damarlar denilen bu damar ağlarının vücudumuzda çok önemli görevleri vardır.

Aşağıda bu görevler sıralanmıştır;

– Normalde bu damar ağlarında biriken kan anüsün (makatın) tam kapanmasını sağlar.

Böylelikle hemoroidal damarlar, kişi istemli olarak anüsü kontrol eden kaslarını

kasmadığı halde, dışkılama kontrolünün sağlanmasına yardımcı olur.

– Anüsü çevreleyen kas kitlesinin (sfinkter) üzerinde koruyucu bir yastık tabakası işlevi sağlar. Dışkı anal kanaldan (makat)geçerken bu kasların direkt olarak dışkı ile teması hemoroidal damarlar ile korunur. Böylelikle her dışkılamada bu kasların hasar görmesi engellenmiş olur.

– Dinlenme ve uyku halinde anüsü (makat) tam kapatarak dışkının kilodu kirletmesine engel olur. Hemoroidal damarlar yerleşim yerine göre eksternal (dış) ve internal (iç) olarak ikiye ayrılmaktadır.

Anal Kanal ve Hemoroidal Damarlar

– Eksternal (dış) hemoroidler anüsün çevresinde gelişir ve ince bir deri ile kaplıdır..

– İnternal (iç) hemoroidler anüsün içinde gelişir.

HEMOROİD HASTALIĞI NEDİR ?

Bazı kişilerde anüs (makat) ve rektum (kalın bağırsağın son bölümü) çevresinde bulunan hemoroidal damarlar aşırı derecede genişler ve anüsten dışarıya taşarlar. Örneğin Kabızlık şikayeti olan bireylerde dışkı sertleşir ve dışkılama işlevi zorlaşır. Birey bu sert dışkıyı boşaltmak için aşırı ıkınma ve zorlanmaya gerek duyar. Bu sırada anal kanalı örten tabaka ve damarlar zedelenir. Bu da damarlarda genişleme ve şişmeye neden olur. Damarlardaki bu genişleme ve şişmeye hemoroidal hastalık ya da kısaca hemortoid denir. Bu durumda damarlar normal işlevlerini yapamazlar ve bazen de ciddi şikayetlere neden olurlar. Bu belirti ve bulgular hangi hemoroidal grup hastalandı ise ona göre farklılık gösterir.

• Eksternal (dış) hemoroid anüsün çevresinde gelişir ve ince bir deri ile kaplıdır. Eğer bu damarların içinde bir kan pıhtısı oluşursa oldukça ağrılı olur. Hasta, makadının hemen yanında eline sert ve ağrılı şişliğin (memelerin) geldiğini söyler. Yırtıldıkları zaman kanama şikayetine neden olur.

• İnternal (iç) hemoroid anüsün içinde gelişir. Ağrısız kanama en önemli belirtisidir. Bazen iç hemoroidler dışkılama sırasında anüsten (makattan) dışarı çıkarlar ve hasta eline bir şişlik geldiğinden şikayet eder. Buna ek olarak dışkılama sırasında dışarı çıkan ve içeri girmeyen iç hemoroidler ağrıya neden olabilir.

HEMOROİDAL HASTALIĞIN NEDENLERİ

Kesin nedeni bilinmemekle birlikte insanın, diğer canlılardan farklı olarak ayakta dik durması, makattaki toplardamarlara (anüsteki venlere) büyük bir basınç ve hacimde kan dolmasına neden olmaktadır. Bu da hastalığın gelişmesini kolaylaştıran bir etkendir.

Önemli diğer bir nedeni, beslenme alışkanlığıdır. Batı toplumunda 20. yüzyıldan itibaren endüstrinin gelişmesiyle beslenme alışkanlığı da değişmiştir. Sonuçta diyetteki lifli (posalı) yiyecekler azalmıştır. Oysa vücutta sindirilemeyen lifler, emilinceye kadar kitlesinin 30 katı kadar su çekmekte böylece bu kitlenin sindirimi zorlaşmaktadır. Böylelikle, kolay, zorlamadan ve ıkınmadan dışkılama yapılabilir. Aksi takdirde ıkınma ve zorlama bu bölgedeki basıncı daha artırır. Bunun sonucunda hemoroidal hastalık gelişebilir. Diyetsel lifli besinlerin kullanılmaması durumunda, hemoroid hastalığının görülme sıklığı da artmaktadır.

Çoğu insan, hemoroidi olmasına rağmen alışkanlıklarını değiştirmemektedir. Dışkılama alışkanlığının düzenli olmaması, dışkının sertleşmesine neden olur. Dışkılama sırasında ıkınma, tuvalette uzun zaman beklenmesi bu damarlardaki genişlemeyi arttırır. Katı ve sert olan dışkının makattan geçmesi sırasında bu damarlarda hasar oluşur. Bu nedenle de ağrı ve bazen de kanama meydana gelir.

Dışkılama alışkanlığını düzenlemede diğer önemli bir etken de içilen su miktarıdır. Günde en az 8-10 bardak su içilmesi gereklidir. Az miktarda su içmek kabızlığa neden olabilir. Kabızlık da ıkınmaya neden olacağı için hemoroide ait şikayetler artabilir.

Buna ek olarak hastalığın şiddetlenmesine neden olan faktörler şunlardır:

– yaş

– kronik (uzun süreli) Kabızlık veya ishal

– hamilelik

– genetik nedenler (kalıtsal)

– dışkılamayı kolaylaştıran ilaçların (laksatiflerin ve lavmanların) sık kullanımı

– dışkılamak için zorlu ve uzun süreli ıkınmalar

– tuvalette uzun zaman oturulması (gazete, kitap okunması, vb)

– ağır yük kaldırılması

– hastalığın şiddetlenmesine neden olan besin maddelerinin tüketilmesi (alkol, baharatlı yiyecekler)

Nedeni ne olursa olsun bu damar ağlarını (makat kanalındaki toplar damarları) destekleyen dokular gerilir ve sonuçta bu damarlar genişler, çevre destek dokusu ve duvarları incelir ve kanama meydana gelir. Eğer gerginlik artar, basınç devam ederse incelmiş olan bu damarlar makattan dışarı çıkarlar.

HASTALIĞIN BELİRTİLERİ NELERDİR ?

Dışkılama (büyük abdest yapma) esnasında kanama

en önemli belirtisidir. Sıklıkla damla damla burun kanaması gibi taze parlak kırmızı renktedir. Dışkının üzerine ve temizlik sırasında kan fark edilebileceği gibi tüm tuvalet kan ile kirlenebilir. Genelde kanama ağrısızdır.

Dışkılama (büyük abdest yapma) esnasında makatın dışarı çıkması, ele gelen şişlikler.

Hasta makattan dışarı doğru çıkan yumuşak bir şişlikten, kitleden şikayet eder. Bazı hastalar bu dışarı çıkan şişliği makat içine doğru içeriye geri itebilirler.

Anal bölgede (makatta) kaşıntı

Hemoroidal damarların normal işlevlerini yapamaması ile makat bölgesinin hijyeni de bozulur. Makatın tam kapanmaması ile dışkı ve akıntı kaçağı olur. Buna bağlı kaşıntı ihtiyacı oluşur.

Ağrı

Hastalar bu şikayetlerini tam olarak ifade edemezler. Sancı, sızlama veya yanma şeklinde bir his olarak tanımlayabilirler. Özellikle dış hemoroidlerin tromboze (damar içinde kan pıhtısı oluşması) olması şiddetli ağrıya neden olur.

Sürekli olarak anal kanalın (makatın) dışında kalan ve dokunulduğunda ağrılı olan şişlikler

İç hemoroidlerin makattan dışarı sarkması sonucu gelişebileceği gibi dış hemoroidlerin tromboze olması ile de ortaya çıkabilir.

• Kilodun akıntı , kanama veya dışkı ile kirlenmesi

HEMOROİD HASTALIĞINDA KLİNİK MUAYENE NASIL YAPILIR ?

Anamnez:(hastalık hikayes)i: Doktor hastanın şikayetlerini dikkatle dinler. Bu görüşmenin amacı hastaya ait özellikler ve hastalığın seyrini ortaya koymaktır. Hastanın diyet şekli, dışkılama ve tuvalet alışkanlığı, hastalığın şiddetlenmesine neden olabilecek etkenler ve ailesel hikayesi değerlendirilir.

Muayene: Hastanın utanmasına neden olmayacak bir ortamda yapılmalıdır. Bu muayene sırasında doktor makat bölgesini ve kalın bağırsağın son kısmı olan rektumu da parmakla muayene etmesi gerekir. Bu şekilde ayırıcı tanıda akla gelebilecek diğer hastalıkların varlığı da araştırılır.

Endoskopik muayene (Anoskopi-Rektosigmoidoskopi-Kolonoskopi): Kalın bağırsağın içini örten tabakanın direkt gözle incelenmesine endoskopi denir. Bu işlem sadece makat için yapılırsa anoskopi, rektum ve sigmoid kolon için yapılırsa rektosigmoidoskopi ve tüm kalın bağırsak için yapılırsa kolonoskopi denir.

Dışkıdan kan gelmesi şikayeti olan bir hastada ayırıcı tanı için en az rektosigmoidoskopi yapılmalıdır. Aksi takdirde kanamaya neden olabilen diğer hastalıklar gözden kaçabilir. Örneğin dışkılama sırasında kanamaya neden olan erken evredeki bir kalın bağırsak kanserinin farkına varılmazsa ve hemoroid hastalığı diye yanlış tedavi edilirse, ileride ciddi sağlık sorunlarına neden olabileceği unutulmamalıdır. Bu nedenle ayırıc tanı için mutlaka endoskopik tetkiklerden yararlanılmalıdır.

98 Yanıt

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