Hemoroid/ Basur Nedir?
Halk arasında basur ya da mayasıl olarak da bilinen hemoroid, can yakıcı olmasının yanında yaşam kalitesini düşüren bir hastalıktır. Genel olarak belirtileri, başka bir hastalığın habercisi olabilir. Makatta kanama, dışkılamada değişiklik ya da düzensizlik ve ağrı gibi belirtiler kesinlikle ihmal edilmemelidir.
Hemoroid Nasıl Oluşur?
Kalın bağırsağın son kısmı olan anus olarak adlandırdığımız bölümündeki ya da makat bölgesinde damarların şişmesi veya büyümesine hemoroid denir. Anal kanaldaki damar yumakları sarkar ve kimi zaman da sıkışıp kanar. Zaman ilerledikçe bu yumaklar makatın dışına çıkabilir. Bu hastalık iç (internal) ve dış (external) olarak ikiye ayrılır. İç hemoroid genellikle ağrısız geçerken dış hemoroid oldukça sancılı geçebilir. Kimi zaman genişlemiş damarlara pıhtı oturur ve şiddetli bir ağrı, şişlik ve kızarıklık oluşur. İç hemoroid ise dört farklı evreye göre değerlendirilir.
Hemoroid Evreleri;
- Evre: Hemoroidde kanama ile kendini belli eder. Küçük kanamalar, tuvalet kağıdını kirletecek şekilde ya da kimi zaman damla şeklindedir. Bu evrede hemoroidler sarkmaz. Ancak rektoskopi ile görülür.
- Evre: Hemoroidler dışkılama ile birlikte dışarı sarkarlar ve sonrasında kendiliğinden geri giderler.
- Evre: Hemoroid memeleri artık anüs dışına çıkmıştır. Yalnızca parmakla itilerek anüse geri itilebilmektelerdir. Çok sık olarak ödem gerçekleşir ve ağrıya sebep olurlar.
- Evre: Hemoroidlerin makattan dışarı sarktığı evredir. Memeler genellikle büyük ve ıslaktır. Şikayetler arasında büyük abdestten sonra tam temizlenememe nedeniyle iç çamaşırının kirlenmesi vardır ve otururken ağrı da oluşabilmektedir.
Sıklıkla Karşılaşılan Hemoroid Belirtileri;
- Dışkılama sırasında ağrı ya da yanma hissi
- Rektal kanama (Makattan taze kırmızı renkli kanama)
- Makatta şişlik, akıntı veya ıslaklık hissi
- Kaşıntı
- Dışkılamada düzensizlik
Açık ve Ameliyatsız Tedavi
Tedavisinde öncelikle bağırsak hareketlerinin düzenlenmesi amaçlanır. Sürekli meydana gelen kabızlık ya da ishal gibi sorunlarınız varsa önce buna yol açan sebepler bulunmalı ve çözüme kavuşturulmalıdır. Uzman doktor tarafından kesin hemoroid tanısı konmadan herhangi bir hemoroid kremi ya da ilaç kullanılmamalıdır. Daha çok l. ve 2. evredekiler için ilaç ve krem tedavisi uygulanır. Krem genel olarak ağrı, şişlik ve yanmayı engellemek için kullanılır. Bunun yanında az miktarda nitrogliserin içeren kremle sorun olan bölgeye masaj yapılması da ağrı ve yanmayı azaltabilir. Bu kremler makat kaslarını gevşetip rahatlatabilir. Ancak kullanılan kremler etkisi ağır olan kremlerdir. Fazla miktarda alınmaması gerekir.
Gaita Yumuşatıcı İlaçlar
Gayta yumuşatıcı olarak Pursenid draje ve Laktüloz (Duphalac şurup, Osmolak şurup) kullanılabilir. Lokal anestezik ve antienflamatuar içeren rektal krem ve supozituvarlar (Proctolog, Proctoglyvenol), Hidrokortizonlu rektal krem ve fitiller (Kortos) 10-12 gün süresince kullanılması anal kanaldaki irritasyon ve hemoroid semptomlarına iyi gelir. Steroidli ilaçların bir iki aydan fazla kullanılması deride atrofilere yol açabilir. Eksternal anal tahrişler hasta tarafından istenildiği kadar kullanılabilen pişik merhemleriyle tedavi edilebilir.
Soğuk Uygulama
Soğuk kompres ya da ice pack denen torbalardan faydalanılabilir.
Ağrı Kesiciler
Parasetamol (Parol, Tylol, Tamol, Calpol) ve diğer nonsteroid antienflamatuar ilaçlar (Aprol, Apranax) kullanılabilir. Grade 3-4 tromboze ve tromboze olmayan iç hemoroidlerde günde 2-3 defa sıcak oturma banyoları, gayta yumuşatıcı ajanlar, fitil ve kremlerle tedavi edilebilir. İnternal hemoroidler için operasyonsuz tedavi genellikle 4-6 hafta süresince denenmelidir. Bu süreden sonra hastanın şikayetleri devam ederse cerrahi tedavi önerilebilir. Eksternal akut trombozlar,eğer doku nekrozu bulguları yoksa ve ağrı çok değilse, başlangıçta fitil, krem ve oturma banyoları ile ameliyatsız tedavi edilebilirler. Ancak, eğer hastada çok fazla ağrı, yüzeyel nekroz mevcut ise trombektomi yapılmalıdır.
Ilık Suya Oturma
Dışkılama sonrası herhangi bir küvete ılık su konarak yaklaşık on beş yirmi dakika oturulması da hemoroid tedavi yöntemlerindendir. Oturma banyosu adı verilen bu yöntemde dezenfektan kullanılabilir ve rahatlama sağlar. Ardından da makat kağıt havluyla kurulanır.
Skleroterapi
Bir diğer tedavisi ise skleroterapi’dir. İğne ya da enjeksiyon tedavisi olarak da geçen bu yöntemde sorun olan bölgeye bazı maddeler enjekte edilir. Bu yöntemle oluşan sarkma giderilmeye çalışılır. Narkozsuz uygulanan yöntem, ağrısız ve kısa sürelidir.
Boğma tedavisi
Boğma tedavisi ya da bant ligasyonu ise geliştirilen bir başka tedavi yöntemidir. Bu yöntemde hemoroid memesinin etrafına bir lastik takılır ve meme çürümeye terk edilir.
Hemoroid Ameliyatı
En Etkili Tedavi Yöntemi Hemoroid Ameliyatıdır.
Hemoroid tedavisi, hastalığın gelişimine bağlı olarak klasik cerrahi ile yani ameliyatla da yapılabilir. 3., 4. evredeki hemoroidlerde daha çok tercih edilen hemoroid ameliyatı; genel anestezi altında ya da özel cihazlarla bölgesel anestezi yapılarak gerçekleştirilir. Üçüncü bölge hemoroid tedavisi içinse lazer tedavisi de uygulanabilir. Bu yöntemde de ameliyat süresi oldukça kısa ve ameliyat sonrası ağrısızdır. Hastalık için en etkili tedavi yöntemi olup ameliyat sonrasında hastalığın tekrar etme ihtimali azdır.
Hemoroid Nasıl Geçer Ve Hastalığı Tetikleyen Unsurlar Nelerdir?
Öncelikle posalı yiyeceklerden oluşan bir diyet tavsiye edilir. Ancak bu diyetin mutlaka doktor kontrolünde yapılacak diğer uygulamalarla birlikte yapılması çok önemlidir. Temel nedeni bazen dışkılamada yapılan yanlışlıklardır. Vücudumuzun boşaltım sisteminin doğal bir düzeni vardır. Eğer siz sabah gelen doğal dışkılama isteğini erteler ya da baskılarsanız, bunun dışında başka bir zamanda doğal rutin dışında kendinizi dışkılamaya zorlarsanız hastalığı tetiklemiş olursunuz. Ayrıca gelişen sürekli kabızlık ya da ishal gibi sindirim sorunları da bu hastalığa yol açabilir.
- Bol su içmek genel olarak sağlıklı bir yaşam için önerilir. Hemoroide yakalanmamak ve düzenli bağırsak hareketleri için de bol su içmek şarttır. Sindirim sisteminizdeki kabızlık gibi bir sorun da olasılığı artırdığı için yediğiniz yiyeceklere dikkat etmeniz gerekir. Lifli gıdalardan yeteri derecede almak diğer bir çok hastalık için olduğu gibi bu hastalık için de önemlidir.
- Düzensiz fiziksel aktivitenin olduğu bir yaşam da hastalığın sebebi olabilir. Yani çok fazla fiziksel aktivite ya da fiziksel aktivitenin hiç olmaması, uzun süre oturmanın da bu hastalığa sebep olduğunu söyleyebiliriz. Bu nedenle her hastalığın tedavisinde ve sağlıklı bir yaşamın sürdürülmesinde düzenli spor yapmak gereklidir. Size uygun bir spor dalına devam etmek ya da en azından düzenli yürüyüşü hayatınıza dahil etmek bir çok hastalığın tedavisinde önemli bir etkiye sahiptir.
- Öte yandan kadınlar gebelikte ve doğum sonrasında bu hastalığa yakalanabilir. Şoförlük ve pilotluk gibi mesleklere mensup kişilerin de özellikle bağırsak sağlığına dikkat etmesi gerekir. Egzersizler ihmal edilmemeli ve beslenme düzenine lifli ve posalı yiyecekler dahil edilmelidir. Ayrıca alkol alışkanlığı da hemoroide neden olabilir.
Hemoroid Farklı Hastalıkların Habercisi Olabilir!
Hemoroid için önemli olan bir başka mesele hastalığın altında herhangi bir tümör olup olmadığıdır. Hemoroid kalın bağırsak kanseri habercisi olabilir. Dolayısıyla eğer makatınızdan kan gelme gibi belirtiler varsa ve şiddetli bir ağrı oluşuyorsa mutlaka tam donanımlı bir hastaneye başvurmalısınız. Doktorunuzun önerisi dışında herhangi bir krem ya da ilaç almamalısınız. Hastalık ancak rektoskopik ya da kolonoskopik bir tetkik sonucunda teşhis edilebilir. Özellikle tümör gibi daha ciddi bir hastalığın belirtisiyse doktora gitmekte gecikmemelisiniz. Erken teşhis her hastalığın tedavisinde hayati bir öneme sahiptir.
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