Sausage and Hemorrhoid: Difference between pages

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{{Infobox_Disease |
{{otheruses1|the prepared meat}}
Name = Hemorrhoids |
[[Image:Kielbasa7.jpg|thumb|Biała, szynkowa, kiełbaska śląska, podhalańska (Poland)]]
Image = Hemorrhoid.png|
[[Image:Wurst1.JPG|thumb|Plate with ''German Wurst'' (liver, blood and ham sausage)]]
Caption = Schematic demonstrating the anatomy of hemorrhoids.|
A '''sausage''' is a prepared [[food]], usually made from [[ground meat]], animal fat, salt, and [[spices]] (sometimes with other ingredients such as herbs), typically packed in a [[casing (sausage)|casing]]. [[Sausage making]] is a traditional [[food preservation]] technique.
DiseasesDB = 10036 |
ICD10 = {{ICD10|I|84||i|80}} |
ICD9 = {{ICD9|455}} |
ICDO = |
OMIM = |
MedlinePlus = 000292|
eMedicineSubj = med|
eMedicineTopic = 2821|
eMedicine_mult = {{eMedicine2|emerg|242}} |
}}
An apple a day keeps the hemorrhoids away!
'''Hemorrhoids''' ([[AmE]]), '''haemorrhoids''' ([[BrE]]), '''emerods''', or '''piles''' are [[Varices|varicosities]] or [[swelling (medical)|swelling]] and [[inflammation]] of [[veins]] in the [[rectum]] and indoor-[[anus]]. The anatomical term "hemorrhoids" technically refers to "'Cushions of tissue filled with blood vessels at the junction of the [[rectum]] and the [[anus]]."<ref>[http://medlineplus.nlm.nih.gov/medlineplus/ency/presentations/100026_1.htm MedlinePlus Medical Encyclopedia:Hemorrhoid surgery - series: Normal anatomy]</ref> However, the term is popularly used to refer to varicosities of the hemorrhoid tissue. [[Perianal hematoma]] are sometimes misdiagnosed and mislabeled as hemorrhoids, when in fact they have different causes and treatments.<ref>[http://www.medbroadcast.com/channel_section_details.asp?text_id=1450&channel_id=1017&relation_id=5225 Perianal hematoma - Medbroadcast<!-- Bot generated title -->]</ref>


==Causes==
Traditionally, casings are made of animal intestines though are now often synthetic. Some sausages are cooked during processing, and the casing may be removed at that time. Sausages may be preserved by [[curing (food preservation)|curing]], drying in cool air, or [[Smoking (food)|smoking]]


Increased straining during bowel movements, by [[constipation]] or [[diarrhea]], may lead to hemorrhoids.<ref name="titleHemorrhoids during pregnancy: Treatment options - MayoClinic.com">{{cite web |author=Harms R |title=Hemorrhoids during pregnancy: Treatment options |url=http://www.mayoclinic.com/health/hemorrhoids-during-pregnancy/AN01720 |date=November 3, 2007 |publisher=MayoClinic |accessdate=2007-11-28}}</ref> It is thus a common condition due to constipation caused by water retention in women experiencing [[premenstrual syndrome]] or [[menstruation]].
== History ==
[[Image:Sausage making-H-1.jpg|thumb|right|Ordinary [[sausage making]]]]
[[Image:Cooking snags over campfire.jpg|thumb|Australian "snags" cooking on a campfire]]
Sausage is an outcome of efficient [[butcher]]y. Sausage-makers put to use meat and animal parts that are edible and nutritious, but not particularly appealing -such as scraps, organ meats, blood, and fat- in a form that allows for preservation: typically, salted and stuffed into a tubular casing made from the cleaned intestine of the animal, producing the characteristic cylindrical shape. Hence, sausages, [[puddings]] and [[salami]] are amongst the oldest of prepared foods, whether cooked and eaten immediately or dried to varying degrees. The sausage can also be shaped in a square, such as in Africa the sausage is sometimes shaped like a square hamburger patty.
It is believed that sausages were invented by [[Sumerians]] in what is present day　[[Iraq]], around [[3000 BC]].{{Fact|date=September 2008}} [[Chinese sausage]] ''làcháng'' (臘腸/腊肠), which consisted of goat and lamb meat, was first mentioned in [[589 BC]]. [[Homer]], the [[poet]] of [[Ancient Greece]], mentioned a kind of blood sausage in the [[Odyssey]] (book 20, verse 25), and [[Epicharmus]] (ca. [[550 BC]] – ca. [[460 BC]]) wrote a comedy titled ''The Sausage.'' Evidence suggests that sausages were already popular both among the ancient Greeks and Romans, and most likely with the non-literate tribes occupying the larger part of Europe.


[[Hypertension]], particularly [[portal hypertension]], can also cause hemorrhoids because of the connections between the portal vein and the [[vena cava]] which occur in the rectal wall -- known as [[portocaval anastomoses]].<ref>{{cite web |title=Causes of Hemorrhoids |url=http://www.mayoclinic.com/health/hemorrhoids/DS00096/DSECTION=3 |date=November 28, 2006 |publisher=Mayo Clinic |accessdate=2007-12-07}}</ref>
Sausage in [[Italy]] has its roots in [[Lucania]], the actual [[Basilicata]]. Philosophers such as [[Cicero]] and [[Martial]] stated a kind of sausage called "lucanica", actually widespread in [[Italy]], was introduced by Lucanian slaves during the [[Roman empire]].<ref> Touring Club Italiano ''Le città dell'olio'', 2001, Touring Editore pag. 237 ISBN 883652141X</ref> During the reign of the Roman emperor [[Nero]], sausages were associated with the [[Lupercalia]] festival. The early Catholic Church outlawed the Lupercalia Festival and made eating sausage a sin.{{Fact|date=May 2008}} For this reason, the Roman emperor [[Constantine I (emperor)|Constantine]] banned the eating of sausages. {{Fact|date=May 2008}} Early in the [[10th century]] in the [[Byzantine Empire]], [[Leo VI the Wise]] outlawed the production of blood sausages following cases of food poisoning.


[[Obesity]] can be a factor by increasing rectal vein pressure. Sitting for prolonged periods of time can cause hemorrhoids. Poor muscle tone or poor posture can result in too much pressure on the rectal veins.
Traditionally, sausage casings were made of the cleaned intestines (or stomachs in the case of [[haggis]] and other traditional puddings) of animals. Today, however, natural casings are often replaced by [[collagen]], [[cellulose]] or even [[plastic]] casings, especially in the case of industrially manufactured sausages. Additionally, luncheon meat (such as [[Spam (food)|Spam]]) and sausage meat are now available without casings in tins and jars.


[[Pregnancy]] causes hypertension and increases strain during bowel movements, so hemorrhoids are often associated with pregnancy.
The most basic sausage consists of meat cut into pieces or ground and filled into a casing such as an animal intestine. The meat may be from any animal, but traditionally is pork, beef or veal. The meat/fat ratio is dependent upon the style and producer, but in the United States, fat content is legally limited to a maximum of 30%, 35% or 50%, by weight, depending on the style. The [[United States Department of Agriculture|USDA]] defines the content for various sausages and generally prohibits fillers and extenders.<ref>[http://www.cfsan.fda.gov/~lrd/9CF319.html USDA Standards of Identity; see Subparts E, F & G]</ref> Most traditional styles of sausage from Europe and Asia use no bread-based filler and are 100% meat and fat (excluding salt and other flavorings, such as herbs).<ref>''Joy of Cooking,'' Rombauer & Becker; ''The Fine Art of Italian Cooking,'' Bugialli</ref> In the UK and other countries with English cooking traditions, bread and starch-based fillers account for up to 25% of ingredients. The filler used in many sausages helps them to keep their shape as they are cooked. As the meat contracts in the heat so the filler expands.


Excessive consumption of [[alcohol]] or [[caffeine]] can cause hemorrhoids.<ref name="titleHemorrhoids">{{cite web |author=Burney RE |title=Hemorrhoids |url=http://www.med.umich.edu/1libr/aha/aha_hem_crs.htm |month=November | year=2005 |publisher=University of Michigan Health System |accessdate=2007-11-28}}</ref> Both can cause diarrhea. Note that caffeine ingestion increases blood pressure transiently, but is not thought to cause chronic hypertension. Alcohol can also cause [[alcoholic liver disease]] leading to [[portal hypertension]].
The word ''sausage'' is derived from [[Old French]] ''saussiche,'' from the [[Latin]] word ''salsus,'' meaning ''salted.''


== Classification of sausages ==
[[Image:Reunion sausages dsc07796.jpg|thumb|right|200px|Sausages from [[Reunion Island]]]]
[[Image:kielbasa2.jpg|thumb|right|200px|Swojska (Polish)]]
[[Image:Krajanska.jpg|thumb|right|200px|Krajańska (Polish)]]
[[Image:Szynkowa.jpg|thumb|right|200px|Szynkowa (Polish)]]
[[Image:Frankfurter wurst.JPG|thumb|right|200px|A frankfurter sausage contains a lot of protein, yet low calories/fat (for meat)]]
Sausages may be classified in any number of ways, for instance by the type of meat and other ingredients they contain, or by their consistency. The most popular classification is probably by type of preparation, but even this is subject to regional differences of opinion. In the English-speaking world, the following distinction between fresh sausages, cooked sausages and dry sausages seems to be more or less accepted:
* ''Cooked sausages'' are made with fresh meats and then fully cooked. They are either eaten immediately after cooking or must be refrigerated. Examples include [[hot dog]]s, [[Braunschweiger]] and liver sausages.
* ''Cooked smoked sausages'' are cooked and then smoked or smoke-cooked. They are eaten hot or cold, but need to be refrigerated. Examples include [[Kolbász|Gyulai kolbász]], [[kielbasa]] and [[Mortadella]].
* ''Fresh sausages'' are made from meats that have not been previously cured. They must be refrigerated and thoroughly cooked before eating. Examples include [[Boerewors]], [[Italian sausage|Italian pork sausage]], [[breakfast sausage]] and [[Yarraque]].
* ''Fresh smoked sausages'' are fresh sausages that are smoked. They should be refrigerated and cooked thoroughly before eating. Examples include [[Mettwurst]] and Romanian sausage.
* ''Dry sausages'' are fresh sausages that are dried. They are generally eaten cold and will keep for a long time. Examples include [[salami]], [[Droë wors]], [[Sucuk]], [[Landjäger]], and [[summer sausage]].


===Symptoms===
The distinct flavor of some sausages is due to [[fermentation]] by ''[[Lactobacillus]]'' during curing.


Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching, also called [[pruritus ani]], have similar symptoms and are incorrectly referred to as hemorrhoids.
Other countries, however, use different systems of classification. [[Germany]], for instance, which boasts more than 1200 types of sausage, distinguishes raw, cooked and pre-cooked sausages.


Hemorrhoids usually are not dangerous or life threatening. In most cases, hemorrhoidal symptoms will go away within a few days.
* ''Raw sausages'' are made with raw meat and are not cooked. They are preserved by [[lactic acid fermentation]], and may be [[drying (food)|dried]], [[brining|brined]] or [[smoking (food)|smoked]]. Most raw sausages will keep for a long time. Examples include [[cervelat]], [[mettwurst]] and [[salami]].
* ''Cooked sausages'' may include water and [[emulsifier]]s and are always cooked. They will not keep long. Examples include [[Jagdwurst]] and [[Weißwurst]].
* ''Pre-cooked sausages'' are made with cooked meat, and may include raw organ meat. They may be heated after casing, and will keep only for a few days. Examples include [[Saumagen]] and [[Blutwurst]].


Although many people have hemorrhoids, not all experience symptoms. The most common symptom of internal hemorrhoids is bright red blood covering the stool, on toilet paper, or in the toilet bowl. However, an internal hemorrhoid may protrude through the anus outside the body, becoming irritated and painful. This is known as a protruding hemorrhoid.
In Italy, the basic distinction is:
* ''Raw sausage'' (''salsiccia'')
* ''Cured or cooked sausage'' (''salume'')


Symptoms of external hemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms. This condition is known as a thrombosed external hemorrhoid.
The US has a particular type called '''pickled sausages''', commonly found in gas stations and small roadside delicatessens. These are usually smoked and/or boiled sausages of a highly processed [[frankfurter]] ([[hot dog]]) or [[kielbasa]] style plunged into a boiling brine of vinegar, salt, spices (red pepper, paprika...) and often a pink coloring, then [[canning|canned]] in wide-mouth jars. They are available in single blister packs, e.g., [[Slim Jim (snack food)|Slim Jim]] meat snacks, or in jars atop the deli cooler. They are shelf stable, and are a frequently offered alternative to beef [[Jerky (food)|jerky]], beef stick, and kippered beef snacks.


In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Draining mucus may also cause itching.
Certain countries classify sausage types according to the region in which the sausage was traditionally produced:


===Food===
* [[France]]: [[Montbéliard]], [[Morteau]], [[Strasbourg]], [[Toulouse]], [[Merguez]]...
{{Unreferencedsection|date=September 2006}}
* [[Germany]]: [[Frankfurt]], [[Thuringia]], [[Nuremberg]], [[Pomerania]], ...
Insufficient liquid can cause a hard stool, or even chronic constipation, which can lead to hemorrhoidal irritation. An excess of [[lactic acid]] in the stool, a product of excessive consumption of dairy products such as [[cheese]], can cause irritation; reducing such consumption can bring relief. [[Vitamin E]] deficiency is also a common cause.
* [[Austria]]: [[Vienna]], ...
* [[Italy]]: [[Merano|Merano (Meran)]]
* [[UK]]: [[Cumberland sausage|Cumberland]], [[Chiltern]], [[Lincolnshire sausage|Lincolnshire]], [[Glamorgan sausage|Glamorgan]] ...
* [[Slovenia]]: [[Carniola|Kranjska]] ([[Kranjska klobasa|klobasa]]), after the Slovenian name for the province of [[Carniola]]
* [[Spain]]: [[botifarra]] [[Catalonia|catalana]], [[chorizo]] [[La Rioja (autonomous community)|riojano]], chorizo [[Galicia (Spain)|gallego]], chorizo de [[Teror, Las Palmas|Teror]], longaniza de [[Aragón]], morcilla de [[Burgos]], morcilla de [[Ronda]], morcilla [[Extremadura|extremeña]], morcilla dulce [[Canary Islands|canaria]], llonganissa de [[Vic]], [[fuet]] d'[[Olot]], [[sobrassada]] [[Mallorca|mallorquina]], botillo de [[León (province)|León]], llonganissa de [[Valencia (autonomous community)|Valencia]], farinato de [[Salamanca]], ...
* [[Poland]]: [[kielbasa]] krakowska ([[Kraków]]-style), toruńska ([[Toruń]]), żywiecka ([[Żywiec]]), bydgoska ([[Bydgoszcz]]), krotoszyńska ([[Krotoszyn]]), podwawelska (literally: "from under [[Wawel]]"), zielonogórska ([[Zielona Góra]]), rzeszowska ([[Rzeszów]]), śląska ([[Silesia]]), swojska, wiejska, jałowcowa, zwyczajna, polska, krajańska, szynkowa, parówkowa ...
* [[Hungary]]: [[kolbász]] gyulai (after the town of [[Gyula]]), csabai (after the city of [[Békéscsaba]]), [[Debrecener]] (after the city of [[Debrecen]]).


Eating fruit helps avoid conditions that lead to hemorrhoids.
== National varieties ==
[[Image:Russian Sausage Making.jpg|right|thumb|[[Sausage making]] in [[Russia]]]]


Food considered "[[probiotic]]", such as yogurt with active culture, may help keep the gut functioning normally and thus prevent flare-ups.{{Fact|date=August 2008}}
Many nations and regions have their own characteristic sausages, using meats and other ingredients native to the region and employed in traditional dishes.


==Types of hemorrhoids==
=== Argentina ===
[[Image:Hemorrhoids2.jpg|thumb|right|Direct view of hemorrhoid seen on [[sigmoidoscopy]]]]
In Argentina many sausages are consumed. Eaten as part of the traditional [[asado]], [[Chorizo]] (beef and/or pork, flavored with spices) and [[Morcilla]] (Blood Sausage or Black pudding) are the most popular. Both of them share a Spanish origin. A local type is the salchicha Argentina, criolla (Argentinian sausage) or parrillera (literally BBQ-style), made of the same ingredients as the Chorizo but thinner.<ref>[http://www.asadoargentina.com/article/sausage-chorizo/ Asado Argentina » Sausage-Chorizo<!-- Bot generated title -->]</ref>
* (I84.3-I84.5) '''External hemorrhoids''' are those that occur outside of the [[anal verge]] (the [[distal]] end of the [[anal canal]]). They are sometimes painful, and can be accompanied by swelling and irritation. Itching, although often thought to be a symptom from external hemorrhoids, is more commonly due to skin irritation.
** (I84.3) External hemorrhoids are prone to [[thrombosis]]: if the vein ruptures and a [[blood clot]] develops, the hemorrhoid becomes a '''thrombosed hemorrhoid'''.<ref>E. Gojlan, ''Pathology, 2nd ed.'' Mosby Elsevier, Rapid Review series.</ref>
* (I84.0-I84.2) '''Internal hemorrhoids''' are those that occur inside the [[rectum]]. As this area lacks pain [[sensory receptor|receptors]], internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may bleed when irritated.
* (I84.1) Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: ''prolapsed'' and ''strangulated hemorrhoids'':
** '''Prolapsed hemorrhoids''' are internal hemorrhoids that are so distended that they are pushed outside the anus.
** If the anal [[sphincter]] muscle goes into [[spasm]] and traps a prolapsed hemorrhoid outside the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a '''strangulated hemorrhoid'''.


There are hundreds of salami-style sausages. A very popular is the Salame Tandilero, from the city of [[Tandil]]. Others examples are: Longaniza, Cantimpalo and Sopresatta.<ref>http://www.argentina.ar/_en/country/C161-the-gastronomy-in-the-world.php</ref>


Vienna sausages are eaten as an appetizer or in hot dogs (called panchos) which are usually served with different sauces and salads.


===By degree of prolapse===
Leberwurst is usually found in every market and it is eaten as a cold cut or a Pâté.
The most common grading system was developed by Banov:<ref name="emedicine-emerg-242">{{eMedicine|emerg|242|Hemorrhoid}}</ref><ref name="pmid3861909">{{cite journal |author=Banov L, Knoepp LF, Erdman LH, Alia RT |title=Management of hemorrhoidal disease |journal=J S C Med Assoc |volume=81 |issue=7 |pages=398–401 |year=1985 |pmid=3861909 |doi=}}</ref>


* '''Grading of Internal Hemorrhoids'''
Weisswurst is also a common dish, eaten usually with mashed potatoes or chucrut ([[Sauerkraut]]), in some regions.<ref>[http://www.clarin.com/diario/2005/05/27/sociedad/s-04201.htm La salchicha de viena cumple 200 años<!-- Bot generated title -->]</ref><ref>[http://www.pasqualinonet.com.ar/Propuesta%20empanada.htm La inmigración<!-- Bot generated title -->]</ref>
** '''Grade I:''' The hemorrhoids do not prolapse.
** '''Grade II:''' The hemorrhoids prolapse upon defecation but spontaneously reduce.
** '''Grade III:''' The hemorrhoids prolapse upon defecation, but must be manually reduced.
** '''Grade IV:''' The hemorrhoids are prolapsed and cannot be manually reduced.


=== China ===
==Prevention==
{{Unreferencedsection|date=September 2006}}
[[Lap cheong]] (also lap chong, lap chung, lop chong). Dried pork sausages flavored with [[char siu]] that look and feel like pepperoni, but are much sweeter. In southwestern China, sausages are flavored with salt, red pepper and wild pepper. People often cure sausages by smoking and air drying.They have sweet and spicy yet a tangy sour spice added on to it. It is from oxex penis. It is a greta use of cooking for breakfest,medicen for fevers,and feeding dogs. It can store up to one-year in the fridge or out in a storage.Also it can help with a great smoothie in Korea or other places.
Prevention of hemorrhoids includes drinking more fluids, eating more [[dietary fiber]] (such as fruits, vegetables and cereals high in fiber), exercising, practicing better posture, and reducing [[bowel movement]] strain and time. Hemorrhoid sufferers should avoid using [[laxatives]] and should strictly limit time straining during bowel movement. Wearing tight clothing and underwear will also contribute to irritation and poor muscle tone in the region and promote hemorrhoid development. Some sufferers report a more comfortable experience without underwear or wearing only very lightweight underwear.


Women who notice they have painful stools around the time of [[menstruation]] would be well-advised to begin taking extra [[dietary fiber]] and fluids a couple days prior to that time.
=== France ===
Saucisson is perhaps one of the most popularized forms of dried sausage in France, with many different variations from region to region. Usually saucisson contains pork, cured with a mixture of salt, wine and/or spirits. Regional varieties have been known to contain more unorthodox ingredients such as nuts and fruits.


Fluids emitted by the intestinal tract may contain irritants that may increase the fissures associated with hemorrhoids. Washing the anus with cool water and soap may reduce the swelling and increase blood supply for quicker healing and may remove irritating fluid.
=== Poland ===
[[Poland|Polish]] sausages, ([[Kiełbasa]]), come in a wide range of styles such as Swojska, Krajańska, Szynkowa, Biała, śląska, and podhalańska.


[[Kegel exercise]]s for the pelvic floor may also prove helpful.
=== Hungary ===
[[Kolbász|Hungarian sausage]]s called [[kolbász]], are two types, the smoked, cured sausages like ”[[Kolbász|Gyulai]]” and “[[Kolbász|Csabai]]” sausage.
[[Hungary|Hungarian]] The other type are the boiled sausages called "Hurka". Rice Liver Sausage ("Májas") and Rice [[Blood Sausage]] ("Véres").
In the first case the main ingredient is the liver and the stuffing consist of rice.
In the other case the blood is mixed with rice, or pieces of bread roll.
Spices, pepper, salt and marjoram are added. See even [[winter salami]],


Many people do not get a sufficient supply of dietary fiber (20 to 25 grams daily) and small changes in a person's daily diet can help tremendously in both prevention and treatment of hemorrhoids.
=== Italy ===
[[Italy|Italian]] sausages are often a mix of pork and veal.


=== USA ===
=== Use of squat toilets ===
Based on their very low incidence in the developing world, where people squat for bodily functions, hemorrhoids have been attributed to the use of the unnatural "sitting" toilet.<ref>{{cite journal |author=Sikirov BA |title=Primary constipation: an underlying mechanism |journal=Med. Hypotheses |volume=28 |issue=2 |pages=71–3 |year=1989 |pmid=2927355|doi=10.1016/0306-9877(89)90016-9}}</ref><ref>{{cite journal |author=Sikirov D |title=Comparison of straining during defecation in three positions: results and implications for human health |journal=Dig. Dis. Sci. |volume=48 |issue=7 |pages=1201–5 |year=2003 |pmid=12870773|doi=10.1023/A:1024180319005}}</ref> In 1987, an Israeli physician, Dr. Berko Sikirov, published a study testing this hypothesis by having hemorrhoid sufferers convert to [[squat toilets]].<ref name="pmid3623887">{{cite journal |author=Sikirov BA |title=Management of hemorrhoids: a new approach |journal=Isr. J. Med. Sci. |volume=23 |issue=4 |pages=284–6 |year=1987 |pmid=3623887 |doi=}}</ref> Eighteen of the 20 patients were completely relieved of their symptoms (pain and bleeding) with no recurrence, even 30 months after completion of the study. [http://naturesplatform.com/images/Sikirov_table.gif This chart] summarizes the results.
In the USA, precooked sausages (wieners, franks and hot dogs) are most often consumed. Fresh-cooked sausages in the form of cased links (italian, [[bratwurst]], [[chorizo]], [[andouille]]) are widely available, but fresh or precooked "[[breakfast sausage]]s," in patty, log, or link form are consumed much more often, and are usually what is referred to by the term "sausage". Pepperoni and Italian crumbles are popular pizza toppings. Many types of "ethnic" sausages are used as sliced sandwich toppings, with [[Lebanon bologna]] and several examples of Italian [[salami|salume]] examples being some of the more unique adaptations. Head cheese and scrapple are examples of square sausage-like products in this category.


No follow-up studies have ever been published. The [http://www.fascrs.org/displaycommon.cfm?an=1&subarticlenbr=12 American Society of Colon & Rectal Surgeons] is silent regarding the therapeutic value of squatting.
=== Germany ===
[[Germany|German]] sausages, or [[:Category:German sausages|würste]], cover a variety of uncooked and unfilled things (no casing), like [[frankfurters]], [[bratwurst|bratwürste]], rindswürste, blargenwurst, [[knackwurst|knackwürste]], and [[bockwurst|bockwürste]].


=== UK ===
==Examination==
[[Image:Hemorrhoids.jpg|200px|right|thumb|Endoscopic image of internal hemorrhoids seen on retroflexion of the flexible [[sigmoidoscopy|sigmoidoscope]] at the ano-rectal junction]]
In the [[United Kingdom|UK]] sausages are very popular. British sausages are normally made from pork or beef mixed with a variety of herbs and spices, many recipes of which are traditionally associated with particular regions (for example [[Buckinghamshire|Bucks]] sausages). They normally contain a certain amount of [[Rusk]], or [[Rusk|Bread-Rusk]], and are traditionally cooked by frying, grilling or roasting prior to eating. Due to their habit of often exploding due to shrinkage of the tight skin during cooking, they are commonly referred to as '''bangers''' particularly when served with the most common accompaniment of mashed potatoes to form one the national dish known as [[Bangers and Mash]]. (The designation banger is also said to have arisen during [[World War II]], when scarcity of meat led many sausage makers to add water to the mixture, making it more likely to explode on heating. Although sometimes stated that the term "bangers" has its origins in World War II, the term was actually in use at least as far back as 1919.) They may also be baked in a [[Yorkshire pudding]] batter to create '[[Toad in the Hole]]', often served with [[gravy]] and onions.
After visual examination of the anus and surrounding area for external or prolapsed hemorrhoids, a doctor would conduct a [[Rectal examination|digital examination]]. In addition to probing for hemorrhoidal bulges, a doctor would also look for indications of rectal [[tumor]] or [[Polyp (medicine)|polyp]], enlarged [[prostate]] and [[abscess]]es.


Visual confirmation of hemorrhoids can be done by doing an [[anoscopy]], using a medical device called an [[anoscope]]. This device is basically a hollow tube with a light attached at one end that allows the doctor to see the internal hemorrhoids, as well as polyps in the rectum.
Famously, they are an essential component of both a [[Full breakfast#Full English breakfast|Full English Breakfast]].
In the UK alone there are believed to be over 470 different types of sausages<ref>According to [http://www.sausagefans.com Sausagefans.com]</ref>; some made to traditional regional recipes such as those from [[Cumberland sausage|Cumberland]] or [[Lincolnshire sausage|Lincolnshire]], and increasingly to modern recipes which combine fruit such as apples or apricots with the meat, or are influenced by European styles such as the [[Toulouse]] or [[Chorizo]].


If warranted, more detailed examinations, such as [[sigmoidoscopy]] and [[colonoscopy]] can be performed. In sigmoidoscopy, the last 60cm of the [[colon (anatomy)|colon]] and rectum are examined whereas in colonoscopy the entire bowel is examined.
In many areas "sausage meat" for frying and [[stuffing]] into poultry and meat, is sold as slices cut from an oblong block of pressed meat without casing: in Scotland this is known as ''Lorne Sausage'' or often ''sliced'' or ''square'' while the usual form is sometimes called ''[[sausage links]].''


A pathologist will look for dilated vascular spaces which exhibit thrombosis and recanalization.
A popular and widespread snack is the [[sausage roll]] made from sausage-meat rolled in [[puff pastry]]; they are sold from most [[bakeries]] and often made in the home.


==Treatments==
[[Battered sausage]], consisting of a sausage dipped in batter, and fried, is sold throughout Britain from [[Fish and Chips| Fish and Chip]] shops. In England, [[Saveloy]] is a type of pre-cooked sausage, larger than a typical hot-dog which is served hot. A saveloy skin was traditionally colored with [[bismarck brown|bismarck-brown]] dye giving saveloy a distinctive bright red color.
Treatments for hemorrhoids vary in their cost, risk, and effectiveness. Different cultures and individuals approach treatment differently. Some of the treatments used are listed here in increasing order of intrusiveness and cost.


For many people, hemorrhoids are mild and temporary conditions that heal spontaneously or by the same measures recommended for prevention. There is no medicine that will cure hemorrhoids but local treatments such as warm sitz baths, using a bidet, extendable showerhead, cold compress, or topical analgesic (such as Nupercainal), can also provide temporary relief.
A short variety of sausage, known as the [[chipolata]] or 'cocktail sausage' is often wrapped in bacon and served alongside roast [[turkey]] at [[Christmas]] time, or served cold at children's parties throughout the year.


Especially in the case of external hemorrhoids with a visible lump of small size, the condition can be improved with warm bath causing the vessels around rectal region to be relaxed. Consistent use of medicated creams during the early stages of a hemorrhoid flare-up will also provide relief and may stave off further development and irritation. However, creams containing steroid preparations weaken the skin and may contribute to further flare-ups. Keep the area clean and dry, with some lubrication provided by hemorrhoidal creams or a lubricant. Ointment or [[Suppository|suppositories]] such as Proctosedyl<ref>[http://www.netdoctor.co.uk/medicines/100002157.html Proctosedyl ointment/suppositories<!-- Bot generated title -->]</ref><ref>[http://www.medbroadcast.com/drug_info_details.asp?brand_name_id=946 Proctosedyl - Drugs - Medbroadcast<!-- Bot generated title -->]</ref> and Faktu<ref>http://www.vghks.gov.tw/ph/%E8%99%95%E6%96%B9%E9%9B%86/drug/faktu.htm</ref> can also relieve the symptoms.
Due to health concerns over the quality of the meat contained in many commercially produced sausages (heightened by the [[BSE]] crisis in the 1990s) there has been a marked improvement in the quality of meat content in commonly available British sausages with a marked return to the artisanal production of high quality traditional recipes, which had previously been in decline.
There are currently organisations in a number of UK counties such as [[Lincolnshire]] who are seeking European [[Protected designation of origin]] (PDO) for their sausages so that they can be made only in the appropriate region and to an attested recipe and quality.<ref>[http://www.lincs-sausage-association.co.uk/protect%20our%20saus%20page.html protect the lincolnshire sausage<!-- Bot generated title -->]</ref>


===Macedonia===
===Natural treatments===
Some people{{Who|date=September 2008}} claim to have successfully applied natural procedures for treatment or reversal of chronic conditions. These procedures largely echo the prevention measures. However, self-care measures, including herbal or "natural" remedies, should not be undertaken without medical consent to avoid possible drug interactions.
Macedonian sausages (''kabasa, lukanec'') are made from fried pork, [[onions]], and [[leeks]], with herbs and spices.
They include:
* Reducing regional pressure in such ways as improving posture and muscle tone, or in severe cases, undergoing a profound psychophysical reeducation, by a method such as the [[Alexander Technique]].
=== Portugal, Spain and Brazil (in regions of Portuguese colonization) ===
* Taking herbs and dietary supplements that strengthen vein walls, such as [[Butcher's Broom]], [[Horse-chestnut (tree)|Horse-chestnut]], [[bromelain]], and [[Styphnolobium|Japanese Pagoda Tree]] extracts. Drinking 99% pure aloe juice can also relieve itching and swelling.{{Fact|date=March 2008}}
* Topical application of natural [[astringent]]s and soothing agents, such as [[Witch hazel (astringent)]], [[Cranesbill]], [[Aloe|Aloe vera]], and honey.
* Drinking [[chamomile tea]] several times a day.
* Eating fiber-rich bulking agents such as [[plantain]] and [[Psyllium seed husks]] to help create a softer stool that is easier to pass, to lessen the irritation of existing hemorrhoids.
* Using the squatting position for bowel movements.<ref>{{cite journal | author=Christine Dimmer, Brian Martin, Noeline Reeves and Frances Sullivan | title=Squatting for the Prevention of Hemorrhoids | journal=Townsend Letter for Doctors & Patients | issue=159 | year=1996 | month=October | pages=66–70 | url=http://www.uow.edu.au/arts/sts/bmartin/pubs/96tldp.html}}</ref>
* For sufferers of hemorrhoids caused by poor vein circulation (coupled with varicose veins in lower extremities and/or varicocele), sleeping overnight with raised legs helps reduce or completely eliminate especially external hemorrhoids.
* Using a hand held shower massage to direct a pulsating stream of ''cold'' water at external hemorrhoidal tissue for a few minutes each day tends to shrink the swelling, stop the itch and over time may reduce or eliminate the condition. Pressure used must be low at first but should be increased over time during future applications as tolerance builds.


The combination of internal and external remedies is particularly recommended, e.g., Witch-hazel suppositories combined with frequent cups of strong chamomile tea.<ref>K. Kraft and C. Hobbs, ''Pocket Guide to Herbal Medicine''. New York: Thieme.</ref>
[[Embutido]]s or Enchidos generally contain hashed meat, particularly pork, seasoned with aromatic herbs or spices (pepper, red pepper, paprika, garlic, rosemary, thyme, cloves, ginger, nutmeg, etc.)


Dietary supplements can help treat and prevent many complications of hemorrhoids, and natural botanicals such as Butchers Broom, Horse-chestnut, and bioflavonoids can be an effective addition to hemorrhoid treatment.<!--
=== Scandinavia ===
--><ref>{{cite journal |author=MacKay D |title=Hemorrhoids and varicose veins: a review of treatment options |journal=Altern Med Rev |volume=6 |issue=2 |pages=126–40 |year=2001 |pmid=11302778 |doi= |url=http://www.thorne.com/altmedrev/.fulltext/6/2/126.pdf |format=PDF}}</ref>
[[Scandinavia]]n sausages ([[Finnish language|Finnish]]: ''makkara'', [[Danish language|Danish]] and [[Norwegian language|Norwegian]]: ''pølse,'' [[Icelandic language|Icelandic]]: ''bjúga/pylsa,'' [[Swedish language|Swedish]]: ''korv'') are usually made of 60-75% very finely ground [[pork]], very sparsely spiced with [[Black pepper|pepper]], [[nutmeg]], [[allspice]] or similar sweet spices (ground [[mustard seed]], onion and sugar may also be added). Water, lard, rind, potato flour and soy or milk protein are often added for binding and filling. In southern Norway, grill- and wiener sausages are often wrapped in a potato lompe, a kind of [[lefse]].


[[Butcher's Broom]] extract, or ''Ruscus aculeatus'', contains [[ruscogenin]]s that
Virtually all sausages will be industrially precooked and either fried or warmed in hot water by the consumer or at the hot dog stand. Since [[hot dog]] stands are ubiquitous in [[Denmark]] some people regard ''[[pølser]]'' one of the [[national dish]]es. The most noticeable aspect of Danish cooked sausages (never the fried ones) is that the cover often contains a traditional bright-red dye. They are also called ''wienerpølser'' and legend has it they originate from [[Vienna]] where it was once ordered that day-old sausages be dyed as a means of warning. The [[Sweden|Swedish]] ''[[falukorv]]'' is a similarly red-dyed sausage, but about 5 cm thick, usually baked in the oven coated in mustard or cut in slices and fried. Unlike ordinary sausages it is a typical home dish, not sold at hot dog stands. In Sweden sausages are often accompanied by [[potato]] mash rather than bread. In [[Iceland]], [[Lamb and mutton|lamb]] may be added to sausages, giving them a distinct taste. Horse sausage and mutton sausage are also traditional foods in Iceland, although their popularity is waning.
have anti-inflammatory and vasoconstrictor effects that help tighten and strengthen veins. Butcher's Broom has traditionally been used to treat venous problems including hemorrhoids and varicose veins.<!--
--><ref name="two">{{cite book | editor=Pizzorno JE and Murray MT, eds. | title=Encyclopedia of Natural Medicine | edition=revised 2nd edition | location=CA | publisher=Prima Publishing | year=1998 | pages=829}}</ref><!--
--><ref>{{cite journal |author=Rudofsky G |title=[Improving venous tone and capillary sealing. Effect of a combination of Ruscus extract and hesperidine methyl chalcone in healthy probands in heat stress] |language=German |journal=Fortschr. Med. |volume=107 |issue=19 |pages=52, 55–8 |year=1989 |pmid=2668140 |doi=}}</ref><!--
--><ref>{{cite journal |author=Cappelli R, Nicora M, Di Perri T |title=Use of extract of Ruscus aculeatus in venous disease in the lower limbs |journal=Drugs Exp Clin Res |volume=14 |issue=4 |pages=277–83 |year=1988 |pmid=3048951 |doi=}}</ref>


Horse-chestnut extract, or ''Aesculus hippocastanum'', contains a [[saponin]] known as [[aescin]], that has anti-inflammatory, anti-edema, and venotonic actions. Aescin improves tone in vein walls, thereby strengthening the support structure of the vein. Double blind studies have shown that supplementation with Horse-chestnut helps relieve the pain and swelling associated with chronic venous insufficiency.<!--
[[Image:Sixteen sausages wooden bowl.jpg|200px|thumb|Sixteen raw sausages in a wooden bowl.]]
--><ref>{{cite journal |author=Pittler MH, Ernst E |title=Horse-chestnut seed extract for chronic venous insufficiency. A criteria-based systematic review |journal=Arch Dermatol |volume=134 |issue=11 |pages=1356–60 |year=1998 |pmid=9828868|doi=10.1001/archderm.134.11.1356}}</ref><!--
--><ref>{{cite journal |author=Diehm C, Trampisch HJ, Lange S, Schmidt C |title=Comparison of leg compression stocking and oral Horse-chestnut seed extract therapy in patients with chronic venous insufficiency |journal=Lancet |volume=347 |issue=8997 |pages=292–4 |year=1996 |pmid=8569363|doi=10.1016/S0140-6736(96)90467-5}}</ref>


Bilberry extract, or ''Vaccinium myrtillus'', is an anthocyanoside bioflavonoid. Supplementation with this potent flavonoid protects and maintains venous strength and function.<!--
==== Finland ====
--><ref name="two" /><ref><!--
-->{{cite book | author=Murray MT. | title=Encyclopedia of Nutritional Supplements | location= NY | publisher=Three Rivers Press | year=1996 | pages=326}}</ref>


===Surgical and non-medicinal treatments===
One local [[Finland|Finnish]] variety is ''[[mustamakkara]]'', a "black sausage" prepared with blood, which is a specialty of [[Tampere]]. It is very close to the [[Scotland|Scottish]] [[black pudding]].
Some people require the following medical treatments for chronic or severe hemorrhoids:
*[[Rubber band ligation]]<br />Sometimes called Baron ligation. Elastic bands are applied onto an internal hemorrhoid to cut off its blood supply.<ref name="pmid16412076">{{cite journal |author=Longman RJ, Thomson WH |title=A prospective study of outcome from rubber band ligation of piles |journal=Colorectal Dis |volume=8 |issue=2 |pages=145–8 |year=2006 |pmid=16412076 |doi=10.1111/j.1463-1318.2005.00873.x}}</ref> Within several days, the withered hemorrhoid is sloughed off during normal bowel movement.
*[[Hemorrhoidolysis/Galvanic Electrotherapy]]<br />Desiccation of the hemorrhoid by electrical current.
*[[Sclerotherapy]] (injection therapy)<br />Sclerosant or hardening agent is injected into hemorrhoids. This causes the vein walls to collapse and the hemorrhoids to shrivel up.
*Cryosurgery<br />A frozen tip of a [[cryoprobe]] is used to destroy hemorrhoidal tissues.<ref name="pmid6979469">{{cite journal |author=MacLeod JH |title=In defense of cryotherapy for hemorrhoids. A modified method |journal=Dis. Colon Rectum |volume=25 |issue=4 |pages=332–5 |year=1982 |pmid=6979469 |doi=}}</ref> Rarely used anymore because of side effects.
*Laser, infrared or BICAP coagulation<br />[[Laser]], [[infrared]] beam, or [[electricity]] is used to cauterize the affected tissues. Lasers are now much less popular. Infrared coagulation has been studied in comparison with RBL and found to be as effective in hemorrhoids up to grade III. These are the most readily available non-surgical procedures in the US.
*Hemorrhoidectomy<br />A true surgical procedure to excise and remove hemorrhoids. Has possible correlation with incontinence issues later in life; in addition, many patients complain that pain during recovery is severe. For this reason is often now recommended only for severe (grade IV) hemorrhoids.
*[[Stapled Hemorrhoidectomy]]<br />Also called the procedure for prolapse and hemorrhoids, it is designed to resect soft tissue proximal to the dentate line, which disrupts the blood flow to the hemorrhoids. It is generally less painful than complete removal of hemorrhoids and also allows for faster recovery times. It's meant for hemorrhoids that fall out or bleed and is not helpful for painful outside conditions.
*[[Enema]]<br />This practice is used to clean the rectum. While it is a simple procedure, it can be complicated by hemorrhoids, so in such cases, it should be done by a doctor. In an enema, water is injected into the rectum and then flushed out, cleaning the area.
*[[Doppler Guided Hemorrhoidal Artery Ligation]]<br />The only evidence-based surgery for all grades of hemorrhoids. It does not involve cutting tissues or even a stay at the hospital; patients are usually back to work on the same day. It is the best treatment for bleeding piles, as the bleeding stops immediately. <ref name="pmid16399113">{{cite journal |author=Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S |title=Doppler-guided hemorrhoidal artery ligation |journal=Am. J. Surg. |volume=191 |issue=1 |pages=89–93 |year=2006 |pmid=16399113 |doi=10.1016/j.amjsurg.2005.10.007}}</ref>
*[[HAL-RAR]]<br />To date, Doppler Guided Hemorrhoidal Artery Ligation was indicated in management of Grade II & Grade III Hemorrhoids but with the availability of HAL Recto Anal Repair Management of prolapsing hemorrhoids without excision is also possible.
*Transanal hemorrhoidal dearterialization (THD)<br />Similar to HAL, but more standardizable and therefore safer, less painful and has a shorter recovery time.


*Radiofrequency Coagulation
''Makkara'' is typically similar in appearance to Polish sausages or [[bratwurst]]s, but have a very different [[taste]] and [[Texture (food)|texture]]. Most makkara is very light on [[spices]] and is therefore frequently eaten with [[Mustard (condiment)|mustard]], [[ketchup]], or other table condiments without a bun. Makkara is usually [[Grilling|grilled]], roasted over coals, or cooked on [[sauna]] heating stones until the outer skin begins to darken and crack.


===Diseases with similar symptoms===
When a steak made out of makkara is eaten inside a sliced, fried bun with cucumber salad and other fillings, it becomes a ''porilainen'' after the town of [[Pori]]. Pickled makkara intended to consumed as slices is called ''kestomakkara''. This class includes various [[mettwurst]], [[salami]] and Balkanesque styles. The most popular ''kestomakkara'' in Finland is ''meetvursti'' (etymologically this word comes from ''[[mettwurst]]''), which contains finely ground full meat, ground fat and various spices. It is not unlike [[salami]], but usually thicker and less salty. ''Meetvursti'' used to contain horse meat, but only a few brands contain it anymore, mostly due to the high cost of production.
Symptoms associated with [[rectal cancer]], [[anal fissure]], [[anal abscess]], [[anal fistula]], [[Perianal hematoma]], and other diseases may be similar to those produced by hemorrhoids and may be reduced by the topical analgesic methods described above. For this reason, it is a good idea to consult with a physician when these symptoms are encountered, particularly for the first time, and periodically should the problem continue. In the US, colonoscopy is recommended as a general diagnostic for those over age 50 (40 with family history of bowel cancers); a clear (normal) scope is good for 10 years.


==References==
=== South Africa ===
{{reflist|2}}
In [[South Africa]], traditional sausages are known as ''[[boerewors]]'' or farmer's sausage. Ingredients include game and beef, usually mixed with pork or lamb and with a high percentage of fat. Coriander and vinegar are the two most common seasoning ingredients, although many variations exist. The coarsely-ground nature of the mincemeat as well as the long continuous spiral of sausage are two of its recognisable qualities. Boerewors is traditionally cooked on a ''braai'' ([[barbecue]]).


==See also==
Boerewors can be dried out in a dry-curing process similar to [[biltong]], in which case it's called [[droë wors]].
* [[Anal fissure]]
* [[Anal fistula]]
* [[Perianal hematoma]]
* [[Proctoscopy]]
* [[Anal abscess]]


==External links==
=== Switzerland ===
* {{DMOZ|Health/Conditions_and_Diseases/Digestive_Disorders/Anorectal/Hemorrhoids/}}
[[Image:Cervelat.jpg|thumb|[[Cervelat]].]]
The [[cervelat]], a cooked sausage, is often referred to as Switzerland's national sausage. A great number of regional sausage specialties exist as well.


{{Vascular diseases}}
=== The Philippines ===
In the Philippines, there are different kinds of sausages called "Longaniza" or "Longanisa" with mixes dependent on their size of origin: Vigan Longaniza, Lucban Longaniza are examples.


[[Category:Gastroenterology]]
=== North America ===
[[Category:Proctology]]
[[North America]]n [[breakfast sausage|breakfast or country sausage]] is made from uncooked ground pork mixed with [[Black pepper|pepper]], [[Common sage|sage]], and other spices. It is usually sold in a large synthetic plastic casing, or in links which may have a protein casing. In some markets it is available sold by the pound without a casing. It is commonly sliced into small patties and pan-fried, or cooked and crumbled into [[scrambled eggs]] or [[gravy]].
[[Category:Medical conditions related to obesity]]


[[ar:بواسير]]
The [[hot dog|frankfurter or hot dog]] is the most common sausage in the US and Canada.
[[bg:Хемороиди]]

[[cs:Hemoroid]]
=== Turkey===
[[de:Hämorrhoiden]]
In [[Turkey]] sausage is known as [[sosis]] which is made of beef.
[[dv:ފުރަގަސް ފަރާތު ބަލި]]

[[et:Hemorroidid]]
[[Sucuk]] (pronounced tsudjuck or soudjouk or [[sujuk]] with accent on the last syllable) is a type of sausage made in Turkey and neighboring Balkan countries.
[[el:Αιμορροΐδες]]

[[es:Hemorroides]]
There are many types of sucuk, but it is mostly made from beef. It is fermented, spiced (with garlic and pepper) and filled in an inedible casing that needs to be peeled off before consuming. Slightly smoked sucuk is considered superior. The taste is spicy, salty and a little raw, similar to pepperoni. Some varieties are extremely hot and/or greasy. Some are "adulterated" with turkey, water buffalo meat, sheep fat or chicken.
[[eo:Hemoroido]]

[[fr:Hémorroïde]]
There are many dishes made with sucuk, but grilled sucuk remains the most popular. Smoke dried varieties are consumed "raw" in sandwiches. An intestinal loop is one sucuk. Smoked sucuk is usually straight.
[[gd:Neasgaid-fala]]

[[ko:치질]]
=== Malta ===
[[hy:Թութք]]
Maltese sausage [[zalzett tal-Malti]] is typically made of pork, sea salt, black peppercorns, coriander seeds, garlic and parsley.
[[id:Wasir]]

[[it:Emorroidi]]
=== Vietnam ===
[[he:טחורים]]

[[ku:Hemorrhoid]]
See [[Chả]]
[[lb:Hämorrhoiden]]

[[lt:Hemorojus]]
=== Other variations ===
[[hu:Aranyér]]

[[ml:അര്‍ശസ്]]
Sausages may be served as [[hors d'oeuvre]], in a [[sandwich]], in a bread roll as a [[hot dog]], wrapped in a [[tortilla]], or as an ingredient in dishes such as [[stew]]s and [[casserole]]s. It can be served on a stick (like the [[corn dog]]) or on a bone as well.<ref>[http://taiwanonymous.blogspot.com/2006/08/sausage-on-bone.html Sausage on a bone], a relatively recent phenomenon.</ref> Sausage without casing is called '''sausage meat''' and can be fried or used as stuffing for poultry, or for wrapping foods like [[Scotch egg]]s. Similarly, sausage meat encased in [[puff pastry]] is called a [[sausage roll]].
[[ms:Penyakit Buasir]]

[[nl:Aambei]]
Sausages can also be modified to use indigenous ingredients. Mexican styles add oregano and the "guajillo" red pepper to the Spanish [[chorizo]] to give it an even hotter spicy touch.
[[nds-nl:Gatbezen]]

[[ja:痔]]
Certain sausages also contain ingredients such as cheese and apple; or types of vegetable.
[[no:Hemoroide]]

[[pl:Żylaki odbytu]]
=== Vegetarian sausage ===
[[pt:Hemorróida]]
{{Cookbook|Vegan cuisine#Vegan Bratwurst|Vegan Bratwurst}}
[[qu:Uquti unquy]]

[[ru:Геморрой]]
[[Vegetarian]] and [[vegan]] [[vegetarian sausage|sausage]]s are also available in some countries, or can be made from scratch. These may be made from [[tofu]], [[seitan]], [[nut (fruit)|nut]]s, [[pulse (legume)|pulse]]s, [[mycoprotein]], [[soybean|soya]] protein, [[vegetable]]s or any combination of similar ingredients that will hold together during cooking. These sausages, like most meat-replacement products, generally fall into two camps: some are shaped, colored, flavored, etc. to replicate the taste and texture of meat as accurately as possible; others such as the [[Glamorgan sausage]] rely on spices and vegetables to lend their natural flavor to the product and no attempt is made to imitate meat.
[[scn:Murròiti]]

[[sk:Hemoroidy]]
==Sausage fingers==
[[sl:Hemoroidi]]
"Sausage fingers" is an English saying suggesting a person with clumsy hands, for example somebody who finds it difficult to play the Piano.
[[sr:Хемороиди]]

[[fi:Peräpukama]]
== References ==
[[sv:Hemorrojder]]

[[tr:Basur]]
{{reflist}}
[[ur:بواسیر]]

[[zh-yue:痔瘡]]
== See also ==
[[zh:痔疮]]
{| border="0" cellpadding="1" cellspacing="0"
|-
!
!
|- valign="top"
|
* [[Andouille]]
* [[Black pudding]] (or [[Blood Sausage]])
* [[Boudin]]
* [[Breakfast Roll]]
* [[Butifarra]]
* [[Chinese sausage]]
* [[Chipolata]]
* [[Currywurst]]
* [[Fuet]]
* [[Glamorgan sausage]]
* [[Haggis]]
* [[Hot Dog]]
* [[Kranjska klobasa|Käsekrainer]]
* [[Kishka (food)|Kishka]]
* [[Knackwurst]]
* [[Kovbasa]]
* [[Kransky]]
* [[Landjäger]]
|
* [[Linguiça]]
* [[Leberwurst|Liver sausage]]
* [[Loukaniko]]
* [[Lukanka]]
* [[Merguez]]
* [[Mettwurst]]
* [[Mincemeat]]
* [[Mustamakkara]]
* [[Pølsevogn]]
* [[Rookworst]]
* [[Salami]]
* [[Sausage Race]]
* [[Soujouk]]
* [[Tasso (sausage)|Tasso]]
* [[Thüringer]]
* [[Usinger's]]
* [[White pudding]]
|
|}

== External links ==
{{commons|Sausage|Sausage}}
{{Cookbook}}
* [http://dmoz.org/Home/Cooking/Meat/Sausage/ Open Directory Category]
* [http://www.ext.nodak.edu/extpubs/yf/foods/he176w.htm The Art and Practice of Sausage Making]
* [http://www.3men.com/allyou.htm All about sausages]
* [http://lpoli.50webs.com/AlphabeticalList.htm Tested formulations for homemade sausage]


[[Category:Sausages|*]]
[[Category:Garde manger]]
[[Category:Breakfast foods]]
[[Category:Meat processing]]
[[Category:Meat]]

[[ar:سجق]]
[[bg:Наденица]]
[[cs:Párek]]
[[da:Pølse]]
[[de:Wurst]]
[[et:Vorst]]
[[es:Salchicha]]
[[fr:Saucisse]]
[[gl:Salchicha]]
[[ko:소시지]]
[[id:Sosis]]
[[it:Salume]]
[[he:נקניק]]
[[lt:Dešra]]
[[hu:Kolbász]]
[[ms:Sosej]]
[[nl:Worst]]
[[ja:ソーセージ]]
[[no:Pølse]]
[[nrm:Saûciche]]
[[pl:Wędliny]]
[[pt:Salsicha]]
[[ru:Колбаса]]
[[ksh:Woosch]]
[[simple:Sausage]]
[[fi:Makkara]]
[[sv:Korv]]
[[uk:Ковбаса]]
[[th:ไส้กรอก]]
[[vec:Lugànega]]
[[yi:ווורשט]]
[[zh:香腸]]

Revision as of 19:30, 13 October 2008

Hemorrhoid
SpecialtyGeneral surgery Edit this on Wikidata

An apple a day keeps the hemorrhoids away! Hemorrhoids (AmE), haemorrhoids (BrE), emerods, or piles are varicosities or swelling and inflammation of veins in the rectum and indoor-anus. The anatomical term "hemorrhoids" technically refers to "'Cushions of tissue filled with blood vessels at the junction of the rectum and the anus."[1] However, the term is popularly used to refer to varicosities of the hemorrhoid tissue. Perianal hematoma are sometimes misdiagnosed and mislabeled as hemorrhoids, when in fact they have different causes and treatments.[2]

Causes

Increased straining during bowel movements, by constipation or diarrhea, may lead to hemorrhoids.[3] It is thus a common condition due to constipation caused by water retention in women experiencing premenstrual syndrome or menstruation.

Hypertension, particularly portal hypertension, can also cause hemorrhoids because of the connections between the portal vein and the vena cava which occur in the rectal wall -- known as portocaval anastomoses.[4]

Obesity can be a factor by increasing rectal vein pressure. Sitting for prolonged periods of time can cause hemorrhoids. Poor muscle tone or poor posture can result in too much pressure on the rectal veins.

Pregnancy causes hypertension and increases strain during bowel movements, so hemorrhoids are often associated with pregnancy.

Excessive consumption of alcohol or caffeine can cause hemorrhoids.[5] Both can cause diarrhea. Note that caffeine ingestion increases blood pressure transiently, but is not thought to cause chronic hypertension. Alcohol can also cause alcoholic liver disease leading to portal hypertension.


Symptoms

Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching, also called pruritus ani, have similar symptoms and are incorrectly referred to as hemorrhoids.

Hemorrhoids usually are not dangerous or life threatening. In most cases, hemorrhoidal symptoms will go away within a few days.

Although many people have hemorrhoids, not all experience symptoms. The most common symptom of internal hemorrhoids is bright red blood covering the stool, on toilet paper, or in the toilet bowl. However, an internal hemorrhoid may protrude through the anus outside the body, becoming irritated and painful. This is known as a protruding hemorrhoid.

Symptoms of external hemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms. This condition is known as a thrombosed external hemorrhoid.

In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Draining mucus may also cause itching.

Food

Insufficient liquid can cause a hard stool, or even chronic constipation, which can lead to hemorrhoidal irritation. An excess of lactic acid in the stool, a product of excessive consumption of dairy products such as cheese, can cause irritation; reducing such consumption can bring relief. Vitamin E deficiency is also a common cause.

Eating fruit helps avoid conditions that lead to hemorrhoids.

Food considered "probiotic", such as yogurt with active culture, may help keep the gut functioning normally and thus prevent flare-ups.[citation needed]

Types of hemorrhoids

File:Hemorrhoids2.jpg
Direct view of hemorrhoid seen on sigmoidoscopy
  • (I84.3-I84.5) External hemorrhoids are those that occur outside of the anal verge (the distal end of the anal canal). They are sometimes painful, and can be accompanied by swelling and irritation. Itching, although often thought to be a symptom from external hemorrhoids, is more commonly due to skin irritation.
    • (I84.3) External hemorrhoids are prone to thrombosis: if the vein ruptures and a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid.[6]
  • (I84.0-I84.2) Internal hemorrhoids are those that occur inside the rectum. As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may bleed when irritated.
  • (I84.1) Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids:
    • Prolapsed hemorrhoids are internal hemorrhoids that are so distended that they are pushed outside the anus.
    • If the anal sphincter muscle goes into spasm and traps a prolapsed hemorrhoid outside the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a strangulated hemorrhoid.


By degree of prolapse

The most common grading system was developed by Banov:[7][8]

  • Grading of Internal Hemorrhoids
    • Grade I: The hemorrhoids do not prolapse.
    • Grade II: The hemorrhoids prolapse upon defecation but spontaneously reduce.
    • Grade III: The hemorrhoids prolapse upon defecation, but must be manually reduced.
    • Grade IV: The hemorrhoids are prolapsed and cannot be manually reduced.

Prevention

Prevention of hemorrhoids includes drinking more fluids, eating more dietary fiber (such as fruits, vegetables and cereals high in fiber), exercising, practicing better posture, and reducing bowel movement strain and time. Hemorrhoid sufferers should avoid using laxatives and should strictly limit time straining during bowel movement. Wearing tight clothing and underwear will also contribute to irritation and poor muscle tone in the region and promote hemorrhoid development. Some sufferers report a more comfortable experience without underwear or wearing only very lightweight underwear.

Women who notice they have painful stools around the time of menstruation would be well-advised to begin taking extra dietary fiber and fluids a couple days prior to that time.

Fluids emitted by the intestinal tract may contain irritants that may increase the fissures associated with hemorrhoids. Washing the anus with cool water and soap may reduce the swelling and increase blood supply for quicker healing and may remove irritating fluid.

Kegel exercises for the pelvic floor may also prove helpful.

Many people do not get a sufficient supply of dietary fiber (20 to 25 grams daily) and small changes in a person's daily diet can help tremendously in both prevention and treatment of hemorrhoids.

Use of squat toilets

Based on their very low incidence in the developing world, where people squat for bodily functions, hemorrhoids have been attributed to the use of the unnatural "sitting" toilet.[9][10] In 1987, an Israeli physician, Dr. Berko Sikirov, published a study testing this hypothesis by having hemorrhoid sufferers convert to squat toilets.[11] Eighteen of the 20 patients were completely relieved of their symptoms (pain and bleeding) with no recurrence, even 30 months after completion of the study. This chart summarizes the results.

No follow-up studies have ever been published. The American Society of Colon & Rectal Surgeons is silent regarding the therapeutic value of squatting.

Examination

Endoscopic image of internal hemorrhoids seen on retroflexion of the flexible sigmoidoscope at the ano-rectal junction

After visual examination of the anus and surrounding area for external or prolapsed hemorrhoids, a doctor would conduct a digital examination. In addition to probing for hemorrhoidal bulges, a doctor would also look for indications of rectal tumor or polyp, enlarged prostate and abscesses.

Visual confirmation of hemorrhoids can be done by doing an anoscopy, using a medical device called an anoscope. This device is basically a hollow tube with a light attached at one end that allows the doctor to see the internal hemorrhoids, as well as polyps in the rectum.

If warranted, more detailed examinations, such as sigmoidoscopy and colonoscopy can be performed. In sigmoidoscopy, the last 60cm of the colon and rectum are examined whereas in colonoscopy the entire bowel is examined.

A pathologist will look for dilated vascular spaces which exhibit thrombosis and recanalization.

Treatments

Treatments for hemorrhoids vary in their cost, risk, and effectiveness. Different cultures and individuals approach treatment differently. Some of the treatments used are listed here in increasing order of intrusiveness and cost.

For many people, hemorrhoids are mild and temporary conditions that heal spontaneously or by the same measures recommended for prevention. There is no medicine that will cure hemorrhoids but local treatments such as warm sitz baths, using a bidet, extendable showerhead, cold compress, or topical analgesic (such as Nupercainal), can also provide temporary relief.

Especially in the case of external hemorrhoids with a visible lump of small size, the condition can be improved with warm bath causing the vessels around rectal region to be relaxed. Consistent use of medicated creams during the early stages of a hemorrhoid flare-up will also provide relief and may stave off further development and irritation. However, creams containing steroid preparations weaken the skin and may contribute to further flare-ups. Keep the area clean and dry, with some lubrication provided by hemorrhoidal creams or a lubricant. Ointment or suppositories such as Proctosedyl[12][13] and Faktu[14] can also relieve the symptoms.

Natural treatments

Some people[who?] claim to have successfully applied natural procedures for treatment or reversal of chronic conditions. These procedures largely echo the prevention measures. However, self-care measures, including herbal or "natural" remedies, should not be undertaken without medical consent to avoid possible drug interactions. They include:

  • Reducing regional pressure in such ways as improving posture and muscle tone, or in severe cases, undergoing a profound psychophysical reeducation, by a method such as the Alexander Technique.
  • Taking herbs and dietary supplements that strengthen vein walls, such as Butcher's Broom, Horse-chestnut, bromelain, and Japanese Pagoda Tree extracts. Drinking 99% pure aloe juice can also relieve itching and swelling.[citation needed]
  • Topical application of natural astringents and soothing agents, such as Witch hazel (astringent), Cranesbill, Aloe vera, and honey.
  • Drinking chamomile tea several times a day.
  • Eating fiber-rich bulking agents such as plantain and Psyllium seed husks to help create a softer stool that is easier to pass, to lessen the irritation of existing hemorrhoids.
  • Using the squatting position for bowel movements.[15]
  • For sufferers of hemorrhoids caused by poor vein circulation (coupled with varicose veins in lower extremities and/or varicocele), sleeping overnight with raised legs helps reduce or completely eliminate especially external hemorrhoids.
  • Using a hand held shower massage to direct a pulsating stream of cold water at external hemorrhoidal tissue for a few minutes each day tends to shrink the swelling, stop the itch and over time may reduce or eliminate the condition. Pressure used must be low at first but should be increased over time during future applications as tolerance builds.

The combination of internal and external remedies is particularly recommended, e.g., Witch-hazel suppositories combined with frequent cups of strong chamomile tea.[16]

Dietary supplements can help treat and prevent many complications of hemorrhoids, and natural botanicals such as Butchers Broom, Horse-chestnut, and bioflavonoids can be an effective addition to hemorrhoid treatment.[17]

Butcher's Broom extract, or Ruscus aculeatus, contains ruscogenins that have anti-inflammatory and vasoconstrictor effects that help tighten and strengthen veins. Butcher's Broom has traditionally been used to treat venous problems including hemorrhoids and varicose veins.[18][19][20]

Horse-chestnut extract, or Aesculus hippocastanum, contains a saponin known as aescin, that has anti-inflammatory, anti-edema, and venotonic actions. Aescin improves tone in vein walls, thereby strengthening the support structure of the vein. Double blind studies have shown that supplementation with Horse-chestnut helps relieve the pain and swelling associated with chronic venous insufficiency.[21][22]

Bilberry extract, or Vaccinium myrtillus, is an anthocyanoside bioflavonoid. Supplementation with this potent flavonoid protects and maintains venous strength and function.[18][23]

Surgical and non-medicinal treatments

Some people require the following medical treatments for chronic or severe hemorrhoids:

  • Rubber band ligation
    Sometimes called Baron ligation. Elastic bands are applied onto an internal hemorrhoid to cut off its blood supply.[24] Within several days, the withered hemorrhoid is sloughed off during normal bowel movement.
  • Hemorrhoidolysis/Galvanic Electrotherapy
    Desiccation of the hemorrhoid by electrical current.
  • Sclerotherapy (injection therapy)
    Sclerosant or hardening agent is injected into hemorrhoids. This causes the vein walls to collapse and the hemorrhoids to shrivel up.
  • Cryosurgery
    A frozen tip of a cryoprobe is used to destroy hemorrhoidal tissues.[25] Rarely used anymore because of side effects.
  • Laser, infrared or BICAP coagulation
    Laser, infrared beam, or electricity is used to cauterize the affected tissues. Lasers are now much less popular. Infrared coagulation has been studied in comparison with RBL and found to be as effective in hemorrhoids up to grade III. These are the most readily available non-surgical procedures in the US.
  • Hemorrhoidectomy
    A true surgical procedure to excise and remove hemorrhoids. Has possible correlation with incontinence issues later in life; in addition, many patients complain that pain during recovery is severe. For this reason is often now recommended only for severe (grade IV) hemorrhoids.
  • Stapled Hemorrhoidectomy
    Also called the procedure for prolapse and hemorrhoids, it is designed to resect soft tissue proximal to the dentate line, which disrupts the blood flow to the hemorrhoids. It is generally less painful than complete removal of hemorrhoids and also allows for faster recovery times. It's meant for hemorrhoids that fall out or bleed and is not helpful for painful outside conditions.
  • Enema
    This practice is used to clean the rectum. While it is a simple procedure, it can be complicated by hemorrhoids, so in such cases, it should be done by a doctor. In an enema, water is injected into the rectum and then flushed out, cleaning the area.
  • Doppler Guided Hemorrhoidal Artery Ligation
    The only evidence-based surgery for all grades of hemorrhoids. It does not involve cutting tissues or even a stay at the hospital; patients are usually back to work on the same day. It is the best treatment for bleeding piles, as the bleeding stops immediately. [26]
  • HAL-RAR
    To date, Doppler Guided Hemorrhoidal Artery Ligation was indicated in management of Grade II & Grade III Hemorrhoids but with the availability of HAL Recto Anal Repair Management of prolapsing hemorrhoids without excision is also possible.
  • Transanal hemorrhoidal dearterialization (THD)
    Similar to HAL, but more standardizable and therefore safer, less painful and has a shorter recovery time.
  • Radiofrequency Coagulation

Diseases with similar symptoms

Symptoms associated with rectal cancer, anal fissure, anal abscess, anal fistula, Perianal hematoma, and other diseases may be similar to those produced by hemorrhoids and may be reduced by the topical analgesic methods described above. For this reason, it is a good idea to consult with a physician when these symptoms are encountered, particularly for the first time, and periodically should the problem continue. In the US, colonoscopy is recommended as a general diagnostic for those over age 50 (40 with family history of bowel cancers); a clear (normal) scope is good for 10 years.

References

  1. ^ MedlinePlus Medical Encyclopedia:Hemorrhoid surgery - series: Normal anatomy
  2. ^ Perianal hematoma - Medbroadcast
  3. ^ Harms R (November 3, 2007). "Hemorrhoids during pregnancy: Treatment options". MayoClinic. Retrieved 2007-11-28.
  4. ^ "Causes of Hemorrhoids". Mayo Clinic. November 28, 2006. Retrieved 2007-12-07.
  5. ^ Burney RE (2005). "Hemorrhoids". University of Michigan Health System. Retrieved 2007-11-28. {{cite web}}: Unknown parameter |month= ignored (help)
  6. ^ E. Gojlan, Pathology, 2nd ed. Mosby Elsevier, Rapid Review series.
  7. ^ Hemorrhoid at eMedicine
  8. ^ Banov L, Knoepp LF, Erdman LH, Alia RT (1985). "Management of hemorrhoidal disease". J S C Med Assoc. 81 (7): 398–401. PMID 3861909.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. ^ Sikirov BA (1989). "Primary constipation: an underlying mechanism". Med. Hypotheses. 28 (2): 71–3. doi:10.1016/0306-9877(89)90016-9. PMID 2927355.
  10. ^ Sikirov D (2003). "Comparison of straining during defecation in three positions: results and implications for human health". Dig. Dis. Sci. 48 (7): 1201–5. doi:10.1023/A:1024180319005. PMID 12870773.
  11. ^ Sikirov BA (1987). "Management of hemorrhoids: a new approach". Isr. J. Med. Sci. 23 (4): 284–6. PMID 3623887.
  12. ^ Proctosedyl ointment/suppositories
  13. ^ Proctosedyl - Drugs - Medbroadcast
  14. ^ http://www.vghks.gov.tw/ph/%E8%99%95%E6%96%B9%E9%9B%86/drug/faktu.htm
  15. ^ Christine Dimmer, Brian Martin, Noeline Reeves and Frances Sullivan (1996). "Squatting for the Prevention of Hemorrhoids". Townsend Letter for Doctors & Patients (159): 66–70. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  16. ^ K. Kraft and C. Hobbs, Pocket Guide to Herbal Medicine. New York: Thieme.
  17. ^ MacKay D (2001). "Hemorrhoids and varicose veins: a review of treatment options" (PDF). Altern Med Rev. 6 (2): 126–40. PMID 11302778.
  18. ^ a b Pizzorno JE and Murray MT, eds., ed. (1998). Encyclopedia of Natural Medicine (revised 2nd edition ed.). CA: Prima Publishing. p. 829. {{cite book}}: |edition= has extra text (help); |editor= has generic name (help)
  19. ^ Rudofsky G (1989). "[Improving venous tone and capillary sealing. Effect of a combination of Ruscus extract and hesperidine methyl chalcone in healthy probands in heat stress]". Fortschr. Med. (in German). 107 (19): 52, 55–8. PMID 2668140.
  20. ^ Cappelli R, Nicora M, Di Perri T (1988). "Use of extract of Ruscus aculeatus in venous disease in the lower limbs". Drugs Exp Clin Res. 14 (4): 277–83. PMID 3048951.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  21. ^ Pittler MH, Ernst E (1998). "Horse-chestnut seed extract for chronic venous insufficiency. A criteria-based systematic review". Arch Dermatol. 134 (11): 1356–60. doi:10.1001/archderm.134.11.1356. PMID 9828868.
  22. ^ Diehm C, Trampisch HJ, Lange S, Schmidt C (1996). "Comparison of leg compression stocking and oral Horse-chestnut seed extract therapy in patients with chronic venous insufficiency". Lancet. 347 (8997): 292–4. doi:10.1016/S0140-6736(96)90467-5. PMID 8569363.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  23. ^ Murray MT. (1996). Encyclopedia of Nutritional Supplements. NY: Three Rivers Press. p. 326.
  24. ^ Longman RJ, Thomson WH (2006). "A prospective study of outcome from rubber band ligation of piles". Colorectal Dis. 8 (2): 145–8. doi:10.1111/j.1463-1318.2005.00873.x. PMID 16412076.
  25. ^ MacLeod JH (1982). "In defense of cryotherapy for hemorrhoids. A modified method". Dis. Colon Rectum. 25 (4): 332–5. PMID 6979469.
  26. ^ Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S (2006). "Doppler-guided hemorrhoidal artery ligation". Am. J. Surg. 191 (1): 89–93. doi:10.1016/j.amjsurg.2005.10.007. PMID 16399113.{{cite journal}}: CS1 maint: multiple names: authors list (link)

See also

External links

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