Hemorrhoids are cushions, made out of blood vessels. They are located inside the anus to seal the opening and prevent leakage of gas or stools.
Hemorrhoids are divided into internal ones which are usually not visible and are covered by a shiny lining called mucosa, and external ones which are covered by normal skin. When the internal and external hemorrhoids become so big that they blend one with the other, then they are called complex hemorrhoids.
The cause of hemorrhoids is usually due to multiple factors such as :
- Chronic constipation,
- The lack of adequate of an adequate amount of fiber in our diet,
- Family history,
- Pregnancy,
- The habit of spending several hours a day in the sitting position.
The most common symptoms of hemorrhoids are
- Rectal bleeding, which is usually bright red, painless and follows bowel movements.
I want to stress the fact that even though bleeding is a very common sign of hemorrhoids, the presence of hemorrhoids does not exclude that the bleeding could be coming from a tumor in the rectum or lower bowel.
Another common symptom is the presence of swelling or lumps in the anal area. Hemorrhoids are also known as piles. They are usually reducible, which means that they could be pushed back in at the end of bowel movements.
Itching and burning are also very common symptoms of hemorrhoids, as it is pain, especially if the hemorrhoids become thrombosed.
The treatment of hemorrhoids has challenged physicians for the last 4,000 years.
The medical treatment of hemorrhoids is based on adding bulk to the diet. The rationale of adding bulk to the diet is to eliminate the need to straining and push too hard or too long during bowel movements.
Ideally, we should consume about 25 grams of dietary fibers per day. Potatoes, beans, onions, strawberries, have a very high fiber content.
Green salads contain mostly water, and much less fibers than we may believe.
Fibers need to be ingested withban adequate volume of water in order to produce the desired effect, otherwise, they could be counter-productive. Physillium products, such as Konsyl, Perdiem, Metamucil, etc. are an excellent source of soluble fibers.
The usage of creams and suppositories usually causes dramatic relief of symptoms, but it is almost always temporary. Those preparations that contain hydro-cortisone should not be used for more than one week, since they can cause atrophy and thinning of the skin.
SURGICAL TREATMENT OF HEMORRHOIDS:
Internal hemorrhoids are not provided with by pain fibers and therefore we cannot feel when they are either cut, burned or ligated.
Small or medium size internal hemorrhoids can be treated by a variety of office procedures. Among those, rubber band ligation, is one of the most effective. It consists of the application of a small rubber band around the base of the hemorrhoid with a special applicator. Usually the rubber band falls off in a few days leaving a shallow ulceration that heals rather quickly.
Infra-red coagulation consists of the application of a probe heated by infra-red light to the feeding vessels of the hemorrhoids. It is a painless and quite effective method.
Sclerotherapy and cryotherapy are techniques that are rarely used in our days.
A surgical hemorrhoidectomy is the gold standard of operation to remove all hemorrhoidal tissue. It is usually performed as an outpatient surgery under local anesthesia.
The judicious use of medical management, rubber band ligation and infra-red coagulation make a surgical hemorrhoidectomy necessary only in the minority of cases.
Recently the use of laser and the harmonic scalpel has been promoted as an alternative to the traditional scalpel and scissors hemorrhoidectomy,; these excisional technique do not provide any significant decrease in the postoperative pain.
The PPH Procedure (also known as stapled hemorrhoidectomy) is a new and less painful method to address the problem of prolapse of hemorrhoids and rectal mucosa. The clinical trials have been quite disappointing, however, failing to demonstrate any measurable advantage in the use of laser over conventional methods.
| Protrudring hemorrhoid external view |
Protruding hemorrhoid internal view |
Rubber band ligation of internal hemorrhoid |
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| Final result after rubber band ligation |
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