07 Sep Know everything about Hemorrhoids
The term “hemorrhoids” refers to a condition in which the veins around the anus or lower rectum swell. This can cause the vein walls to turn alarmingly thin having a considerable negative impact on the health. Given need to be health conscious these days, it is important to understand the types, causes, symptoms, diagnosis, treatment & complication of this condition.
What are the different types of hemorrhoids?
There are two types of hemorrhoids:
These piles (common name used for Hemorrhoids) are inside the anus and generally they do not cause any pain. It is due to the presence of very little nerves in the rectum that one can feel pain and due to this, blood could possibly be the only visible sign of this disease.
These are formed outside the anus making them easily visible and are painful in most of the cases. In some rare cases, blood clots are developed within prolapsed external hemorrhoids resulting in severe pain. This condition is termed as Thrombosis which can be easily cured by removing them if the condition worsens.
Some people develop internal and external piles at the same time.
Internal piles can be classified into grades 1 to 4 according to their severity and size.
Grade 1: They are the most common in which small swellings are formed inside the anal canal. They cannot be seen or felt from outside the anus. In some cases they enlarge further to grade 2 or more.
Grade 2: These are larger in size that may be partly pushed out from the anus when you go to the toilet and spring back inside again after straining.
Grade 3: In this situation, hemorrhoids hang out from the anus when you go to the toilet. One or more small lumps may be felt that hang from the anus. However, it can be pushed back inside the anus manually.
Grade 4: This is the most critical condition in which hemorrhoids permanently hang down from the anus, and cannot be pushed back. They sometimes become quite large resulting in acute Thrombosis.
What causes hemorrhoids?
Generally, the high pressure on abdomen causes veins to bulge. The exact reason for developing hemorrhoids cannot be given, but some of the most common causes could be:
1 Straining during bowel movements
2 Problems during Chronic Constipation
3 Standing or Sitting for a long time
4 Over weight and Pregnancy
5 Family history of hemorrhoids
What are the symptoms to watch out for?
Hemorrhoids usually are not dangerous or life threatening and usually vanish on their own with time. Although in certain cases, there is acute shortage of blood changing the color of skin and this is when patient needs proper medical treatment. Some of the most common symptoms of hemorrhoids can be:
- Blood while passing stool
- Pain or itching around the anus area
- Swelling or bleeding near anus
- Agonizing bowel movement
Symptoms are there- how to go about proper diagnosis?
A thorough evaluation and proper diagnosis by the doctor is immediately required after bleeding from the rectum or blood in the stool occurs. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer.
The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids. A digital rectal exam may be conducted in which a gloved, lubricated finger is inserted in the rectum to feel any abnormalities.
Closer evaluation of the rectum for hemorrhoids requires an exam with an endoscope. It is a hollow, lighted tube used to examine internal hemorrhoids. A proctoscope is effective to completely scrutinize the entire anal canal.
To rule out other causes of gastrointestinal bleeding, the doctor may examine the rectum and lower colon (sigmoid) with sigmoidoscopy or the entire colon with colonoscopy. Sigmoidoscopy and colonoscopy are diagnostic procedures that involve use of lighted, flexible tubes inserted through the rectum.
What are the treatment options available?
- Medical Management: Measures are taken to reduce symptoms in initial stage when damage is not too much. Some of the measures include:
- Increase high fiber food and fluids in the diet: Include high fibre enriched food in the meals besides drinking 6 to 8 glasses of water. This helps in smooth passing of the stool which also eases pressure of the hemorrhoids. It is advised to include wheat bread, brown rice, oatmeal, buckwheat and fruits and vegetables such as pear, carrots, etc.
- Warm water bath several times a day for about 5-7 minutes. For getting instant relief from the pain, an individual may use a warm water bottle
- Apply an appropriate ointment or a cream on the affected area to get quick relief from pain.
- Endoscopic Management: In bit advanced cases, hemorrhoid is treated through endoscopy when it cannot be corrected via changes in lifestyle/ external measures.This method is undertaken to shrink and destroy the hemorrhoidal tissue- a number of methods may be used to remove or reduce the size of internal haemorrhoids including:
- Rubber band ligation or Banding: A rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation of blood instantly and the hemorrhoid withers away within a few days. This method is often used for the prolapsed hemorrhoids.
- Sclerotherapy: A chemical solution is injected around the blood vessel due to which scar is created and the hemorrhoids gets closed. Like any medicated injection it causes mild pain for some time.
- Infrared coagulation or coagulation therapy: Special device such as infrared light, an electric probe or a laser beam is used to burn off hemorrhoids as the end of it gets sealed. It leads to shrinkage and closing of the hemorrhoids. This procedure is best for the prolapsed hemorrhoids.
- Surgical Management : Traditional surgery named haemorrhoidectomy is used for both, the large and uncomfortable internal and external hemorrhoids including thrombosed hemorrhoids, which have reached at unbearable state. A hemorrhoidectomy is performed in the following conditions:
- Symptomatic grade III, grade IV, or mixed internal and external hemorrhoids: In these health states, the anorectal conditions are worse and require surgery.
- Strangulated internal hemorrhoids and some thrombosed external hemorrhoids: In these conditions, the hemorrhoids are found in the ruptured form resulting in a blood clot. This causes extreme pain proving minimally invasive procedures to be ineffective.
Types of hemorrhoidectomies and related procedures of surgery
- Closed Hemorrhoidectomy: Closed hemorrhoidectomy is the most widely used surgical procedure to treat internal hemorrhoids. It involves excision of hemorrhoidal bundles using a sharp instrument such as a scalpel, scissors, electrocautery, or even laser. This is followed by complete wound closure with absorbable suture. Closed hemorrhoidectomy has a 95% success rate.
- Open Hemorrhoidectomy: In an open hemorrhoidectomy, hemorrhoidal tissue is removed in the same manner as in a closed procedure, but here the incision is left open. Surgeons may opt for open hemorrhoidectomy when the location or gravity of disease makes wound closure difficult and there is a high risk of developing infection after the surgery.
In many cases, a combination of open and closed techniques is applied.
Stapled Hemorrhoidectomy for Prolapsing Hemorrhoids: Stapled hemorrhoidectomy is the newest addition to the armamentarium of surgical procedures. Stapled hemorrhoidectomy is mostly used in patients with grade III and IV hemorrhoids and in cases where minimally invasive treatments prove ineffective. In this procedure, a circular stapling device is used to erase the circumferential ring of excess hemorrhoid tissue, thereby lifting hemorrhoids back to their normal position within the anal canal. This technique is opted by the doctor only when a part of tissue is to be removed and the remaining is lifted and stapled into place. Hence, this procedure proves less effective in case of large external hemorrhoids and there are increased chances of recurrence. Stapling also disrupts hemorrhoid blood supply. Studies have suggested that stapled hemorrhoidectomy results in less postoperative pain and curtails time to recover as compared to conventional surgery.
Are there any complications I should be aware of?
Some of the most common complications that can surface could be:
1) Extreme pain
2) Excessive bleeding
3) Urine retention/urinary tract infection
4) Faecal bust
6) Itching or irritation around anal area
As is the famous saying “prevention is better than the cure”, the best treatment is prevention.
Efforts should be made to keep the stools soft which will decrease pressure and straining. Exercise, walking and high fibre enriched diet helps to reduce the likelihood of developing constipation and straining. Bowels should not be emptied forcefully as it enhances the chances of constipation and hemorrhoids. In aggravated health state of unbearable pain, proper medical treatment becomes mandatory.
Dr. Mayank M Madan
MBBS | MS | FNB | IAGES DALS
15+ Years of Experience