Hemorrhoids are veins placed inside the anal canal which, in particular conditions, enlarge, causing their volume to increase and a series of related symptoms and signs.
Hemorrhoids are divided into internal and external. The external ones develop near the anus and are covered by skin .
Hemorrhoids are divided into:
- I degree: completely internal hemorrhoids
- II degree: they protrude from the anal rim at the moment of defecation and then spontaneously re-enter
- III degree: they protrude from the anal edge at the time of defecation, but must be repositioned inside the anal canal manually
- IV degree: external to the anal canal
How hemorrhoids are caused? What are the factors that predispose their onset?
The main factors are:
- somatic constitution
- aging
- chronic constipation
- pregnancy
- familiarity
- intense effort during evacuation
- spend a long time on the toilet
It should also be known that:
- nutrition – One of the best reasons on how hemorrhoids are caused is a slag-free diet which promotes constipation, as well as some foods: alcohol, spices, cocoa, spicy foods, shellfish
- habitual position – sedentary jobs in a sitting position or that require too much to stand upright, can cause a state of increased pressure in the haemorrhoidal veins due to gravity or difficult venous discharge
- particular sports – horse riding, motorcycling, weight lifting, cycling, can cause continuous trauma, poorly supported by the support structures of the anal canal
- endocrine and genital factors – hormonal intake and / or changes (e.g. contraceptive pill, ovulation, menstruation) can affect haemorrhoidal crises, favoring acute episodes
- there are no relationships between hemorrhoids and cancer – the symptoms of hemorrhoids, especially bleeding, are however similar to those of cancer and other colorectal diseases. Therefore it is important that all symptoms are studied by a physician experienced in treating colorectal diseases.
What are the symptoms of hemorrhoids?
The symptoms are: itching, pain, emission of blood and external protrusion.
What are the complications of hemorrhoids?
The complications are: bleeding, thrombosis (when the blood inside the hemorrhoidal vessel coagulates, forming a thrombus).
How hemorrhoids are caused? The diagnosis
Hemorrhoids (or hemorrhoidal disease) are diagnosed by:
- Proctological visit
- Anoscopy
The Treatments
- Elastic ligation (outpatient procedure)
The procedure is performed for I and II degree hemorrhoids.It consists of inserting a small elastic ring at the base of the hemorrhoid, preventing blood flow.The hemorrhoid and the elastic fall off spontaneously in a few days and the wound heals in 1-2 weeks. It can cause mild discomfort and bleeding.
- Milligan-Morgan excision surgery
Surgical removal is the best method for permanent hemorrhoid removal. Performed under general or spinal anesthesia, it may require hospitalization and a period of inactivity.
It is necessary when:
- thromboses in external hemorrhoids recur;
- elastic ligation fails to treat internal hemorrhoids;
- prolapsed hemorrhoids can no longer be reduced;
- there is persistent bleeding.
Advantages: removes excess tissue that causes bleeding and prolapse. Therefore it has fewer relapses than the other methods.
Disadvantages: local pain, open wounds, bleeding, mucorrhea (loss of mucus along with stool) for about 2-3 weeks.
- Hemorrhoidectomy and mucopexy surgery with a PPH circular stapler
The procedure is performed for grade II and III hemorrhoids. It consists in the removal of a cylinder of mucous membrane of the anal canal and subsequent suturing of the same with a series of agraffes. This results in the removal of internal haemorrhoidal drips and an upward repositioning of the haemorrhoidal cushions, with an interruption of the arteries afferent to the haemorrhoids.
Benefits: preservation of the skin of the anal edge and its sensitivity
reduction of postoperative pain (more than 80% of patients complain of only minimal pain in the first 24-48 hours)
Disadvantages:
- increased relapse
- bleeding after a week
- persistent internal staples
- increased risk of infections
- Hemorrhoidal dearterialization surgery with doppler probe and mucopexy (THD)
The procedure is performed for bleeding grade II and III hemorrhoids. It consists in the ligation of the arterial vessels afferent to the haemorrhoidal cushions, to which a pessia of the mucosa is added (accordion suture of the protruding anal mucosa). The ligation is done on the guide of a Doppler probe.
Benefits:
- minimal post-operative pain component
- minimal proctorrhagia
Disadvantages:
- tenesmus (feeling of needing to defecate)
- relapse
