Hemorrhoids: Unveiling the Truth Behind the Pain
Discover the truth about hemorrhoids in our comprehensive guide. We delve into the causes, symptoms, and both medical and natural treatment options. Uncover the facts and regain control of your well-being today.
1) Introduction
Hemorrhoids, often known as
piles, are a common anorectal disease that is distinguished by symptomatic
expansion and distal displacement of the typical anal cushions. They are
similar to varicose veins in that they are bulging veins in the anus and lower
rectum. Internal hemorrhoids form inside the rectum while external hemorrhoids
form under the skin around the anus. Rectal bleeding with bowel movement is the
most prevalent sign of hemorrhoids.
a) Definition and Overview of
Hemorrhoid
Hemorrhoids are defined as
symptomatic anal cushion hypertrophy and distal displacement. They are caused
by aberrant dilation and distortion of the vascular channel, as well as
damaging changes in the anal cushion's supporting connective tissue. This disease
is frequently accompanied by an inflammatory response and vascular hyperplasia.
Internal and external hemorrhoids are distinguished by their location. Internal
hemorrhoids are located inside the rectum and are normally painless, but they
might produce intestinal bleeding or a prolapsed hemorrhoid. External
hemorrhoids occur under the skin around the anus, causing itching, discomfort,
swelling, and bleeding.
b) Causes and Risk Factors of
Hemorrhoid
Hemorrhoids, often known as
piles, are varicose vein-like bulging veins in the anus and lower rectum. They
can form as a result of increased pressure in the lower rectum caused by a
number of reasons.
i) Constipation and Straining
During Bowel Movements
Constipation, which is
characterized by firm and dry stool, can aggravate symptoms of hemorrhoidal
prolapse. Straining during bowel movements, as well as having hard or lumpy
stools at least 25% of the time, were all linked to an elevated risk of hemorrhoidal
disease (HD).
ii) Low Fiber Diet
Constipation is frequently
coupled with a low fiber diet, which might increase the risk of getting
hemorrhoids. Dietary fiber supplements have been demonstrated to be an
effective treatment for non-prolapsing hemorrhoids, with a 50% reduction in the
likelihood of persistent discomfort and bleeding.
iii) High Body Mass Index (BMI)
and Obesity
Obesity and a high BMI can raise
pressure in the lower rectum, resulting in hemorrhoids. Under pressure, the
veins around the anus tend to stretch and may bulge or enlarge.
iv) Sedentary Lifestyle
Sedentary living can cause
constipation, aggravate an existing HD, induce a recurrence, or even cause new
difficulties in those who have never had a hemorrhoid before. Patients should
be encouraged to engage in moderate physical exercise (20-60 minutes per day,
3-5 days per week) because it improves quality of life and can aid in the
effective management of hemorrhoid symptoms.
v) Pregnancy
Because the baby's weight puts
pressure on the anal region, pregnancy can increase the risk of hemorrhoids.
Higher progesterone levels during pregnancy soften the vein walls, allowing
them to swell more easily. Postpartum hemorrhoids can also develop as a result
of pressing during childbirth.
vi) Age
Hemorrhoids become more common as
people age. Because the tissues that support the veins in the rectum and anus
might weaken and expand, this occurs. Hemorrhoids are significantly more common
in adults between the ages of 45 and 65.
vii) Other Factors
Other risk factors include
prolonged bathroom use, chronic diarrhea, frequently moving large objects, and
having anal intercourse. It is crucial to emphasize, however, that the pressure
of anal intercourse is unlikely to induce the type of long-term swelling that
causes hemorrhoids.
Finally, the risk of hemorrhoids
rises as a result of a combination of lifestyle factors, food choices, physical
problems such as obesity and pregnancy, and age. To lower the chance of
developing hemorrhoids, it is critical to maintain a healthy lifestyle that
includes a high-fiber diet and regular exercise.
c) Prevalence and Demographics
for Hemorrhoid
Hemorrhoids, a widespread ailment
that affects millions of people worldwide, are a major medical and
socioeconomic issue. The global frequency of hemorrhoids in the general
population is estimated to be 4.4%. An epidemiologic study in the United States
found that 10 million persons had hemorrhoids, resulting in a 4.4% prevalence
rate.
Hemorrhoids are most common
between the ages of 45 and 65, and developing hemorrhoids before the age of 20
is unusual. This shows that age plays a role in the development of hemorrhoids,
with middle-aged and older persons being more prone.
In terms of racial and
socioeconomic demographics, whites and those with higher socioeconomic status
are more likely to be harmed than blacks and people with lower socioeconomic
status. It should be noted, however, that this correlation may reflect differences
in health-seeking behavior rather than genuine prevalence.
Hemorrhoids were observed to
affect 13%-36% of the general population in the United Kingdom. This suggests
that the occurrence of hemorrhoids varies greatly between countries.
Hemorrhoids are common in both
men and women, affecting around one in every twenty Americans. A study
conducted in Ethiopia, however, discovered that the prevalence of hemorrhoids
was higher in male patients. Hemorrhoids affect around half of all adults over
the age of 50. This lends credence to the concept that the occurrence of
hemorrhoids rises with age.
In terms of risk factors,
research have shown that a lack of dietary fiber, constipation, diarrhea,
hypertension, a high body mass index (BMI), pregnancy, and old age are all
regularly identified risk factors for hemorrhoids development.
Finally, hemorrhoids are a
frequent ailment with a high prevalence rate worldwide. They are more common in
middle-aged and older persons, and their prevalence varies by race,
socioeconomic level, and health-seeking behavior. Hemorrhoids can be caused by a
number of risk factors, including nutrition, lifestyle, and underlying health
issues.
2) Pathophysiology of Hemorrhoids
The specific pathophysiology of
hemorrhoidal development is unknown. However, it is well recognized that
hemorrhoids are characterized by aberrant dilatation and distortion of the
vascular channel, as well as damaging changes in the supporting connective
tissue within the anal cushion. Hemorrhoids are associated with pathologic
conditions that cause increased intra-abdominal pressure, such as chronic
obstructive pulmonary disease (COPD), chronic strain from an enlarged prostate
or urethral stricture, patients with a space-occupying intraabdominal lesion
such as an ovarian tumor or a large rectosigmoid carcinoma, ascites, and
pregnancy.
Hemorrhoids form when the anal
cushion's supporting tissues dissolve or degrade. Constipation, prolonged
straining, and increased intra-abdominal pressure can all contribute to this.
Conditions that induce symptomatic hemorrhoids reduce venous return from the
hemorrhoidal veins, resulting in a pathologic increase in the size of the
vascular cushions. In addition, low-fiber diets create hard stools and
increased straining; the hard stool causes local tissue stress, which causes
bleeding.
b) Vascular Changes and
Connective Tissue Destruction in Hemorrhoids
Hemorrhoidal vascular alterations
include aberrant dilatation and distortion of the vascular channel within the
anal cushion. This is frequently coupled with an inflammatory response and
vascular hyperplasia, which may play a role in hemorrhoidal development.
The arterial blood supply of the
internal hemorrhoidal plexus is widely thought to be involved in hemorrhoid
etiology. According to one study, the mean diameter of arterial branches in
hemorrhoids patients was substantially higher than in the control group. In
addition, patients with hemorrhoids had considerably higher arterial blood flow
than the control group. These findings imply that hemorrhoids are associated
with increased diameter and arterial blood flow of the terminal branches of the
superior rectal artery (SRA).
In hemorrhoids, the connective
tissue within the anal cushion also undergoes damaging alterations. The anal
cushion's supporting tissues erode or degrade, resulting in hemorrhoids.
Hemorrhoids are naturally
occurring vascular tissues that consist loose connective tissue, smooth muscle,
and blood vessels with many arteriovenous connections. Hemorrhoids are
distinguished by aberrant dilatation and distortion of the vascular channel, as
well as damaging changes in the supportive connective tissue within the anal
cushion.
Finally, hemorrhoids are a common
anorectal disorder characterized by abnormalities in the vascular and
connective tissue architecture of the anal cushions. The precise pathogenesis
is unknown, although it is thought to entail aberrant dilatation and distortion
of the arterial channel, damaging alterations in the supporting connective
tissue, and variables that raise intra-abdominal pressure.
3) Symptoms and Diagnosis
for Hemorrhoids
a) Common Symptoms of Hemorrhoids
i) Rectal Bleeding
Rectal bleeding is a common
hemorrhoid symptom. This is typically distinguished by bright red blood on
toilet paper, in the toilet bowl, or on the stool. Internal hemorrhoids are
normally painless, but they might cause intestinal hemorrhage. Small amounts of
bright red blood may be found on your toilet tissue or in the toilet. Rectal
bleeding can also occur as a result of other disorders, such as colorectal
cancer and anal cancer. As a result, if you experience chronic rectal bleeding,
get medical assistance immediately.
b) Anal Itching or Irritation
Another typical symptom of
hemorrhoids is anal itching or irritation. External hemorrhoids, which form
under the skin around the anus, are more likely to cause this symptom. Itching
or irritation in the anal region can be extremely painful, and it may be
accompanied by swelling around the anus.
c) Pain or Discomfort
Hemorrhoids are commonly
characterized by pain or discomfort, particularly during bowel movements or
while sitting. External hemorrhoids are more prone to this symptom. The
discomfort can be excruciating, particularly if the hemorrhoid becomes
thrombosed, which means a clot has developed within the hemorrhoid.
d) Swelling Around the Anus
External hemorrhoids are commonly
characterized by swelling around the anus. These hemorrhoids are located
beneath the skin around the anus and can cause swelling and discomfort.
Swelling can be substantial in some circumstances, making it difficult to keep
the anal area clean.
e) Protrusion of Hemorrhoidal
Tissue
Internal hemorrhoids are
characterized by the protrusion of hemorrhoidal tissue through the anal hole,
commonly known as prolapsed hemorrhoids. Internal hemorrhoids can prolapse, or
protrude, outside the anus if they become big. A prolapsed internal hemorrhoid
is what this is. In severe circumstances, the hemorrhoid may become thrombosed,
which means it is filled with blood and clotted.
b) Physical Examination and
Diagnostic Tests for Hemorrhoids
i) Physical Examination
The perianal area is visually
inspected to detect external hemorrhoids or prolapsed internal hemorrhoids. The
healthcare professional examines the patient for lumps or swelling, internal
hemorrhoids that have prolapsed through the anal orifice, external hemorrhoids
with a blood clot in a vein, stool or mucus leaking, skin irritation, and skin
tags. Generalized illnesses such as psoriasis and vitiligo, as well as
infectious processes such as syphilitic dermatitis and candidiasis, can affect
the perianal skin.
The healthcare provider does a
digital rectal examination by inserting a gloved, lubricated finger into the
rectum to look for any abnormalities. This exam allows the provider to evaluate
the tone of the anus muscles, as well as look for pain, bleeding, internal
hemorrhoids, and lumps or tumors. The prostate, its size, consistency, and the
existence of nodules in males should be observed. In women, the Douglas
rectouterine pouch should be palpated for lumps or discomfort.
ii) Diagnostic Tests
Anoscopy is a process in which a
healthcare provider views the lining of the anus and lower rectum using a short
plastic tube called an anoscope. Most patients do not require anesthesia for
this procedure, which is performed during an office visit or at an outpatient
center. Anoscopy is more sensitive than flexible sigmoidoscopy for anorectal
diseases such as internal hemorrhoids, proctitis, lacerations, fistulas,
ulcers, and tumors.
Proctosigmoidoscopy is a
procedure that involves seeing the lining of the rectum and lower colon with a
proctoscope. This treatment is similar to anoscopy, except the healthcare
provider can inspect a broader section of the rectum and lower intestine. Proctosigmoidoscopy,
like anoscopy, is conducted during an office visit, an outpatient clinic, or a
hospital, and most patients do not require anesthesia.
Finally, diagnosing hemorrhoids
requires a complete strategy that includes a physical examination as well as
diagnostic tests. These treatments enable healthcare providers to precisely
diagnose hemorrhoids while ruling out other illnesses that may appear with
similar symptoms.
c) Grading System for Hemorrhoids
Hemorrhoids are classified into
four grades based on their severity and degree of prolapse. This grading system
is crucial as it helps in determining the appropriate treatment approach for
each case
i) Grade I Hemorrhoids
Internal hemorrhoids of grade I
do not prolapse or extend out of the anus. They can cause bleeding but can only
be seen with an endoscopy or colonoscopy. Dietary adjustments, notably
increased fiber intake, and over-the-counter hemorrhoid medications are the
most popular treatments for Grade I hemorrhoids. These medications, which
include Preparation H, Proctofoam, Tucks hydrocortisone cream, and Analpram,
serve to reduce the inflammation, swelling, and itching produced by hemorrhoid
irritation.
ii) Grade II Hemorrhoids
Internal hemorrhoids of grade II
prolapse during bowel movements but naturally decrease subsequently. Doctors
frequently begin with conservative treatments similar to those given for Grade
I hemorrhoids. If these do not work, they may resort to non-invasive in-office
techniques such rubber band ligation, injectable sclerotherapy, or infrared
coagulation. These treatments are only for internal prolapsed hemorrhoids and
may necessitate numerous administrations. They are not curative because they do
not address the underlying cause of the problem, but they can be useful for a
large number of individuals.
iii) Grade III Hemorrhoids
Hemorrhoids of Grade III prolapse
during bowel movements and must be manually reduced. Internal hemorrhoids that
do not return to the anus unless the patient pulls them back in. Doctors
frequently send patients to surgeons for more serious treatments to treat Grade
III hemorrhoids. Surgical hemorrhoid ectomy or surgical hemorrhoid stapling are
the most prevalent surgical therapies. Excisional hemorrhoidectomy is the most
common surgical procedure and has the greatest results in most cases, but
recovery can be painful and take up to two weeks. Because of the placement of
the incision, the stapled hemorrhoidectomy method is less painful. It includes
removing a rim of tissue and using small staples to hold the tissue together.
iv) Grade IV Hemorrhoids
Hemorrhoids in Grade IV are
permanently prolapsed and cannot be reduced. They are internal hemorrhoids that
have prolapsed and will not return to the anus. These hemorrhoids are prone to
problems such as strangulation and almost always necessitate specialized
treatment, including surgery. Rectal bleeding, discomfort, pain, itching, and
irritation are all common symptoms. Grade IV hemorrhoids are typically treated
surgically, with treatments including hemorrhoid banding and laser excision.
It is vital to remember that
hemorrhoids are treated differently depending on their severity and the
patient's overall health. As a result, it is critical to consult a healthcare
expert for an accurate diagnosis and treatment plan.
4) Conservative Treatments for
Hemorrhoids
Conservative hemorrhoid
treatments are usually the first line of defense and can be quite effective.
According to studies, if conservative therapies are followed correctly, more
than 80% of patients will not require surgical intervention for hemorrhoidal
illness.
The conservative approach to
hemorrhoids therapy frequently includes lifestyle adjustments, dietary changes,
topical therapies, and the use of stool softeners and sitz baths. These
therapies try to alleviate the swelling and discomfort caused by hemorrhoids
while also preventing their recurrence.
a) High-Fiber Diet and LifestyleModifications for Hemorrhoids
Hemorrhoids, often known as
piles, are inflamed, bulging veins in the lower rectum or surrounding the anus.
They might be internal or external, causing pain and bleeding. As a
conservative treatment for hemorrhoids, a high-fiber diet is frequently recommended.
This is because fiber increases stool weight, decreases the amount of time
feces spend in the colon (colon transit time), and increases water retention in
the colon, resulting in softer, easier-to-pass stools.
The Dietary Guidelines for
Americans, 2020-2025, recommend 14 grams of fiber per 1,000 calories ingested.
For example, the fiber requirement for a 2,000-calorie diet is 28 grams per
day.
Grains, fruits, vegetables, and
legumes are all high in fiber. Fiber is present in just 1/3-1/4 cup of high
fiber, ready-to-eat bran cereal. A pear with skin has approximately 5.5 grams
of fiber. Barley contains -glucan, a fiber that breaks down and creates a thick
gel in the colon, softening the feces.
Whole wheat products that are unprocessed or lightly processed are high
in insoluble fiber, which increases fecal weight and colon transit time.
Berries with a high skin-to-flesh ratio, such as raspberries, blackberries, and
strawberries, contain a lot of fiber per serving. Artichokes are abundant in
fiber and are frequently used to cure hemorrhoids in traditional medical
systems. Sweet potatoes contain soluble as well as insoluble fiber.
Aside from dietary adjustments,
lifestyle changes such as frequent exercise can also benefit. To increase
gastrointestinal function, thirty minutes of cardiovascular exercise every day
is recommended. Before consulting a healthcare expert, try over-the-counter
(OTC) hemorrhoid treatments or suppositories for about a week. Using
over-the-counter laxatives or stool softeners. Lifting large objects and
lifting with the knees should be avoided wherever possible. Attempting to
prevent straining during bowel movements, holding in bowel motions, or spending
too much time on the toilet. Staying hydrated by drinking water, fruit juices,
clear soups, or other liquids that may aid in the digestion of fiber from
foods. Taking over-the-counter pain relievers. Taking sitz baths, or sitting in
a warm water bath, multiple times every day. Keeping one's body weight within
the approved healthy range. Keeping anal intercourse to a minimum. Getting
adequate physical activity. Although a high-fiber diet and lifestyle changes can
help control hemorrhoids, they may not fully eliminate the issue. It is advised
to seek medical attention if symptoms persist or worsen.
b) Topical Treatments and Pain
Relief for Hemorrhoids
Topical hemorrhoid treatments are
intended to provide brief relief from discomfort and itching. These remedies
are available over-the-counter and can be applied directly to the affected
area.
Hydrocortisone, a type of steroid
that lowers inflammation and irritation, is a prevalent element in these
treatments. A 1% hydrocortisone cream can be applied to the area outside the
anus, but it should not be used for more than a week without the approval of a
doctor. Preparation H Anti-Itch Hemorrhoid Treatment Cream is an example of a
hydrocortisone-containing medication. Witch hazel is another prominent
component in hemorrhoid topical treatments. Witch hazel is an anti-inflammatory
that can help reduce swelling and itching. TUCKS Medicated Cooling Pads are one
example of a witch hazel-containing product. These pads can relieve burning and
itching immediately, cleanse sensitive regions, soothe and protect irritated
areas, and aid to calm inflammatory tissue.
In addition to lotions and pads,
suppositories are available for hemorrhoid therapy. These are injected into the
rectum and may contain medications such as lidocaine to numb the area, as well
as hydrocortisone or witch hazel to alleviate swelling and itching.
Over-the-counter pain medicines
such as acetaminophen (Tylenol), aspirin, or ibuprofen (Advil, Motrin IB) can
be used momentarily for pain relief. These drugs can help relieve the
discomfort caused by hemorrhoids.
In addition to these therapies,
lifestyle adjustments can help alleviate hemorrhoid pain and itching. These
include taking warm showers or sitz baths, wearing loose clothing, eating a
high-fiber diet, staying hydrated, and, if necessary, using stool softeners.
If your symptoms are severe or do
not improve after a few weeks, your doctor may recommend an operation to reduce
or eliminate the hemorrhoids. These procedures, which include injection, rubber
band ligation, coagulation or cauterization, and surgery, are frequently
performed in the doctor's office.
Keep in mind that, while these
treatments may provide temporary comfort, they do not cure hemorrhoids. A
proper diagnosis and treatment plan require consultation with a healthcare
specialist.
c) Stool Softeners and Sitz Baths
for Hemorrhoids
Stool softeners are a type of
laxative that can help relieve hemorrhoid symptoms by making stools easier to
pass and decreasing straining. They operate by increasing the quantity of water
and fat absorbed by the stool, causing it to soften and pass more easily. This
can assist to avoid the straining and prolonged time spent on the toilet, both
of which can cause or aggravate hemorrhoids.
Stool softeners are classified
into two types: docusate sodium and docusate calcium. These can be administered
orally as tablets, capsules, syrup, or liquid, or rectally as an enema.
However, it is crucial to note that taking stool softeners in excess might
cause diarrhea, which can aggravate hemorrhoids.
Stool softeners are especially
useful for patients who should avoid straining during bowel movements due to
diseases such as heart disease, recent delivery, hemorrhoids, or recent medical
treatments and operations. They can also help pregnant women, as pregnancy
increases the risk of hemorrhoids owing to hormonal changes.
Aside from stool softeners,
lifestyle adjustments such as drinking more water, getting regular exercise,
boosting daily fiber intake, and taking a probiotic might also help relieve
hemorrhoids symptoms.
A sitz bath is a warm, shallow
bath in which you sit to relieve pain, burning, or itching in your perineum,
which is the area between your anus opening and your external genitals. By
relaxing the anal sphincter, which enhances blood circulation in the anal
tissues and promotes healing, sitz baths can help minimize muscle spasms.
Sitz baths can be especially
beneficial for persons suffering with hemorrhoids because they can help lessen
the pain and swelling produced by the ailment. They can also aid patients who
have just had hemorrhoids removed by alleviating any post-surgery discomfort.
To take a sitz bath, fill a
standard bathtub with two to three inches of warm water or use a tiny plastic
tub that fits over your toilet. Two to three times per day, immerse your anal
area in a bath for 15 to 20 minutes. To avoid aggravating the area, gently dry
your buttocks and perineum with a clean towel after your sitz bath.
While sitz baths are generally
safe and simple to use, it is critical to fully clean the bath before usage to
avoid infection. If your pain worsens or your perineum gets red and puffy,
discontinue use of the sitz bath and seek medical attention.
In conclusion, both stool
softeners and sitz baths can be effective treatments for hemorrhoids. However,
before beginning any new treatment regimen, always consult with a healthcare
provider.
5) Office-Based
Procedures for Hemorrhoids
Hemorrhoidal disease (HD) is a
common adult disorder characterized by symptomatic hypertrophy and distal
displacement of the anal vascular vessels. Treatment options are determined by
the nature and severity of the condition, the preferences of the patients, and
the skill of the clinician. There are various options available, including
lifestyle and dietary changes, medicinal treatment (systemic and topical
medicines), office-based procedures, and surgical therapies. Internal HD grades
I through III are often treated medically and/or with office-based procedures,
with surgery reserved for grade IV hemorrhoidal disease, external hemorrhoids,
and disease recalcitrant to conventional treatments.
a) Rubber Band Ligation for
Hemorrhoids
A healthcare provider inserts a
small tool called a ligator via a lighted tube, or scope, during the process.
The ligator is used to wrap a specific rubber band around the hemorrhoid's
base. This band restricts the blood supply to the hemorrhoidal tissue, causing
it to become ischemic and slough off within a week. This causes an ulcer to
form, which heals and anchors the tissue to the underlying muscle.
RBL is approved for grade 1 and 2
internal hemorrhoids, as well as select cases of grade 3 internal hemorrhoids.
Patients with immunodeficiency, those on anticoagulation therapy, those who are
unable to pull sufficient tissue into the band ligator, patients with anorectal
Crohn's disease, patients who are unlikely to follow up, and those with a
concurrent anorectal infectious process are all contraindicated.
RBL has been shown to be a safe
and effective treatment for internal hemorrhoids. It has a success rate ranging
from 60% to 80%. RBL significantly improved prolapse and bleeding control
(93.1% RBL vs. 66.4% sclerotherapy, RR 1.34, 95% CI 1.12-1.60 and 89.1% RBL vs.
78.7% SCL, RR 1.17, 95% CI 1.02-1.34, respectively). However, this method
resulted in much more post-procedural pain (24% RBL vs. 14% sclerotherapy, RR
1.74, 95% CI 1.32-2.28).
Bleeding, thrombosed external
hemorrhoids, and bacteremia are all possible complications of RBL. If more than
four bands are required to eradicate symptoms, the likelihood of success is
reduced. Higher bleeding rates have been linked to the usage of acetylsalicylic
acid/nonsteroidal anti-inflammatory medications and warfarin.
Patients may have pain and a
feeling of fullness in their lower abdomen after the treatment, as well as the
need to urinate. This normally goes away after a few days of the procedure.
During this period, patients may require pain medication. Normal is a small
amount of bleeding from the anus 7 to 10 days after surgery, when the
hemorrhoid breaks off. Some people can resume normal activities soon away,
while others may require 2 to 3 days of bedrest. While recovering, patients are
recommended to avoid hard lifting and straining with bowel movements.
b) Injection Sclerotherapy for
Hemorrhoids
Injection Sclerotherapy is a
common treatment for internal hemorrhoids of various grades. It entails
injecting a solution into an internal hemorrhoid, which causes scar tissue to
develop. This scar tissue shuts off the hemorrhoid's blood supply, causing it
to shrink.
The surgery is often regarded as
one of the most visible, cost-effective, and widely utilized treatments for
internal hemorrhoids. It is an office-based ambulatory type of therapy, which
means it can be performed without the requirement for hospitalization in a
doctor's office. It is inexpensive and free of serious problems, making it a
preferred choice for many people.
Different sclerosants, or
solutions used in the treatment, have their own set of benefits and drawbacks.
For injectable sclerotherapy, aluminum potassium sulfate and tannic acid (ALTA)
is more efficient than phenol in almond oil (PAO). ALTA has been demonstrated
to be effective in treating prolapsing internal hemorrhoids in grades II, III,
and IV.
Patients generally handle the
surgery well, with high patient satisfaction, a low complication rate, and
excellent long-term results. However, while patient satisfaction was much
greater with rubber band ligation (RBL), sclerotherapy had comparable benefits
in terms of pain alleviation, overall symptom control, and risk of recurrence
at 3 months.
Endoscopic rubber band ligation
had a significantly higher success rate than endoscopic injection sclerotherapy
in terms of resolution of anal protrusion, but with a higher pain score, in a
study comparing sclerotherapy with 3% polidocanol foam and rubber band ligation
in the management of second- and third-degree hemorrhoids.
Sclerotherapy with 3% polidocanol
foam was also found to be a safe and effective method in III- and IV-degree
bleeding hemorrhoids in another investigation. Long-term data on foam duration
must to be reviewed in additional investigations.
c) Infrared Photocoagulation
Hemorrhoids
Infrared photocoagulation (IRC)
is a medical treatment used to treat internal hemorrhoids that are small to
medium in size. A gadget that emits a powerful beam of infrared light is used
in the procedure. The light's heat induces scar tissue to develop, cutting off
the blood flow to the hemorrhoid. The hemorrhoid dies as a result, and a scar
forms on the anal canal wall. This scar tissue aids in the retention of
surrounding veins, preventing them from bulging into the anal canal.
The procedure is usually carried
out in a doctor's office and does not necessitate hospitalization. It is
usually regarded as a safe and effective hemorrhoid treatment with a low risk
of consequences. It should be noted, however, that the surgery may need to be
repeated for multiple hemorrhoids, with treatments commonly spaced at 10- to
14-day intervals.
Patients may experience heat and
pain during the operation, although the use of short-duration anesthetic should
reduce this discomfort. Patients may notice a feeling of fullness in the lower
abdomen or the need to urinate following the treatment. Some patients may also
feel a warm sensation at the treatment location, which normally goes away after
an hour.
Minor bleeding or spotting from
the anus may also occur 7 to 10 days following the treatment, when the
hemorrhoid breaks off. This bleeding is usually little and resolves on its own.
Patients are usually able to
resume normal activities nearly immediately after the treatment, but they are
encouraged to avoid heavy lifting and straining during bowel movements while
they heal. Patients should also eat a high-fiber diet to avoid constipation and
straining during bowel movements, which can lead to the development of
hemorrhoids.
While IRC is usually thought to
be safe, there are certain hazards linked with the process. Minor bleeding and
pain following the surgery may usually be handled with over-the-counter pain
medication and should go away within a few days. There is also a little chance
of infection, however this is quite unlikely. In rare circumstances, the
hemorrhoid may not shrink completely or may return.
6) Surgical Treatments for
Hemorrhoids
a) Hemorrhoidectomy for
Hemorrhoids
Hemorrhoidectomy is a surgical
treatment used to eliminate widespread or severe internal or external
hemorrhoids. Small cuts around the anus are made to remove the enlarged veins,
which can be done with a scalpel, scissors, electrocautery, or laser. Hemorrhoidectomy
can be done as a closed procedure, with absorbable sutures closing the
incisions, or as an open procedure, with the incisions left open to heal.
Hemorrhoidectomy is the most successful treatment for hemorrhoids, although it
has the highest rate of consequences, including bleeding, infection, anal
fissuring, and anal stricture.
b) Stapled Hemorrhoidopexy for
Hemorrhoids
Stapled hemorrhoidopexy, also
known as stapled hemorrhoidectomy, is a surgical treatment that removes
hemorrhoidal tissue and lifts the hemorrhoids back to their original position
within the anal canal using a particular stapling equipment. This operation is
less intrusive than typical hemorrhoidectomy, resulting in less postoperative
pain and a speedier recovery. However, when compared to standard
hemorrhoidectomy, stapled hemorrhoidopexy may have a higher likelihood of
recurrence.
A circular stapling device is
used in stapled hemorrhoidopexy to remove a circumferential strip of the
superfluous mucosa-submucosa at the proximal aspect of the internal
hemorrhoids. This raises the prolapsed hemorrhoidal tissue while decreasing
blood flow to the hemorrhoids, causing them to shrink. The surgery is normally
completed in 20 to 30 minutes while under general or spinal anesthesia.
Following surgery, patients often have decreased discomfort, bleeding, edema,
and itching around the anus and inside the rectum. It normally takes around two
weeks to recuperate completely from stapled hemorrhoidopexy.
Despite its benefits, stapled
hemorrhoidopexy has been linked to a higher long-term risk of hemorrhoid
recurrence and prolapse symptoms when compared to traditional excisional
hemorrhoid operations. In a meta-analysis of randomized controlled studies, patients
who received stapled hemorrhoidopexy had a considerably greater recurrence rate
of hemorrhoids than those who got traditional hemorrhoidectomy. Furthermore,
patients undergoing stapled hemorrhoidopexy were more likely than those
undergoing traditional hemorrhoidectomy to require subsequent operational
operations.
c) Hemorrhoidal Artery Ligation
for Hemorrhoids
Hemorrhoidal artery ligation
(HAL) is a minimally invasive surgical treatment used to treat hemorrhoids. It
is also known as transanal hemorrhoidal dearterialization. The goal of the
surgery is to restrict blood supply to the hemorrhoids, forcing them to shrink.
A Doppler ultrasonography probe
is utilized during the HAL operation to find the arteries supplying blood to
the hemorrhoids. The blood supply is subsequently cut off by suturing these
arteries. A raised suture (rectopexy) is utilized to relocate the hemorrhoids
back to their normal anatomical position in cases of redundant prolapse.
The HAL method is effective in
treating all grades of hemorrhoids, with little pain and a speedy recovery. It
has been found to have a less than 10% recurrence rate and a greater patient
satisfaction rating of roughly 90% with less postoperative pain. However, it is
crucial to highlight that the efficacy of HAL in comparison to other surgical
and non-surgical hemorrhoid therapies is currently being studied. The
randomized controlled trial (RCT) evidence, for example, demonstrated a balance
between the advantages and hazards associated with stapled hemorrhoidectomy,
closed hemorrhoidectomy, and open excisional (Milligan-Morgan)
hemorrhoidectomy.
In terms of advantages, HAL has
been linked to symptom and quality of life improvement, as well as a shorter
length of hospital stay. Potential disadvantages, on the other hand, include
postoperative pain and general problems.
Furthermore, while HAL is helpful
in treating early hemorrhoids characterized by per rectal hemorrhage and/or
perianal discomfort, it has a restriction in treating prolapsing hemorrhoids.
To address this, RAR (simultaneous recto-anal repair) was recently introduced.
HAL in conjunction with RAR has been shown to improve surgical results and
increase patient satisfaction.
To summarize, while HAL is a
promising treatment for hemorrhoids, further research is required to completely
evaluate its efficacy in comparison to other treatment alternatives. Patients
should always consult with their healthcare professional to find the best
treatment option for their particular ailment.
7) Complications
and Recurrence of Hemorrhoids
Hemorrhoids are bulging veins
that grow inside and outside of the anus and rectum. They can be painful and
cause rectal bleeding. While hemorrhoids are normally not hazardous, in rare
circumstances they might cause difficulties. Anemia, blood clots in external
hemorrhoids, infection, skin tags, and strangulated hemorrhoids, in which
muscles in the anus shut off blood flow to a prolapsed internal hemorrhoid, are
among the problems.
Diet and lifestyle decisions
might result in increased pressure on the veins in the rectum and anus,
resulting in recurring hemorrhoids. Constipation, diarrhea, extra weight,
prolonged sitting, hard lifting, and pregnancy are all causes of hemorrhoids.
When a blood clot forms inside a
hemorrhoidal vein, it obstructs blood flow and causes a painful swelling of the
anal tissues. Thrombosed hemorrhoids are not harmful, although they can be
excruciatingly painful and cause rectal bleeding if ulcerated.
Thrombosed hemorrhoids are most
usually external, meaning they appear below the dentate line, but internal
hemorrhoids can also become thrombosed. A clinical history and physical
examination, including an examination of the anus and a digital rectal exam,
can be used to diagnose thrombosed hemorrhoids.
The goal of treatment for
thrombosed hemorrhoids is to alleviate pain and shorten recovery time. In cases
of severe pain, surgical removal of the blood clot is advised during the first
24-48 hours of commencement. Individuals are typically treated with conservative
techniques such as oral or topical pain medications and warm water sitz baths
many times per day if more than 24 hours have passed.
Prolapsed hemorrhoids are bulging
veins inside the rectum that bulge (prolapse) out of the anus. These are
distinct from external hemorrhoids, which form on or near the anus's surface,
and internal hemorrhoids, which remain within the rectum. Although prolapsed
hemorrhoids are rarely painful, they can cause bleeding, itching, and
discomfort, especially when sitting or during bowel movements.
Venous thrombosis, in which a
blood clot forms inside a hemorrhoidal vein, restricting blood flow and causing
painful swelling of tissues, is one of the complications of prolapsed
hemorrhoids. Some thrombosed hemorrhoids are as big as grapes or even bigger.
Another risk is hemorrhoid imprisonment and strangulation, which occurs when a
hemorrhoid becomes imprisoned in anal muscles and is completely deprived of
blood flow, resulting in intense discomfort, fast tissue death, and gangrene.
Hemorrhoids might reappear even
after therapy. This is frequently due to the failure to address the underlying
issues. Diet, physical activity, and bowel habits, for example, might all
contribute to the recurrence of hemorrhoids.
Hemorrhoid banding is a long-term
cure for reoccurring hemorrhoids. It is a non-surgical method that can
permanently eradicate internal hemorrhoids. This method involves wrapping a
rubber band around the hemorrhoid's base, cutting off its blood supply. The
hemorrhoid shrivels up and falls out due to a lack of blood supply. Scar tissue
replaces the hemorrhoid, preventing any other veins from bulging into the anal
canal.
8) Real life Testimonials and
Patient Experiences
Neil, a patient suffering from
grade 3 hemorrhoids, opted for the Rafaelo surgery as his treatment.
Hemorrhoids are a frequent anorectal condition that can produce symptoms such
as bleeding, itching, pain, and prolapse, all of which can have a negative influence
on a patient's quality of life. Living with hemorrhoids was described as a
hardship in Neil's instance, creating shame and negatively damaging his quality
of life.
Rafaelo is a novel surgical
treatment for hemorrhoids that was just authorized by the National Institute
for Clinical Excellence (NICE). It employs well-established radio frequency
technology to treat hemorrhoids in a minimally invasive manner, with no tissue
incisions. To avoid discomfort, the treatment is usually performed under local
anesthesia, and the area around the hemorrhoid is anesthetized. The hemorrhoid
is subsequently treated with radio frequency energy, which reduces blood supply
to it, causing it to shrink and eventually disappear. This usually only takes
one 15-minute treatment session and requires very little after-care. The
symptoms should start to improve virtually immediately.
The Rafaelo technique primarily
relieves pain, bleeding, discharge, discomfort, and itching caused by
hemorrhoids. It enables patients to walk in and walk out with minimal, if any,
post-operative pain and to instantly resume normal daily activities. The procedure
is simple and safe, with a short learning curve. Coagulation of the hemorrhoid
occurs quickly (typically within 5-10 seconds), and because the pile bulk is
directly coagulated, the hemorrhoid disappears immediately under eyesight.
The Rafaelo technique is safe and
effective for all types of internal hemorrhoids. It is primarily intended to
treat internal hemorrhoids of grades 1-3, although some grade 4 hemorrhoids may
also be decreased because the operation targets the internal component, which
decreases the exterior component, making following surgery easier if necessary.
The Rafaelo surgery was quite
helpful in treating Neil's illness. The technique resulted in a statistically
significant improvement in hemorrhoidal disease (HD) symptoms and is linked
with low discomfort and an early return to regular activity for the patient.
The Rafaelo technique has a recurrence rate of less than 10%.
The symptoms of the 18-year-old
patient, including pain, itching, and a lump in the anal region, as well as
blood on the toilet paper, are consistent with hemorrhoids, a disorder
characterized by enlarged veins in the anus and lower rectum. Internal hemorrhoids
(within the rectum) and external hemorrhoids (under the skin around the anus)
have different symptoms. External hemorrhoids can cause itching, pain,
swelling, and bleeding in the anal region, but internal hemorrhoids are
normally painless but can cause bleeding during bowel movements.
Hemorrhoids can develop as a
result of increased pressure in the lower rectum, which can be caused by
factors such as straining during bowel movements, sitting for long periods of
time, chronic diarrhea or constipation, obesity, pregnancy, anal intercourse, a
low-fiber diet, and lifting heavy items on a regular basis.
Because hemorrhoids can be a
source of humiliation for many people, the patient's unwillingness to seek
medical care owing to embarrassment and fear is not unusual. However, if
hemorrhoids do not resolve after a week of home treatment or if there is bleeding
during bowel movements, it is critical to seek medical attention, as rectal
bleeding can be an indication of other disorders, such as colorectal cancer and
anal cancer.
The online doctor's advice to the
patient to eat more fruits, vegetables, and fiber-rich meals, drink more water,
and exercise regularly is consistent with the recommended lifestyle adjustments
for controlling hemorrhoids at home. A high-fiber diet helps soften feces,
increase volume, and decrease the likelihood of straining, which can irritate
hemorrhoids. Drinking plenty of drinks and exercising regularly might help keep
stools smooth and prevent constipation.
Other home remedies for
hemorrhoids include warm baths, over-the-counter lotions or wipes containing
witch hazel to relieve discomfort and itch, applying a tiny cold pack to the
affected area several times per day, and avoiding scratching the area. Wearing
loose, soft underwear is also advised to keep the area aired out and prevent
moisture build-up.
In addition to these lifestyle
modifications, the patient should have regular check-ups with her doctor to
evaluate her symptoms and confirm that the hemorrhoids are improving. If the
hemorrhoids cause severe pain and discomfort, a medical procedure, including
surgery, may be required.
9) Conclusion
Finally, hemorrhoids, a
widespread problem that affects millions of individuals throughout the world,
can be properly treated via a mix of lifestyle adjustments, natural remedies,
and medical treatments. A high-fiber diet, frequent exercise, and enough
hydration can help avoid hemorrhoids and relieve discomfort in individuals who
already have them. Natural remedies such as sitz baths, Epsom salts, and
topical treatments such as aloe vera, witch hazel, and coconut oil can
alleviate pain and inflammation.
It is crucial to remember,
however, that while these therapies can help control symptoms, they may not
fully eliminate hemorrhoids. Medical therapies such as rubber band ligation,
sclerotherapy, or surgical procedures may be required for persistent or severe
instances.
It's also important to realize
that, while hemorrhoids are usually harmless, they might mimic symptoms of more
serious illnesses. As a result, if you have persistent or severe symptoms, you
should seek medical attention.
Finally, while hemorrhoids can be
uncomfortable and sometimes painful, they are a common condition that many
individuals suffer from. If you're suffering with this problem, there's no need
to feel embarrassed or alone. There are numerous services and therapies
available to assist you in managing your symptoms and improving your overall
quality of life.
FAQ’s
Hemorrhoids are swollen and
inflamed veins in the rectum or anus. They can occur inside the rectum
(internal hemorrhoids) or near the anal opening (external hemorrhoids) and can
cause symptoms such as rectal bleeding, itching, and pain
Although hemorrhoids can be
painful and irritating, they are not usually serious. However, they can
significantly affect your quality of life
3) What are the common symptoms of hemorrhoids?
Common symptoms of hemorrhoids
include painful bowel movements, rectal bleeding, anal itching, swelling of
rectal tissue, and stool leakage
Hemorrhoids can be caused by
increased pressure in the veins of the anus due to factors such as pregnancy,
obesity, straining during bowel movements, constipation, diarrhea, and sitting
for long periods of time
5) How are hemorrhoids diagnosed?
A healthcare provider will
diagnose hemorrhoids based on symptoms and a physical exam, which may include a
digital rectal exam, anoscopy, sigmoidoscopy, or colonoscopy
6) How can I treat hemorrhoids at home?
You can often treat hemorrhoids
at home by eating a high-fiber diet, taking a stool softener or fiber
supplement, drinking plenty of water, not straining during bowel movements,
using over-the-counter hemorrhoid creams or ointments, and taking warm sitz baths
7) When should I see a doctor for hemorrhoids?
You should see a doctor if your
hemorrhoids do not improve after a week of home care, if you have severe pain
or bleeding, or if you experience other concerning symptoms
8) What are the treatment options for hemorrhoids?
Treatment options for hemorrhoids
include over-the-counter creams, ointments, and suppositories, as well as
medical procedures such as rubber band ligation, sclerotherapy, coagulation,
and surgical removal (hemorrhoidectomy)
9) Can hemorrhoids be prevented?
You can help prevent hemorrhoids
by eating a high-fiber diet, drinking plenty of water, not straining during
bowel movements, not sitting on the toilet for long periods of time, avoiding
heavy lifting, and maintaining a healthy weight
10) Do hemorrhoids always require surgery?
No, most hemorrhoids do not
require surgery. Over 95% of hemorrhoids can be treated using non-surgical
methods, such as rubber band ligation, infrared photocoagulation, and
sclerotherapy
11) What is the recovery time after hemorrhoid surgery?
Recovery time after hemorrhoid
surgery varies depending on the type of procedure and the individual patient.
Hemorrhoidectomy, which involves the complete removal of hemorrhoids, can be
painful and may take several weeks for recovery. Hemorrhoid stapling, which
involves cutting off the blood supply to the hemorrhoid and moving prolapsed
tissue back in place, typically has a shorter recovery time and less pain
12) Can hemorrhoids recur after treatment?
Yes, hemorrhoids can recur after
treatment, especially if you do not make lifestyle changes to address the
factors that contributed to their development in the first place. Preventing
constipation and maintaining a healthy weight are important steps to reduce the
risk of hemorrhoid recurrence
13) Are there any complications associated with hemorrhoids?
Complications of hemorrhoids are
rare but may include anemia (due to ongoing blood loss), strangulated
hemorrhoid (when the blood supply to an internal hemorrhoid is cut off), and
blood clot formation in hemorrhoids
14) Can pregnancy cause hemorrhoids?
Yes, pregnancy can cause
hemorrhoids due to the increased pressure on the veins near the anus from the
growing uterus. Hemorrhoids are common during the third trimester of pregnancy
15) What is the difference between hemorrhoids and anal fissures?
While both hemorrhoids and anal
fissures can cause pain, bleeding, and itching in the anal area, hemorrhoids
are caused by swollen blood vessels, whereas anal fissures are caused by a tear
or cut in the lining of the anus
16) How can I manage the pain and discomfort of hemorrhoids?
To manage the pain and discomfort
of hemorrhoids, you can try taking over-the-counter pain relievers, applying a
cold compress, using hemorrhoid creams or ointments, taking warm sitz baths,
and wearing loose, breathable clothing
17) What lifestyle changes can help prevent hemorrhoids?
Lifestyle changes that can help
prevent hemorrhoids include eating a high-fiber diet, drinking plenty of water,
exercising regularly, avoiding straining during bowel movements, not sitting on
the toilet for long periods of time, and maintaining a healthy weight
18) Are there any natural remedies for hemorrhoids?
Natural remedies for hemorrhoids
include increasing fiber intake through diet or supplements, drinking more
water, taking sitz baths, and applying cold compresses or witch hazel to the
affected area
19) When should I seek emergency care for hemorrhoids?
Seek emergency care if you
experience large amounts of rectal bleeding, lightheadedness, dizziness, or
faintness, as these could be signs of a more serious condition
20) Can hemorrhoids be treated with over-the-counter medications?
Yes, over-the-counter medications
such as creams, ointments, and suppositories can help relieve the pain,
swelling, and itching associated with hemorrhoids. However, these treatments
may not address the underlying cause of the hemorrhoids, and it is important to
consult a healthcare provider if symptoms persist or worsen
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