What are Hemorrhoids? Hemorrhoids are cushions of submucosal vascular tissue located in the anal canal, beginning near the dentate line. These vascular cushions are a normal anatomical structure of the anal canal, and their presence does not necessarily indicate hemorrhoidal disease. Hemorrhoidal disease occurs when there is increased pressure in the veins of the anus or rectum, leading to symptoms such as bleeding, prolapse, pain, thrombosis, mucous discharge, and itching. Hemorrhoids may be internal, external, or mixed. Internal hemorrhoids arise from the internal hemorrhoidal plexus above the dentate line, while external hemorrhoids arise from the external plexus below the dentate line.
Laser Hemorrhoid Treatment:
This is a modern method that has emerged in recent years using laser technology in medical procedures. It is known to be less painful and safer for the patient. – Laser hemorrhoid treatment works by cauterizing the blood vessels instead of excising them, as done in traditional surgery. The hemorrhoid gradually shrinks after laser cauterization until the tissue returns to its normal size. – The procedure can be performed under local, general, or spinal anesthesia. – It is considered a same-day surgery, with no need for the patient to stay in the hospital for more than a few hours.
Doppler Hemorrhoid Treatment:
This is a widely adopted modern technique in medical practice. The Doppler method, or THD (Transanal Hemorrhoidal Dearterialization), involves using a Doppler device to locate the arteries feeding the hemorrhoids, which are then ligated by the surgeon using surgical threads. This closes off the blood supply, causing the hemorrhoids to shrink back to normal size.
Advantages of Doppler Hemorrhoid Treatment:
No tissue excision
No surgical incisions
Minimal pain
Reduced risk of bleeding and infection compared to traditional surgery
The patient may require mild painkillers for a few days.
Warm sitz baths are recommended during the initial days.
Drink at least 2 liters of fluids daily.
Avoid constipation-inducing factors.
Hemorrhoid Grades:
Grade I: Bleeding during defecation (usually bright red), without prolapse. Conservative management with diet modification and improved hygiene is typically sufficient.
Grade II: Prolapse during straining or defecation, which reduces spontaneously. Can be treated with rubber band ligation or other non-surgical techniques.
Grade III: Prolapse requiring manual reduction. Surgical excision is usually necessary.
Grade IV: Irreducible prolapse, often involving multiple areas. Excision is essential, especially if strangulation occurs.
Causes of Hemorrhoids:
Although the exact cause is not clearly defined, downward displacement of vascular cushions is believed to be the most likely factor. Common contributing factors include:
Straining during defecation (due to chronic constipation or diarrhea)
Increased intra-abdominal pressure (e.g., pregnancy), obesity, or prolonged standing
Low fiber intake
Genetic predisposition (especially involving weakened venous walls or suspensory ligaments)
Certain sexual practices
Diagnosis:
Diagnosis involves a detailed symptom history and a thorough examination with an anoscope. Other serious conditions like colon cancer or colitis must be ruled out. A gloved, lubricated finger is also used to palpate the rectum for any internal bleeding or masses. Patients should inform their doctor of any changes in bowel habits, diet, or new medications.
Symptoms of Hemorrhoids:
Bleeding, pain, and prolapse are the most common symptoms. Internal hemorrhoids are usually painless, while external ones are often painful, especially during bowel movements. External hemorrhoids may present as purplish tissue bulging from the anus, causing a sensation of fullness, irritation, and mucous discharge. Pain may be accompanied by itching or a burning sensation. Swollen external hemorrhoids can sometimes shrink, leaving skin tags.
Treatment Options:
Patients with immune deficiency are at higher risk of anal abscess and delayed wound healing post-surgery. Treatment is based on symptom severity and patient preference.
