Hemorrhoids – Treatment options
Miracles don’t happen in our time .
Multiple relatively bloodless and less painful procedures have been devised for the treatment of hemorrhoidal disease. Nevertheless, the time-proven invasive Milligan-Morgan resection is still applied in severe cases of protruding piles. It is considered as the surgical technique with the best long-term results.
The proctologist surgeon should be familiar with a wide range of surgical procedures and should select the appropriate after careful history, digital examination and proctoscopy. Proctoscopy should be performed while the patient attempts defecation. Then hemorrhoids, that were not previously obvious, can be diagnosed. The common classification of hemorrhoids in four stages does not always reflect the gravity of the disease or the indication for operative treatment. Fourth-degree hemorrhoids that consist mainly of skin tags are well tolerated and do not require any intervention while some third-grade hemorrhoids should be treated surgically because they cause severe discomfort or bleeding. The personality type of the patient and the pain tolerance should be taken into consideration. We cannot apply a painful procedure in a pain intolerant patient. On the other hand, some patients prefer a permanent treatment no matter how painful it will be.
Hemorrhoids do not always require any invasive treatment. They should be treated while they are quiet. If they are operated in exacerbation (usually resection), the postoperative wound is extensive and painful. Fundamentally, hemorrhoids should be treated invasively if they bleed, are large, secrete extensive discharge or make cleaning difficult. Hemorrhoids should be differentiated from anal fissure that cause intensive and constant pain. Nevertheless, significant but transient pain can be seen in acute hemorrhoidal thrombosis.
Any patient (usually women) with constipation or a sense of incomplete evacuation and delaying in the toilet, might have internal bowel prolapse and secondarily hemorrhoids. The diagnosis of prolapse is done with proctoscopy and is confirmed with defecography. Hemorrhoidectomy in this case does not provide any substantial help. The treatment of internal prolapse should be via laparoscopy or other abdominal procedures.
Before any intervention for hemorrhoids is decided, the patient should modify his habits in defecation and toilet hygiene. A diet rich infibers should be prescribed in order to make stools soft. The patient should stay sit on the toilet only for five minutes and he should avoid aggravating activities sych as intensive gym exercises, prolonged standing, etc.
I do not operate patients who continue to sit on the toilet for more than 10 minutes.
Frequently, modifying habits in defecation and toilet hygiene significantly improve symptoms (bleeding) and may eliminate the need of surgery. In any case of bleeding from anus, it should be taken in account that blood may originate higher from the large intestine, and colonoscopy should be arranged in order to examine entire large bowel.
First-degree hemorrhoids rarely need any treatment. It si acommon condition in most individuals.
Second degree hemorrhoids are treated with rubber bind ligation if hemorrhoids have a stalk and do not protrude extensively. If performed according to precise indications, the results are excellent. If the dentate line is involved or if there is n hemrrhoidal stalk, then laser (LHP) is convenient. Ligation of hemorrhoidal vessels with ultrasound and suture suspension is the best option for hemorrhoids with circular prolapse as in patients who sit on the toilet too long.
RUBBER BAND LIGATION
LASER HEMORRHOIDOPLASTY (LHP)
- The combination of ultrasound and laser procedures have the best results with minimal pain.If hemorrhoids are of fourth degree, large, external and require surgery, resection is unavoidable . Surgical resection may be less extensive if combined with HAL-RAR operation.
Hemorrhoids that require resection.
- Hemorrhoidal clots are very often treated conservatively. Clot removal should be done during first 24 hours or in order to achieve quick relief of severe pain. Continuous exacerbations of thrombosis should be treated with appropriate instructions. Resection in a quiescent phase is rarely indicated for continuous exacerbations of thrombosis..
- If the acute hemrrhoidal thrombosis is of mucosal type, application of crystallic sugar helps removing the excessive tissue fluid from engorged piles. In any case, in acute hemorrhoidal thrombosis the patient should reste and wait until the swelling resolves in couple of weeks.
ΘΕΡΑΠΕΙΑ ΜΕ ΖΑΧΑΡΗ