Hemorrhoids – External – Internal | treatment
The causes of hemorrhoids (aimorroidopatheia) are mostly chronic constipation, hereditary predisposition, pregnancy etc. Aimorroidopatheia often occurs during pregnancy or after childbirth, without no symptoms in the past.
External hemorrhoids are actually not hemorrhoids, but a sudden coagulation in the outer region of the anus which is covered by skin. For this reason, the right term of the condition is «perianal thrombosis». In some cases coexisting internal and external hemorrhoids. Unfortunately, the confusion of a perianal thrombosis with hemorrhoids are common. For this reason, the correct diagnosis should be made by a qualified surgeon. The perianal thromboses usually due to acute constipation. External hemorrhoids must be treated immediately with minor surgery, to remove that clot under local anesthesia, which did not extend the clot in the internal hemorrhoids, which may require the course more radical surgery.
Categories and hemorrhoids symptoms
Internal hemorrhoids or simply hemorrhoids (i.e. normal hemorrhoids) are covered by the mucosa, but may project (projecting) outwardly. Depending on their size divided into:
1st degree hemorrhoids: not project outwardly
Hemorrhoids Grade 2: projecting outwardly defecation and reconfigures (put back into the anal tube) alone
Hemorrhoids grade 3: projecting outwardly defecation and reconfigures only by hand
Hemorrhoids grade 4: projecting outwards and not permanently reconfigures or by hand.
Hemorrhoids are usually three. If projecting all three, then «speak» for rectal prolapse (not rectal prolapse, ie the entire wall of the final part of the colon).
As one proceeds to the upper level, the symptoms intensify. The main symptoms of «hemorrhoids» is pain in the anal area, heartburn (tingling), pruritus (itching), bleeding, localized swelling, mucus secretion, foreign body sensation in the area, etc… Note that the symptoms of hemorrhoids are often confused with symptoms of other diseases of the anal area (eg fissure), so it is clear that the correct diagnosis is important for planning the analogue therapy. Therefore experience and attention required during the examination of a patient by a specialist.
Considerable complication of hemorrhoids independently stage is their coagulation, appearing as sudden painful swelling. The hemorrhoid thrombosis (often combined with throttling of hemorrhoids) should be urgently treated because of the thrombosis risk of spreading to the rest of hemorrhoids, but also because of the creation infection risk in the liver.
The 1st and 2nd degree hemorrhoids are usually treated conservatively (non-invasive) and of grade 3 and 4 are usually treated surgically.
The conservative therapy includes:
maintenance arrangement (plenty of fiber and fluids) to avoid constipation, in some cases taking additional medications temporarily «soften» faeces but not laxatives
«Cleansing» of the area with soap and water and avoiding paper use
painkillers and anti-inflammatory ointments
The most effective and safe surgical procedures / techniques for treatment of hemorrhoids is now internationally including:
Hemorrhoidectomy by Milligan – Morgan, ie radical removal of hemorrhoids. The surgery is now done using a special tool: Laser (laser) or ilektrodiathermia or ultrasonic tool targeting less pain postoperatively (by painless haemorrhoids surgery) possible.
Hemorrhoidectomy – Aimorroidopixia by Longo. During this painless method is substantially the hemorrhoids are removed, but with a special tool cyclically removed a portion of the mucosa above the hemorrhoids. The result is the disruption of the blood supply of hemorrhoids (which leads to a gradual shrinkage due to less longer blood volume entering hemorrhoids) and their rehabilitation ( «LIFTING» of hemorrhoids) region. This technique is painless because it leaves no open wounds.
Method THD or HAL. During this painless technique is used a special tool that emits ultrasound. Ultrasound identify the arteries that supplies blood to the hemorrhoids. Then these arteries sygkleiontai with seams (ligation). The result is the gradual shrinking of hemorrhoids after surgery, due to the smaller amount of blood now results in hemorrhoids. This method is painless because it also leaves open wounds after surgery.
Proceeding from the first to the third method decreases the pain after the operation, but the radicalness method. The rate of complications and also the three methods is very low, if the surgery is performed by a qualified surgeon. Also, there is no risk of incontinence after surgery, since in these 3 techniques are not the surgeon intervene in clamp. Regarding the choice of method to mention that the best method is not one. Depending on the size of hemorrhoids, their localization (cyclic or topically) or the existence of a complication of hemorrhoids (e.g. thrombosis) is applied as a best one of these three methods. That is why the proctology Surgeons should be well aware of all the methods and individualize the surgical treatment of hemorrhoids, aiming at permanent and not just a temporary solution. All well interventions performed under short general anesthesia or epidural anesthesia. The discharge is usually carried out a few hours after the hemorrhoid surgery.