Hemorrhoids or piles are a cushion made up of blood vessels and elastic fibers, which is located on the inside of the anus and helps to keep it closed.
Why hemorrhoids appear
When the tissue inside the anus descends out of the anal canal or becomes inflamed, hemorrhoids occur. According to experts in coloproctology, this is a frequent problem, more than half of the population will suffer some symptoms during their lives. There may be a certain hereditary predisposition in their appearance, and upright posture for long periods of time may also favor them. Constipation, pregnancy and childbirth are the circumstances most related to hemorrhoids, since they congest and dilate them, helping their externalization.
Symptoms of hemorrhoids and what they mean in the daily life of the sufferer
There are two types of hemorrhoids:
- External hemorrhoids develop under the skin. Their symptoms derive from a thrombosis of the veins that compose them, usually after an important effort to evacuate or a diarrhea, producing intense pain.
- Internal hemorrhoids are inside the rectum. In the initial grades, the only symptom is bleeding of bright red blood when wiping, or dripping or gushing after defecation (Grade I). Progressively, in addition to this symptom, which may be associated with itching or stinging, hemorrhoids come out of the anus during defecation (prolapse), but return inward later thanks to their elasticity (Grade II). When this elasticity is lost, hemorrhoids do not return spontaneously, but must be helped (Grade III). Finally, in some cases, hemorrhoids are permanently outside the anus (Grade IV). Pain only appears in the presence of complications, such as thrombosis or in association with other problems such as anal fissure.
Although hemorrhoids are a very frequent cause of bleeding, this is also a symptom of more serious processes such as inflammatory bowel diseases, and especially polyps and cancer of the colon and rectum. For this reason, it is necessary to see a coloproctologist who will indicate the necessary diagnostic tests. On the other hand, hemorrhoids do not predispose to cancer, but the symptoms can be similar, so it is necessary to go to a specialized consultation.
Treatments and tips for treating hemorrhoids
The treatment of hemorrhoids should be individualized according to the specific degree of the disease.
If the symptoms are mild, an increase in fiber in the diet is indicated, associated with an increase in the intake of liquids to obtain a soft stool. Caffeinated beverages, alcohol and spicy foods should be avoided. Spending long periods of time in the toilet promotes congestion and should be avoided. Also beneficial are warm water sitz baths, and creams or ointments, although these should not be used for more than a few days to avoid side effects. Some venotonic medications improve circulation in the area and are also useful.
Effective and recommended techniques to combat hemorrhoids
In more advanced degrees (II and III), certain techniques performed in the doctor’s office can definitively solve the problem, such as sclerosis, the application of infrared or elastic ligation. The latter consists of placing a rubber band over the hemorrhoid, which strangles it, preventing its blood flow. They can be performed without discomfort and on an outpatient basis without requiring anesthesia.
Severe cases require surgery. At present there are several techniques, depending on the characteristics of each patient. They are generally performed under local anesthesia and sedation and require a few hours of hospitalization.
- Hemorrhoidal dearterialization and pexy: this is one of the newest techniques, and consists in the ligation or sealing of the blood vessels that feed the hemorrhoids, fixing at the same time the rectal mucosa so that it does not come out of the anus. We can use a special technology with a Doppler probe that exactly locates the blood vessels, although it is not strictly necessary. Postoperative discomfort is generally scarce, and it is indicated in cases that are not very advanced.
- Hemorrhoidectomy: it is the removal of hemorrhoids, with multiple variants and is used for the most severe cases. To improve postoperative discomfort, techniques can be used that produce minimal trauma to the tissues, without sutures and using coagulation and vascular sealing instruments, ranging from cautery with a fine tip, sealing generators, ultrasonic scalpel, laser, etc., and in all cases special care must be taken not to injure the anal sphincters.
- Stapler fixation (Longo Technique): this is a technique that does not remove the hemorrhoids but makes them occupy their original position in the rectum. A special stapler is used for this purpose. Its use should be restricted to the few cases in which there is a large prolapse of the anal mucosa.
Is the postoperative period for hemorrhoids very uncomfortable?
Any of the techniques used in the intervention is associated with discomfort, sometimes significant for a few days, requiring analgesia. This is because the wounds are in one of the most sensitive areas of the body, they are pressed by the anal sphincters and, in addition, they have to dilate when defecating. There are no “miraculous or painless” instruments or techniques for cases requiring removal (hemorrhoidectomy).
Can hemorrhoids come back or does the treatment guarantee their elimination?
Surgery is neither the only nor the best option, it all depends on the specific degree and individual characteristics of the patient. Two different techniques can be combined to guarantee healing and to do so with the least possible aggression and discomfort. Usually the problem does not reappear if the indicated treatment is carried out correctly.
Can the patient lead a normal life after surgery for hemorrhoids or should he/she follow any habits?
After the process is cured, the patient can lead a normal life, although following hygienic-dietary habits. It is very important not to abuse irritants such as alcohol, coffee or spicy foods, to eat a diet rich in fiber, drink plenty of fluids and do physical exercise.