Hemorrhoids are dilatations of the veins lining the anal canal. They are comparable to varicose veins in the legs.
Causes
1. Genetic predisposition
2. Increased pressure in the abdomen, as in pregnancy.
3. Uncontrolled habitual constipation
4. Much less frequently, due to other diseases that increase venous flow in that area, such as liver cirrhosis with portal hypertension.
Symptoms
1. Bleeding
2. Stinging
3. Sometimes pain
4. Prolapse (when they come out of the anal canal).
Treatments
1. Various anti-inflammatory drugs, creams, and dietary measures, mainly to avoid constipation.
2. Sclerosing injections: a substance is injected which hardens and occludes the dilated veins and cuts off their circulation.
3. Elastic ligatures: consists of ligating the base of the hemorrhoid, cutting off its circulation and causing it to necrose.
4. Surgical procedures
Surgery
Surgery is usually performed when hemorrhoids cause a lot of discomfort, bleed a lot, or remain permanently outside the anal canal and, urgently, if they become thrombosed.
The most common method consists in the resection of the area of the veins that is dilated, with thermal sealing of the venous ends, leaving a wound that must then heal by second intention.
This can be done with various procedures such as CO2 laser, thermocautery with fine tungsten tip, etc..
There are other procedures such as placing a circular mechanical suture in the anal canal or ligation of the hemorrhoidal arteries, which, in our opinion, are less definitive in their results and are not used in very advanced hemorrhoids.