Inside the anus, below the mucous membrane, is an extensive network of blood vessels that create a corpus cavernosum that can swell when filled with blood. This allows the anus to close completely.
Hemorrhoids are formed as a result of the dilatation of these vessels, i.e. they are venous accumulations located in the inner part of the anal canal (the short tube that connects the rectum to the outside) in the area called the anal cushions. These cushions are present in all people and their usefulness is to facilitate and cushion the passage of stool during defecation.
The bulging of these cushions means that they lose their normal consistency, enlarge and become flaccid, so that they can cause pain, may hemorrhage and may even protrude to the outside. Constipation and pregnancy, as well as defecatory efforts favor the appearance of hemorrhoids.
Four grades are defined according to their size:
Grade I: internal hemorrhoids, pain and bleeding with defecation.
Grade II: Pain and hemorrhage with defecation and hemorrhoids come out to the outside, but return to the inside at the end of defecation.
Grade III: Pain and bleeding. Hemorrhoids must be manually reintroduced into the anal canal after defecation.
Grade IV: Pain and bleeding. Hemorrhoids are always on the outside.
Hemorrhoid symptoms
The most common are: itching, discomfort during bowel movements, pain and bleeding.
Any patient with persistent bleeding should be seen by a proctologist to analyze the hemorrhoids and rule out a rectal tumor.
Diagnosis of hemorrhoids
Anal exploration, renal examination, anoscopy and sometimes colonoscopy are the necessary tests for the analysis and diagnosis of a hemorrhoidal problem.
Treatment of hemorrhoids
Medical treatment: It should be performed in patients with hemorrhoids grade I, II and III. It consists of a diet with foods rich in fiber (vegetables, fruit, whole wheat bread, cereals, etc.). In addition to the intake of at least one liter of water daily and maintaining a regular meal schedule.
It is associated with the use of antihemorrhoidal creams and ointments of local action and can be used drugs that promote blood flow.
Surgical treatment: Surgical treatment is recommended in grade IV hemorrhoids or in grades I, II and III if medical treatment has failed. There are different techniques, such as:
- Sclerosing infiltration.
- Ligation with elastic bands.
- Removal of hemorrhoids according to the classic Milligan and Morgan technique.
- Extirpation with laser surgery.
Occasionally patients present a hemorrhoidal crisis with pain, bleeding and possible thrombosis, which may require urgent surgical treatment, in this situation laser surgery is the most suitable for the resolution of the acute clinical picture.
According to our experience, the technique that offers the best results, in the short and long term, is removal by laser surgery. The advantages of this surgery are less tissue aggression, no need for stitches, less bleeding in the postoperative period, less pain and better and faster recovery.
In some cases our patients have returned to work 48 hours after surgery.
Anesthesia in Hemorrhoid Surgery
The anesthesia is usually crazy regional (epidural anesthesia is performed, from the waist down), although sometimes general anesthesia is performed if the patient requests it or if there is any contraindication in performing epidural anesthesia. In any case, the patient can discuss the type of anesthesia with the anesthesiologist based on previous experience or preference.