What are hemorrhoids, why do they occur and how can we prevent them?
Hemorrhoids are a vascular ball, i.e. an accumulation of veins, both inside the anal canal and outside, so we have 3 hemorrhoidal groups and each group has an internal component and an external component and serve to cushion the exit of feces through the anal canal and maintain the temperature of the canal.
There are 4 stages, stage 1 is the patient that I have noticed blood in the stool, this patient goes to the doctor, they look at him, they maybe do a colonoscopy and they tell him that he has internal hemorrhoids and that is why he is bleeding. Stage 2 is the patient who after some time without bleeding starts bleeding again, the patient no longer goes to the doctor because he was told that he had internal hemorrhoids but he has also noticed that they prolapse, that is to say that at the moment of bowel movements the hemorrhoids come out and they reposition themselves, this is stage 2. Stage 3 is the patient whose hemorrhoids prolapse, the internal ones come out at the moment of bowel movements but they reposition themselves thanks to the patient’s help, this would be stage 3. And stage 4 is that patient who comes saying: “look doctor, I have to have surgery because now I bleed even in the street, not necessarily when I go on my stomach”, meaning that his hemorrhoids come out but even if he repositions them they come out again, that is to say, he does not have the capacity to keep them inside because of how big they are. There is another scenario which is the patient with a hemorrhoidal thrombosis, a patient who does not necessarily have hemorrhoids, what happens is that an external hemorrhoid thromboses, a clot under the skin, this hurts for 2-3 days with a lump, then the pain subsides and little by little, this external hemorrhoidal thrombus melts and in a matter of 4-8 days it disappears. The way to prevent it would be to follow a diet that involves a soft stool, that the patient has a good bowel movement, that he/she does not have to force. It is true that there are families in which there are more cases of hemorrhoids, several members of the family have hemorrhoids, but the basic factor is to force the patient to have a bowel movement.
What is the treatment of hemorrhoids?
The treatment consists of basically eliminating the internal hemorrhoidal group. It is true that when a patient has significant external hemorrhoids, it is necessary to eliminate both external and internal hemorrhoids, it is rare for a patient to have only external and not internal hemorrhoids and it is also very rare for a patient to have very large internal hemorrhoids and not have any external component, in other words, it is always in proportion. But the ones that cause the clinic are the internal hemorrhoids that bleed and prolapse, they do not hurt, this is something that must be very clear, hemorrhoids, in all this history of a patient of 15 years bleeding, do not hurt. So there are several treatments. The treatment of choice for hemorrhoids would be to remove these hemorrhoids surgically, that is to say with a wound, with a ligation of the hemorrhoidal pedicle inside, the so-called Milligan and Morgan technique, the classic technique for hemorrhoids, is undoubtedly the best and the definitive one. It has a bad press because this surgery is painful, or very painful, and several parallel treatments to the classic Milligan and Morgan hemorrhoidectomy have emerged, such as doppler ligation, which is not a painless technique as it is being said, the truth is that the entire rectal mucosa is plicated and the hemorrhoidal pedicles are ligated through the laser but many sutures remain inside the channel and this is, if not painful, if very annoying for a few days. In this technique the external hemorrhoids are not treated as they were in the Milligan and Morgan hemorrhoidectomy.
When a patient has a stage that only bleeds but has large internal hemorrhoids or they prolapse, but they do not prolapse much, or the patient does not even have to reposition them but they prolapse and possibly reposition themselves, which would be stage 2, you can use infiltration of the hemorrhoids with a sclerosing substance or you can use ligation of the hemorrhoids, a technique that many people think is very modern and is very old, It is Barron’s ligation and what is done is to place a rubber band strangling the internal hemorrhoidal group or the 3 internal hemorrhoidal groups, this means that no irrigation reaches them, no blood reaches them, and they are also strangled in such a way that after 3 – 4 days those hemorrhoids by necrosis, that is to say because they rot, fall outside, the patient does not even notice it, they come out with a bowel movement and that’s it. This would basically be the panorama of hemorrhoid treatment, the 3 or 4 most frequent or most used treatments today. Throughout history there have been many more but today you either give a patient a definitive intervention and also functionally, which is the Milligan and Morgan hemorrhoidectomy despite the pain it causes and despite the postoperative period it has or the bad press, or you try to do a doppler guided ligation to ligate his hemorrhoidal pedicles, his venous pedicles, or if he has an earlier stage he does not need an intervention, what he needs is just a ligation or an infiltration.
Does drinking alcohol make hemorrhoids worse?
The truth is that many patients come with this theory or this idea that alcohol or even spice can influence the development of hemorrhoids. What happens is that alcohol dilates, it is a vascular dilator, and so what it does is dilate these vascular tangles that we have and if a patient has a little hemorrhoids, he will notice a little more but it does not directly influence the development of hemorrhoids. The truth is that alcohol also has another toning effect, depending on the amount of alcohol drunk, so the great enemy of the patients who come to see me is to tone up their anal canal and their internal sphincter too much, which is an involuntary muscle that can feel more toned, stronger than normal, after drinking alcohol, and this does make venous return more difficult in some way because the anus is more contracted. So it has an indirect effect but no direct effect on the development.
Does diet influence hemorrhoids?
Well, food has a direct influence on the development of hemorrhoids or on the clinical symptoms of hemorrhoids, it has an influence because if you have a diet that you know is going to constipate you, you will have to force more to go to the stomach, so basically the diet has to have enough liquid so that the stool is soft and not difficult to extract and basically nothing else, it does not influence the spicy, any particular type of food, …. it only influences the type of stool you are going to have, softer or harder.