Why are hemorrhoidal discomfort more frequent during pregnancy?
Hemorrhoids are already a common pathology in the general population, what happens in pregnant women is that a series of physiological and metabolic changes occur that favor things like worsening constipation, difficulty in evacuating and difficulty in venous return at the level of the pelvic area and lower extremities that can progressively cause hemorrhoids to develop or worsen hemorrhoidal symptoms that the pregnant patient had previously.
What to do during and after pregnancy?
Pregnancy itself conditions the therapeutic options to be offered, which is basically conservative medical treatment that includes dietary supplements with fiber and liquids, the use of topical ointments with local anesthetics and anti-inflammatory and vasotonic substances that promote venous return.
After delivery is when the specialist in General Surgery really makes an assessment of how the patient is doing. In some cases all the symptomatology is resolved and the patient remains asymptomatic, so nothing more should be done. But in some cases, and with some frequency, the symptomatology persists. Basically there is bleeding, inflammation, itching and lumps that swell and deflate periodically. In these cases is when we consider indicated to go to a specialist, to carry out a proper examination and diagnosis of the degree of hemorrhoids and, thus, also indicate the best treatment individually for each case.
When is hemorrhoid surgery indicated?
The surgical indication is given to us by our patients. When we have a patient whose symptoms we cannot control with conservative medical treatments is when we recommend surgery. As for surgical options, we have been relying on laser energy for years. Initially we used the CO2 laser which cut very well but had a lower coagulation potential and that, when it comes to operating on areas as vascularized as the hemorrhoidal area, is a drawback. In recent years we have developed surgery with diode-laser that has a much greater potential for coagulation and in surgeries we practically do not see a drop of blood.
As for the different techniques, in the case of internal hemorrhoids we use photo-coagulation, with which we manage to eliminate the hemorrhoidal tissue without wounds. There is simply a small ulcer, a burn, and the post-operative period is practically painless. In cases of more developed, external hemorrhoids with hypertrophic tissue that needs to be removed, we use the contact version of the diode-laser, a kind of electric scalpel but using laser energy, which does not burn the tissues as much, which results in less inflammation and less pain in the post-operative period.