Overview:
- Hemorrhoids, also called piles, are swollen and inflamed veins around your anus or in your lower rectum.
- The two types of hemorrhoids are:
external hemorrhoids, which form under the skin around the anus.
internal hemorrhoids, which form in the lining of the anus and lower rectum.
Etiology:
- When intra-abdominal pressure over anal veins increases, they expand and lead to formation of fragile and thin-walled hemorrhoidal piles
- Hemorrhoids are classified according to their location into:
- external hemorrhoids: venous dilatations under skin of anus, it is painful more than internal hemorrhoids
- internal hemorrhoids: venous dilatations under rectal mucosa , it is more able to bleeding than external hemorrhoids.
- Hemorrhoids are classified according to size into:
- first degree: it is hemorrhoids that remain in the rectum and never protrude.
- second degree: it is the one that protrudes through anus while defecation, and returns to its place post defecation.
- third degree: it is the one that protrudes through anus while defecation and does not return back itself, needs to be pushed back by patient’s finger.
- fourth degree: which remains protruding outside anus at all times
Symptoms:
- Anal discomfort
- Pain
- Anal itching
- Feeling a lump hanging from the anus during defecation
- Bleeding
Causes:
Anal hemorrhoids, as mentioned, are dilation of veins around anus as a result of excessive intra-abdominal pressure
Risk factors include:
- poor fiber diet
- chronic constipation
- long sitting on bathroom seat
- diarrhea
- obesity
- pregnancy
- anal sex
- age
- heavy lifting
Diagnosis:
- clinical examination with detailed clinical story
- rectal examination
- anoscope
- Lower gastrointestinal endoscopy when suspected of inflammatory bowel disease or cancer
Treatment:
- Lifestyle modification:
- exercise 20-30 minutes a day
- a balanced diet rich in fiber, vegetables and fruits, beans, Bran and whole grains.
- drink at least 2 liters of water a day
- do not ignore the urge to defecate (can be try daily regularly after a certain meal)
- avoid long time sitting on bathroom seat
- laxatives if needed
- Medication:
usually effective in mild and moderate cases:
- warm baths at least 3 times a day
- topical ointments: remedy work _ local anesthetic
- pain killer
- laxatives
- Surgical treatment:
in advanced cases and when not responding to conservative treatment
Thrombosed hemorrhoids pile surgery:
creates an incision over the clot, and squeeze out the clot.
Excision of anal hemorrhoids by open technique:
dissection of the hemorrhoidal piles
ligate pile neck
excision hemorrhoidal pile
Excision of hemorrhoids by ligation of the artery assisted by Echo Doppler (THD):
This technique is based on ligation of perianal arteries which feeding the hemorrhoids
Mucopexy for prolapsed mucosa.
The position of perianal arteries can be easily reached with the assistance of Echo Doppler.
LASER ablation for hemorrhoidectomy:
dilated hemorrhoidal piles are exposed to a laser ablation, which allows them to shrink and reduce their size to a minimum.
Stapler hemorrhoidectomy:
This technique is used when there are several hemorrhoidal piles protrude outside the anus, or when there is a rectal prolapse,
Circumferential ring of the entire mucosa is excised using stapling, which allows repair of prolapse
