Hemorrhoids

Hemorrhoids is one of the most common conditions that can significantly affect the quality of daily life of the patient.

 

What are hemorrhoids?

Hemorrhoids are a normal anatomical element of the anal area. They are essentially blood vessels, small veins and arteries, “tubes” that carry blood to the area of the anus. They form a complex of vessels, called the “hemorrhoidal plexus”. Together with the overlying mucosa and submucosa they form protective pads in the area where the anal sphincter is located.

During defecation, with the relaxation of the anal sphincter, the plexus is emptied of blood and refills after the end of this function. Thus hemorrhoids, to some extent, assist the anal sphincter in closing the anus and thus contribute to stool continence.

The problem begins when the hemorrhoids swell, grow and the tissues that hold them in place loosen.

Hemorrhoids can be internal or external.

Internal hemorrhoids are classified into four (4) stages depending on their severity.

• Stage 1: Hemorrhoids do not prolapse, so the only way for the patient to discover them is by bleeding.
• Stage 2: Hemorrhoids prolapse (hang) but retract (pull back) spontaneously.
• Stage 3: Hemorrhoids prolapse (hang) and retract (pulled back) only with mechanical assistance (patients retract them with their hand).
• Stage 4: Hemorrhoids prolapse (hang) permanently outside of the anus.

Hemorrhoids is a very common disorder and affects a large part of the population.

 

What are the main causes for hemorrhoids?

There are many factors that contribute to the occurrence of hemorrhoids, the most important of them being constipation. Constipation is hereditary but can also be the result of a diet lacking in fiber. The prevailing diet in Western societies and by extension also in our country is low in fiber.

Other causes that contribute to the appearance of hemorrhoids include:

• Pregnancy (Most often women get rid of hemorrhoids, after the end of pregnancy. Hemorrhoids in women show the typical symptoms).
• The habit of some people to spend a lot of time on the toilet bowl (Reading on the toilet).
• Age, because there is relaxation of the tissues.
• Chronic severe cough because it increases intra-abdominal and thus venous pressure.
• Hereditary predisposition.

Like all conditions of the anus, hemorrhoids are a taboo topic. Patients tend to feel uncomfortable to discuss or ask the doctor about issues related to the area and thus they usually end up seeking medical advice too late, when the situation is no longer bearable. For this reason, most patients visiting a surgeon suffer from grade 3 or 4 hemorrhoids and quite often there is thrombosis, purulence or they are accompanied by thrombosed external hemorrhoids.

The correct diagnosis and the differentiation from other disorders of the area such as anal fissures, rectal prolapse, perianal abscesses must be carried out by a surgeon with experience in the surgical pathology of the area.

Only a correct diagnosis will lead to an effective treatment of hemorrhoids.

 

What are the symptoms of hemorrhoids?

• Pain in the region of the anus
• Bleeding
• Mucus secretion
• Irritation of the area
• Itching
• Asymptomatic or painful swelling
• Feeling of incomplete bowel movement

Any discomfort in the anus area must be evaluated immediately by a medical specialist.

 

How is the condition diagnosed?

The diagnosis usually derives from the patients’ medical history and is made during the first physical examination by a specialized surgeon. In addition, a digital examination, rectosigmoidoscopy or proctoscopy can be required, for identification and differential diagnosis.

 

What are the treatment options for hemorrhoids?

HOW DO HEMORRHOIDS GO AWAY WITH CONSERVATIVE NON-OPERATIVE TREATMENTS

Treatment of hemorrhoids in the initial stages can be conservative.

Combating constipation. The simplest way to achieve this is by increasing fiber and water in the diet. The American College of Colorectal Surgeons advises consuming 6-8 glasses of water and at least 30 grams of fiber daily. Reading magazines and spending much time on the toilet bowl should also be avoided.

Injection sclerotherapy

With this method, substances are injected that cause fibrosis and shrinkage of the hemorrhoidal plexuses. This treatment does not always have satisfactory results and can be painful.

Rubber band ligation

This method is especially good for small hemorrhoids of the 1st – 2nd stage. Essentially, the elastic rubber bands strangulate the hemorrhoids cutting off the blood flow. The band can be placed without general anesthesia.

Internal hemorrhoids

The use of anal ointments helps, but only temporarily! Their abuse can lead to atrophy of the skin of the anus, due to the cortisone that these products often contain, but also to dangerous forms of perianal dermatitis, which can be more excruciating and difficult to treat than the hemorrhoids themselves.

When hemorrhoids persist, despite the above measures, when they are very swollen and do not retract, but especially when they bleed continuously, then a surgical treatment is required.

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Surgical techniques

Hemorrhoid excision (Milligan Morgan or Ferguson Method)

Surgical excision of hemorrhoidal nodules at sites 3, 7 and 11. Special care must be taken to maintain skin-mucosal flaps between the resection sites to avoid stricture of the anus which is particularly painful.

It is a particularly effective method and is applied in severe stage 4 hemorrhoids, but it can be painful post-operatively.

Hemorrhoid Excision (Logo Method)

By using a circular stapler, the hemorrhoidal pads and the loose tissue that surrounds them is removed. This technique is very effective, in cases where prolapse coexists. Post-operative pain is minimal.

Sphincterotomy, anal dilatation

This surgery is applied in cases of sphincter hypertonia, such as when there are thrombosed external hemorrhoids.

Hemorrhoidal artery ligation (H.A.L- R.A.R Method)

This method involves the ligation of the vessels that feed the hemorrhoids, after identifying them with the help of a special ultrasound that is integrated in the proctoscope. This is how blood supply is cut off and the hemorrhoids shrink! At the same time, using a special stich, the entire mucous membrane of the anus is realigned inward, essentially reconstructing the anatomy of the area (anal lifting).

 

This technique offers excellent and permanent results, allowing patients to get back to their daily life very quickly.

Patients that chose this treatment have very high levels of satisfaction with the outcome.

On average, the operation lasts about half an hour. The pain is much less compared to conventional surgical treatment of hemorrhoids.

Patients can return to their home the same day and to their daily activities the following day. No special care or medication is needed either pre- or post-operatively.

Laser Hemorrhoid Coagulation (LHP and HeLP Method)

Laser Hemorrhoid Coagulation (LHP and HeLP Methods)

The use of Laser is applied with great success in a bloodless and entirely painless treatment of hemorrhoids. The Diode Laser energy is delivered into the hemorrhoids disrupting the their blood supply and leading to their shrinkage. This method used for the treatment of hemorrhoids, as well as pilonidal cysts and perianal fistulas, is applied at Athens Medical Center by Dr. Chrysocheris.

Laser Hemorrhoidoplasty (LHP) presents significant advantages for the patient compared to alternative surgical treatments:

• It is performed under sedation without the need for general anesthesia.
• There is significantly less need for analgesic drugs postoperatively in comparison to all other surgical methods.
• There are incisions or sutures in the area of the ​​hemorrhoids, avoiding much postoperative pain and causing less fear in patients.
• The mucosa is kept intact, avoiding the possibility of postoperative strictures.
• The sphincter is kept intact preventing any possibility of incontinence.
• Recovery is extremely short.
• Patients are discharged the same day and immediately return to their usual activities, with little or no postoperative pain.
• The clinical results are excellent.

To learn more about the treatment of hemorrhoids and the cost (all methods & Laser), contact the doctor for an appointment.

Hemorrhoidal artery ligation using ultrasound to identify the feeding vessels and use of laser

 

Advanced-training Course by Dr. Chrysocheris: Use of Laser in the treatment of Hemorrhoids, Pilonidal Cysts and Fistulas