Hemorrhoids are vascular structures in the anal canal. They are devided on external and internal. When they are inflamed they give signs of hemorrhoid disease. Internal hemorrhoids occur inside the anal canal. When are not expressed they cannot be seen or touched externally. In most cases they do not require surgical treatment. External hemorrhoids develop under the skin just outside the opening of the anus.
They become a disease when swollen or inflamed.
The signs and symptoms of hemorrhoids vary depending on the type present.
Internal hemorrhoids are usually characterized by bright red bleeding when defecating and they are painless.
External hemorrhoids are painful and there is swelling around the anus. If bleeding occurs it is usually dark in color.
Hemorrhoids may cause bleeding, itching, burning and pain.
Possible causes of hemorrhoids include: constipation, diarrhea and sitting, especially if the patient spends much time on the toilet for a long time.
Genetics also plays an important role in the formation of hemorrhoids as well as obesity, inadequate diet and excessive physical efforts.
Hemorrhoids affect people most often about 50 years of age and it is considered that 70% of people living in the industrialized countries have problems with hemorrhoids.
Hemorrhoids are classified into four grades based on the degree of prolapse:
-Grade I- no prolapse, just prominent blood vessels
-Grade II- prolapse upon defecation but spontaneous reduction
-Grade III- prolapse upon defecation requiring manual reduction
-Grade IV- prolapse with inability to be manually reduced
Hemorrhoids are diagnosed by physical examination with the use of anoscope.
How is the procedure carried out?
Depending on the degree and symptoms, treatments of hemorrhoids in the Atlas General Hospital can be surgical and conservative.
Conservative treatment consists of non-steroidal anti-inflammatory drugs, sitz baths and rest, applying topical agents (cremes, balms, ointments,etc). Sclerotherapy is a fixative procedure typically prescribed for treating small, internal, first or second degree hemorrhoids. It involves the injection of a sclerosing agent into the hemorrhoid. Rubber band ligation may be also used. It includes applying an elastic band on an internal hemorrhoid.
Surgical treatment can be classical or modern.
Classical surgical methods of removing hemorrhoids involve the removal of the much of the abnormally enlarged hemorrhoidal tissue by a repositioning of the remaining hemorrhoidal tissue back to its normal position.
Classical surgical treatments are associated with a certain complications including bleeding, infection, anal strictures, prolonged recovery, etc.
Classical surgical treatment is performed under general anaesthesia, while modern methods are carried out using only short intravenous analgosedation.
They are minimally painful. The recovery period is short and patients can return to their normal daily activities after 24-48 hrs.
There are two modern methods of treating hemorrhoids.
Hemorrhoid ligation is a method in which a rubber band is placed around the tissue just above the hemorrhoid where there are few pain-sensitive nerve endings.Banding procedure works by cutting off the blood supply to the hemorrhoid. It can be preform in ambulatory setting.
The other modern method is a laser hemorrhoidoplasty which involves laser sclerosation of distended hemorrhoidal veins.
Both methods are routinely performed in developed countries.
In the Atlas General Hospital, these two modern methods are most frequently used.
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Prof. dr Dragutin KecmanovićSpecialist in general and abdominal surgery
Dr Mladen MiloševićSpecialist in general surgery
Dr Dragomir MirkovićSpecialist in general surgery