Hemorrhoids (commonly called Piles) are abnormality of the vascular cushions inside the anal canal. The vascular cushions form the termination of the blood supply within the anal canal and contribute to the maintenance of control of anal opening. Hemorrhoidal disease occurs as the result of abnormalities within the connective tissue of these cushions, producing bleeding with or without prolapse of the hemorrhoidal tissue.Hemorrhoid swelling occurs when there is an increase in the pressure in the small vessels that make up the hemorrhoid causing them to swell and engorge with blood. This causes them to increase in size leading to symptoms. Increased pressure may be caused by a variety of factors:
Pregnancy –because of the pressure of pregnant uterus on veins
Aging –Common in the age group of 45yrs-65yrs. This does not mean, however, that young people and children do not get them.
Diarrhea –If for long duration
Chronic constipation – Forceduring defecation puts additional pressure on the blood vessels’ walls.
Sitting – for long periods
Lifting – especially heavy objects repeatedly
Obesity – often dietary related, such as not following a high-fiber diet.
Genetics – some people inherit a tendency to develop hemorrhoids.
Types of Hemorrhoids:
Hemorrhoids can be broadly divided into two types depending on their situation:
- Internal hemorrhoids:they occur inside the anal canal and are not visible from outside. Bleeding along with something coming out per rectum are the two characteristic complains, patient presents with. They are usually painless
- External hemorrhoids: They mainly originates under the skin around the anus and hence they are visible. The external hemorrhoids are usually painful
In the management of hemorrhoids, prevention is better than cure.
The practice of taking plenty of water and high fibers in diet plays a critical role in the prevention of hemorrhoids. It is utmost important even after surgery to prevent recurrence. Some food items that are rich in fibers are-
Whole Wheat, Brown rice, Oatmeal, Pears, Carrots, Grains, Cereals, Drumsticks etc. Daily around 20-30gm of fibers is recommended
- Seitz Bath: A seitz bath refers to sitting in a few inches of warm water three times a day for 15 to 20 minutes. A seitz bath may help decrease the inflammation of hemorrhoids.
- Stool softener: Stool softeners may help, but once hemorrhoids are present, even liquid stools may cause inflammation and infection of the anus. Always discuss with your physician before starting the same
- Sclerotherapy: Sclerotherapy is one of the oldest forms of treatment for hemorrhoids. During sclerotherapy, a liquid (commonly phenol) is injected into the base of the hemorrhoid.The veins thrombose, inflammation sets in, and ultimately scarring takes place. Ultimately sclerotherapy causes the hemorrhoid to shrink. Pain may occur after sclerotherapy, but usually subsides by the following day
- Rubber band Ligation: The principle of ligation with rubber bands is to encircle the base of the hemorrhoidal mass with a tight rubber band. The tissue cut off by the rubber band dies, and is replaced by an ulcer that heals with scarring.
These non-surgical methods have higher incidence of recurrence in comparison to surgical management. They are indicated in the very early cases or whenever a patient is not fit for surgery.
Patients who don’t recover on non-surgical management, they are candidates for surgical management. Both open and minimal access procedures are available. In these days of development in technology, the minimal access procedure(Stapled Hemorrhoidopexy) is definitely better in terms of pain, recovery and cosmesis.
During an Open hemorrhoidectomy, the internal hemorrhoids and external hemorrhoids are cut out. The wounds left by the removal may be sutured (stitched) together or left open.
Stapled hemorrhoidectomy is a minimal access surgical technique for treating hemorrhoids.Through your anal canal, the stapler (disposable instrument with a circular stapling device at the end) is introduced. When it fires, the stapler cuts off the circumferential ring of expanded hemorrhoidal tissue trapped within the stapler and at the same time staples together the upper and lower edges of the cut tissue.During stapled hemorrhoidectomy, the arterial blood vessels that travel within the expanded hemorrhoidal cushions and feed the hemorrhoidal vessels are cut, thereby decreasing the blood flow to the hemorrhoidal vessels and reducing the size of the hemorrhoids. During the healing of the cut tissues around the staples, scar tissue forms, and this scar tissue anchors the hemorrhoidal cushions in their normal position higher in the anal canal. The staples are needed only until the tissue heals. After several weeks, they then fall off and pass in the stool unnoticed.
In experienced hands, Stapled hemorrhoidopexy has better compliance for the patients.