Hemorrhoids are blood vessels located in the anus and help mechanically prevent gastrointestinal leakage.
Hemorrhoids can be external or internal. External hemorrhoids can accumulate blood inside them and cause pain. In cases of clot formation within those hemorrhoids, particular severe pain may develop.
In contrast, internal hemorrhoids do not cause pain and will usually only be detected with the appearance of fresh red blood in.l, stool.
Hemorrhoid treatment options
Hemorrhoids can be treated with a variety of methods, including the use of medical preparations and lifestyle changes, such as adding fiber to the diet and drinking plenty of fluids to soften stools and relieve bleeding from internal hemorrhoids.
Mild to moderate internal hemorrhoids can be treated with a simple surgical procedure. One of the simplest methods that is widely used is ligation of the hemorrhoids. Because internal perforations do not cause pain, it is a painless procedure that usually does not require sedation.
Another clinical option is to reduce hemorrhoids by injecting medicine into the vessels, which makes them shrink (sclerotherapy) or laser treatment and infrared light. These techniques have a good success rate in the short term, but the recurrence rates are higher later on.
Surgery is the preferred option in cases of large, severe or recurrent hemorrhoids. Additionally, surgery is recommended for patients who are not suitable for ligation therapy, such as patients taking anticoagulants and blood thinners. The surgical methods include removal of the hemorrhoid incision, use of thermal or supersonic energy or suturing of the hemorrhoids by adhering them to the anus.
The use of thermal or supersonic energy on the hemorrhoid tissue for its removal has been found to be effective and may even reduce the duration and severity of pain after surgery.
How hemorrhoid surgery is performed
Hemorrhoid surgery can be performed using various methods. Hemorrhoidectomy is usually the best long-term treatment compared to other treatments. In the case of painful external hemorrhoids with an inside clot is usually recommended to undergo the surgery within 72 hours of the onset of the pain. In this case the procedure can be performed under local anesthesia.
In hemorrhoid resection surgery, an elliptical incision is made that surrounds the hemorrhoid area in the most minimal way in order to avoid damage to the anal tissue. Absorbent sutures can be left (closed surgery) or the incision left as is until self-healing (open surgery).
Another surgical method is stitching hemorrhoids by stapling (stapled hemorrhoidopexy). This method involves stapling with the help of a dedicated device that attaches the hemorrhoids to the upper tissue of the anus in order to fix them in place and interrupt the blood supply to them.
The duration of the procedures is about 30 minutes. The surgeries can be performed under general anesthesia, sedation or local anesthesia, at the discretion of the surgeon taking into account the patient's request.
Preparation before surgery
Most people require an enema before each of these surgical procedures, but there is no need to completely cleanse the bowel. The surgeon should be consulted in case of taking regular medications and especially of taking blood thinners.
If the operation is performed under general anesthesia, an anesthesiologist must perform an evaluation before the operation. The patient should be in complete food fast mode as per the instructions of the medical staff.
Recovery from surgery
Postoperative pain and swelling are common symptoms that usually last 3 to 5 days after the procedure. For relief, it is recommended to take sitting baths, use stool softeners and take painkillers as needed. However, in case of significant swelling and redness in the area of surgery, fever or non-transient pain, a medical examination should be sought.
Recovery from hemorrhoid surgery is considered relatively quick and the patient can usually return to work within a week to two weeks from surgery. It is important to follow a high-fiber diet and drink plenty of fluids to avoid constipation.
The degree of success of the surgery, similar to the rates of complications, depends, among other things, on the method chosen. The success rate is usually high at 95% of the time. In simple hemorrhoid resection hemorrhoids have lower recurrence rates compared to other methods, such as ligation or stapling.
Possible complications after hemorrhoid surgery
The onset of complications is influenced by the method of surgery chosen. Among the complications that appear after hemorrhoid resection it can be seen that up to 30% of patients will suffer from urinary retention near surgery, especially after using regional anesthesia. 5% will suffer from urinary tract infections.
More rare complications such as narrowing of the anus or problems controlling the sphincter occur at significantly lower rates (1-2%).
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