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General Surgery

Colo-Rectal

Hemorrhoids

Hemorrhoids, commonly known as piles refer to a condition in which the veins around the anus or in the rectum become swollen and inflamed. Majority of people may suffer from hemorrhoids at some point in their life time. It is more common in individuals aged between 45 and 65 years and in pregnant women. External hemorrhoids occur on the skin around the anus whereas internal hemorrhoids develop in the rectum. Internal hemorrhoids tend to protrude out through the anus.

Several factors are considered to as the causes for hemorrhoids and some of them include

  • Chronic constipation and diarrhoea
  • Excessive straining during bowel movement
  • Diet which lacks fibrous food
  • Aging (weak connective tissue in the rectum and anus)
  • Pregnancy (increased pressure in the abdomen)

Symptoms

Internal hemorrhoids: The most common symptom is passage of bright red blood with the stools. If the hemorrhoids have prolapsed, it causes pain, discomfort and itching around the anus.

External hemorrhoids: Blood clots may form in the swollen veins causing bleeding, painful swelling or a hard lump.

Diagnosis

Your doctor will perform physical examination which involves digital rectal exam with a gloved, lubricated finger and an anoscope. Additional diagnostic tests may be ordered to rule out other causes of bleeding.

  • Colonoscopy: Colonoscopy is a procedure in which a flexible lighted tube is passed through the anus into the rectum and the colon. The colonoscope helps to view the pictures of inside of the rectum and colon.
  • Sigmoidoscopy: This procedure uses a shorter tube called a sigmoidoscope to transmit images of the rectum and the sigmoid colon (the lower portion of the colon).
  • Barium enema X-ray: This procedure involves taking an X-ray after injecting a contrast material called barium into the colon.

Treatment

Lifestyle modifications and dietary changes often are helpful in reducing the symptoms of hemorrhoids. A diet having high fibre content soften the stools and helps to pass them easily thereby avoids straining. Fruits, vegetables and cereals serve as a good source of dietary fibres. Fibre supplements such as methylcellulose or stool softeners can be taken. Drinking plenty of water (8-ounce glasses) and adequate exercise helps prevent constipation. Over-the-counter creams and suppositories help relieve the pain and itching. However, these are short time remedies as long-term use can cause damage to the skin.

Medical Treatment

Outpatient treatments are provided for internal hemorrhoids and include the following:

  • Rubber band ligation: This procedure involves placement of a special rubber band around the base of the haemorrhoid. This band obstructs the blood circulation causing the haemorrhoid to shrink.
  • Sclerotherapy: This involves injecting a chemical solution into the blood vessel so that the haemorrhoid shrinks.
  • Infrared coagulation: In this procedure, the haemorrhoid tissue is shrunk using heat.

Surgical removal becomes necessary when the hemorrhoids are large enough and do not respond to conservative treatment.

Transanal hemorrhoidal dearterialization (THD) is an innovative surgical procedure for treating hemorrhoids. The procedure is a minimally invasive type of surgery and is offered as an outpatient surgery.

During the procedure, your surgeon detects the artery that supplies the hemorrhoid using a small ultrasound device called a Doppler probe. Each of these arteries is then gently sutured to block the blood supply to the hemorrhoid. This will cause the hemorrhoids to shrink over the next few days and weeks.

The THD procedure causes minimum pain and allows faster recovery. However, as with any surgical procedure, the risks associated with THD include mucous discharge, urinary retention and bleeding. But these are minor and temporary.