The hemorrhoidal condition, more widely known as piles, refers to inflammations of the veins located in the area of the rectum and anus.
Anatomically, these rectum walls contain soft structures of submucosal tissue in which the blood vessels of the anal canal are located.
They have the function of keeping the anal sphincter closed and, therefore, contain the exit of the stool.
This pathology occurs when there is a problem in blood circulation in the area, and the blood does not return correctly to the heart.
It causes an increase in the pressure of the veins, which causes them to dilate excessively and give rise to inflammations that are commonly known as hemorrhoids.
Types of hemorrhoids
Internal hemorrhoids occur in the lower area of the rectum, above the anus, and are covered by a mucous membrane.
External hemorrhoids are found in the lower part of the area where the anus meets the rectum and are covered by the skin.
The line that separates the veins that are considered internal from the external veins is called the pectinate line or dentate line, and if the inflammation occurs on both sides of this line, they are called mixed hemorrhoids.
Within the internal hemorrhoids, four grades of hemorrhoids are differentiated:
- Grade I: Hemorrhoids are slightly inflamed and are not visible from the outside of the anus. They usually do not cause discomfort, but bowel movements accompanied by blood may occur.
- Grade II: The inflammation that occurs is more significant, and during the evacuations, it usually leaves the anus and is then reintroduced.
- Grade III: Prolapses already appear in this degree of inflammation; the hemorrhoids go out of the anus during the evacuation or spontaneously and can only be reintroduced into the anus manually, pushed with the finger.
- Of degree IV: It is the degree of more significant inflammation, and the hemorrhoids are prolapsed permanently; they are constantly outside the anus. This can cause some tissues of the anus to move out, as is the case of mucous tissue.
Hemorrhoids usually appear to be subject to high and repeated pressures in the veins of the rectum and anus.
Constipation is the cause because a great effort must be made in the anal area, which can cause the pumping of large quantities of blood, giving rise to this pathology.
Also, when constipation occurs, fecal matter accumulates in the rectum, pressing the veins.
Diarrhea can also favor the appearance of hemorrhoids by contact of liquid stools with veins; if soft stools are continued, they irritate the veins.
Hemorrhoids can occur in anyone and at any age.
There are a series of circumstances that may favor the appearance of this pathology, such as:
- Obesity: Because there is an increase in pressure on the pelvic floor due to the rise of the abdomen, making it difficult for the blood to circulate in the veins of that area.
- Pregnancy: The hormonal changes that are caused in this period can cause constipation, and on the other hand, the weight of the fetus, especially in recent weeks, produces an increase in pressure on the pelvic area.
- Perform activities that merit spending a lot of time standing or sitting daily or loading weighty objects.
- The existence of hereditary factors.
- A diet with little fiber does not favor the proper functioning of the intestines. It may be caused by excessive consumption of spicy foods.
- We are presenting problems in the colon.
It is possible that in some cases, hemorrhoids may cause other complications.
When external hemorrhoids develop blood clots, they cause much pain; these hemorrhoids are called thrombosed hemorrhoids.
In the case of internal hemorrhoids, they can prolapse, irritate or become infected and may require urgent surgery.
The appearance of internal hemorrhoids usually does not cause discomfort.
These can bleed without the presence of pain after an evacuation.
However, they can cause difficulties if they bleed too much or have a prolapse.
Bleeding is characteristic after a bowel movement is performed when you have hemorrhoids.
In internal hemorrhoids, the symptoms will depend on the degree they present, increasing their intensity and discomfort as they increase in degree.
External hemorrhoids can also cause bleeding after bowel movements occur.
Because they are very exposed, they can often become irritated, itchy, stinging, discomfort, pain, and bleeding.
Another common complication of external hemorrhoids is the presence of blood clots within the vessels, or what is commonly referred to as a thrombosed hemorrhoid.
Although the appearance of these clots is usually not fatal, they can cause severe and severe pain.
The blood product of this condition is fresh and bright appearance and is observed from the outside of the stools, never inside or mixed.
The stools are also accompanied by mucus secretions and exudates that dirty the underwear, which causes irritations.
When the patient suffers from hemorrhoids, going to the bathroom is very annoying and uncomfortable, so it is avoided for fear of pain.
However, this causes an increase in the pressure in the veins and will worsen the situation, turning this process into a vicious circle.
Symptoms can be synthesized as follows:
- Rectal bleeding: Rectal bleeding is usually a common element in cases of internal and external hemorrhoids that are thrombosed, but it is also a symptom of cancer and other diseases. This is worrisome if rectal bleeding is not related to a bowel movement.
- Defecation of narrow stools: In the case that the feces have a smaller diameter than usual, thin as a pencil, these may indicate an intestinal blockage.
- Constipation: The inability to expel stool or the presence of severe diarrhea with companies of inflammation.
- Fever: The patient may present fever along with the other symptoms.
- The presence of lumps: A lump on the outside of the anus represents a common sign of the presence of a thrombosed hemorrhoid.
To make the diagnosis, perform a physical examination in the rectal area to detect external hemorrhoids.
For the diagnosis of internal hemorrhoids, tests are performed that include:
- Digital rectal exam: In this test, the doctor inserts the finger with a lubricated glove to feel for hemorrhoids or other abnormalities in the rectal area.
- Sigmoidoscopy is a complete examination of the lower colon to rule out colon cancer, abnormal lumps, and other diseases.
- Anoscopy: To perform the anoscopy in diagnosing internal hemorrhoids, an anoscope will consist of a short, rigid, and hollow tube that usually contains light. The anoscope is inserted through the anal canal, and the last two inches of the colon are checked. During the anoscopy, a biopsy can be taken.
Anoscopy will reveal the presence of hemorrhoids, polyps, or other abnormal tissues, to make a correct diagnosis.
A digital rectal examination and an anoscopy of hemorrhoids are sufficient to perform differential diagnoses in patients under 50. They will be the only tests the doctor will need for the first evaluation in cases where hemorrhoids are apparent.
Patients older than 40 years, who have a family history of colon cancer, should undergo flexible sigmoidoscopy to obtain a more precise diagnosis.
Treatment – How to Treat Hemorrhoids
In most hemorrhoidal outbreaks, they stop hurting after two weeks of treatment.
A diet high in fiber should be followed, and 8 to 10 glasses of water should be drunk daily. Usually, this can promote more regular and smooth stools.
It is also recommended to use fecal softeners to reduce the effort made during bowel movements; topical ointments are also advised to relieve occasional itching, pain, or swelling.
Sometimes a more invasive treatment is needed, such as surgeries:
Surgeries without anesthesia
Some surgeries to eliminate hemorrhoids can be performed outpatient without anesthesia.
Banding or band ligation is an outpatient procedure used to treat internal hemorrhoids.
In this procedure, a tight band is used around the base of the hemorrhoid to prevent the blood supply to the veins.
These bands are carried out in two or more procedures that are carried out two months apart from each other.
This procedure is not painful, but you may feel mild pressure or discomfort.
The band ligation procedure is not recommended for those patients who have been prescribed anticoagulant drugs because of the high risk of hemorrhagic complications.
This procedure involves applying injections with a saline solution or a chemical solution in the varicose vein that prevents hemorrhoids from contracting and bleeding.
Most people can experience little or no pain.
Sclerotherapy is performed on an outpatient basis and presents very few risks.
This becomes an option if you are receiving anticoagulant treatment because there is no bleeding.
Sclerotherapy is a very successful practice in cases of small internal hemorrhoids.
Coagulation therapy is also called infrared photocoagulation.
In this treatment, infrared light is used, and extreme heat or cold therapy is used to make hemorrhoid retract.
This procedure is performed on an outpatient basis and is usually performed in conjunction with an anoscopy.
People may experience mild discomfort or cramping during treatment.
Ligation of hemorrhoidal arteries:
The ligature of the hemorrhoidal artery, also known as transanal hemorrhoidal dearterialization, is a minimally invasive technique used to eliminate hemorrhoids.
With this method, the blood vessels causing the hemorrhoids are located, and with the help of ultrasound and a ligament, those vessels are closed.
It offers a more practical option than rubber bands, but it causes more prolonged pain.
It is an option when the band method fails.
Surgeries with anesthesia
Other types of surgery should be performed in an operating room, such as:
Hemorrhoidectomy is used in the case of large external hemorrhoids, internal hemorrhoids prolapsed or causing discomfort, and do not respond to non-surgical treatment.
This procedure is usually done in a surgery room.
General anesthesia, regional anesthesia, and local anesthesia may be applied.
A sedative may also be administered to help relax the patient if local or regional anesthesia is received during the procedure.
Once the anesthesia is applied, the surgeon will amputate the large hemorrhoids.
The most common risks associated with this type of surgery are pain and infections.
Hemorrhoidopexy is a surgery that requires stapling and is used to treat prolapsed hemorrhoids.
It is a primary surgical procedure that fixes the prolapsed hemorrhoid with staples within the rectum and cuts off the supply of blood flow for the tissue to contract and be reabsorbed.
This technique avoids that the interventions are more painful and shortens the surgical intervention’s duration, which is why the recovery is faster.
Rectal and anal pain may occur after having a hemorrhoid surgery.
Analgesics are likely prescribed to relieve pain and discomfort.
To achieve quick recovery, you must:
- Adopt a diet with high fiber content.
- A good level of hydration should be maintained by taking 8 to 10 glasses of water per day
- Use treatments to soften the stool and not exert much effort during bowel movements.
- Any activity that involves lifting heavy objects should be avoided.
- The use of sitz baths alleviates postoperative discomfort.
The procedure of the sitz bath involves placing the anal area in a container with warm salt water solution several times a day for ten minutes.
Although the recovery varies, the average recovery is estimated not to exceed 14 days according to each patient.