WHAT ARE
HAEMORRHOIDS?
WHAT IS HAEMORRHOIDAL
DISEASE?
WHAT CAUSES
HAEMORRHOIDS?
WHAT ARE THE SYMPTOMS
OF HAEMORRHOIDS?
IS THERE ANY
CORRELATION WITH CANCER?
WHAT FORMS OF
TREATMENT ARE THERE?
WHAT ARE
HAEMORRHOIDS?
They are vascular cushions, composed mainly of venous blood. Their
purpose is:
- Accompany faeces to the outside reducing anal trauma
- Complete the complex system of faecal continence.
Only when symptoms are present, they can be defined as a haemorrhoidal
disease.
They are the most common cause of pain in the anorectal region.
More than 50% of the adult population of the western world suffers or has
suffered from them.
Many people neglect symptoms for a long time before seeking medical
help.
Current forms of treatment are able to eliminate the problem with little
or no pain, especially in the early stages.
WHAT IS HAEMORRHOIDAL
DISEASE?
They are erroneously described as “varicose
of the anus”. Pathological haemorrhoids are cavern like corpses, increased
in volume, with contain blood of the veins and of the arteries, and can
protrude from the anus. Depending on the plexus where they have origin, they
can be divided into internal and external.
Internal haemorrhoids increase their volume inside the anus
and one becomes aware of them
only during the passage of faeces because of pain, bleeding and rash, they can prolapsed towards the outside of the anus
ad return inside spontaneously or with manual
help. They become painful if they can’t be placed back into position.
External haemorrhoids develop at the margin of the anus, if under tension they become painful;
they become more complicated than internal haemorrhoids due to the formation of internal clot (haemorrhoidal thrombosis).
WHAT CAUSES
HAEMORRHOIDS?
It is a multifactorial disease and there isn’t one only cause. Haemorrhoids
disease develops more with: the increase in age, excessive straining during evacuation,
long periods of time on the toilet, very hard or irritating stools such as in diarrhea,
pregnancy and hereditary factors, hygienic-behaviours such as a
low-fibre diet, low intake of fluids, sedentary life style.
WHAT ARE THE SYMPTOMS
OF HAEMORRHOIDS?
As already mentioned, if any of
the following symptoms are present, it is possible to speak of haemorrhoidal
pathology:
1.
Bleeding during the passage of
stools or on toilet paper or in the cup of water at the end of defecation. (sparkling fresh red blood).
2.
Prolapsed that can re-enter more
or less easily.
3.
Itching often accompanied by the
feeling of humidity (in the anus).
4.
Pain, generally as a burning
sensation.
5.
External painful lumps, at times
they develop within a few hours.
IS THERE ANY CORRELATION
WITH CANCER?
There is no correlation. However many of these symptoms can be present
even when there is a rectal cancer. This makes it necessary to undergo a proctologic check-up, even type of
treatment which is given without specialist indications, can cause an
unacceptable delay in a correct diagnosis and in prescribing adequate
treatment.
WHAT FORMS OF
TREATMENT ARE THERE?
Medical treatment must be aimed at the possible cause:
- If constipation: increase in vegetable fibre and use of laxatives forming a mass that gives
softer stools.
- Correction of diarrhea, if present.
- Regaining the habit of a correct passage of stools (avoiding pushing too much and for too
long).
- Bidet with warm water to reduce spasm and pain.
- Flavonoids.
- Correction of diet, intake of fluids, avoids irritating foods and alcohol.
In case of severe attacks, mostly due to haemorrhoidal thrombosis, these
aids can be useful, in
combination with analgesics and within about seven days the attack clears
up. If the pain persists,
the doctor in charge carries out a small incision, under local anaesthetic
in order to remove the clot/s.
If the case is of a more serious nature and is a thrombosis, treatment in
hospital may be necessary.
Treatment can be given as an outpatient or in hospital depending on the
stage of the disorder and
on its clinical importance.
Of course, after accurate proctologic
examination, exploration, proctoscopy (and eventually a colonoscopy)
and a classification of the severity of haemorrhoidal disease can undergo
therapy.
Medical treatment should be given to patients with piles of 1st and 2nd
degree without complication and is based on the use of different substances.
Initially, if necessary, we must encourage evacuation daily and
"soft" to avoid the effort and are useful for this purpose all those
substances which increase faecal bulk and are not irritants. We must promote
increased circulation to the haemorrhoidal venous return with preparations of
flavonoids and the like. Finally you can use to relieve symptoms, creams, and
pastes, gels containing anti-inflammatory, anaesthetics and lately hyaluronic
acid.
In some cases, resistant to medical treatment, can be implemented local
treatments, para-surgical therapies such as rubber band ligation used in
treating haemorrhoids and for internal rectal prolapsed mucosa. It consists in
the application of small elastic rings at the basis of the haemorrhoids or prolapsed;
this is carried out without any anaesthetic. This procedure does
not generally cause pain although in the hours that follow the procedure
there could be a
bothersome heavy feeling. The small elastic rings remain in place between 7
and 15 days
and generally their expulsion is not felt except for a slight loss of blood
that should not
frighten the patient. Only in exceptional cases there is a haemorrhage, and
it is necessary
to go to emergency or to contact one’s own
doctor or specialist.
Sclerotherapy and infrared coagulation are only
used in the treatment of general
haemorrhoids and not for prolapsing ones. Such procedures cause only slight
pain and the
result is a discrete reduction in volume of the haemorrhoids.
Patient’s refractory to these therapies, in cases where it has been
impossible to obtain a satisfactory result and haemorrhoids of 3rd
and 4 degree with skin tags are candidates for surgery.
Typically require a brief hospitalization (or often outpatient day-surgery) and are made under anaesthesia. There are several protocols for the control of postoperative pain and discomfort.
So the surgical intervention in haemorrhoidal disease is indicate in:
Typically require a brief hospitalization (or often outpatient day-surgery) and are made under anaesthesia. There are several protocols for the control of postoperative pain and discomfort.
So the surgical intervention in haemorrhoidal disease is indicate in:
- The haemorrhoids of 2nd and 3 rd degree and refractory to medical para-surgical therapy.
- In haemorrhoids 4 degree.
- In cases of haemorrhoids recurrence.
- In cases associated with occult rectal mucosal prolapsed.
- In cases associated with anal fissure.
The ideal intervention should meet several requirements: NO PAIN, NO COMPLICATIONS AND minimum hospital
stays with an early return to work.
Techniques that use laser scalpel do not give a reduction in pain compared to the more traditional. The use of new tools for radiofrequency coagulation (LigaSure®) and ultrasound can reduces post-operative pain.
Above mentioned techniques, or in cases that have not reached satisfactory results, there
Techniques that use laser scalpel do not give a reduction in pain compared to the more traditional. The use of new tools for radiofrequency coagulation (LigaSure®) and ultrasound can reduces post-operative pain.
Above mentioned techniques, or in cases that have not reached satisfactory results, there
are many techniques that have in common the removal of haemorrhoids. They
require a
short stay in hospital and are performed under anaesthesia. There are
different protocols
that control the discomfort and post-operational pain. Techniques that make
use of laser
scalpel do not reduce the amount of pain, compared to traditional scalpel.
A new technique foresees the use of circular stitches.
Mucoprolassectomy with mechanical (circular)
stapler is used, with sufficient consensus in literature,
for haemorrhoids of 3rd degree, while for other grades there is
still a lot of discussion among experts.
Mucoprolassectomy is carried out in hospital with spinal anaesthesia. The
short term
results are good but relapses are frequent. Complications are rare,
sometimes persistent
and difficult to treat.
The ligation of the terminal superior haemorrhoidal artery identified by a
post-surgery
doppler system and followed by haemorrhoidal surgery is a new technique. It
is mainly
performed on haemorrhoids of 3rd degree even if scientifically
studies have described this
technique in haemorrhoids of different grades. The procedure is performed
in day surgery,
under local or spinal anaesthesia.
80% of patients do not require analgesics following the procedure, and the
complications
are minimum in severity and duration of time. Only a very small percentage
of
patients requires a new procedure due to relapse.
The ligation of the superior haemorrhoidal artery terminal branches
identified with the intraoperative use of a Doppler system and the hemorrhoidopexy (THD®) is carried out mainly
in haemorrhoids of 3rd degree, although scientific studies have
described this technique for others. The treatment is performed
as an outpatient, under local anaesthesia with sedation or spinal anaesthesia,
and 80% of patients did not need analgesics after surgery, and complications
are minimal in the reported number, severity and duration; only a small
percentage of patients need new treatments for relapse. The surgery is
performed in an area devoid of nerve endings and thus has little or no pain. It
is a minimally invasive intervention.
Cryotherapy, in radical treatment, is painful in comparison to other forms of outpatient treatment has a higher risk of recurrence. Other techniques such as direct fulguration and BICAP are not a preferable form of treatment in major international centres of proctology.
Cryotherapy, in radical treatment, is painful in comparison to other forms of outpatient treatment has a higher risk of recurrence. Other techniques such as direct fulguration and BICAP are not a preferable form of treatment in major international centres of proctology.
Therefore, as a guideline for the treatment of haemorrhoidal disease we
can say that haemorrhoids grade 1 and 2 symptomatic,
first is important to performed medical nutrition therapy, if no improvement of
symptoms them we proceed with the para-surgical techniques (rubber band
ligation, sclerotherapy, photocoagulation).
In the third degree and degrees in the failure of previous surgery we will can use: THD®, prolassectomia with stapler if there is in association with mucosal prolapsed.
In the third degree and degrees in the failure of previous surgery we will can use: THD®, prolassectomia with stapler if there is in association with mucosal prolapsed.
In the fourth
degree with big skin tags: haemorrhoidectomy (LigaSure®, Ultracision®,
Milligan-Morgan or THD® with removal of the skin tags.
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