Hemorrhoids
Hemorrhoids (US English) or haemorrhoids (UK /ˈhɛmərɔɪdz/), are vascular structures in the anal canal which help with stool control. They become pathological or piles when swollen or inflamed. In their physiological state, they act as a cushion composed of arterio-venous channels and connective tissue that aid the passage of stool. The symptoms of pathological hemorrhoids depend on the type present. Internal hemorrhoids usually present with painless rectal bleeding while external hemorrhoids present with pain in the area of the anus.
Recommended treatment consists of increasing fiber intake, oral fluids to maintain hydration, NSAID analgesics, sitz baths, and rest. Surgery is reserved for those who fail to improve following these measures. There are two types of hemorrhoids, external and internal, which are differentiated via their position with respect to the dentate line. ExternalExternal hemorrhoids are those that occur below the dentate line. They may actually be concealed from view however. Specifically, they are varicosities of the veins draining the territory of the inferior rectal arteries, which are branches of the internal pudendal artery. They are sometimes painful, and often accompanied by swelling and irritation. Itching, although often thought to be a symptom of external hemorrhoids, is more commonly due to skin irritation. The skin irritation may be brought about by the inflammation of the external hemorrhoid which in turn leads to a barely noticeable watery discharge and skin irritation. External hemorrhoids are prone to thrombosis: if the vein ruptures and/or a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid.
InternalInternal hemorrhoids are those that occur above the dentate line. Specifically, they are varicosities of veins draining the territory of branches of the superior rectal arteries. As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may bleed when irritated. Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids. Prolapsed hemorrhoids are internal hemorrhoids that are so distended that they are pushed outside the anus. If the anal sphincter muscle goes into spasm and traps a prolapsed hemorrhoid outside the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a strangulated hemorrhoid.
Internal hemorrhoids can be further graded by the degree of prolapse.
Treatment
Conservative treatment typically consists of increasing dietary fiber, oral fluids to maintain hydration, non-steroidal anti-inflammatory drugs (NSAID)s, sitz baths, and rest. Increased fiber intake has been shown to improve outcomes, and may be achieved by dietary alterations or the consumption of fiber supplements.
While many topical agents and suppositories are available for the treatment of hemorrhoids, there is little evidence to support their use. Steroid containing agents should not be used for more than 14 days as they may cause thinning of the skin. Skin protectants such as petroleum jelly or zinc oxide cream may potentially reduce injury and itching.
Procedures
Recommended treatment consists of increasing fiber intake, oral fluids to maintain hydration, NSAID analgesics, sitz baths, and rest. Surgery is reserved for those who fail to improve following these measures. There are two types of hemorrhoids, external and internal, which are differentiated via their position with respect to the dentate line. ExternalExternal hemorrhoids are those that occur below the dentate line. They may actually be concealed from view however. Specifically, they are varicosities of the veins draining the territory of the inferior rectal arteries, which are branches of the internal pudendal artery. They are sometimes painful, and often accompanied by swelling and irritation. Itching, although often thought to be a symptom of external hemorrhoids, is more commonly due to skin irritation. The skin irritation may be brought about by the inflammation of the external hemorrhoid which in turn leads to a barely noticeable watery discharge and skin irritation. External hemorrhoids are prone to thrombosis: if the vein ruptures and/or a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid.
InternalInternal hemorrhoids are those that occur above the dentate line. Specifically, they are varicosities of veins draining the territory of branches of the superior rectal arteries. As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may bleed when irritated. Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids. Prolapsed hemorrhoids are internal hemorrhoids that are so distended that they are pushed outside the anus. If the anal sphincter muscle goes into spasm and traps a prolapsed hemorrhoid outside the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a strangulated hemorrhoid.
Internal hemorrhoids can be further graded by the degree of prolapse.
- Grade I: No prolapse.
- Grade II: Prolapse upon defecation but spontaneously reduce.
- Grade III: Prolapse upon defecation and must be manually reduced.
- Grade IV: Prolapsed and cannot be manually reduced.
Treatment
Conservative treatment typically consists of increasing dietary fiber, oral fluids to maintain hydration, non-steroidal anti-inflammatory drugs (NSAID)s, sitz baths, and rest. Increased fiber intake has been shown to improve outcomes, and may be achieved by dietary alterations or the consumption of fiber supplements.
While many topical agents and suppositories are available for the treatment of hemorrhoids, there is little evidence to support their use. Steroid containing agents should not be used for more than 14 days as they may cause thinning of the skin. Skin protectants such as petroleum jelly or zinc oxide cream may potentially reduce injury and itching.
Procedures
- Rubber band ligation is a procedure in which elastic bands are applied onto an internal hemorrhoid at least 1 cm above the dentate line to cut off its blood supply. Within 5–7 days, the withered hemorrhoid falls off. If the band is placed too close to the dentate line, intense pain results immediately afterwards. Cure rate has been found to be about 87%.
- Sclerotherapy involves the injection of a sclerosing agent, such as phenol, into the hemorrhoid. This causes the vein walls to collapse and the hemorrhoids to shrivel up. The success rate four years after treatment is 70%.
- A number of cauterization methods have been shown to be effective for hemorrhoids, but are usually only used when other methods fail. This can be done using electrocautery, infrared radiation, laser surgery,[3] or cryosurgery.
- Hemorrhoidectomy is a surgical excision of the hemorrhoid used primarily only in severe cases. It is associated with significant post-operative pain and usually requires 2–4 weeks for recovery.
- Doppler-guided, transanal hemorrhoidal dearterialization is a minimally invasive treatment using an ultrasound doppler to accurately locate the arterial blood inflow. These arteries are then "tied off" and the prolapsed tissue is sutured back to its normal position. It has a slightly higher recurrence rate, but fewer complications compared to a hemorrhoidectomy.
- Stapled hemorrhoidectomy, or, more properly, stapled hemorrhoidopexy, is a procedure that involves the resection (removal) of much of the abnormally enlarged hemorrhoidal tissue, followed by a repositioning of the remaining hemorrhoidal tissue back to its normal anatomic position. It is generally less painful than complete removal of hemorrhoids, and is associated with faster healing compared to a hemorrhoidectomy
- o Due to gravid uterus
o Hot sitz bath for comfort