HEMORRHOIDS (Piles)

Hemorrhoid, is a word of Greek origin, means "blood flow". Hemorrhoidas are vascular structures in the anal canal. Hemorrhoidal venous cushions consist of vascular plexus mucosa + sub-mucosa layers.

Hemorrhoids play an important role in bowel movements

Stages of Hemorrhoidal disease

Stage 1: No prolapse, just prominent blood vessels

Stage 2: Prolapse upon bearing down,  but reduce spontaneously

Stage 3: Prolapse upon bearing down requiring manual reduction

Stage 4: Prolapse with inability to be manually reduced.

Etiology:

The exact cause of hemorrhoidal disease is unknown.

Risk factors include chronic constipation, pregnancy, low-fiber diet, genetics, obesity, chronic cough, lifting heavy objects. Diet consisting bitter or spicy food is not an etiologic factor but can cause irritation of sensitive cushions wall and increase pain.

Symptoms:

There are three main symptoms of hemorrhoidal disease:

• Bleeding (due to rupture)

• Pain (due to thrombosis and irritation of the wall)

• Mass (prolapse)

Bleeding is the most common symptom.

Treatment:

On the early stages of hemorrhoidal disease is treated symptomatically medication and diet is recommended. Surgical treatment is recommended in advanced stages.

Stage 1-2 of hemorrhoidal disease: local medication + diet

• Local anesthetics cream

• Ointments containing steroids

• Oral drugs that increase venous tone

• Hot water bath

• High-fiber diet

Stage 3: Fixation or surgical procedure (sclerotherapy, banding, electro-photo-thermocuagulation)

Stage 4: Surgery

Surgery:

The surgical method of treating hemorrhoidal disease is hemorrhoidectomy.

Its recurrence rate is the lowest from all types of treatment.

Indications:

Presence of hemorrhoids in 3, 4 stage

No response to medical treatment

Additional to hemorrhoidal disease anal disorders (fissures, fistulas, ulceration)