Hemorrhoids are the enlargement or swelling of veins in the inner rectum, the area around the anal opening, or the anal canal. Patients suffering from hemorrhoids may experience bloating or protrusions in the anal region. Hemorrhoids are classified into two groups: internal (above the dentate line) and external. Internal hemorrhoids are typically manifested as bright red swelling or prolapse from the anal canal. External hemorrhoids usually cause discomfort in the anal area or acute pain if a blood clot forms inside the hemorrhoid.
Risk factors for the development of hemorrhoids include constipation, older age, increased abdominal pressure, and pregnancy.
Hemorrhoids can be divided into 4 grades based on their clinical symptoms:
1. Grade 1: Internal hemorrhoids that are not prolapsed.
2. Grade 2: Hemorrhoids that prolapse during defecation but spontaneously reduce (go back in).
3. Grade 3: Hemorrhoids that prolapse and require manual reduction (pushing back in).
4. Grade 4: Hemorrhoids that are prolapsed and cannot be manually reduced.
The treatment for hemorrhoids is usually tailored according to the grade of the hemorrhoids. Grades 1-2 hemorrhoids are managed conservatively, while grades 3-4 may require more invasive approaches. The goal of conservative treatment is to prevent constipation and reduce pressure on the anal canal. This is achieved by adding fiber to the diet – increasing the consumption of fruits and vegetables – and using fiber supplements at a dose of 25-30 mg per day. In case of pain, sitz baths and the use of creams to reduce inflammation and itching are recommended.
Hemorrhoid ligation is performed on an outpatient basis and has a success rate of 70%-80% of patients. Rare complications include pain or bleeding that usually occurs 4-7 days after the procedure. Even rarer complications include infection in the anal region or thrombosis of other hemorrhoids. However, the overall rate of recurrence after ligation is significant and requires multiple treatments.
Additional outpatient treatments include cauterization or sclerotherapy.
Surgical treatment (hemorrhoidectomy) is usually performed under regional anesthesia in the operating room. This procedure is also often performed on an outpatient basis, and the patient is discharged a few hours after the surgery. Possible complications include infection, bleeding, and urinary retention.