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Hemorrhoids Treatment

hemoroid basur ağrısı

What is Hemorrhoids?

In fact, hemorrhoids are normal anatomical elements of the human body. The name of the disease comes from the Latin and is formed from the combination of the words hem (blood) and roos (flow). It is a very common disease in Turkish society due to nutritional habits and lifestyle.

In general, the end of the intestine,iç ve dış hemoroid the enlargement of the hemorrhoidal veins (vascular structures) feeding the anus due to different reasons and their sagging downwards in the anus are the reasons for the onset of the disease. In relation to this; although it is often seen around 50-70 years of age due to weakening of the anal muscles and vessel wall, the age of occurrence of hemorrhoids has been withdrawn to earlier periods due to reasons such as diet with fast foods, ready-to-eat foods, low-fiber foods, constipation and diarrhea. There is no significant difference between men and women in terms of gender, but pregnancy is an important risk factor for women.

Causes of Hemorrhoids

  • Irregular bowel habits (chronic episodes of constipation and diarrhea)
  • Excessive consumption of hot and spicy foods, less consumption of fiber-rich foods and water
  • Working standing or sitting for long periods
  • Frequent heavy lifting (athletes and heavy workers)
  • Pregnancy
  • Genetics
  • Holding the toilet or spending a long time on the toilet
  • Anal intercourse
  • Chronic cough
  • Obesity and overweight
  • Alcohol use
  • Inflammatory bowel diseases such as chron and ulcerative colitis
  • Chronic diseases such as severe heart failure, liver cirrhosis

Types of Hemorrhoids

dış hemoroid ve iç hemoroid
Internal Hemorrhoids

Hemorrhoids located in the inner part of the anus. It is evaluated according to the stage it is in.

Stage1: The hemorrhoidal pouch is prominent inside the anus but cannot be seen with the naked eye.  It is painless and may cause rectal bleeding somtimes. It can only be seen during anoscopy (viewing the part of the rectum up to 10 cm with an instrument) or rectosigmoidoscopic (endoscopy in which the part of the intestine up to 30-40 cm is evaluated).

Stage 2: It is in the form of patches that appear during straining and defecation and then disappear spontaneously. It can cause bleeding, discharge and itching from the anus.

Stage 3: It is in the form of packs that become evident after straining, do not disappear on their own, but disappear if pushed in with the help of hand. There is bleeding and discharge from the rectum. It is itchy and may cause a feeling of fullness in the rectum, since adequate cleaning cannot be provided after the toilet.

Stage 4: It is the last stage of the disease. All packs are outside and cannot return to the rectum. Suffocated packs between tight anal muscles cause serious pain and bleeding.

External (External) Hemorrhoids

It is in the form of swelling located in the area between the end of the anus and the skin of the anal region. If a blood clot settles in these hemorrhoids, severe pain, purple swelling (thrombosis) and sometimes bleeding occur as a result of eroding. These are called Thrombosed Hemorrhoids.

Mixed Hemorrhoids

The patient has both internal and external hemorrhoids.

Symptoms of Hemmorhoids

hemoroid kanamasıBleeding from the rectum is the most reason that brings patients to the doctor. In some patients, after defecation, bleeding may drip into the toilet, sometimes only in the form of smearing on toilet paper, and it may squirt out rarely. Although the cause is often internal hemorrhoids, eroded external hemorrhoid packs can also bleed. If this situation is neglected, patients may also come with deep anemia and related complaints (weakness, fatigue, low blood pressure, palpitations).

basur ağrısıAnother reason is pain in the rectum. It is most commonly seen due to a blood clot (thrombus) that has settled in the external hemorrhoidal pouches.

This condition, which we call thrombosed hemorrhoids, usually occurs suddenly after a difficult defecation. A repetitive “pain cycle” is expressed by the patient with the pressure of the hard stool that hardens because of the pain and difficulty in defecation. In such cases, evacuation of the existing clot by applying local anesthesia will be a quick and relaxing form of treatment for the patient.

Palpable bulge  in the form of pieces of meat in the anus are the result of the hemorrhoidal pouches hanging out of the anal canal. It is one of the findings showing that the disease is in an advanced stage.

Itching in the rectum is due to the mucous content secreted from the prominent hemorrhoidal pouches and due to the leakage of feces from the rectal muscles that cannot be fully tightened (not closed) due to the existing pouches. In addition, patients with stage 3 and 4 hemorrhoids feel itching after toilet because they cannot adequately clean the stool on the packs. Hygienic problems are common.

How to Diagnose Hemorrhoids

Although it may seem like an unpleasant examination by our patients, anal and rectal examinations are very valuable for us surgeons. Rectal touch (finger examination) is important both in the diagnosis of benign diseases such as hemorrhoids, breech tears, condyloma, and in terms of not missing diseases such as rectum tumors, anal cancer, polyps. Usually, the visual examination performed by positioning the patient on the knees and elbows is sufficient for the diagnosis of hemorrhoids. However, for the diagnosis of stage 1 and 2 internal (internal) hemorrhoids, it will be appropriate to evaluate it by looking into the rectum with a rectal touch (based on experience) or an instrument called an anoscope.

If during the examination, especially in patients presenting with rectal bleeding, if there is no hemorrhoid or breech tear to explain the situation, further investigations such as colonoscopy should be performed to reveal the cause of bleeding.

Are Hemorrhoids Common in Pregnant Women?

Most of our female patients point to pregnancy for the initial period of their complaints. The frequency of hemorrhoids during pregnancy is high due to the increase in intra-abdominal pressure caused by the growing baby, the change in bowel movements due to hormonal effects, and the decrease in blood fluidity. Complaints gradually increase towards the last period and regress somewhat with delivery. During pregnancy, surgical interventions are avoided as much as possible and progress is made with medical treatment. Already after the birth, there is a regression in the swelling of the existing packs, since the causes are partially eliminated. However, if there is not enough improvement, a re-evaluation should be made. Having hemorrhoidal disease does not prevent normal delivery.

What is Relief Hemorrhoids?

In its early stages, hemorrhoids can be treated without surgery. It will be good for the patients to take a hot water sitz bath. In addition, your doctor may prescribe medications in the form of hemorrhoid cream and suppository used in the treatment of hemorrhoids. If hemorrhoids are caused by staying in a sitting position for too long, patients should consciously reduce their sitting time.

Hemorrhoid Treatment and Surgery

Most of our patients, who are generally decided to have hemorrhoid surgery, are patients who have tried most of the medical treatment methods up to this stage, but their current complaints have not regressed.

Depending on the type of surgery planned, spinal anesthesia (anesthetizing from the waist down) or general anesthesia (putting the patient to sleep) is preferred.

The treatment of hemorrhoid surgery is the removal of problematic hemorrhoidal packs. Current techniques used are LIGASURE vessel sealing system, HARMONIC scalpel, LONGO stapler hemorrhoidopexy and LASER coagulation method.

Thanks to these techniques, parameters such as bleeding during and after surgery, duration of surgery, post-operative pain and hospital stay are minimized compared to classical methods.

ligasure aleti

Ligasure is an instrument with a scissor-like tip, which is placed on the underside  of the pack and the vascular structure is removed by cutting and sealing. In this way, there is no bleeding or very little, no need for stitches.

Harmonic scalpel is the cutting of the bottom of the pack using ultrasonic waves with the help of a tool with a scissor-like tip. There is no or very little bleeding, again, it does not require stitches.

longo stapler cihazıThe longo stapler is a round-tipped instrument that we use in patients with circumferential internal hemorrhoidal packs. It is a form of surgery that encloses and cuts all internal hemorrhoidal pouches at the same time, staples them with metal sutures, and preserves the opening of the breech canal at the same time.

Laser procedure, on the other hand, is a method that we have been using quite frequently recently and is preferred in terms of postoperative patient comfort (discharge on the same day, minimal postoperative pain, bleeding and risk of infection). It is a technique that is inserted into the hemorrhoidal pouch through a small incision with the help of a fiber with a laser at its end, causing the package to be damaged by the effect of heat and light and to adhere to the anus wall depending on the structural change as a result. It is considered a seamless and bloodless method.

Despite all these options, it should be kept in mind that hemorrhoids is a disease that can recur, no matter how good the surgery is. There are always vascular structures in the anus that can be changed due to “same mechanisms”.

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