Laparoscopic Surgery
Hemorrhoids are a common medical condition in which the blood vessels and soft tissues in the lower rectum and anus become swollen and inflamed. They can cause discomfort, pain, itching, and bleeding, affecting millions of people worldwide. Understanding the causes and seeking appropriate treatment is essential to alleviate symptoms and improve the quality of life for those affected by hemorrhoids.
Types of Hemorrhoids
Internal hemorrhoids lie inside the rectum and are covered with cells that line the rest of the intestines. They are deep inside the rectum and not visible from outside. Without complications, they do not usually produce rectal pain, discomfort or irritation in the anal region. However, the hemorrhoids might protrude through the rectum from straining during bowel movement.
External hemorrhoids are hemorrhoids that affect veins and soft tissues outside the anus. External bulges can be visibly seen and touched around the anal area. They are covered with cells that resemble skin, typically slightly less pink than the surrounding skin. Due to the irritation of surrounding nerve, symptoms might include pain or discomfort, itching or swelling around the anus and rectal bleeding that might be found during defecation.
Causes of Hemorrhoids
Straining during bowel movements: Constipation and straining during bowel movements put pressure on the veins in the rectal area, leading to the development of hemorrhoids. This is a major factor cause of hemorrhoids.
Chronic diarrhea: Frequent diarrhea can irritate the anal region and contribute to hemorrhoid formation.
Pregnancy: The increased pressure on the pelvic region during pregnancy can cause hemorrhoids to develop.
Obesity: Being overweight or obese can put extra pressure on the rectal veins, making hemorrhoids more likely.
Sedentary lifestyle: Lack of physical activity and prolonged sitting can impede blood flow in the rectal area, increasing the risk of hemorrhoids.
Low fiber diet: A diet low in fiber can lead to constipation, further straining the rectal veins during bowel movements.
Signs and Symptoms
Hemorrhoids might exhibit different signs and symptoms in different stages:
The internal hemorrhoid bulges into the canal but does not prolapse. These may cause rectal bleeding, especially accompanied with chronic constipation.
The hemorrhoid protrudes through the rectum by straining during a bowel movement. But it spontaneously returns to the original position once the straining has subsided after bowel movements.
The hemorrhoid protrudes with any straining, especially during exertion that increases abdominal pressure e.g. sneezing, coughing, lifting heavy objects. Protruding hemorrhoids require the patient to push them inside manually.
The hemorrhoid gets bigger and protrudes through the rectum without straining. Prolapsing hemorrhoid cannot be pushed back. Aggravating symptoms are itchy, swelling or inflamed anus, persistent rectal bleeding and pus or mucus discharge mixed with stool, causing discomfort and severe rectal pain.
If left untreated, hemorrhoids are more likely to become infected with severe bleeding which is a major cause for developing anemia, fatigue, fainting and unintentional weight loss.
Treatment for Hemorrhoids
There are various effective treatments available to manage and alleviate hemorrhoid symptoms. Depending on the severity of the condition, the following treatments can be recommended:
- Injection (sclerotherapy) A chemical solution is injected into the hemorrhoid tissue in order to shrink it by damaging blood vessels and reducing the blood supply to the hemorrhoids. Recommended regimen is an injection for every 3-5 weeks. The injection can reduce symptom for 3-6 month.
- Rubber band ligation During this procedure, one or two tiny rubber bands are placed around the base of an internal hemorrhoid to cut off its circulation. The hemorrhoid withers and falls off within a week.
- Conventional Hemorrhoidectomy is the surgical procedure most commonly used to treat internal hemorrhoids. It consists of the excision of hemorrhoidal bundles using a sharp instrument, such as a scalpel, scissors or electrocautery followed by complete wound closure with absorbable suture. Typically, all three hemorrhoidal columns are treated at one time. Postoperative care includes mild analgesics and avoidance of constipation. Potential complications include pain, delayed bleeding, urinary retention, infection, wound breakdown. Although this technique has more postoperative discomfort and pain. New methods are being devised to decrease the pain associated with the surgery and should allow for a better patient experience.
- Laser hemorrhoidectomy The laser probe will be inserted into the anal canal to target and eliminate the terminal branches of the superior hemorrhoidal arteries. This laser-based hemorrhoidectomy procedure ensures a cosmetic advantage, as patients won’t bear any surgical incision marks around the anal area. The utilization of laser technology in this procedure also results in reduced discomfort and facilitates a quicker recovery process for the patient. Laser hemorrhoidectomy is the least painful hemorrhoidectomy and fastest recovery. This technique is suitable for 2nd to 3rd internal hemorrhoids.
- Stapled hemorrhoidectomy
The treatment of choice for third-degree haemorrhoids. A circular, hollow device is inserted into the anal canal. The doctor will use a stapler-like device to reposition the hemorrhoids and cut off their blood supply. Without blood, they’ll eventually shrivel and die. Through this device, the stapler (a disposable instrument with a circular stapling at the end) is placed through the first hollow tube and the ends of the suture are pulled. The hemorrhoidal cushions are pulled back up into their normal position within the anal canal. The stapler then is fired. It cuts off the circumferential ring of expanded hemorrhoidal tissue trapped within the stapler and at the same time stapling together the upper and lower edges of the cut tissue. This procedure moves the hemorrhoid to where there are fewer nerve endings and the right position in anal canal, so it hurts much less than a conventional hemorrhoidectomy. This technique is the most effective procedure for prolapsing symptoms. You’ll also recover faster and have less bleeding and itching and there are generally fewer complications.
Hemorrhoidal Artery Ligation and Recto Anal Repair (HAL-RAR) is a new procedure in which a miniature Doppler sensor is inserted in the anus to detect the arteries supplying blood to hemorrhoids. The surgeon can pinpoint the arteries supplying the hemorrhoids and can tie them off to cut the blood supply. The hemorrhoids are reduced almost immediately and within weeks, are no longer noticeable. The procedure is effective and less pain.
Prevention of Hemorrhoids
Preventing hemorrhoids involves adopting a healthy lifestyle and making choices that reduce the risk of developing the condition. Some preventive measures include:
Eating a high fiber diet
Consuming foods rich in fiber such as fruits, vegetables, whole grains, and legumes can promote regular bowel movements and reduce the strain on the rectal area.
Staying Hydrated
Drinking plenty of water helps maintain soft stools and eases bowel movements.
Regular Exercise
Engaging in physical activity promotes healthy blood flow and helps prevent constipation.
Avoiding prolonged sitting
Taking breaks from prolonged sitting and avoiding sitting on the toilet for extended periods can reduce pressure on the rectal area.
Hemorrhoids are a common and treatable condition that affects many individuals. By understanding the causes and adopting preventive measures and effective treatments, those affected by hemorrhoids can find relief and improve their overall well-being. If symptoms persist or worsen, seeking advice from a healthcare professional is essential for a proper diagnosis and personalized treatment plan
Grade I-II : the treatment should be medication, sclerosing injection or rubber band ligation.
Grade III-IV and large external hemorrhoids: the treatment of choices are surgery by conventional, laser or stapler hemorrhoidectomy.
Haemorrhoids clinic at BNH Hospital
We provide gentle and privatized services. All of surgeries could be done under local anesthesia with sedation which is safer and faster recovery by specialists and colo-rectal surgeon.
Yongsun Wongwiwatseree, M.D.
Colorectal & Haemorrhoid Clinic, Surgery Department
Specialty
General Surgery,Colon and Rectal Surgery
Language
Thai, English
– Diplomate, Thai Board of Colon and Rectal Surgery, 2002
– Diplomate, Thai Board of Surgery, 1999
– Clinical Fellowship in Colon and Rectal Surgery Chulalongkorn University, 2002
– Residency in General Surgery, Chulalongkorn University, 1999
– MD. Chulalongkorn University, 1993
Doctor’s Schedule
| Day | Time | Location |
|---|---|---|
| Monday | 09:00 – 17:00 | Colorectal & Haemorrhoid Clinic, Surgery Department |
| Tuesday | 09:00 – 15:00 | Colorectal & Haemorrhoid Clinic, Surgery Department |
| Wednesday | 11:00 – 16:30 | Colorectal & Haemorrhoid Clinic, Surgery Department |
| Thursday | 09:00 – 17:00 | Colorectal & Haemorrhoid Clinic, Surgery Department |
| Sunday | 09:30 – 12:00 | Colorectal & Haemorrhoid Clinic, Surgery Department |