Pain, burning, bleeding, and even prolapse. The symptoms that accompany hemorrhoids can vary in severity, but they should never be underestimated, as they may require surgery.
Dr. Corrado Bottini , general surgeon at Humanitas Mater Domini and at the Humanitas Medical Care clinic in Varese , talks to us about it .
What are hemorrhoids?
Hemorrhoids are soft, vascularized tissue pads found in the anal canal that perform various functions, such as maintaining anal continence .
Under normal conditions, their presence is not noticed; however, when they increase in volume they become bothersome and cause problems such as:
- itching
- burning
- pain
- bleeding
- prolapse (i.e. protrusion of the hemorrhoids from the anal canal)
Generally, hemorrhoids are classified according to their severity into four stages:
- First degree: slight increase in internal hemorrhoidal congestion without prolapse
- Second degree: moderate increase in hemorrhoidal congestion with external prolapse that tends to reduce spontaneously
- Third degree: significant hemorrhoidal congestion with external prolapse that can only be reduced manually
- Fourth degree: non-reducible external hemorrhoidal mucus prolapse
Who is most at risk for hemorrhoids?
Approximately a third of the population suffers from hemorrhoids. Women , due to pregnancy , are the most vulnerable (about 40% suffer from them during pregnancy or immediately after childbirth).
When is it necessary to see a specialist?
When any disorder related to the anus appears .
How are hemorrhoids treated?
It is up to the proctologist to establish the best treatment for the patient, taking into account that, given equal efficacy, the more conservative treatment will be preferable.
However, it is essential to follow certain behaviors and hygienic habits in both the treatment and prevention of hemorrhoids.
Among these we recall:
- eat lots of fruit, vegetables and water regularly
- carry out regular physical activity, even light, but constant
- don’t spend too much time in the bathroom (lose the habit of reading)
- try to always have a bowel movement at the same time
- take warm bidets with liquid detergent after bowel movements
There are also a number of medications in the form of ointments, suppositories, tablets, and rectal gels, which are effective against symptoms but cannot permanently resolve the problem . These products are often only indicated for symptomatic treatment of hemorrhoids.
When is surgery necessary?
Surgery was once viewed with terror by patients, given the significant post-operative pain and high number of complications and recurrences, but today they can be faced with peace of mind.
The proposed interventions are safe, effective, and cause acceptable postoperative pain; they are often performed as day-hospital procedures, resulting in a relatively early return to normal daily activities. Broadly speaking, they can be divided into two types : those that act by “removing” and those that act by “modifying . “
Among the former ( those that act by “removing” ) , the most commonly performed procedure is the Milligan-Morgan hemorrhoidectomy , named after the surgeons who developed it in the first half of the 20th century. It is the procedure that many patients remember with horror due to the postoperative pain, but which today is performed using specific precautions and, at times, special instruments that significantly reduce pain and recurrence. The postoperative recovery, however, is relatively long, and a full return to normal activities can take up to a month.
The ” modifying ” interventions, on the other hand , have been introduced much more recently and are particularly indicated in cases of prolapsed internal hemorrhoids , and for this reason their long-term results are not yet fully known. They are certainly characterized by a significant reduction in pain, sometimes negligible, and a more rapid return to social life: 7-15 days are usually sufficient.
The first of these procedures, in order of appearance in our operating rooms, is the prolapsed hemorrhoidectomy with a mechanical stapler , developed by an Italian surgeon (Dr. Antonio Longo). A circular piece of rectal mucosa is resected and simultaneously sutured with titanium stitches (which will subsequently dissolve spontaneously), thus repositioning the prolapsed hemorrhoids to their original position.
This technique, however, after initial enthusiasm, has been performed less and less due to the high percentage of recurrences and serious complications it can cause.
The second procedure in this category was developed by Japanese surgeon Morinaga and is based on Doppler-guided transanal ligation of the hemorrhoidal arteries . This technique, which can be performed under local anesthesia or sedation, reduces blood flow, resulting in a rapid reduction in bleeding episodes, and fixes the rectal mucosa, reducing or eliminating prolapse. Postoperative pain and complications are also minimized in this case.
Further recently introduced interventions are based more or less on the same principle (such as, for example, the de-arterialization of hemorrhoids using laser technique ).
In conclusion, to achieve the best results, it is necessary to choose the procedure that guarantees the best cost-benefit ratio for the patient based on the clinical situation, which can be quite varied. Only a dedicated surgeon, however, can correctly perform all the different types of procedures, tailored to the severity, any previous procedures, the coexistence of other pathologies, and the individual patient’s needs or expectations.
