Hemorrhoids: From Symptoms to Modern Treatment Methods

Hemorrhoids are a common condition associated with inflammation, thrombosis, pathological enlargement, and tortuosity of the hemorrhoidal veins that form clusters around the rectum and anus. This condition can significantly impair quality of life, causing discomfort, pain, and bleeding. Understanding the symptoms and available treatment methods is crucial for seeking timely medical attention and effectively resolving the problem.

Main symptoms of hemorrhoids: How to recognize the problem?

Symptoms of hemorrhoids can vary depending on the stage and type (internal or external). The most common manifestations include:

• Bleeding: Bright red blood on toilet paper, in the toilet bowl, or on the surface of the stool is one of the most common symptoms. It is important to note that any rectal bleeding requires mandatory consultation with a doctor to rule out other, more serious diseases. For example, blood in the urine (hematuria) is a completely different condition that requires separate diagnosis and treatment, especially in women, including pregnant women [1], as well as in children, where it may be a sign of serious urological or systemic problems [6].
• Pain and discomfort: A feeling of heaviness, burning, itching, or pain in the anal area, especially during or after defecation. External hemorrhoidal nodes can be painful to the touch.
• Prolapse of nodes: Internal hemorrhoidal nodes can prolapse from the anus during defecation or physical exertion. In the early stages, they may retract on their own; in later stages, they require manual reduction or remain prolapsed.
• Itching and irritation: Constant irritation of the skin around the anus caused by mucous discharge or difficulty in maintaining hygiene.
• Sensation of a foreign body: A feeling of incomplete bowel movement or the presence of something in the rectum.

Diagnosis of hemorrhoids: When to see a doctor?

Diagnosis of hemorrhoids usually begins with a detailed medical history and physical examination. A proctologist or surgeon performs a visual inspection of the perianal area to identify external nodes and signs of inflammation. To evaluate internal hemorrhoidal nodes and rule out other rectal pathologies, the following methods are used:

• Digital rectal examination: Allows for the assessment of sphincter tone, the presence of internal nodes, their size, and tenderness.
• Anoscopy: Insertion of a short instrument (anoscope) into the rectum to visualize the mucous membrane and hemorrhoidal nodes at a depth of up to 10-12 cm.
• Sigmoidoscopy: A deeper examination of the rectum and sigmoid colon using a sigmoidoscope, allowing for the exclusion of polyps, tumors, and other diseases.
• Colonoscopy: In some cases, especially when alarming symptoms are present (e.g., unexplained weight loss, changes in bowel habits, anemia), a colonoscopy may be recommended for a complete examination of the large intestine.

Hemorrhoid treatment methods: From conservative to surgical

The choice of hemorrhoid treatment method depends on the stage of the disease, the severity of symptoms, and the individual characteristics of the patient.

Conservative therapy

In the early stages of hemorrhoids, as well as to alleviate symptoms during an exacerbation, conservative treatment is used:

• Lifestyle and dietary changes: Increasing fiber intake (vegetables, fruits, whole grains) and fluid intake to soften stool and prevent constipation. Regular physical activity.
• Topical agents: Ointments, creams, and suppositories containing anesthetics, anti-inflammatory components, and venotonics (e.g., with lidocaine, hydrocortisone, heparin). They help reduce pain, itching, and inflammation.
• Systemic drugs: Venotonics (e.g., diosmin, hesperidin) in tablet form to strengthen vein walls and improve microcirculation. Painkillers (NSAIDs) for pain management.
• Hygiene: Thorough cleaning of the perianal area after defecation, preferably with warm water instead of dry toilet paper.

Minimally invasive procedures

If conservative treatment is ineffective or in cases of stage II-III hemorrhoids, minimally invasive methods may be recommended:

• Rubber band ligation: A latex ring is placed on the base of the hemorrhoidal node, which cuts off the blood supply. The node dies and falls off within a few days.
• Sclerotherapy: Injection of a special sclerosing solution into the hemorrhoidal node, which leads to its collapse and scarring.
• Infrared photocoagulation: Exposure of the node base to infrared radiation, causing tissue coagulation and cessation of blood flow.
• Hemorrhoidal artery ligation (HAL-RAR): Ligation of the arteries supplying the hemorrhoidal nodes under ultrasound guidance. Often combined with lifting (rectoanal repair) of prolapsed nodes.

Surgical treatment

For stage III-IV hemorrhoids, large nodes, significant prolapse, thrombosis, or the failure of other methods, surgical intervention is indicated.

• Hemorrhoidectomy: Surgical removal of hemorrhoidal nodes. There are several modifications (Milligan-Morgan, Ferguson) that can be open or closed. This is the most radical method, providing a long-term result but requiring a longer recovery period.
• Longo procedure (stapled hemorrhoidopexy): Circular excision of a portion of the rectal mucosa above the dentate line using a special stapler. This pulls the hemorrhoidal nodes upward and reduces their blood supply.

Prevention of hemorrhoids: How to avoid recurrence?

Prevention of hemorrhoids and their recurrence includes the following measures:

• Maintaining regular, soft stools through a fiber-rich diet and adequate water intake.
• Avoiding prolonged sitting on the toilet and excessive straining during defecation.
• Regular physical activity.
• Maintaining a healthy weight.
• Avoiding prolonged sitting or standing.

Seeking timely medical attention when the first symptoms appear allows for the selection of the most effective treatment method and prevents the progression of the disease.

Sources

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The information provided in this article is for reference purposes only and cannot replace professional medical advice. Always consult a qualified specialist for diagnosis and treatment.