Hemorrhoids - Diagnosis and treatment (Part three)

The treatment of hemorrhoids can be done conservatively (non-surgically) as well as surgically.

The effectiveness of the therapy for hemorrhoidal disease is assessed by how satisfied the patient will remain after the treatment. Usually, patients are satisfied with conservative therapy, if their complaints are less pronounced or acceptable, even if anatomical abnormalities are still visible to the doctor.

Conservative treatment will be undertaken if the patient will adhere to a set of lifestyle rules.

• Increasing fiber in their diet.
• Increasing the use of clear fluids in the daily diet.
• Avoid straining during the act of defecation.
• Avoid sitting for a long time on the toilet during defecation.

Conservative treatment:

Usually, patients who apply these measures can improve their complaints. During follow-up visits, it must be reiterated to the patient that the necessity of following these few rules is very important and that any other therapy that may be undertaken is destined to fail if these rules are not adhered to.

Creams and ointments with local action can relieve symptoms of hemorrhoids but it has not been proven that they constitute a proper treatment for hemorrhoids. Even after the symptoms have disappeared following this treatment, the patient should undergo a clinical re-examination by the doctor.

• Anesthetic ointments such as lidocaine-based ones are commonly used.
• The affected area can be treated with ice packs.
• Oral analgesics can be taken.
• Laxatives can be taken to facilitate defecation.

For the outpatient treatment of hemorrhoids, several methods have been proposed, with not very reliable results and with some complications that should not be neglected. Such methods include:

• Elastic band ligation with aspiration.
• Sclerotherapy treatment with injections.
• Combined treatment.
• Cryotherapy and photocoagulation.

Surgical treatment of hemorrhoids:

In surgical treatments, these methods are summarized:

1. Open hemorrhoidectomy. (Scalpel method). It is the standard intervention.
2. Ligation of hemorrhoidal arteries under Doppler guidance.
3. Ligation of hemorrhoidal arteries with Doppler and anorectal repair.
4. Stapler hemorrhoidopexy.

It is important to inform the patient that each of these interventions performed in the perianal area may also have consequences such as: (Bleeding, infections, anal stenosis, damage to the anal sphincter, uncontrollable defecation).

Patients should be aware that the rehabilitation period can last several weeks and that after the intervention they should use:

• Non-steroidal anti-inflammatory drugs such as ibuprofen (if there are no contraindications)
• Metronidazole tablets orally for 5 days.
• Laxatives such as: Lactulose as long as they are still not able to tolerate the defecation of solid fecal matter.
• The Doppler technique is a technique usually used in patients with internal hemorrhoids with bleeding.
• The technique of ligation of hemorrhoidal arteries with anorectal repair is a variant of the Doppler technique and is usually used in patients presenting with prolapsed hemorrhoids with bleeding.
• The technique of stapler hemorrhoidopexy, also known as the stapler hemorrhoidectomy, is the preferred intervention in many specialized centers compared to open hemorrhoidectomy.
• Statistically, there have been no significant differences between the techniques of open hemorrhoidectomy and stapler techniques.

Recent studies have shown that patients who underwent stapler hemorrhoidopexy experienced less pain and the healing time was shorter compared to the open hemorrhoidectomy method. However, the percentage of hemorrhoid recurrence, over several years, was much higher in Stapler interventions.