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Haemorrhoids (Piles) and its Treatment

One condition that people are embarrassed about discussing is haemorrhoids, or piles as it is commonly called. The stigma is so high that medical attention is sought at an advanced level when the issues have started affecting the quality of life. Very few people even know that this is a GI condition and a GI surgeon is to be consulted for Haemorrhoids. Knowing about haemorrhoids helps us seek the right solution for both prevention and treatment. This condition affects men and women equally and a study indicates that nearly 50% the population of men and women above the age of 50 are affected by haemorrhoids and only 4% seek medical attention and treatment.

Haemorrhoids presents with a typical symptom of rectal pain, itching and bleeding. This is due to distended and swollen blood vessels that lie beneath the mucous membranes lining the lowest part of the rectum and the anus. These are caused when the veins become swollen to a cluster size that just looks similar to varicose veins.

Haemorrhoids are classified into two types based on their location; Internal Haemorrhoids – if the distended swollen veins occur in the lower rectum and External Haemorrhoids –if the swollen veins develop in the lining of the anus. Internal Haemorrhoids are typically painless when compared to the external ones which are the most uncomfortable and very painful during blood clotting.

Treatments

Treatment of Haemorrhoids (or piles) range from home measures, traditional haemorrhoid removal to minimally invasive treatments that are less painful and allow a quicker recovery. In many instances, when conservative treatment fails to produce effective management, it is advisable to go to the doctor who carefully assesses, diagnose, and treats the haemorrhoid patient. Surgical treatment is the final stage of treating haemorrhoids which is required at a very advanced stage.

Home Treatment

Treatment at home is the best option to manage pain and itching at a very initial stage. Good bathroom habits, rub on relief, icing, drinking lot of fluids, exercise, making a habit to sit on a soft cushioned surface, taking warm bath, and increasing intake of fibre can improve haemorrhoid symptoms dramatically.

Topical treatment

Topical treatment are used for mild itching and controlling the symptoms in combination with other treatments for moderate to severe haemorrhoids. Creams and suppositories including ointment, gel and medicated wipes deliver temporary relief of acute symptoms of haemorrhoids, such as bleeding and pain on defecation.

Non- surgical treatment

Rubber Band Ligation (RBL)

It is a simple, quick, cost-effective and widely used treatment for internal haemorrhoids, but is limited to 1 to 2 haemorrhoids at a time. The procedure involves tying the swollen cluster at its base with rubber bands restricting the blood flow. RBL require fewer sessions for treatment, although poses higher rate of post-treatment pain.

Sclerotherapy

It is a fixative non-surgical procedure typically prescribed for first and second-degree haemorrhoids and for those who do not respond well for the home treatment. The procedure employs injecting a chemical into the base of the haemorrhoid that hardens the inflamed tissue, thus reducing haemorrhoids blood flow.

Surgical treatment

Haemorrhoidectomy

Haemorrhoidectomy is a surgical procedure that is recommended by doctors when there is a failure in non-operative management and is opted only for the most severe cases. It is one of the effective treatment when compared to other treatments. There are several techniques of Haemorrhoidectomy which are briefed below

Conventional Surgical Haemorrhoidectomy (CH)

Certainly conventional surgical techniques are more invasive and painful in post-operative period and yield better long-term results. It basically involves the excision of the piles by clamping, tying off and then cutting the haemorrhoidal tissue. The risk of recurrence is lower. CH is suggested in IV grade cases.

Stapled Haemorrhoidectomy (SH) Non-excisional

It is a new technique using a stapler to excise a ring of mucosa. For patient with second-degree haemorrhoids and recurrent bleeding, who have failed to respond to non-surgical methods and in the management of third- or fourth-degree haemorrhoids, SH is the gold standard method. The advantages of this surgery includes shorter operative time, less urinary retention, less post-operative pain and quick recovery when compared to conventional one.

Harmonic scalpel removal:

It uses ultrasonic technology to cut and coagulate the haemorrhoidal tissue at the fixed point of application. This treatment modality is most widely used for large haemorrhoids. The pain and recovery time is lesser when compared to conventional surgical haemorrhoidectomy.

Laser removal

It uses laser to remove haemorrhoids by vaporizing and excising, offering less discomfort, less medication, and faster healing. The heat of the laser cauterizes the blood vessels so the haemorrhoid removal procedure is nearly bloodless. Laser can be used alone or in combination with other modalities.

Atomizing (Ferguson Haemorrhoidectomy)

It involves reducing a haemorrhoid into very minute particles. Atomizing is cost-effective and results in less bleeding and yielding excellent results with very rare complications

Summary

Treatment of haemorrhoids ranges from dietary and lifestyle modification to radical surgery, depending on degree and severity of symptoms. Surgery becomes an effective treatment of haemorrhoids, only for advanced disease and when non-operative treatment fail to resolve appreciable complications. Hence, a better understanding of the physiological process of haemorrhoids are needed to aid the development of novel and innovative methods for the treatment of haemorrhoids.

For further information, contact BIG hospital at 080-67779777/11

Reference

http://www.ijppsjournal.com/Vol3Suppl5/2136.pdf
http://www.health.harvard.edu/diseases-and conditions/hemorrhoids_and_what_to_do_about_them
https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids/treatment
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342598/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037334/
https://www.ncbi.nlm.nih.gov/pubmed/22462333
http://www.hemorrhoid.net/harmonic.php

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