40-50% of the population suffers from anal complaints at least once in their lives. One of the most frequent reasons of these complaints is hemorrhoids disease. Hemorrhoids Disease develops when blood-filled cushions located within the anal canal prolapse due to swelling or as a result of bleeding caused by a trauma. There two types; internal and external hemorrhoids.
External Hemorrhoids Disease develops around the anus. The most common complaint is the mass that is palpable to the patient. Sometimes, when the blood inside coagulates a special condition called thrombosed hemorrhoids develops and this causes very severe pain.
Internal Hemorrhoids Disease progresses inside the anus. Painless, fresh red colored bleeding during or after defecation is the most important symptom. Most common complaints are bleeding in the anus, papillae formation in the anus, flow and itch. Patients can palpate a mass prolapsing outwards from the anus during defecation. And they can push this swelled tissue back inside. However, as the disease further progresses, it becomes impossible to push the tissue inside. Therefore, constantly humid anus area causes itchiness complaint and feces and flow around the region leads to hygiene problems.
Does Hemorrhoids Disease Turn Into Cancer?
No, hemorrhoidal disease is not a cancer precursor. However, mass and bleeding in the anus should never be neglected. It is very wrong for patients to avoid doctor examination due to embarrassment or to try to remedy themselves with hearsay medications. Because similar complaints and symptoms may be present in large intestine, rectum (colorectal) and anus cancers.
How Should Be The Treatment
The choice of treatment depends on the severity of the patient's symptoms, the findings of the examination, duration and stage of the disease. This disease can recover by itself without any treatment in the early stages, and in many patients, simple measures can provide successful treatment results. However, it is difficult to achieve success with these conservative methods for long existing and advanced stage disease that disrupts the quality of life of the patient. In these cases, surgery is inevitable to completely get rid of the disease. The most important issue to keep in mind is that the symptoms of hemorrhoids can easily be confused with the symptoms of colorectal cancers or inflammatory bowel diseases. Therefore, a detailed anorectal examination and colonoscopic evaluation of all the patients should be performed before the treatment decision is made.
Contemporary Interventional Methods Applied for Hemorrhoids Disease Treatment
1. COAGULATION (CAUTERY) METHOD
This method is based on the principle to form tissue damage on hemorrhoids using a heat or light (laser) source. This way, piles are reduced and bleeding is prevented. This method can be used for early stage hemorrhoidal diseases that are not prolapsed from the anus (Stage 1-2) but causing bleeding complaints. Cautery is a short method that can be performed under polyclinic conditions.
2. BAND LIGATION METHOD
This is a painless and simple method that can be performed under polyclinic conditions. It is a suitable treatment method for prolapsed hemorrhoids (Stage 3-4) and patients with rectal bleeding complaint. In this method, hemorrhoid pads are tied from their roots with a rubber band using a special hand tool. These hemorrhoid tissues, of which the blood circulation is disrupted, are disposed during defecation in a few days. In general, the procedure is performed on a single hemorrhoid pad. Therefore, it may be necessary to repeat the procedure periodically with this method. There may be a feeling of discomfort or small bleedings in the anus after the procedure.
When these methods are supported by topically applied medication and diet, they can provide 90% treatment success for early stage diseases. It should not be forgotten that despite being beneficial for allowing the patients to return to work and social life early. The disease will reoccur in 70% of the patients treated with these methods.
3. SURGICAL TREATMENTS
a. Classical operation technique
This is the most suitable treatment option for patients with long-term hemorrhoids that are irresponsive to medication and preventive measures, prolapsed from the anus (Stage 3-4) with pain and bleeding complaints accompanied by external hemorrhoidal disease. Classical operation technique is based on removal of hemorrhoid tissues by incision. With the technological advancements, the use of instruments that use high thermal energy for the removal of these tissues enables less post-op pain. This operation is performed under surgery room conditions by applying spinal anesthesia and patients return home after spending one night at the hospital.
Hemorrhoids Disease | Classical operation technique
b. LONGO Method
This is a surgical method performed with specifically designed surgical tools (stapler) for the disease that is prolapsed from the anus (Stage 3-4). Hemorrhoid tissues, which are located at a region without a sense of pain, are not removed in this technique, instead, extra intestinal tissue is removed in a circular manner through an incision right above the anal canal and prolapsed tissues are pulled up inside the anus. As the procedure is performed on an intestinal segment without sense of pain, post-op patient comfort is quite high. Disease may relapse in 10% of the patients during the long term follow up.
c. THD (Transanal hemorrhoidal dearterialisation) Method
In this technique, tip of a very thin ultrasonography device showing the artery going to the hemorrhoid tissues is inserted inside the anus. Arteries going to the hemorrhoid tissues are found and ligated with sutures. It is applied to prolapsed (Stage 3) and bleeding (Stage 2) diseases and selected Stage 4 internal hemorrhoidal diseases. This is a very simple method and patients can return their normal life the next day.
Hemorrhoids Disease | THD (Transanal hemorrhoidal dearterialisation) Method