Dr. Ertan Beyatlı

Current Treatment Options for Hemorrhoids

(Update: ) - Digestive System Diseases

Hemorrhoids or breech complaints are not given much importance in the society, people are ashamed and do not want to go to the doctor. This is a sad situation. Because hemorrhoids It is also a disease such as blood pressure and sugar. Who wouldn't want to get rid of this disease !!?

I wrote this article based on hundreds of patients I treated. I hope it will cure your complaints as well ..

Contents


What is Hemorrhoids?

Hemorrhoids are swelling of the breech vessels in the shape of the breast. in public hemorrhoids, haemorrhoids, how are you ve buasir called. Hemorrhoids can be a stand-alone disease or a symptom of another disease. For example, constipation or malignant bowel disease.

Why Does It Happen?

In the breech area When the pressure increases, hemorrhoids may occur. The ends of the veins begin to swell like a breast and this hemorrhoid pack called. The following reasons can cause hemorrhoids:

  • Constipation, diarrheaprolonged waiting in the toilet (with a mobile phone or tablet),
  • spore (weight lifting, cycling, motorcycle and horseback riding, rowing),
  • sexual intercourse (rectal),
  • obesity (obesity), pregnancy,
  • old age and inactivity Situations such as (sitting or standing for a long time) can increase the pressure.
  • COVID-19 (Coronavirus).

In recent months, there has been an increase in hemorrhoid cases in our country and in the world due to the coronavirus pandemic. There are two main reasons for this. The first was that people stayed at home for longer periods of time due to less mobility and the holidays of work and schools. Consequently, the time spent in front of TV, computers and phones has prolonged. This situation caused swelling of the vein ends in the anus region. The second reason is the increase in the rate of blood clotting in COVID-19 disease, which led to coagulation in the silent hemorrhoid breasts (Thrombosed External Hemiroid) (Dr. Ertan BEYATLI August 2020)

There are two main types: interior and exterior. Internal hemorrhoids in Latin internal hemorrhoidsexternal hemorrhoids external hemorrhoids It called. What are impacted teeth? When one or more teeth fails to grow in the correct position and is therefore held below the normal gum line, it is called an impaction. This can be complete, such as completely unerrupted (buried) third molars (wisdom teeth) or partial when just part of the tooth is visible in the mouth. Why are impactions important? For best function and appearance the teeth should grow in a healthy alignment. When one or more teeth is impacted, this can affect the function of that tooth but also the function and appearance of other teeth. Whether all impactions should be treated is still controversial and your dentist and oral and maxillofacial team can explain the advantages and disadvantages or treatment for you, which is usually surgical.

How do I know if I have hemorrhoids?

If you have these complaints in your rectal area, there is a high probability of hemorrhoids:

  • Pain or aches in the rectal area, especially during and after the toilet
  • Rectal blotchy or clotted blood
  • Soft or hard breast-like swelling in the breech area
  • Itching and moistening in the seat area
  • Stopping in the toilet for a long time
Hemorrhoid distribution according to clockwise

The diagnosis is made by examination. Rectal examination is performed by a General Surgery Specialist. Especially the intestine and rectal diseases Colorectal surgeon (proctologist, proctology expert) is called.

Breech examination can be performed as if kneeling or lying on the side. As seen in the photo above, hemorrhoid swellings (hemorrhoids) are named clockwise. Breasts are most often at the level of 1,5,9 o'clock. (in lithotomy position 3,7,11). There are main veins in these regions.

Any swelling or bleeding in the rectal area, hemorrhoids NOT. (Dr. BEYATLI, 2004)

Some malignant bowel diseases do this too. Therefore, in middle and elderly people colonoscopy It is important to scan the intestines with. Hemorrhoids are like an iceberg. You just notice its top.

How many degrees does it have?

  1. First degree: no swelling and is found by chance
  2. Second degree: swelling occurs and goes out but disappears spontaneously
  3. Third degree: the swelling is only pushed inwards by hand.
  4. Fourth degree: swelling does not disappear at all.

There may be bleeding in any degree of hemorrhoids.

Hemorrhoid Stages - Grade-Classification - Grading
Degree of Hemorrhoids (Hemorrhoid Stages): 1. no breast, 2. breast disappear spontaneously, 3. breast is lost by hand, 4. breast is constantly outside and does not disappear.

In complicated situations (we can call it 5th degree), problems such as wounds, inflammation, bursting, coagulation, and cancer occur in the breasts.

Bleeding

As I mentioned before, bleeding occurs at every stage of hemorrhoids and this is called Hemorrhoid bleeding. The most important cause of bleeding is the erosion of the veins that expand in the style of the breast in the anus region due to friction. Sometimes bleeding is a drop or two, and some patients may have excessive bleeding. Blood coming from the anus like a tap. In fact, when some of my patients come to the examination, their clothes are covered with blood and even the chair they sit on is stained with blood. These are mostly seen in stages and neglected hemorrhoids.

In some patients with hemorrhoids Anal fissure also accompany. In these cases, the blood from the fissure also adds to the hemorrhoid bleeding. In cases of fissure, there is also excessive anal pain during and after the toilet. Pain like a glass cut, this condition causes spasm of the rectal muscles.

In some cases, besides hemorrhoids Anal fistula is seen. In these cases, there is bloody discharge. In addition, there is moistening, itching and redness in the anus area.

In some cases, the cause of bleeding may not be hemorrhoids. In diseases in the upper parts of the intestine, it may cause blood to come from the urine. for example colon inflammation - colitis, diverticulum disease, colon polyp, Colon cancer etc.

Rectal pain

Hemorrhoids do not cause pain in the first stages. When the breasts are out of the anus, pain may begin. Sometimes blood clots occur in the breast due to excessive straining. This condition can cause sudden and severe pain. This is especially seen in external hemorrhoids and Thrombosed External Hemorrhoids It is called. Also, accompanying fissures can be the cause of pain.

Hemorrhoids and Hemorrhoids Which is right?

The word hemorrhoids has passed from Latin to Turkish. In Latin (hemorrhoid) is written as. Some sources incorrectly wrote the last letter as (t) instead of (d) during translation, following the Turkish spelling rules. Suffix - when it comes to it, it brings to mind the state of infection. The correct thing is that it is written as (Hemorrhoids).

Constipation (Hemorrhoids and Constipation)

This situation is similar to the story of chicken or egg coming out of chicken 🙂 Some studies show that the main cause of hemorrhoids is constipation. Other studies argue that hemorrhoids cause constipation. There is a vicious circle. Both views may be correct, but the important thing is that both situations trigger each other. Therefore, it is important for patients to change their lifestyle after treatment. Drinking plenty of water, eating fresh vegetables and fruits, and regular meals can relieve constipation.

What is Thrombosed External Hemorrhoids?

Especially if a clot occurs in the outer hemorrhoid breast, a very painful and purple-colored hardness is seen. This Thrombosed External Hemorrhoids called. In other words, clotted external hemorrhoids. It is usually seen in cases of extreme diarrhea or extreme constipation and straining. Patients who experience this condition cannot sit due to pain, and some become unable to walk and speak.

thrombosed hemorrhoids
thrombosed hemorrhoids

In hemorrhoids that continue for a long time, the blood flow in the enlarged vein slows down and sometimes causes clot formation. The most important factors that trigger this situation are excessive constipation and straining. Occasionally, patients who undergo surgery for internal hemorrhoids also have a clotted external hemorrhoid condition due to excessive discharge after surgery.

Other causes of thrombosed hemorrhoids are blood clotting problems, immobility, and large intestine tumors and diverticula especially in elderly patients.

What are its harms and dangers?

Hemorrhoids can turn people's lives upside down. Going to the toilet is literally torture. There may be other problems in patients who keep their toiletries. e.g İBSdiverticulum. Patients are always nervous and sleepless. Hemorrhoids can cause pain during sexual intercourse due to anatomical proximity, common nerves and muscles. Penile erection may decrease in men and may cause reluctance in women (loss of libido).

Related Article: What can hemorrhoids cause?

Our promise to an ancestor says "drop by drop becomes a lake". Blood flowing from the breasts can cause anemia over time (anemia). Blood is sometimes mixed with stool and cannot be understood. This situation can lead to heart failure and valve insufficiency. Patients sometimes become unable to sit, stand, work or speak. Severe hemorrhoid breasts sometimes Stool Incontinence Disease (fecal incontinence) may cause.

What is the cure for hemorrhoids?

What is good for anal pain? There is a remedy for every problem, of course, the important thing is the correct diagnosis. There are some puzzling questions. What is the exact solution, will there be recurrence, how long will the surgery take? Will it be pain, will you faint, when can I go back to work, how much is the price, will it not be if I do not have surgery .. these questions will go on and on ..

Home treatment

Things that are good for hemorrhoids: Diet rich in fiber (vegetables and fruits), probiotics, sitting bath and creams. for example Containing zinc, nitroglycerin and cortisone, eg Proctologist. In addition, drugs that regulate the blood flow in the anus area, such as Daflon and Doxium, can be used. Do not wait long on the toilet. Don't worry. Drink 1.5-2 Lt of water a day.

Attention ! "Hel Kim H8 Centaury Oil Extract Cream" sold under the name of hemorrhoid cream in the market may contain some undesirable substances and is not recommended.

In some cases, the hemorrhoid nozzle hangs out of the anus and edema occurs. These situations are very painful and require immediate intervention. Using a lubricating gel or cream, the hemorrhoid nozzle can be inserted back into the anus with gloves. This is a temporary solution.

Hemorrhoids treatment according to stages

  1. Stage Hemorrhoid Treatment: Generally, patients are not treated because they have no complaints. At this stage measures to be taken at home medication can be used. In cases where there is no response, non-surgical methods can be applied.
  2. Stage Hemorrhoid treatment: At this stage Laser hemorrhoid treatment It emerges as the best option. Alternatively, other non-surgical methods can be applied, but the success rates are lower than laser treatment.
  3. Stage Hemorrhoid Treatment: At this stage, laser hemorrhoid option is at the forefront and has a high treatment success. In addition, rubber band ligation and other non-surgical methods can be applied. Surgery (hemorrhoidectomy) is an alternative.
  4. Stage Hemorrhoid Treatment: Unfortunately, many patients in our country come to a doctor's examination only at this stage. At this stage, the laser method is again used for fast and comfortable treatment. Since the size of the hemorrhoid nozzle is large, the success rate of other non-surgical methods (eg band ligation and sclerotherapy) is very low. Again, hemorrhoid surgery is a powerful alternative treatment. However, this option is gradually being replaced by laser method due to the operation time, recovery time and postoperative problems.
  5. Complicated Hemorrhoid Treatment: Abscess, fissure, fistula, prolapse, polyps with hemorrhoids. In cases, more than one treatment option can be applied. For example, partial surgical intervention may be required in addition to laser treatment.

Non-Surgical Solutions

Non-surgical hemorrhoid treatment options are as follows:

  • Hemorrhoids can suffocate with a rubber band (band ligation).
  • Laser or infrared Nozzles can be extinguished with light.
  • Burning method (Cauterization, Bipolar coagulation) It is a very old method and was made by Şerafettin Sabuncuoğlu during the Ottoman period.
  • The medicine can be squeezed dry for your breasts (Sclerotherapy).

Laser Hemorrhoids treatment

Laser hemorrhoid treatment is a new method and is not a surgery. In other words, scissors, knives and stitches are not used in this method. Hemorrhoids are not cut. Hemorrhoid vessels are closed with a laser needle. Breasts shrink and disappear like a pierced balloon. Pain and bleeding also cease. Laser treatment can be done in the office or hospital with local anesthesia. It is an easy, fast (5 minutes) procedure that can be done daily without going to bed.

Patients can return home after an hour. One day later, he can continue his normal life. They can take a walk, take a bath, drive a car, and go to work.

Laser operation, hemorrhoids degree It can be done, but it may be required to be used with surgical intervention, especially in some advanced cases. In this context, when we look at the patient comments after laser hemorrhoid treatment, it is possible to obtain very successful results. Many factors may play a role in laser treatment costs. The general condition of the patient, the degree of hemorrhoids, other accompanying pathologies, etc.

Why should I choose Laser Hemorrhoid treatment?

  1. Fast. The treatment time (15 minutes) and recovery time (2-3 days) are short.
  2. Non-surgical method. No stitches, scissors and knives.
  3. Comfortable. No post-treatment pain, bleeding and discharge
  4. Easy. The procedure does not require special preparation or hospitalization
  5. Effective. After the procedure, the patient can return to his daily life, walk, bathe, drive and go to work.
Mr. Sabis, our patient who came from Belgium for fistula treatment and underwent laser application.

Laser therapy can also be applied in anal fissure, fistula and ingrown hair diseases. Treatment fees can be very different. The condition of the patient, the degree of hemorrhoids, the practitioner and the hospital, the brand of the laser device, etc. situations can affect the cost of laser therapy.

Hemorrhoid Surgery

Breasts are cut and removed (Hemorrhoidectomy). Remaining tissues are left open (Milligan Morgan method) or sewn off (Ferguson method). When the tissues are stitched, the wound healing time becomes shorter.

Stages of hemorrhoid surgery (Bailey And Love's Short Practice Of Surgery @ertanbeyatli)
Stages of hemorrhoid surgery (Bailey And Love's Short Practice Of Surgery @TurkishTurkish)

Recovery period after surgery can be 20-90 days. Avoid straining after surgery. Take pulp-free food for a few days. For example, soup, milk, yoghurt, eggs, cheese, butter, honey, jam, light tea, fresh juices, peeled fruit. Avoid spicy and spicy foods.

Laser vs Surgery Comparison

System FeaturesLeisureOperation
EaseDailylying
Süre5-15 min30-60 min
Pain, Bleeding, inflammationazmuch
Improvement2 days40-90 days
CostNormalLow
PrevalenceAzVery

To watch Laser Hemorrhoid Treatment videos - Click

What is Sitting Bath?

It can be made in a basin or tub. There are special plastic sitting tubs. 3 times a day for 15 minutes at a temperature that does not burn the elbow (38oC) sit in the warm fountain water. Sea water can also be used and accelerates wound healing. Sitting bath hemorrhoids, fissure, fistula, anal abscess can be done in situations.

Sitting Bath - plastic sitting tub

In order to reduce pain and accelerate wound healing, especially after surgery, patients are offered sitz baths. (sitz bath) recommended. Alcoholic solutions (Rivanol etc.) and iodized solutions (Batticon®, Betadine®, batikon water etc.) may delay wound healing.

Does hemorrhoids recur?

Does not repeat !!

Repetition of complaints after treatment inadequate treatment, new hemorrhoids formation or other diseases indicates that it is. For example; fissure, fistula, polyps, crohn's and colitis disease, etc.

New hemorrhoids are the most common reason we encounter. In the breech area There are 2 main veins, 1 on the right and 3 on the left. This condition can sometimes occur in only one vein. New hemorrhoids may develop in other vessels after surgery. The reason for this is that patients continue the same lifestyle.

Surgeries can sometimes be insufficient. To the physician dealing with rectal diseases Proctologist (Proctology) called. 75% of hemorrhoids are in the anal canal. It is like an iceberg as I explained above. The intervention made only to the top of the iceberg will not make the mountain disappear! Cut a balloon in the middle, tie a knot and blow again. The balloon will inflate again. Therefore, breasts, some of which are removed, will of course swell and expand again over time!

Hemorrhoids do not recur after adequate treatment. New hemorrhoids may occur, the intervention may be insufficient, or the diagnosis of hemorrhoids may not be correct. Op.Dr.Ertan BEYATLI

F.A.Q.'s

Does bitter food cause hemorrhoids?

No. Hot and spicy foods alone do not cause this situation, but they can cause exacerbation of complaints in people with hemorrhoids.

What should be done for hemorrhoids during pregnancy?

Most of the hemorrhoids that occur with pregnancy may disappear after birth. Therefore, if there are no serious complaints or complications, the situation should be followed up.

Does hemorrhoids cause gas and bloating?

Of course it does. Since advanced hemorrhoids cause a narrow passage in the anus region, it increases the gas and stool waiting time in the intestines. In this case, swelling, bloating and colic in the abdomen stomach painIt may cause.

Does hemorrhoids turn into cancer?

Cancer transformation in hemorrhoid tissue is an extremely rare condition. The main reason for this situation can be caused by the hemorrhoid nozzle that is constantly exposed to friction. In addition, the long waiting time of the stool in the large intestine can also lead to colon cancer. However, these two cases are very rare.

Does diarrhea cause hemorrhoids?

In case of excessive and prolonged diarrhea, external hemorrhoids may develop. Sometimes, painful clots form within the hemorrhoids. Thrombosed external hemorrhoids It called. What are impacted teeth? When one or more teeth fails to grow in the correct position and is therefore held below the normal gum line, it is called an impaction. This can be complete, such as completely unerrupted (buried) third molars (wisdom teeth) or partial when just part of the tooth is visible in the mouth. Why are impactions important? For best function and appearance the teeth should grow in a healthy alignment. When one or more teeth is impacted, this can affect the function of that tooth but also the function and appearance of other teeth. Whether all impactions should be treated is still controversial and your dentist and oral and maxillofacial team can explain the advantages and disadvantages or treatment for you, which is usually surgical.

What is the effect of swimming in the sea and pool in rectal diseases?

Going into the sea contributes very positively and speeds up wound healing. Especially in the summer months, it is beneficial to swim in the sea and stay for a long time. Patients who do not have the opportunity to enter the sea may enter the pool. There is no question of the wound getting germs from chlorine-containing pool water or sea water.

Olive oil is good for hemorrhoids?

Olive oil has benefits before and after surgery with hemorrhoids and anal fissures. It softens the area, reduces irritation and accelerates wound healing.

Are laser treatments performed in public hospitals?

This situation varies with the province. In some provinces, for example, in Ankara and Istanbul, some state hospitals and medical faculties provide laser hemorrhoid treatment.

Is there a non-surgical solution?

First and some early second-degree hemorrhoid breasts may regress and disappear over time with medication. During this period, attention should be paid to eating and drinking habits and constipation and straining. 3rd and 4th degree hemorrhoids can only be treated with laser, drying, strangulation or surgery. also laser method You can get rid of this situation without surgery.

Which doctor does hemorrhoid surgery?

It is treated by General Surgery specialists.

How long will it heal? How many days does it pass?

Recovery time is a few days in treatments with laser, strangulation or drying methods. In hemorrhoid surgeries, it may take a few weeks to a few months depending on the degree of hemorrhoids, the number of breasts, the type of procedure performed and the general health of the patient.

How many types of hemorrhoids are there?

It has internal and external types. Internal hemorrhoids are called female, internal hemorrhoids, and external hemorrhoids are called male or external hemorrhoids.

How old does hemorrhoids start? who does not have

It is a disease that can occur at any age from 7 to 70. However, the rate of hemorrhoids is higher, especially after the age of 20. Factors such as constipation, pregnancy, and obesity may increase the risk of developing this disease.

How does hemorrhoids pass at home?

Keeping the rectal area warm, warm sitz bath, consuming fresh fruits and vegetables and drinking plenty of water can be good. In addition, not standing or sitting for too long can prevent this from happening.

How much hemorrhoids bleed?

The amount of blood coming from the hemorrhoid can be from 1-2 drops to 1-2 liters. As I explained above, bleeding occurs in all degrees of this disease, but the amount of bleeding may be higher in advanced stage hemorrhoids. Some patients are covered in blood even when they come to the examination.

When does hemorrhoids cause pain?

Usually it does not cause pain. However, when the breasts reach a large size, the possibility of rubbing with feces increases. Irritation and redness caused by friction can be painful and painful. In very advanced cases, since the breasts are constantly outside the breech ring, they are compressed and cause pain.

Sometimes external hemorrhoids have clotting and can cause very severe and sudden pain (Thrombosed External Hemorrhoids). When inflammation or abscess occurs in the breasts, there may be pain. In some patients, the cause of the pain is not hemorrhoids, but there may be accompanying tears or cracks in the anus region (Anal Fissure).

When are hemorrhoids operated?

In previous years, surgery was performed for all stages of hemorrhoids. With the development of technology, the operation is performed only in complicated hemorrhoid cases. Non-surgical treatment methods are becoming increasingly important.

Especially laser hemorrhoid applications When it is performed by an experienced surgeon, it gives very nice and pleasing results. For detailed information click here.

When does hemorrhoids get ragged? what triggers?

Excessive straining, constipation, excessive diarrhea, bitter and spicy foods can cause hemorrhoids.

When is hemorrhoids dangerous?

In advanced cases, excessive blood loss may occur. This condition can cause early heart failure.

Where does hemorrhoids cause pain?

First of all, it may cause pain in the anus area. In addition, hemorrhoids can be felt in the groin, waist, lower abdomen and legs due to common nerves.

Which cream is good for hemorrhoids?

There are many creams, ointments and mixes available in pharmacies, and the number is increasing day by day. If you ask which is the best, I would say the cream your doctor prescribed for you is the best.

How many days will hemorrhoids be reported?

In hemorrhoid treatments performed with laser method, 3-5 days of rest report can be given. After hemorrhoid surgeries, the report period is given according to the recovery status. In some difficult situations, even a committee report may be required.

When should a doctor be seen?

You should go to the doctor with the first drop of blood coming from the anus area. He must first be sure if he has hemorrhoids. Don't be shy and feel free.

In which position is hemorrhoid surgery performed?

It can be made in two main positions. In the gynecological (lithotomy) position, the patient is placed on his back and the legs are suspended. A support pillow is placed in the groin area of ​​the patient in the face-down position and he is laid face down. Left or right side lying position may be preferred especially for treatment with local anesthesia.

How many hours does hemorrhoid surgery take?

Depending on the degree and number of hemorrhoids, the operation time may take 15-60 minutes.

How to get hemorrhoids inside?

It is made using a lubricating gel or cream in a convenient position. With the help of the hand, the breasts that hang out are applied for 1-2 minutes. When the breasts start to shrink a little, they are pushed inwards with the help of a finger.

What is the symptom of hemorrhoids?

As I mentioned above, hemorrhoids are swelling of the veins in the breech area. This situation indicates that something is wrong. Any disease that causes constipation, straining, diarrhea can cause hemorrhoids. Also hemorrhoids in the large intestine diverticulum disease ve Colon cancer may also be a symptom of their condition.

Where is laser hemorrhoid treatment done?

Special laser devices are required for laser treatment of hemorrhoids. These devices may not be available in every hospital or center. Therefore, you should discuss this situation with the hospital and physician you have decided for treatment.

Does hemorrhoids cause gas incontinence?

Severe and especially more than one hemorrhoid nozzle causes stenosis in the exit part of the anus region. Therefore, the voluntary gas extraction situation becomes difficult for patients. In the breech area The accumulated gases start to leak unintentionally due to the pressure and gas leakage event occurs. In addition, some hemorrhoid surgeries have damaged the muscles and nerves in the anus region. gas and stool incontinence condition can be experienced. Such risks laser hemorrhoid treatments it is almost negligible.

SUMMARY
Illness: HEMOROID, BASUR.
Causes: Seizures, constipation, diarrhea, eating and drinking habits, etc.
Symptoms: Anal swelling, pain, and bleeding
Diagnosis: Inspection is enough. A rectoscopy or colonoscopy may be required.
Treatment: Medication, band ligation, Sclerotherapy, Laser, Surgery.

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