Treatment of hemorrhoids

Treatment of hemorrhoids depends on the stage of development of the disease.

You can read about the disease, stages of hemorrhoids, and preventive measures in the article “ Hemorrhoids ”.

How to treat hemorrhoids?

As a rule, hemorrhoids of stages I and II are treated conservatively if they are not accompanied by severe pain or complications.

For hemorrhoids of stages III and IV, surgical treatment is usually necessary.

External hemorrhoids, if they do not cause itching, weeping and are not accompanied by inflammation, thrombosis and frequent and heavy bleeding, do not require special treatment. To prevent complications, a particularly thorough toilet after stool and baths with potassium permanganate are recommended.

Treatment of hemorrhoids during exacerbation

In case of acute inflammation of hemorrhoids (“bumps”), strict bed rest is necessary for 7-14 days.

It is advisable to hold stool for 4-5 days. To do this, you must adhere to a slag-free diet.

Nutrition for exacerbation of hemorrhoids

Products for slag-free nutrition:

• white omelette,
• beef broth,
• boiled meat, turned through a meat grinder,
• slimy rice porridge in water with a small piece of butter,
• white bread crackers 3-4 times a day,
• Drink plenty of fluids - 4-6 glasses of lightly sweetened tea.

First aid for hemorrhoids

In the first two days, cold lotions from a weak solution of potassium permanganate must be applied to the inflamed nodes. Lotions are made with cotton swabs soaked in this solution. They must be done in sessions, 3-4 sessions a day.

One session consists of applying lotions every 15 minutes for 1.5-2 hours.

After 2 days, a novocaine blockade into the thickness of the anal sphincter is recommended (done by a doctor).

After the blockade, a wide compress with Vishnevsky ointment is applied to the area of ​​​​the inflamed nodes, which is left for 2 days.

Starting from 4-5 days, baths with potassium permanganate (temperature 34 ºС) are prescribed once a day, suppositories and compresses with Vishnevsky ointment.

Herbal infusion for exacerbation of hemorrhoids

It is useful to drink an infusion from the collection of the following medicinal herbs:

• senna leaves,
• yarrow grass,
• buckthorn bark,
• coriander fruits,
• licorice fruits.

Preparation: mix herbs in equal quantities, pour 1 tablespoon of the mixture with a glass of boiling water, leave for 30 minutes, strain.

Drink 1 glass of infusion at night.

Laxatives

It is necessary to monitor the stool. If the act of defecation is difficult and accompanied by straining, and the herbal infusion does not help, then it is recommended to drink Vaseline oil at night.

In case of persistent constipation, cleansing enemas should be given. In this case, the following rule for administering an enema should be strictly observed.

The enema tip, generously lubricated with petroleum jelly, must be inserted into the anus along the healthy wall of the anus so as not to touch the painful node.

In this case, a cleansing enema is preferable to laxatives, as it helps relax the sphincter and better cleanse the intestines.

Severe inflammation with complications of thrombophlebitis lasts a long time, sometimes 3-4 weeks.

Treatment of bleeding from hemorrhoids

Suppositories are used as a local treatment for bleeding from the veins of the rectum.

Suppositories are administered 2 times a day, at night and after stool.

In addition, it is necessary to take 10% calcium chloride solution orally, 1 tablespoon 4-5 times a day.

With repeated bleeding of internal hemorrhoids, especially if anemia develops, surgical treatment is necessary.

Sclerotherapy for hemorrhoids

This is another method to stop bleeding. It consists of introducing special sclerosing solutions into internal hemorrhagic nodes. These solutions cause blood clotting in the node and its subsequent cicatricial wrinkling.

This method is effective. However, it cannot be used if the internal nodes fall out of the anus.

Before the procedure, a cleansing enema is given, and then an injection is made through the anoscope with a long needle. One node is sclerosed in one session.

Sclerotherapy gives good results in the treatment of stages I, II, III hemorrhoids. Used as a way to stop ongoing bleeding in patients with stage IV hemorrhoids.

The procedure uses a fiberoptic anoscope to allow the doctor to clearly see bleeding internal hemorrhoids located in the rectum.

A special syringe is used to inject drugs into the hemorrhoid.

Sclerotherapy allows internal hemorrhoids to be reduced and healed.

Immediately after the procedure, the patient has the opportunity to return to his usual lifestyle - go to work, drive a car.

During the first 14 days after surgery, you should not take thermal procedures (sauna, steam bath, bath), and also take aspirin and aspirin-containing drugs that reduce blood clotting.

After 12-14 days, the patient comes for examination to a coloproctologist, who decides whether to continue or complete treatment.

Sclerotherapy is usually carried out in a course of 1-3 sessions. At the initial stage of hemorrhoids, even 1 session is enough to cure hemorrhoidal disease.

Treating hemorrhoids at home

If internal hemorrhoids bleed, but are not complicated by prolapse of nodes, anemia does not cause headaches or deterioration in health, then treatment can be carried out conservatively.

Strict adherence to the diet is necessary. Doctors believe that even a small amount of alcohol (including beer) can cause bleeding.

Spicy or too salty foods can have the same effect.

Intestinal function is of great importance.
If you are concerned about constipation, then you need to take measures to eliminate it. You can read about this in the article “ Constipation ”.

In addition, it is recommended to eat one of the following foods to soften the stool at night:

• boiled red beets with vegetable oil or sour cream,
• carrot juice,
• one-day kefir,
• 1 tablespoon of Vaseline oil.

Treatment of hemorrhoids complicated by thrombophlebitis

In case of exacerbation of thrombophlebitis, the first 3-4 days require bed rest and diet.

To resolve a blood clot, sitz baths (34-35 ºC) with potassium permanganate are prescribed for 10-15 minutes.

Suppositories are administered 2 times a day. The following composition of suppositories is recommended - belladonna extract 0.015 g, novocaine 0.12 g, xeroform 0.1 g, streptocide 0.08 g, base - cocoa butter - up to 2 g).

If after 10 days the blood clot does not begin to resolve, then surgical removal is indicated.

Treatment of stage III and IV hemorrhoids should be surgical.

Surgical methods for treating hemorrhoids

Hemorrhoids of stages I and II with disturbing pain and frequently recurring bleeding causing anemia are treated with minimally invasive methods, which the surgeon performs on an outpatient basis.

These methods include:

• sclerotherapy described above,
• infrared photocoagulation (laser treatment),
• radio wave therapy,
• ligation of nodes with latex rings.

Treatment of hemorrhoids with laser

Infrared photocoagulation is a minimally invasive treatment method that is used in the initial stages of hemorrhoids complicated by bleeding.

The procedure is performed on an outpatient basis using a special device - an infrared coagulator.

A powerful light beam of infrared radiation with high temperature affects the hemorrhoidal node and leads to coagulation (compression) of its tissues.

According to the developers of the method, when the tissue of the internal hemorrhoid is exposed to light, photocoagulation necrosis of the tissue occurs, which, upon healing, leads to scarring and fixation of the node to the adjacent tissues.

How is the procedure performed?

On the day of the procedure, the patient must undergo special preparation.

The patient can choose one of the preparation schemes that will be more comfortable and accessible for him: a cleansing enema using 1-1.5 liters of boiled water cooled to room temperature or using 2 tubes of the drug “Microlax”.

An infrared coagulator is inserted into the rectum through an anoscope equipped with fiber optics. The coagulator is installed in the area of ​​the vascular pedicle of the hemorrhoid.

The duration of coagulation depends on the size of the node and averages 1-3 seconds.

After treatment, a “mark” is observed on the intestinal mucosa in the form of a white-gray area of ​​necrosis, which extends to a depth of 4-6 mm.

No more than 3 small hemorrhoids can be treated in one session. A repeat session of infrared coagulation is possible only after 12-14 days.

Advantages of the method

The advantages of the laser treatment method for hemorrhoids are as follows:

• bloodlessness of manipulation;
• speed of execution, which makes it possible to save patients’ time;
• the resulting effect from the procedure exceeds the results of conservative therapy.

Infrared coagulation can be combined with other methods of treating advanced stage hemorrhoids, for example, ligation with latex rings, etc.

Treatment outcome and possible complications

Infrared coagulation is used at stages I and II of hemorrhoids, but does not eliminate the cause of the disease, so relapse of the disease occurs in 60-70% of cases in the period from 6 to 8 months after the procedure. Therefore, in most specialized centers this method is practically not used.

After infrared coagulation, slight bleeding from the anus may occur on days 7-10. This is not a complication, but means the “exit” of destroyed tissues or the result of injury to the mucous membrane by feces at the treatment site.

Painful sensations can be observed for several hours to several days after the session. Also, as a complication, thrombosis of the node is possible if there is insufficient coagulation of its stem.

Indications and contraindications

Internal hemorrhoids of stages I-II can be treated using infrared coagulation.

Contraindications to the procedure are the presence of hemorrhoids of stages III and IV, as well as concomitant pathology of the anal canal (anal fissure, cryptitis, rectal fistula, combined hemorrhoids, etc.).

Radio wave therapy

Radio wave therapy involves excision of nodes using a radio knife (Surgitron device). Under local anesthesia, the doctor removes varicose veins. The undoubted advantage of this method of treatment is the almost complete absence of contraindications. The procedure is carried out quickly, it does not damage the surrounding tissues of the intestine and anus, which means that the likelihood of scarring and bleeding is reduced to zero.

Ligation of internal hemorrhoids with latex rings

The technology of this procedure is simple: the knot is grabbed by a vacuum manipulator, and a latex ring is placed on top, which is secured to the base of the knot. As a result, blood flow to the node stops and it gradually contracts. After about a week, the hemorrhoidal “bumps” are rejected along with such a ring, without causing significant inconvenience to the patient.

Ligation performed according to indications allows avoiding hemorrhoidectomy in the vast majority of patients.

For 3 to 10 days after the procedure, you may need to take strong analgesics due to pain. In this regard, only one node is ligated per procedure. Typically, 3 to 5 procedures are necessary for complete cure.

The main disadvantage of all minimally invasive treatment methods is that they do not eliminate the cause of the disease and there is a high probability of relapse. According to statistics, after 3-4 years the problem returns in approximately 70% of patients. In addition, they can only be used for stages I and II of hemorrhoids.

More radical are full-fledged surgical operations:

• transanal disarterization (HAL-RAR),
• hemorrhoidectomy,
• transanal resection (Longo operation).

Transanal disarterization (HAL-RAR)

As the leading and most effective method of treating stage II-IV hemorrhoids, coloproctologists recommend transanal disarterization, which has received well-deserved recognition throughout the world.

Initially, in 2000, the HAL technology was introduced - ligation of hemorrhoidal arteries under the control of Doppler ultrasound, effective for stages II and III of hemorrhoids.

Subsequently, the method was supplemented with RAR technology - lifting or tightening of hemorrhoids, used in stages III and IV of the disease.

Thus, HAL-RAR is one of the most effective and low-traumatic methods for treating hemorrhoids of any stage today.

The criterion for a positive treatment outcome is the cessation of bleeding and prolapse of nodes, improvement in the general well-being of patients.

Advantages of the method

Treatment by disarterization of hemorrhoids is the most common nowadays, since this method has a number of advantages.

• It has a small number of contraindications and poses minimal risk to patient health.
• In most cases, after surgery there are no wounds or severe pain.
• The procedure lasts on average 30 minutes.
• The risk of complications and bleeding after surgery is practically reduced to zero. The patient can return to work within 1-2 days after the operation.
• This method can be used at any stage of the disease and combined pathologies, that is, with a combination of hemorrhoids and anal fissure, rectal fistula and other diseases.

The procedure is performed under anesthesia.

After disarterization, after 10-12 hours, when the doctor is convinced that the patient’s condition is satisfactory, he can go home - there is no need to stay in a 24-hour hospital.

HAL-RAR procedure

The procedure involves identifying the position of the artery that supplies blood to the hemorrhoid using an ultrasound probe and suturing it with self-absorbable suture material.

The procedure is performed using an anoscope, which is inserted into the rectum. The device is equipped with illumination and a Doppler sensor, and has a special “window” through which manipulation is performed.

Similar manipulations are carried out with other arteries leading to the node. The knot itself is also stitched from the top to the base, which allows it to be pulled to the intestinal wall, freeing up its lumen.

Deprived of blood supply, hemorrhoids decrease in size and “shrink” within 1-2 weeks. The prolapse of nodes and bleeding stops.

Postoperative period

After the operation, you must adhere to a special diet, limit physical activity, do not lift heavy objects, and do not take thermal procedures (sauna, steam bath, hot baths).

Hemorrhoidectomy

Hemorrhoidectomy is the removal of venous nodes arising from the rectal plexus, followed by their ligation or complete excision. The postoperative period is quite difficult, but if you follow medical recommendations and periodic medical examinations, the patient's condition improves significantly.

This full-fledged surgical operation has been used in proctological practice for many decades. It is performed under general anesthesia. The rehabilitation period after hemorrhoidectomy is about a month, since the healing process of the postoperative wound can be lengthy.

For hemorrhoids, surgery using the hemorrhoidectomy method is a last resort, and it is performed if the patient has very large hemorrhoids and there is a high risk of massive bleeding.

There are several options for performing such surgical intervention. During hemorrhoidectomy, internal and external hemorrhoids are removed along with the affected rectal mucosa.

Moreover, if the wounds remain open, then this option is called the Milligan-Morgan operation, and if they are sutured, then the Ferguson operation.

Hemorrhoidectomy almost completely prevents the possibility of recurrence of the disease.

Despite its high efficiency, this method has a number of significant disadvantages:

• duration of the operation (about 40 minutes);
• significant blood loss;
• high risk of complications;
• need for hospital stay (3–7 days);
• difficult and painful rehabilitation.

The recovery period after surgery to remove hemorrhoids is 20-30 days.

Transanal resection

Transanal resection or Longo's operation for hemorrhoids is widely used as one of the most effective methods for treating the internal form of the disease.

Longo's operation is more gentle than a classic hemorrhoidectomy, since a small area of ​​the mucous membrane is removed, and the nodes are not excised, but rather pulled up and fixed. Blood flow to the veins decreases, and they are gradually replaced by connective tissue. For suturing the mucous membrane at the site of removal, titanium staples are used, which are applied using special staplers.

The operation using the Longo method takes about 15 minutes, and local anesthesia is sufficient to perform it. Low morbidity, but at the same time excellent therapeutic effect, low likelihood of complications and relapses make it preferable in elderly patients and people with severe concomitant pathology.

Despite the undoubted advantages, removal of hemorrhoids using the Longo method also has some disadvantages, including the impossibility of excision of externally located dilated veins and the need to monitor the patient for at least a week after the operation. In addition, due to the relatively short period of use of this operation, it is not yet possible to judge the long-term consequences of treatment.

Complications after surgery

The most common postoperative complications include:

• suppuration and inflammation in the area of ​​postoperative wounds caused by infection;
• fistula formation;
• narrowing of the anal canal;
• bleeding;
• urinary retention;
• pain syndrome;
• psychological discomfort;
• rectal prolapse.

Postoperative period

An important condition for the patient’s quick and successful recovery after surgery is adherence to a certain diet.

First of all, during this period, meals should be fractional: 5-6 times a day, in small portions. It is allowed to eat gentle food that promotes regular bowel movements.

Products that are recommended to be excluded from the diet: vegetables, fruits, greens with a high content of coarse fiber (sorrel, spinach), white cabbage, turnips, radishes, radishes, onions, garlic, apples, dates, grapes, tangerines, raspberries and gooseberries; pork, goose and lamb; sugar, pastries, sweets and brown bread; all legumes, mushrooms, raisins, nuts, milk, kvass and carbonated drinks.

It is strictly prohibited to consume smoked, pickled, spicy, canned foods and alcohol during the postoperative period!

If postoperative wounds remain as a result of the treatment, they are treated daily until complete healing with special agents prescribed by the doctor.

After each urination or bowel movement, it is necessary to wash with antibacterial agents to prevent infection.

To reduce pain, local and systemic pain medications can be prescribed.

Compliance with all recommendations of the attending physician in the postoperative period reduces the risk of complications.