Hemorrhoids, also known as piles, are swollen veins in the rectum and anus that can cause discomfort, pain, and sometimes bleeding. They can be internal, occurring inside the rectum, or external, forming under the skin around the anus. Many factors contribute to their development, including straining during bowel movements, chronic constipation or diarrhea, obesity, pregnancy, and a sedentary lifestyle.
When patients with hemorrhoids present in the outpatient department, they often complain of symptoms such as rectal bleeding, itching, pain, or a lump near the anus. As a surgeon, it's crucial to conduct a thorough physical examination, which includes a digital rectal examination (DRE) and proctoscopy. These examinations help in assessing the grade and severity of hemorrhoids.
Hemorrhoids are graded based on their severity:
- Grade I: Hemorrhoids that bleed but do not prolapse.
- Grade II: Hemorrhoids that prolapse with straining but spontaneously reduce.
- Grade III: Prolapsing hemorrhoids that require manual reduction.
- Grade IV: Prolapsed hemorrhoids that cannot be manually reduced.
In cases where conservative management fails, surgical intervention may be necessary. Excisional hemorrhoidectomy is a surgical procedure performed to remove hemorrhoids indications for surgery are grade 2 hemorrhoid's with failure of medical management, grade 3 and grade 4 hemorrhoid's, thrombosed internal hemorrhoids and the interne external hemorrhoid's
Another surgical option is Doppler-guided hemorrhoidal artery ligation (DG-HAL). This minimally invasive procedure involves identifying and ligating the arterial blood vessels supplying the hemorrhoids, thereby reducing blood flow and shrinking the hemorrhoidal tissue. Usually done for grade 2 to grade 4 hemorrhoids. There is another minimally invasive procedure , the stapler hemorrhoidopexy in which a circular device is used to reduce the prolapsed hemorrhoidal mass .
Advancements in technology have led to the use of lasers in the treatment of hemorrhoids. Laser treatment, or hemorrhoid laser procedure (HeLP), involves using a laser to shrink and remove hemorrhoidal tissue. It offers several benefits over traditional surgery, including reduced pain, faster recovery, and minimal post-operative complications.
Hemorrhoids are a common medical condition that can significantly impact a patient's quality of life. While conservative measures are often effective, some cases may require surgical intervention. Whether it's through excisional hemorrhoidectomy, Stapler hemorrhoidopexy, DG-HAL, or laser treatment, the goal remains the same - to alleviate symptoms and improve the patient's well-being.
Remember, if you're experiencing symptoms of hemorrhoids, don't hesitate to seek medical advice. Your doctor can provide personalized treatment options tailored to your needs. Stay healthy and informed!
Dr. Deepak Chawla