Natural remedies for hemorrhoids – Harvard Health

Hemorrhoids are painful, unpleasant, and, um, well, difficult to talk about. But they actually are quite common: about half of people over age 50 have had them. However, they’re easy to treat and manage.

“Hemorrhoids can be troublesome and embarrassing, but they often shrink on their own with simple self-help care and over-the-counter remedies,” says Dr. Howard LeWine, assistant professor of medicine at Harvard Medical School.

What are hemorrhoids?

Hemorrhoids are swollen veins near the anus. Common symptoms are rectal pain, itching, bleeding, and occasional protruding veins outside the anus.

There are two types of hemorrhoids: internal and external. You can have either type by itself, or both at the same time.

Internal hemorrhoids. These form inside the anal canal and usually are painless. However, they may cause intermittent bleeding with bowel movements, and sometimes discharge mucus. Internal hemorrhoids also can protrude outside the anus and look like small, grapelike masses.

External hemorrhoids. These form just outside the anal opening and can cause swelling, protrusions, and discomfort.

Why do hemorrhoids occur?

Sometimes hemorrhoids develop for no reason, but often they are associated with chronic constipation or diarrhea, straining during bowel movements, and prolonged sitting on the toilet. You can reduce your risk by following these three easy steps:

• Get enough fiber in your diet (guidelines suggest 14 grams for every 1,000 calories)
• Stay well hydrated (drink six to eight glass of water daily)
• Exercise regularly (aim for 150 minutes of moderate-intense activity per week).

Are there natural treatments for hemorrhoids?

First, some very good news: Neither type of hemorrhoid is dangerous, and severe complications that require medical care are rare. Symptoms often can be relieved by trying a few natural and self-care treatments.

• Draw a sitz bath. To relieve itching and irritation, fill a tub with three to four inches of warm (not hot) water and sit in it with your knees bent for about 10 to 15 minutes. Gently pat yourself dry with a towel, but don’t rub the area.
• Take fiber supplements. These draw water into your stool and make it easier to pass, helping to reduce hemorrhoid bleeding and inflammation. A psyllium husk fiber supplement, like Metamucil or a generic version, is a good choice. If psyllium causes gas or bloating, try a supplement with wheat dextrin (Benefiber) or methylcellulose (Citrucel).
• Ease discomfort. Apply over-the-counter products that shrink the inflamed tissue and relieve itching. Try pads infused with witch hazel (Tucks), or soothing creams that contain lidocaine, hydrocortisone, or phenylephrine (Preparation H).

You can also take steps to prevent flare-ups.

• Don’t delay. Putting off bowel movements can cause stool to back up, leading to increased pressure and straining, which aggravates your hemorrhoids.
• Sit right. Try not to sit on the toilet for long periods; this tends to make hemorrhoids push out and swell up. A way to speed up things is to elevate your feet with a step stool as you sit. This changes the position of your rectum to allow for easier passage of stools. Also, using a cushion beneath you when you sit on a chair or hard surface can ease swelling.
• Keep it clean. After every bowel movement, gently clean your anal area with a witch hazel pad, a soothing baby wipe, or a cotton cloth soaked in warm water. If you have any irritation afterward, apply petroleum jelly or aloe vera gel.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Hemorrhoid Treatment for Internal, External, or Bleeding Hemorrhoids

Written by WebMD Editorial Contributors

• Hemorrhoid Home Care
• Hemorrhoid Medications
• Medical Procedures for Hemorrhoids

Hemorrhoids often get better without surgery or even procedures your doctor can do in the office. Start with over-the-counter products and lifestyle changes. (If you’re pregnant, you should talk to your doctor before you try any medicine or change your diet.)

Try these tips to soothe the pain and itching of hemorrhoids.

• Warm Bath or Sitz Bath. It’s a time-honored therapy: Sit in about 3 inches of warm (not hot) water for 15 minutes or so, several times a day. This helps reduce swelling in the area and relaxes your clenching sphincter muscle. It’s especially good after pooping.
• Ointments. Put a little petroleum jelly just inside your anus to make pooping hurt less. Don’t force it! Or use over-the-counter creams or ointments made for hemorrhoid symptoms. A 1% hydrocortisone cream on the skin outside the anus (not inside) can relieve itching, too. But don’t use it for longer than a week unless your doctor says it’s OK.
• Witch Hazel. Dab witch hazel on irritated hemorrhoids. It’s a natural anti-inflammatory that can work against swelling and itching.
• Soothing Wipes. After you poop, clean yourself gently with a baby wipe, a wet cloth, or a medicated pad.
• Cold Compress. Try putting a simple cold pack on the tender area for a few minutes to numb it and bring down the swelling.
• Loose Clothing. Weaning loose clothing in a breathable fabric like cotton may help with discomfort.
• High-Fiber Diet. It’s the best thing for hemorrhoids: A diet rich in high-fiber foods and with few processed foods. Eat mostly vegetables, fruit, nuts, and whole grains to avoid constipation.
• Stool Softeners. If you can’t get enough fiber from food, your doctor may want you to take a fiber supplement or stool softener. Don’t take laxatives, because they can cause diarrhea that could irritate hemorrhoids.
• Keep Hydrated. Drink seven to eight glasses of water each day, at least a half-gallon total. If you’re very active or you live in a hot climate, you may need even more.

Even if your doctor prescribes medication or suggests surgery, you’ll probably need to change your diet. Introduce new foods slowly to avoid gas.

Pain relievers, including acetaminophen, ibuprofen, and aspirin, may help with your hemorrhoid symptoms. You can also choose from a variety of over-the-counter creams, ointments, suppositories, and medicated pads. They contain medicines like lidocaine to numb the area, or hydrocortisone or witch hazel, to reduce swelling and itching.

If your symptoms are severe or aren’t getting better after a couple of weeks, your doctor may suggest a procedure to shrink or remove the hemorrhoids. Many can be performed in their office.

Injection. Your doctor can inject an internal hemorrhoid with a solution to create a scar and close off the hemorrhoid. The shot hurts only a little.

Rubber band ligation. This procedure is often done on prolapsed hemorrhoids, internal hemorrhoids that can be seen or felt outside. Using a special tool, the doctor puts a tiny rubber band around the hemorrhoid, which shuts off its blood supply almost instantly. Within a week, the hemorrhoid will dry up, shrink, and fall off.

Coagulation or cauterization. With an electric probe, a laser beam, or an infrared light, your doctor will make a tiny burn to remove tissue and painlessly seal the end of the hemorrhoid, causing it to close off and shrink. This works best for prolapsed hemorrhoids.

Surgery. For large internal hemorrhoids or extremely uncomfortable external hemorrhoids, your doctor may recommend surgery.

• Hemorrhoidectomy. The most effective technique is to completely remove the hemorrhoids. But recovery is painful and can take several weeks.
• Hemorrhoid stapling. This technique cuts blood flow to internal hemorrhoids and moves prolapsed tissue back in place. Recovery is easier, but there’s a greater chance of the hemorrhoids coming back.

Newer procedures use less invasive techniques to identify and cut off the blood supply to the problem tissues.

Medical treatments are effective, but unless you change your diet and lifestyle, hemorrhoids may come back.

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Get rid of hemorrhoids quickly and forever!

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Get rid of hemorrhoids quickly and permanently!

02/09/2021

Many people suffer from hemorrhoids for years and do not dare to undergo surgery, believing that it will hurt and put them out of action for a long time.

However, today there is a progressive technology that allows you to operate on hemorrhoidal disease without incisions and severe pain. And it will allow the patient to return to the usual mode of life, as a rule, after 7-14 days.

We are talking about the HAL-RAR method – desarterization of hemorrhoids under the control of ultrasound Doppler in combination with mucopexy. The technique is successfully applied in the Reaviz multidisciplinary clinic.

The essence of the technique?

Under anesthesia, a special instrument is inserted into the rectum – an anoscope with a built-in ultrasonic sensor. Using a sensor, the surgeon identifies all the arteries that feed the hemorrhoids. Then, through a special hole in the anoscope, the doctor bandages these vessels, and the flow of arterial blood to the nodes is blocked. Deprived of blood flow, the nodes collapse and are replaced by connective tissue.

This technique is well combined with a laser (method – LHP), which produces the so-called “evaporation” of nodes. It consists in the fact that a light guide is inserted through a puncture into the thickness of the hemorrhoidal node and the laser energy acts on it, destroying or, more correctly, evaporating the contents of the node. Quite quickly after this, the node turns pale and the mucosa sticks together

This combination of techniques is especially effective in “neglected” cases.

What are the advantages of the HAL-RAR methodology?

• The operation is low-traumatic, bloodless and painless

• In the postoperative period (within 1-2 days), the patient experiences moderate pain and moderate discomfort for up to two weeks.

• A new node cannot form in place of the old one.

• The duration of the operation is on average 30-40 minutes

• The time of the patient’s stay in the hospital (taking into account the preoperative preparation and the postoperative period in the day hospital) is up to 24 hours.

• The ability to return to a working mode of life on average after 2 weeks.

The technique is effective for II and early III stages of the disease.

As you can see, there is no reason to be afraid of the operation! The main thing is not to delay your visit to the doctor and live in comfort!

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How to get rid of hemorrhoids forever?

Ekaterina Kryukova: Hello, this is the Online Reception channel, where we discuss a variety of medical issues. Today we are discussing the topic of how to get rid of hemorrhoids forever. Rustam Abdullayev, coloproctologist, surgeon at the MedikCity clinic, will help me understand this issue. Hello Rustam.

Rustam Abdullayev: Hello, Ekaterina.

Ekaterina Kryukova: How do you like these prospects, how possible are they in the case of hemorrhoids?

Rustam Abdullayev: Yes, it’s all possible. You can get rid of hemorrhoids forever, there are several ways.

Ekaterina Kryukova: Let’s first understand what it is.

Rustam Abdullayev: Let’s first understand the causes of the disease, and then I will explain how it is all treated.

The cause of hemorrhoids is that there are hemorrhoids in the anal canal – these are formations that have a venous structure. But, unlike the veins, they have a spongy structure, the blood enters there through the arteries, and flows out through the vein. When the outflow of blood is disturbed, the inflow is always preserved, because the blood enters the hemorrhoids through the artery, which pulsates and actively brings blood to the nodes. When a person is sitting, for some other reason, when the outflow is disturbed, the nodes begin to increase in size, the mucosa over them becomes thinner. The ligaments that hold this knot are stretched and torn off, and the knots begin to fall out, bleed, etc. There are different methods of treating hemorrhoids.

Ekaterina Kryukova: Let’s be specific. We have a rectum, inside the built-in hemorrhoids are the essence of the veins that help the blood circulation of the rectum.

Rustam Abdullayev: They don’t really help. In fact, this is a rudimentary formation, that is, only upright walkers suffer from hemorrhoids, four-legged animals do not suffer from hemorrhoids, because when a person stood up, internal pressure on the terminal section of the rectum increased. In this case, the outflow suffers, while the inflow remains.

Ekaterina Kryukova: That is, we have an urge to go to the toilet, there is an inflow, we do it, but in the future it drags on, formations appear, these knots fall out.

Rustam Abdullayev: Quite right.

Ekaterina Kryukova: The first stage of hemorrhoids is manifested by internal nodes that do not yet fall out, not visible to the eye. How does this happen?

Rustam Abdullaev: There are only 4 stages. The first stage can pass without symptoms at all. They do not fall out, they can only bleed, itching may appear, and other symptoms that patients do not pay attention to. In fact, they pass quickly. If the patient begins to use drugs, then the first stage passes very quickly and is asymptomatic. And very rarely, when a patient comes to us with the first stage of hemorrhoids. Someone is afraid of blood, they come right away, and this is the right decision, because blood can be not only from nodes.

Ekaterina Kryukova: We have advertisements about certain candles, and men who work in the office use them as a panacea. Does this make any sense?

Rustam Abdullaev: Only in Russia there are so many drugs for hemorrhoids: suppositories, ointments, tablets, dietary supplements, homeopathy. Abroad, in developed countries, there are two or three types of ointments and suppositories. This is a symptomatic treatment. If the patient has complaints in the first stage, he can be prescribed treatment, but it does not eliminate the very cause of the violation of blood outflow. In this case, the disease progresses further, that is, we remove only the symptoms. All candles, ointments are needed only to relieve the aggravation. If this is thrombosis, when blood stagnation occurs, blood clots form, then these are effective drugs, ointments or suppositories, those that thin blood clots, with glucocorticosteroids. They help a lot in the initial stages, but this is not a radical treatment.

Only in Russia there are so many drugs for hemorrhoids. Abroad, in developed countries, there are two or three types of ointments and suppositories. This is a symptomatic treatment

Ekaterina Kryukova: Already at the first stage, we will most likely not cure with medication? But they prescribe drugs, pills for varicose veins. This can not help and prevent hemorrhoids from progressing?

Rustam Abdullayev: There are venotonic drugs that really improve blood circulation, tones the venous walls, but all this is temporary.

Ekaterina Kryukova: Do you observe any general provisions or can this happen to everyone?

Rustam Abdullayev: In whom it occurs more often, in women or in men – 50 to 50. In men, this happens from alcohol, heavy physical exertion, malnutrition, constipation, diarrhea, and so on. In women, this happens during pregnancy, the uterus increases, presses on the lower half, which collects blood from the pelvis and veins of the lower extremities, congestion occurs, and hemorrhoids, varicose veins of the lower extremities appear.

Ekaterina Kryukova: Does a woman have hemorrhoids after pregnancy?

Rustam Abdullayev: As practice shows, for some time. The fact is that during pregnancy it appears, during independent childbirth the situation may worsen, another mechanical factor joins, that is, the childbirth itself, they are quite traumatic, including for the rectum, and thrombosis of hemorrhoids can form. But after a while the symptoms go away. In the future, it still appears, for someone earlier, for someone later, but as a rule, this happens within 5-10 years. Patients come and operate. It is easiest to have an operation at an early stage, but during pregnancy our hands are tied, we can only find conservative therapy, because almost all the drugs that are used for treatment are transmitted through the placental barrier. Then the woman feeds, and here we can already recommend expressing milk for a day, having an operation, and in a day she begins to feed, that is, while we administer drugs to her, they are excreted within 12 hours.

There is one more thing, if a woman brings hemorrhoids to a fairly advanced stage during pregnancy and after childbirth. If there are small nodules, we prescribe treatment and wait without any problems until lactation ends, and then we operate. But there are cases when they come in an acute phase, when all hemorrhoidal nodes, both internal and external, are thrombosed. In this case, we recommend that the woman express her milk, freeze and feed the baby so as not to stop breastfeeding. And we do the operation.

After the operation, you can’t lift weights of more than 10 kg for a month, that is, if the symptoms of hemorrhoids are removed after childbirth with medication, the woman waits for a couple of years, and the baby reaches up to 15 kg, then here we also have to refuse, because she has to lift child, and this is the risk of postoperative bleeding.

Ekaterina Kryukova: I would like to discuss patients with constipation, this is almost the main risk group. Here, constipation is the root cause, or vice versa, hard feces injure the rectum. And we get hemorrhoids, plus a person is afraid to experience pain during defecation due to inflamed hemorrhoids, and constipation occurs.

Rustam Abdullayev: Now you have answered your question.

Ekaterina Kryukova: Why does constipation occur? It already to go to the gastroenterologist?

Rustam Abdullayev: Constipation can cause hemorrhoids. If there has never been constipation, then the person tries to avoid pain and go to the toilet as late as possible. And this situation aggravates, hemorrhoids begin to progress faster.

Ekaterina Kryukova: Let’s get back to the stages. On the first and second bleeding may occur.

Rustam Abdullayev: Bleeding may occur at all stages.

Ekaterina Kryukova: Bleeding is reason enough to see a doctor, because we can have blood loss, anemia, and this is not good for any person. When we got to the proctologist, is a visual examination enough for us or do we need to do a rectal anoscopy? Or recommend some other manipulation?

Rustam Abdullaev: For the initial examination, it is recommended to perform anoscopy, examination of the anal canal, rectal area, terminal rectum, which are not visible on colonoscopy. The anal canal is in good shape, and it is not possible to look in detail on a colonoscopy. Therefore, we perform anoscopy at the initial appointment, that is, it visualizes all the processes that take place there, and we prescribe a rectoscopy. We prescribe quite rarely, because we examine about 25 cm, maximum 30. We examine with a rectoscope, which is straight and not flexible, and we can reach the splenic angle, as much as possible to see only a small piece. On a colonoscopy, we get a complete picture of the entire intestine.

Ekaterina Kryukova: Why colonoscopy, to rule out colitis?

Rustam Abdullayev: Colonoscopy is needed in order to rule out diseases that can occur with similar symptoms. Hemorrhoids or a fissure can bleed, something that we can see on examination. Tumors, polyps can also bleed, they can produce both blood and mucus. It could be Crohn’s disease, specific ulcerative colitis. If the blood comes from the upper sections of the large intestine, then the blood is usually mixed. If it is excreted after a bowel movement, then this is more like a disease of the terminal part of the colon.

Ekaterina Kryukova: Is the third and fourth stages already a more difficult situation when the knots come out?

Rustam Abdullaev: The nodes begin to fall out already at the second stage, but the patient may not feel it. They fall out and immediately return on their own. It is unhygienic for the patient to climb and look, something falls out from him or does not fall out, he does not feel it. The second stage may not lead to a proctologist. Many people can also skip the second stage.

Nodules begin to fall out already in the second stage, but the patient may not feel it. They fall out and immediately reset themselves

Ekaterina Kryukova: Severe itching in the anal ring is already the third stage, when it hurts to sit.

Rustam Abdullayev: Itching can be caused by hemorrhoids, fissures, fistulas, and there can also be problems with the upper gastrointestinal tract. These are problems with the release of bile or dysbacteriosis, errors in the diet. There is such a disease as idiopathic anal itching, when it occurs without any organic pathology. We make this diagnosis extremely rarely, practically never, because we still find out the cause and get rid of it. In the third stage, patients feel that the nodes have fallen out, and they have to set.

Ekaterina Kryukova: It’s hard not to notice here.

Rustam Abdullayev: Yes, they go to the bath, direct the shower and slowly fill these knots. It’s hard not to notice here. Stage 4 is when the nodes have fallen out and are no longer set. This is the last stage of hemorrhoids, it is not treated with any ointments and suppositories. We can say that this is also not treated with minimally invasive methods.

Ekaterina Kryukova: Will we be able to keep the disease in the first stages, and it will not progress?

Rustam Abdullaev: For some time, maybe it will be possible to keep.

Ekaterina Kryukova: What will influence? Maybe it’s a hereditary venous system?

Rustam Abdullaev: Predisposition too.

Ekaterina Kryukova: Food again. ..

Rustam Abdullayev: This is a spicy, highly salty food, smoked products, high meat content.

Ekaterina Kryukova: Carbonated drinks too?

Rustam Abdullayev: Carbonated drinks are not that important.

Ekaterina Kryukova: Alcohol?

Rustam Abdullayev: Alcohol first.

Ekaterina Kryukova: How does it directly affect this?

Rustam Abdullaev: Alcohol has a rather strong effect on blood vessels, including the venous system. It expands, then narrows, increases the violation of the venous outflow.

Ekaterina Kryukova: We have this venous nodule hanging around like an earring…

Rustam Abdullaev: There is more than one venous nodule.

Ekaterina Kryukova: Relatively speaking.

Rustam Abdullaev: There are only 3 hemorrhoids, rarely there is an additional node.

Ekaterina Kryukova: Let’s talk about healing, from the lightest to the heavy artillery. I read that you can use herbal medicine, physiotherapy methods. Are they also meaningless or for aftercare?

Rustam Abdullayev: Pointless treatment in general, I don’t even consider such moments. Pathologies, when a patient cannot perform a radical operation, for example, if he flies on a business trip or a trip, he has exacerbated hemorrhoids, but the inflammation must be removed. And when he arrives, he will come for a second examination, and we will decide on the methodology. In some cases, we can prescribe conservative treatment, which will not give such a big progress, or will remove the inflammation that is present.

Ekaterina Kryukova: What are the easy methods?

Rustam Abdullayev: The easiest methods are minimally invasive, that is, minimal intervention. The easiest method is sclerotherapy. This is an injection of a drug, a sclerosant, that sticks together the vascular tissue. If in a simple way, then the vascular tissue sticks together, a slight inflammation occurs inside the vessel, and due to this inflammation, the nodes collapse, stick together, turn into a small scar. Few doctors know this technique, and often have to be repeated several times. This may or may not depend on the experience of the doctor. The fact is that you need to get into the vascular sac quite accurately and inject the drug exactly there.

Ekaterina Kryukova: How many such injections are required?

Rustam Abdullayev: As a rule, one, in 3 knots.

Ekaterina Kryukova: And the treatment of hemorrhoids ends?

Rustam Abdullayev: For some time. The second disadvantage is that there is a risk of relapse.

Ekaterina Kryukova: Approximately after how many people should repeat this procedure?

Rustam Abdullayev: Enough for several years. It depends on the stage.

Ekaterina Kryukova: We are now taking the first, second stage.

Rustam Abdullayev: At the first stage, I usually do sclerotherapy. The result is good enough.

Ekaterina Kryukova: Are there side effects? Is it painful, costly?

Rustam Abdullaev: This is if you do it with your left foot.

Ekaterina Kryukova: Do you need anesthesia?

Rustam Abdullayev: We now use intravenous sedation everywhere, this is not anesthesia, but medical sleep. The most convenient for the patient, because under local anesthesia it is very painful. This is a zone in which there are a lot of pain receptors, let’s call it shockogenic. Even a minor wound or intervention causes severe pain. Therefore, we use intravenous sedation and local anesthesia. This is a five-minute procedure, then the patient lies down for half an hour, we give him tea or coffee, and he goes home.

Ekaterina Kryukova: Do the protruding knots that are in the second stage go away, do they add up?

Rustam Abdullaev: I won’t say that they completely disappear, they subside and a small scar forms. The most important thing is that the blood that enters the nodes has nowhere to roam, nothing to fill.

Ekaterina Kryukova: Accordingly, there is nothing to inflame.

Rustam Abdullayev: Absolutely right. The method is not the most reliable, but if I do sclerotherapy, I don’t worry about the patient in terms of postoperative complications.

Ekaterina Kryukova: This is quite predictable.

Rustam Abdullaev: Yes, if you use the right concentration of the drug and the right dose. It is very important here, because I have seen many cases when, let’s say, they shot at a sparrow from a cannon. They injected a large amount of sclerosant, and necrosis set in. There is a task, a protocol, a standard according to which you can enter more, this should not be exceeded. There is a vast experience in the use of sclerosants, and it is necessary to use those protocols that were drawn up and invented long before they were used by inexperienced specialists.

Ekaterina Kryukova: In your opinion, is this the best choice for the first and second stages?

Rustam Abdullayev: Yes, this is for the first stage. The method of desarterization of hemorrhoids is used, the operation without a single incision. We have special equipment, we find the hemorrhoidal artery, which supplies the hemorrhoids. The device is an anoscope with a window and a sensor, when we start to operate, it shows the artery itself, the depth, the diameter of the arteries, and the blood flow. We find this artery, which fills the knot with blood, we stitch it and bandage it. However, no cuts are made.

Ekaterina Kryukova: Are we getting rid of the knot?

Rustam Abdullayev: In this case, the node does not die, it also subsides, ceases to be supplied with blood. This is a more reliable method than sclerotherapy. There are combined methods when we use both desarterization and sclerotherapy. We suture and ligate the artery and inject a sclerosant into the base of the node. There are cases when the hemorrhoidal node is supplied not only by large arteries, which we see with the help of this apparatus. There are small vessels, which after a while, it can be several months, years, take over the function of large vessels. They expand in the same volume as large vessels. This process is called revascularization. There are indirect signs that the node is supplied with blood not by one artery, but by several, in this case we also introduce sclerosants.

Ekaterina Kryukova: In these little vessels? Tell me, are we actually blocking the movement of blood in the area of ​​​​the hemorrhoid?

Rustam Abdullayev: Yes.

Ekaterina Kryukova: How is traffic blocked on the road?

Rustam Abdullayev: With , absolutely right.

Ekaterina Kryukova: Is it harmful? Are we artificially creating a dead end?

Rustam Abdullayev: No, this is a very physiological operation. We said at the very beginning of the conversation that these are rudimentary formations. Therefore, the fact that we block the blood flow, small vessels, capillaries remain, they do not allow tissues to die, they remain in place. The nodes subside, but no necrosis occurs.

Ekaterina Kryukova: Complication after?

Rustam Abdullayev: There is one complication, in the early postoperative period within 3 weeks, if the patient does not follow our recommendations. Within a month, you can not lift weights, you can not go to baths, saunas, you can not drink alcohol and observe sexual rest. It is very important. If the patient violates one of the four restrictions, then those ligatures, those sutures that we put on the arteries, can fly off, and then bleeding opens. I have operated on about 2500 patients, I had about 20 such cases.

Within a month after the operation, you must not lift weights, go to baths, saunas, do not drink alcohol and observe sexual rest

Ekaterina Kryukova: Do you have difficulty going to the toilet?

Rustam Abdullayev: There are no difficulties after this method.

Ekaterina Kryukova: Can’t we remove these stitches?

Rustam Abdullayev: No, everything is safe there. If you follow all these recommendations, then there will be no bleeding. The technique has been used for a long time and has been tested. The mucosa stretches, it is elastic, in this regard there is no risk of bleeding.

Ekaterina Kryukova: As for the more advanced stages of the disease, do we resort to a general operation here?

Rustam Abdullaev: At the 3rd stage, we do not use, at least in my practice, such a technique. I know all the methods of hemorrhoid surgery…

Ekaterina Kryukova: What is called big surgery.

Rustam Abdullayev: We can combine. If there is an external component, that is, external hemorrhoids that are large enough, they can be supplied by separate arteries that we cannot ligate with ultrasound. In this case, we do a deserterization and excise the external nodes. This still applies to surgical: either with a scalpel, or a radio wave, or electrocoagulation.

Ekaterina Kryukova: There is the classic Milligan-Morgan operation, there is also Whitehead…

Rustam Abdullayev: The second operation has long been forgotten. We do Milligan-Morgan at the 4th stage, and we do it quite often. It lies in the fact that the nodes are completely cut off. On the vascular pedicle of the artery, which we talked about a lot today, a clamp is applied, towards which the 2nd clamp is applied, and the nodes are completely cut off by the clamps and stitched. This is a reliable way to get rid of, but one of the minuses is the pain syndrome that occurs after the operation.

Ekaterina Kryukova: That is, during defecation.

Rustam Abdullayev: The first days it hurts and at rest.

Ekaterina Kryukova: And constant bleeding, the risk of infection…

Rustam Abdullayev: There is no risk of infection, because the gut is a fairly resistant bacterium. There, everything is calculated by the body, it happens extremely rarely, when an infection gets somewhere between the seams, a small paraproctitis may occur, but this is extremely rare.

Ekaterina Kryukova: Is the recovery period painful, unpleasant?

Rustam Abdullayev: It usually hurts for 7-8 days, and heals completely in a month.

Ekaterina Kryukova: And the hemorrhoids do not return after such an operation?

Rustam Abdullayev: If you do sclerotherapy, then there is a risk of relapse, no more than 10%. If you do desarterization of hemorrhoids under Doppler control, then the risk of recurrence is about 1.5%. After Milligan-Morgan and even less.

If sclerotherapy is done, the risk of recurrence is no more than 10%

Ekaterina Kryukova: In principle, we have no problems with the treatment of hemorrhoids. Why are people suffering so much, looking for the right doctor, the right medicine so much?

Rustam Abdullaev: People, firstly, are shy, secondly, they are very afraid, there are a lot of reviews and all sorts of scares on the Internet. I deliberately sat down, read what my patients are afraid of. They are afraid of a very strong pain syndrome, which heals for six months, in fact, there is no such thing. I have not seen such that six months healed.

Ekaterina Kryukova: Can there be long-term consequences of the operation?

Rustam Abdullayev: Sometimes, under Milligan-Morgan, there is a problem that can be solved.

Ekaterina Kryukova: Does the possession of the anal canal not fall?

Rustam Abdullaev: There is no insufficiency after surgery for hemorrhoids, because we do not touch the muscles at all, we do not touch.

Ekaterina Kryukova: Does the functional side never suffer?

Rustam Abdullayev: Absolutely. There is insufficiency only after certain diseases, acute paraproctitis. There are fistulas, paraproctitis, in some cases we even warn patients that maybe half a year will have to endure. But this is not for hemorrhoids. This is after excision of extrasphincteric fistulas.

Ekaterina Kryukova: When taking a patient at the initial appointment, we do colonoscopy, anoscopy and try to see the whole clinical picture. If we find associated polyps, are you operating on two problems in one?

Rustam Abdullayev: Yes, if it is a visually benign polyp, then it is immediately truncated and sent for histology. If there is suspicion that it is malignant, then a biopsy is taken, in this case we do not operate on hemorrhoids, we are waiting for histology. Colonoscopy is done by endoscopists, that is, we do not do colonoscopy. These are other specialists, but we work very closely. When my patients have a colonoscopy, I always stop by, before the operation, to see how everything is going on there, if there are any problems, so that I can immediately solve it on the spot. If there are benign polyps, they can be immediately excised and sent for histology, and we take them immediately for surgery.

Ekaterina Kryukova: You correctly noted that the topic of diseases of the rectum, hemorrhoids, all this proctology is taboo for us. I think a person who came to an appointment one day would be happy to get rid of everything at once. I would like to discuss these possibilities.

Rustam Abdullayev: We try to get rid of everything at once. By the way, here you are talking about the taboo subject of proctology. Indeed, this is true, patients for the first time, especially the older generation, are very embarrassed by this problem and walk around until they feel like it, and they already come to give up: do what you want, operate, save me from this. Then they start sharing with relatives or colleagues, and it turns out that everyone they know has this problem. And they are operated on by word of mouth, 30 percent are patients who came through word of mouth.

Ekaterina Kryukova: Do you have any idea how this happens in general, maybe at the level of state medicine? What do they prescribe, do they operate on hemorrhoids? Or are ordinary, district proctologists inclined to prescribe medications?

Rustam Abdullaev: You have touched on a very topical issue. The Russian school of colorectal surgery is very strong. At one time there was such an academician Ryzhykh, who organized and built a center for coloproctology. Coloproctology separated from general surgery, they began to deal only with the large intestine.