What are the main causes of hemorrhoid pain. How can you distinguish between hemorrhoids and other rectal conditions. What are the most effective treatments for hemorrhoid pain. When should you consider hemorrhoid surgery. How long does recovery from hemorrhoidectomy typically take. What lifestyle changes can help prevent hemorrhoids.

Understanding Hemorrhoids: More Than Just a Pain in the Rear

Hemorrhoids are a common yet often misunderstood condition that affects millions of people worldwide. These swollen veins in the rectum or anus can cause significant discomfort and, in some cases, excruciating pain. However, it’s crucial to recognize that not all rectal pain is due to hemorrhoids.

Dr. Traci Hedrick, a colon and rectal surgeon, notes that about 40-50% of patients who believe they have hemorrhoids are actually experiencing other conditions. This highlights the importance of seeking a professional diagnosis rather than self-diagnosing based on symptoms alone.

Types of Hemorrhoids

• Internal hemorrhoids: Located inside the rectum, these typically don’t cause pain but can bleed during bowel movements.
• External hemorrhoids: Found on the anus, these are the ones responsible for discomfort, pain, and itching.

Distinguishing Hemorrhoids from Other Rectal Conditions

When experiencing sudden and severe rectal pain, it’s crucial to consider that the cause may not be hemorrhoids. Dr. Hedrick identifies three primary culprits:

1. Thrombosed hemorrhoid: A firm, purple external hemorrhoid caused by a blood clot.
2. Anal fissure: A tear in the lining of the anus, often resulting from severe constipation or diarrhea.
3. Perirectal abscess: An anal gland infection that can be incredibly painful.

Each of these conditions requires different treatment approaches, emphasizing the need for an accurate diagnosis by a healthcare professional.

Seeking Medical Attention: When and Where to Go

If you’re experiencing severe rectal pain that persists, it’s essential to seek medical attention. But where should you go? Contrary to what many might assume, the emergency room isn’t always the best option.

Dr. Hedrick recommends contacting your primary care provider for a referral to a colorectal surgeon. Specialized clinics, like the UVA Digestive Health Center, often have urgent appointments available for severe cases and can provide more targeted care than a general emergency room.

Why Specialized Care Matters

Colorectal surgeons deal with rectal conditions regularly, giving them the expertise to accurately diagnose and treat your specific issue. This specialized knowledge can lead to faster relief and more effective long-term management of your condition.

Treatment Options for Hemorrhoids and Rectal Pain

The treatment for rectal pain depends on its underlying cause. For hemorrhoids, several non-surgical options are available:

• Over-the-counter hemorrhoid creams
• Warm water sitz baths for 10-15 minutes, several times a day
• Avoiding straining during bowel movements
• Increasing fluid intake
• Consuming a fiber-rich diet

For other conditions, treatments may vary. Anal fissures often respond to topical creams, while abscesses might require drainage and antibiotics.

Hemorrhoidectomy: When Surgery Becomes Necessary

While most hemorrhoids don’t require surgery, some cases do warrant a more invasive approach. A hemorrhoidectomy, or surgical removal of hemorrhoids, might be recommended for patients with large hemorrhoids causing persistent issues.

Indications for hemorrhoid surgery include:

• Chronic pain
• Significant blood loss
• Fecal or mucus leakage

Dr. Hedrick notes that at UVA, they perform between 75 to 100 hemorrhoidectomies each year, indicating that while common, surgery is far from the first-line treatment for most patients.

Surgical Techniques and Recovery

Various surgical techniques exist for hemorrhoid removal, including the use of lasers and staples. However, Dr. Hedrick advocates for traditional excision with a sharp blade, stating it’s “the safest and best way to prevent them from coming back.”

Recovery from hemorrhoidectomy typically takes 2-4 weeks, with the first week being the most uncomfortable, particularly during bowel movements. Pain management strategies include:

• Long-acting numbing medication administered during surgery
• Over-the-counter pain relievers like acetaminophen or ibuprofen
• Avoiding opioids when possible to prevent constipation

While the recovery period can be challenging, Dr. Hedrick notes that patients are generally satisfied with the results after about a month.

The Hidden Dangers of Internal Hemorrhoids

While external hemorrhoids are often associated with pain and discomfort, internal hemorrhoids can pose their own risks. These hemorrhoids, located inside the rectum, typically don’t cause pain due to the lack of nerve sensors in the area. However, they can lead to significant bleeding, sometimes to the point of causing anemia.

Internal hemorrhoids can also prolapse, meaning they slip outside the anus. In severe cases, the blood loss from internal hemorrhoids can be so substantial that patients require blood transfusions.

Treating Internal Hemorrhoids

For smaller internal hemorrhoids, surgeons often use a banding procedure performed in the office. This technique cuts off the blood supply to the hemorrhoid, causing it to shrink and eventually fall off.

Lifestyle Changes to Prevent and Manage Hemorrhoids

While some factors contributing to hemorrhoid development, such as pregnancy or aging, are beyond our control, many lifestyle changes can help prevent or manage this condition:

1. Increase fiber intake: Consuming more fruits, vegetables, and whole grains can soften stools and reduce straining during bowel movements.
2. Stay hydrated: Drinking plenty of water helps prevent constipation, a common cause of hemorrhoids.
3. Exercise regularly: Physical activity promotes healthy bowel function and can help maintain a healthy weight, reducing pressure on the rectal area.
4. Avoid prolonged sitting: If your job requires long periods of sitting, take regular breaks to stand and move around.
5. Don’t ignore the urge: Responding promptly to the need for a bowel movement can prevent straining and reduce pressure on the rectal veins.
6. Practice good bathroom habits: Avoid spending excessive time on the toilet and resist the urge to strain.
7. Use proper wiping techniques: Be gentle when cleaning after a bowel movement to avoid irritating existing hemorrhoids.

When to Worry: Red Flags for Rectal Bleeding

While hemorrhoids are a common cause of rectal bleeding, it’s crucial to recognize when bleeding might indicate a more serious condition. Rectal bleeding can be a symptom of colorectal cancer, especially in individuals over 50 or those with a family history of the disease.

Signs that warrant immediate medical attention include:

• Persistent rectal bleeding, especially if it’s dark or accompanied by mucus
• Changes in bowel habits lasting more than a few weeks
• Unexplained weight loss
• Abdominal pain or cramping
• Fatigue or weakness, which could indicate anemia from blood loss

If you experience any of these symptoms, it’s crucial to consult with a healthcare provider promptly. They may recommend additional tests, such as a colonoscopy, to rule out more serious conditions.

The Importance of Regular Screenings

Even if you’re not experiencing symptoms, regular colorectal cancer screenings are essential, particularly for those over 45 or with risk factors. These screenings can detect issues early when they’re most treatable.

Innovations in Hemorrhoid Treatment

While traditional treatments for hemorrhoids remain effective, ongoing research continues to explore new options for managing this common condition. Some emerging treatments include:

• Radiofrequency ablation: This minimally invasive technique uses heat to shrink hemorrhoids.
• Doppler-guided hemorrhoid artery ligation: This procedure uses ultrasound to locate and tie off the arteries feeding the hemorrhoids.
• Cryotherapy: Freezing techniques are being explored as a way to treat hemorrhoids with minimal discomfort.
• Laser therapy: Some studies suggest that certain laser treatments may be effective for treating hemorrhoids with less pain and faster recovery times than traditional surgery.

While these treatments show promise, it’s important to note that more research is needed to establish their long-term effectiveness and safety. Always consult with a healthcare provider to determine the most appropriate treatment for your specific situation.

Living with Hemorrhoids: Coping Strategies for Daily Life

For many individuals, hemorrhoids are a chronic condition that requires ongoing management. While treatment can provide relief, learning to live comfortably with hemorrhoids is equally important. Here are some strategies to help manage hemorrhoids in daily life:

1. Use a donut cushion: These specially designed cushions can reduce pressure on the rectal area when sitting.
2. Wear breathable, loose-fitting clothing: This can help reduce irritation and promote air circulation.
3. Consider using wet wipes: These can be gentler than dry toilet paper, but avoid those containing alcohol or fragrances.
4. Apply cold compresses: This can help reduce swelling and provide relief from discomfort.
5. Practice stress-reduction techniques: Stress can exacerbate hemorrhoid symptoms, so techniques like meditation or yoga may be beneficial.
6. Plan ahead for travel: Long periods of sitting can worsen symptoms, so plan regular stops and movement breaks during long trips.
7. Communicate with your healthcare provider: Keep them informed about your symptoms and any changes, and don’t hesitate to ask for advice or treatment adjustments.

Remember, while hemorrhoids can be uncomfortable and sometimes embarrassing, they are a common condition that affects many people. With proper management and care, most individuals can minimize the impact of hemorrhoids on their daily lives.

The Role of Diet in Hemorrhoid Management

Diet plays a crucial role in managing hemorrhoids. Beyond increasing fiber intake, consider these dietary strategies:

• Incorporate probiotic-rich foods: These can promote digestive health and regular bowel movements.
• Limit spicy foods: These can irritate hemorrhoids and exacerbate symptoms.
• Reduce caffeine and alcohol intake: Both can contribute to dehydration, potentially worsening constipation.
• Consider natural laxatives: Foods like prunes or chia seeds can help promote regular bowel movements.

Remember, dietary changes should be made gradually to avoid digestive upset. Consult with a healthcare provider or nutritionist for personalized advice on dietary management of hemorrhoids.

My Hemorrhoid Pain Was So Bad, I Could See Why People Have Surgery

As a medical writer, my friends often share their health adventures with me. Now that I’m in my 50s, the stories get more interesting. A friend told me recently he had hemorrhoid surgery. A high school swim and tennis coach, he’s the picture of health. So, I was a bit surprised that he needed surgery.

But then I had a days-long bout of terrible hemorrhoid pain and could totally understand why lots of people get a hemorrhoidectomy. Just like it sounds, this is surgery to remove hemorrhoids. Hemorrhoids are swollen veins either inside your rectum or on the anus. They show up right where poop leaves your body.

I’ve been dealing with constipation – a common cause of hemorrhoid pain – my whole life. So going to the bathroom has never been fun for me. But recently, I felt throbbing pain not just when going to the bathroom. I was in pain when I sat, stood, or lay down. For three days.

I was in tears by the time I called my doctor’s office. I thought for sure I had something more severe.

What You Think is

Hemorrhoid Pain Could Be Something Else

Interestingly, hemorrhoids are often not the cause of severe rectal pain, explains colon and rectal surgeon Traci Hedrick, MD.

“People have a lot of misconceptions about hemorrhoids,” Hedrick says. “When someone has rectal pain, they automatically assume it’s hemorrhoids. It’s not actually hemorrhoids for about 40 to 50% of the people I see, who come and complain of hemorrhoids. It’s more commonly a tear in the lining of the anus. So, it’s important to get an accurate diagnosis.”

1 of 3 things can cause sudden and severe rectal pain, Hedrick says:

1. A firm and purple (thrombosed) hemorrhoid that you can feel on the outside of the anus. This happens when a blood clot forms inside a hemorrhoid.
2. A tear in the lining of the anus (anal fissure). This can be caused by a severe bout of constipation or diarrhea. You can develop a skin tag that looks like a hemorrhoid but is swelling that the tear causes.
3. An anal gland infection (perirectal abscess) that Hedrick describes as “horribly, horribly painful.”

Get Urgent Care But Skip the ER

If you have severe rectal pain that doesn’t go away, call your primary care provider so they can refer you to a colorectal surgeon at the UVA Digestive Health Center. “You really need to be seen by someone who deals with this a lot. We have urgent appointments available for very severe pain. We have clinic 4 days a week and even 5 days if we need to,” Hedrick says.

Relief for Rectal Pain

You can usually treat an anal tear with a cream, but it sometimes requires surgery. Antibiotics can treat abscesses, which usually need to be drained when they don’t pop on their own.

You can treat most hemorrhoids by:

• Applying hemorrhoid cream from your local drugstore
• Sitting in warm water for 10-15 minutes a few times a day

• Not straining while going to the bathroom

• Drinking plenty of fluids
• Eating lots of fiber-rich foods like whole grains, fruits, and vegetables

Who Needs a Hemorrhoidectomy?

Surgery’s a good option for people with large hemorrhoids. These can cause:

• Long-lasting pain
• Lots of blood loss
• Leaking stool or mucous

During this outpatient procedure, the surgeon cuts away the hemorrhoid. Doctors can use lasers, staples, and other tools. But removing them with a sharp blade is “the safest and best way to prevent them from coming back,” Hedrick says.

“The vast majority of hemorrhoids don’t require surgery. But it is a common surgery. At UVA, we see hundreds of patients with hemorrhoids and do between 75 to 100 hemorrhoidectomies each year,” says Hedrick. She’s one of three UVA colon and rectal surgeons who do these procedures.

“The biggest downside to surgery is an uncomfortable recovery,” she adds. “It’s going to take 2 to 4 weeks to recover, and the first week is when bowel movements are the most painful. We give a numbing medicine that lasts 2 to 3 days. And taking acetaminophen or ibuprofen can help relieve pain. We try not to use opioids, as they can constipate you.”  

Hedrick adds, “Patients are happy after they’ve done the surgery but usually only after about a month. ”

Hemorrhoids Can Bleed a Lot

There are two types of hemorrhoids: inside and outside. The outside ones on the anus cause the discomfort, pain, and itching. The internal ones don’t typically cause pain (no nerve sensors in the rectum, Hedrick explains).

Still, the internal ones can cause bleeding. They sometimes slip outside the anus (prolapse). They can occasionally cause so much blood loss, Hedrick says, that people become anemic and need blood transfusions.

Bleeding typically happens during a bowel movement. But people can also bleed through their pants while shopping or going about their day.

Surgeons can remove small internal hemorrhoids with an office-based banding procedure that cuts off the blood supply. But a hemorrhoidectomy is needed to remove large internal hemorrhoids that cause lots of bleeding.

Cancer or polyps can also cause bleeding. So, if you have rectal bleeding, you should get a colonoscopy. That way, if you do have polyps, surgeons can take them out before they turn into cancer.

What Causes Hemorrhoids?

Major causes are:

• Constipation
• Straining while going to the bathroom (don’t force anything)
• Pregnancy

3 Ways to Prevent Hemorrhoids

Hemorrhoids are a normal part of life and become more common as we age, according to Hedrick. She says, “Everybody is going to have them to some degree.” To prevent them from becoming a problem, she recommends that you take these steps every day:

• Drink lots of water and get plenty of fiber
• Get exercise
• Don’t sit on the toilet too long

Constipated & Middle Aged Like Me?

Constipation can cause hemorrhoids but can also be a sign of colon cancer.

Colon Cancer Screening Options

Would a stool help? You’ve probably seen the commercials for special stools that give you a more “natural” position when sitting on the toilet. These actually can help, Hedrick says. A stool under your feet helps waste move through your bowels easier and with less strain.

How I Found Relief & the Joys of the Fiber Cocktail

Fortunately, my hemorrhoid pain went away pretty quickly. How did I do it? I:

• Gladly paid more than $80 on prescription-strength hemorrhoid medication (who knew insurance doesn’t cover suppositories?)
• Took a few baths, which I remember worked like a charm after giving birth 16 and 20 years ago
• Skipped squat poses during yoga
• Took a laxative left over from my colonoscopy prep
• Drank a lot of water
• Avoided bagels and pizza, which I love but always constipate me

Now, I don’t go a day without an after-dinner glass of water mixed with a heaping teaspoon of psyllium husks powder. It’s kind of like drinking very fine sawdust (I avoid the brands with added sweeteners). It can make you a bit gassy. But the morning after is much more pleasant. I am so grateful to a good friend who introduced me to the wonders of fiber-laden psyllium husks.

My Colonoscopy Found More Than a Polyp

I’m also grateful that I got my first colonoscopy screening last year. I was not surprised to read in my colonoscopy report that I have an internal hemorrhoid, which explains the blood when I go.

I also wasn’t surprised that I had a polyp in my colon, the kind that could become cancer. My maternal aunt and grandfather both died of colon cancer because they never had a colonoscopy screening. Over the years, my mother and father have both had lots of polyps removed during their colonoscopies.

During my colonoscopy, my polyp was also removed – along with its potential to become cancer. Hopefully, I won’t need to worry about having any hemorrhoid removed. I just need to keep up with my nightly fiber cocktail. Cheers to fun-for-the-go fiber and life-saving colonoscopies!

Can Hemorrhoids Kill You? How to Manage Painful Symptoms

Hemorrhoids, also known as piles, are inflamed blood vessels in the area around your anus.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, hemorrhoids are considered common, with about 50 percent of adults over 50 years of age experiencing them.

Symptoms of hemorrhoids can range from mild to severe and can include not only pain, but also itching and bleeding.

Some people even say that their hemorrhoids are the most painful thing they have experienced. But despite the very real discomfort and pain that hemorrhoids cause, hemorrhoids themselves can’t kill you.

Let’s cover the basics of hemorrhoids symptoms, including what’s normal, what isn’t, and when you should call a doctor.

We’ll also give you some ideas for safely treating your hemorrhoids at home, so you can reduce your symptoms and get back to your life.

Hemorrhoids can cause severe pain and discomfort. However, hemorrhoids themselves are not deadly. Even the most severe flare-ups won’t put your life in danger.

Hemorrhoids can be internal, meaning they line the internal wall of your anus, or external, meaning you can feel them on the outside of your anus.

Both types of hemorrhoids can cause other health complications, some of which aren’t good for your long-term health.

Complications of internal hemorrhoids can include:

• internal bleeding
• infected internal hemorrhoids
• a prolapsed internal hemorrhoid, which emerges from your anus and becomes visible

Complications of external hemorrhoids can include:

• thrombosis (blood clots) due to blood flow concerns
• strangulated hemorrhoids
• hardened lumps and skin tags

What presents as hemorrhoids can sometimes be an indication of another more serious condition. Hemorrhoids share symptoms with:

• colorectal cancer
• inflammatory bowel disease (IBD)
• peptic ulcers
• colonic polyps
• colitis

For this reason, you shouldn’t assume that internal bleeding and pain or lumps at your rectum are caused by hemorrhoids.

If treating your hemorrhoids at home doesn’t provide relief after a week or so, you should schedule an appointment to talk with a doctor about your symptoms.

When to seek emergency attention

Seek emergency help immediately if you:

• have severe pain and internal bleeding
• have a fever
• feel faint or dizzy

Was this helpful?

If you’re experiencing a lot of pain from hemorrhoids, you might want to try some home remedies. These are just some DIY and over-the-counter treatments that can help manage and reduce symptoms of hemorrhoids:

• Use soothing wipes. They can provide immediate relief when you feel swelling after using the bathroom. Look for alcohol-free options with natural botanical ingredients like witch hazel or aloe vera.
• Soak in a warm sitz bath. A sitz bath can help to cleanse the area and soothe inflammation.
• Try an over-the-counter pain reliever. Some examples of these medications include acetaminophen or ibuprofen.
• Use a hemorrhoid cream or suppository. This option is for short-term relief, and shouldn’t be used as a long-term solution.
• Take a stool softener. This can decrease pain during bowel movements and reduce the amount you have to strain to use the bathroom.

After you’ve had a hemorrhoid flare-up, you may want to take steps to prevent more from developing. Hemorrhoids can be activated by:

• dehydration
• a lack of fiber in your diet
• other lifestyle factors

You can prevent hemorrhoids by:

• limiting the amount of time you spend sitting on the toilet
• eating a diet rich in high fiber foods
• drinking plenty of water every day
• staying active, engaging in cardiovascular exercise that keeps you up and out of your chair for a good part of each day

Hemorrhoids can cause pain and discomfort, but hemorrhoids themselves are not considered a danger to your life.

Implementing prevention strategies and trying out home remedies can help to decrease hemorrhoids’ interference in your daily routine.

Chronic pain that appears to be from hemorrhoids can sometimes be caused by another more serious condition.

You should contact your doctor if you have severe anal pain or bleeding, especially if you are also experiencing a high fever and diarrhea too.

How to diagnose hemorrhoid pain

How to diagnose hemorrhoid pain – advice from a proctologist

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How to Diagnose Hemorrhoid Pain : Hemorrhoid pain is an unpleasant or painful sensation in the anus, an experience of physical or emotional suffering. Serves as a protective signal of real or suspected tissue damage. The initial diagnosis of pain in hemorrhoids will require an anoscopy and subsequent consultation with a proctologist. As an additional examination, the doctor may prescribe:

• sigmoidoscopy
• MRI of the rectum.

Which doctor treats pain in hemorrhoids: In case of symptoms of pain in hemorrhoids, you should first consult a proctologist, based on the results of the initial examination, the doctor may prescribe an additional consultation with an oncologist.

Hemorrhoids are pathological enlargement of the hemorrhoidal node, which manifests itself as a bump in and around the anus. Often, inflammation of the hemorrhoid disappears on its own a few days after the exacerbation of the disease.

Causes of hemorrhoids

Hemorrhoids are swollen blood vessels located in the lower part of the rectum, outside (in the area at the entrance to the anus). So far, scientists are not completely clear what causes their anomalous increase. It is believed that this pathology can be provoked by:

• constipation
• straining too hard during defecation
• pregnancy
• weightlifting.

Symptoms of hemorrhoids

Symptoms of hemorrhoids include:

• bright red blood in the stool
• anus irritation
• Feeling like you still have to poop after going to the toilet
• mucus on underwear or on toilet paper
• knot protrusion around the anus
• pain around anus.

Diagnosis of hemorrhoids

The patient should consult a proctologist if:

• the hemorrhoid has not improved after 7 days of treatment at home
• there is severe bleeding from the anus
• hemorrhoids accompanied by high fever
• Pus flows from the anus.

The doctor will be able to make a diagnosis during the initial examination. In rare cases, the proctologist may need MRI or CT results to determine treatment tactics.

Home treatment for hemorrhoids

The patient can relieve hemorrhoids by following the doctor’s advice:

• drink plenty of fluids and eat plenty of fiber to keep stool soft
• wipe your bottom with wet toilet paper
• take a warm bath to relieve itching and pain in the anus
• use an ice pack wrapped in a towel to relieve buttock discomfort
• Gently push the protrusion back inward
• keep your anus clean and dry
• exercise regularly
• cut down on alcohol and caffeine (eg tea, coffee and cola) to avoid constipation
• don’t wipe the knowledge pass too hard don’t ignore the urge to poop
• do not take painkillers containing codeine as they cause constipation
• Do not take ibuprofen if your hemorrhoids are bleeding.

A range of over-the-counter hemorrhoid products can be purchased at the pharmacy:

• creams for the relief of pain, itching and swelling in the anus
• preparations to relieve constipation and soften faeces
• cold compresses to relieve discomfort.

If the hemorrhoids do not improve after home treatment, the patient may need hospital treatment. Common hospital therapies include:

sclerotherapy, where fluid is injected from the nodes to reduce inflammation electrotherapy, where the hemorrhoids are subjected to a mild electric current to shrink them

infrared coagulation, where infrared light is used to reduce blood flow to areas of inflammation.

If the above treatments do not work, the patient may need surgery to remove the nodes. Surgical treatments for hemorrhoids include:

• hemorrhoidectomy – removal of hemorrhoids
• stapled hemorrhoidopexy – pushing and sewing hemorrhoids back into the anus
• hemorrhoidal artery ligation – suturing to cut off the blood supply to the nodes so that they shrink.

Author: Telegina Natalya Dmitrievna

Specialization: Therapist

Where does the appointment: MRI Center and Clinic RIORIT

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Literature

1. Aminev A.M. Guide to proctology / A.M. Aminev. – Kuibyshev: Kuibyshev book. ed – in, 1971. – T. 2. – S.8-179.
2. Belausova S.V. Tactics of treatment of patients with hemorrhoids complicated by anemia: author. dis. . cand. honey. Sciences: 14.00.27 / Belausova Svetlana Vasilievna. – M., 2008. – 20 p.
3. Vasiliev S.V. Comparative evaluation of the Longo operation and suture ligation of the terminal branches of the superior rectal artery in the treatment of chronic hemorrhoids / S.V.Vasiliev, K.N.Komyak, A.I. – 2007. – T.186., No. 3. – P.71-72.
4. Goncharuk R.A. The choice of tactics for the treatment of patients with III-IV stages of chronic hemorrhoidal disease: author. diss. . Candidate of Medical Sciences: 14. 01.17 / Goncharuk Roman Anatolievich. – Vladivostok. – 2013. – 21 p.
5. Karpukhin O.Yu. On the question of evaluating the effectiveness of methods of treating chronic hemorrhoids / O.Yu. Karpukhin // Practical Medicine. -2013. – No. 2. – P.77-79.

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City Clinical Hospital No. 31 im. Academician G.M. Savelyeva

Briefly about the main

Thrombectomy is a minimally invasive (low-traumatic) operation, which is performed to eliminate the thrombus formed in the hemorrhoidal nodes. This intervention is performed at acute hemorrhoids .

Thrombectomy is performed under local anesthesia and takes no more than 10 minutes . The procedure has the shortest list of contraindications and does not require the patient to be admitted to a hospital. You can go home immediately after surgery .

The recovery period passes quickly and is not associated with serious restrictions. It will be necessary to observe elementary hygiene rules: wash the anal area with warm water after each bowel movement. You should also follow all the doctor’s recommendations:
___• Follow a diet,
___• Limit physical and nervous stress,
___• Avoid exclusion of heat treatments,
___• Take prescribed medications,
___• Perform topical treatment of postoperative wound.

Causes of hemorrhoidal vein thrombosis

Thrombosis can develop as a consequence of an acute attack of hemorrhoids for the first time, as well as a complication of chronic hemorrhoids. The likelihood of developing thrombosis in chronic pathology increases with an increase in the “experience” of the disease and the size of the nodes.

An attack can be provoked by:
___• chronic stool disorders (constipation, diarrhea, constipation alternating with diarrhea),
___• increased physical activity,
___• labor activity,
___• intake of spicy food and/or alcohol,
___• hypothermia , overheating.

All conditions accompanied by increased intra-abdominal pressure contribute to the development of acute hemorrhoids – from pregnancy to chronic cough and obesity.

Another factor in the occurrence of hemorrhoids is the stagnation of blood in the veins of the small pelvis, which often occurs as a result of a sedentary lifestyle, “sedentary” work.

Mechanism of thrombus formation

Thrombosis of external hemorrhoids occurs more frequently. It is extremely rare that the process spreads from external to internal nodes. Even less often, it occurs in isolation in internal nodes.

Thrombosis of the external hemorrhoid occurs in both acute and chronic process. In both cases, the pathology develops as a result of a combination of three factors:
___ • slowing of blood flow in the node,
___ • thickening of the blood,
___ • damage to the vascular network of the hemorrhoid.

Signs of thrombosis

___• The main symptom of thrombosis is a sharp excruciating pain that prevents normal bowel movements. The pain syndrome increases many times with straining, movement, and also in the sitting position. In severe cases, the pain takes on a pulsating character and, depending on the location of the node, can be given to the leg, inside the rectum or to the external genitalia.
___• Bleeding often occurs, which has a different intensity – from individual drops on the surface of the feces to a trickle of blood during a bowel movement.
___• Thrombosis of the internal node causes a sensation of a foreign body inside the rectum. Since the bleeding injured node is in contact with the feces, a secondary infection is possible. In such cases, mucous or purulent discharge appears, the body temperature rises.

When thrombectomy is needed

Indications for surgery

Most cases of acute hemorrhoid thrombosis (uncomplicated thrombosis, small node size) respond well to conservative treatment. The main thing is to consult a doctor in a timely manner.

Surgical manipulations are performed if the period from the onset of the disease is 48-72 hours. If more time has passed since the onset of thrombosis, the doctor prescribes conservative treatment followed by surgical treatment. Surgical removal of a thrombosed node is carried out at a later date from the onset of the disease in the following cases :
___• Conservative therapy was ineffective,
___• Acute pain syndrome, poorly relieved by standard painkillers,
___• symptoms of intoxication (general weakness, fever, headache),
___• contraindications to prescribing thrombolytic agents (pregnancy, lactation),
___• large hemorrhoids.

The decision on surgical intervention is made by the doctor after an examination, which will reveal contraindications for surgical intervention. Another goal of diagnostic manipulations is the choice of the method of surgical intervention.

Operations

Thrombus removal for external hemorrhoids

Thrombus removal for external hemorrhoids is the simplest operation that lasts only a few minutes. The doctor makes a small incision over the clot. Then the blood clot is removed with tweezers or a clamp, the wound is not sutured. Almost immediately, the inflammatory edema subsides, the pain subsides, and the general condition of the patient improves.

According to the indications, a more complex operation can be performed – excision of an external hemorrhoid with blood clots , which is also performed under local anesthesia and does not require the patient to be admitted to a hospital. During excision, the pathological element is removed, which reduces the risk of recurrent thrombosis.

Removal of a thrombus in internal hemorrhoids

Thrombosis of internal hemorrhoids occurs much less frequently and, as a rule, develops in the late stages of the development of the process (III-IV stages of hemorrhoids).

Treatment in this case is conservative. After stopping the acute process, treatment is carried out aimed at removing internal hemorrhoids (hemorrhoidectomy).

Diagnosis

Diagnosis of hemorrhoidal thrombosis is not difficult. The diagnosis is established by external examination of the anal region .

If the proctologist makes a decision on surgical intervention, it will be necessary to pass tests :
___• general blood test,
___• coagulogram,
___• blood glucose level.

It is necessary to tell the attending surgeon about all drugs taken, since some drugs (oral contraceptives, non-steroidal anti-inflammatory drugs, etc.) affect blood clotting.

Contraindications

___•  The operation is not performed if the patient’s condition is extremely serious (general exhaustion, complications of cardiovascular diseases, sepsis).
___• Surgical interventions are not prescribed for severe pregnancy (severe anemia, poorly controlled early toxicosis with dehydration, late toxicosis with generalized edema, etc.).

Since thrombectomy is a minimally invasive (low-traumatic) operation, the procedure can be prescribed after the patient’s condition has stabilized. The decision on the operation or its inadmissibility is made individually, taking into account all risk factors.

Preparation for the procedure

If the doctor decides on thrombectomy, the patient is prescribed diet with the exception of foods that provoke gas formation in the large intestine (cabbage, legumes, fresh fruits and juices from them). The ban also includes products that cause a rush of blood to the rectum and / or have an irritating effect on the mucous membrane (smoked meats, spicy dishes, alcohol).

Immediately before the procedure (in the morning and evening before the operation), you will need to clean the intestines with Microlax microenemas.

Preparation for thrombectomy is carried out when the patient’s condition allows. With a pronounced pain syndrome and an impressive size of the node, bowel cleansing is not carried out, and in case of a threat of the development of severe complications, surgical removal of a blood clot is carried out on an emergency basis.

How the operation works

The procedure can be performed on a gynecological chair or on a couch and takes a few minutes. First, doctors give an anesthetic injection, which “freezes” the tissues, as in a dental office. Therefore, the patient is conscious, but does not feel pain.

Surgical intervention takes several minutes and involves three manipulations:
___• Opening the affected node (small incision),
___• Removing a blood clot,
___• Stopping bleeding (the wound can be sutured, but more often it is not sutured)

After the procedure you can go home.

The exception is those cases of thrombosis when severe complications occur (gangrene of the node, paraproctitis, severe bleeding) that require hospitalization.

Rules of conduct in the postoperative period

If the evacuation of blood clots of hemorrhoids was carried out against the background of a satisfactory condition of the patient, then the postoperative period does not provide for significant restrictions.

The following are prohibited:
___• physical activity,
___• thermal procedures (bath, sauna, beach vacation),
___• prolonged sitting or squatting.

Foods that cause a rush of blood to the vessels of the small pelvis or irritation of the mucous membrane are excluded from the diet: spicy, salty, smoked dishes and alcohol.

Food should be rich in fiber, which stimulates the bowels (prunes, apples). It is not recommended to eat foods that can provoke constipation (rice and semolina porridge, potatoes, pasta). When stool is delayed, a mild laxative is prescribed (for example, Forlax).

After each bowel movement, wash the anal area with warm water and change the sterile napkin. If you have any suspicious symptoms (pain, bleeding, discharge from the wound), you should immediately consult a doctor.

Possible complications and side effects

Complications after hemorrhoid thrombectomy are extremely rare. However, it is necessary to observe a protective regime in order to avoid unpleasant consequences.

With physical exertion, systematic constipation and thermal procedures in the early postoperative period, bleeding or re-thrombosis of the wound may develop.

Patient testimonials and doctors’ recommendations

We analyzed online testimonials from patients who underwent removal of hemorrhoid thrombosis. The overwhelming majority of patients were satisfied with the procedure. The most common impression is: “The procedure itself is not as unpleasant as waiting for it.”

No reports of surgical complications were found. The most common complaint is soreness in the area of ​​the postoperative suture, which disappears after a few hours, but may reappear with a bowel movement.

A more serious drawback is the likelihood of relapse. In order to avoid re-thrombosis, it is necessary to follow all the recommendations of the attending physician.

Advantages and disadvantages of the method

Thrombectomy is a low-traumatic method for the treatment of acute thrombosis of hemorrhoids, which has both advantages and disadvantages. The method involves surgical intervention, so it is prescribed if conservative methods are contraindicated or ineffective.

Positive aspects of thrombectomy:
___ • A short list of contraindications,
___ • does not require placement in a hospital,
___ • The shortest restoration period with a minimum number of restrictions,
___ • Minarly severity of the side effects of the operation (pain, weakness, edema) ,
___• Complications are extremely rare.

Disadvantages of the method. Thrombectomy does not involve removal of the hemorrhoid, so re-thrombosis is possible. For this reason, in recurrent thrombosis, a more radical operation to remove thrombosed nodes is indicated ( hemorrhoidectomy ).

Prevention of recurrence

Basic principles of prevention

Thrombosis of the hemorrhoid occurs as a complication of hemorrhoids, so the prevention of relapse is to prevent the occurrence of enlarged hemorrhoids.

Hemorrhoids are a disease with hereditary predisposition. Therefore, if there has already been one attack, there is a high probability of relapse. However, the implementation of a negative scenario is possible if there are additional risk factors:
___• Pregnancy,
___• Taking hormonal drugs,
___• Overweight,
___• Permanent violation of the diet: intake of spicy and fatty foods, alcohol,
___• Abuse of thermal procedures (bath and sauna) or regular hypothermia,
___ • work that involves prolonged sitting or heavy physical work.

Precautions to be taken

Most often, acute thrombosis occurs as a result of long-term disturbance of the stool (chronic constipation). Therefore, you need to achieve daily bowel movements with a diet rich in fiber.

It is advisable to refrain from physical and nervous overload, as well as from hypothermia and overheating of the lower half of the body. You should not abuse alcohol, as well as spicy, smoked and salty foods.

When “sedentary” work, you need to take regular breaks, during which to carry out exercises that prevent hemorrhoids. Many chronic diseases can contribute to the development of hemorrhoids, so taking care of your health is a reliable prevention of thrombosis of hemorrhoids.

Dangerous regarding the development of hemorrhoids and obesity. With this pathology, intra-abdominal pressure increases, the rheological properties of the blood change, there are problems with the stool, and the hormonal background is disturbed. Therefore, normal weight is not only beauty, but also health.

Is it possible to do without surgery?

If doctors have recommended a hemorrhoid thrombectomy, this means that conservative therapy is not indicated in your case. You should not try to treat thrombosis with “folk” methods.

If treatment is inadequate or absent, complications may develop:
___• bleeding,
___• node gangrene,
___• paraproctitis (purulent fusion of perirectal fatty tissue).

In some cases, the affected node can open on its own and free itself from a blood clot. In place of the “bump” a skin fold is formed – anal fringe, which causes discomfort (itching, weeping) and is an unpleasant cosmetic defect.

Treatment of thrombosis of hemorrhoids in City Clinical Hospital No. 31 (Moscow)

The Consultative and Diagnostic Center of City Clinical Hospital No. 31 has the necessary medical and diagnostic equipment to help patients with hemorrhoids. An experienced proctologist will conduct a diagnostic examination and prescribe the best treatment method for your case. If the patient’s condition allows, we try to carry out therapy with conservative and minimally invasive methods. We can also treat hemorrhoids during pregnancy and other conditions when special care must be taken when prescribing medications.

If there is an indication for surgery, the patient is referred to a short-stay hospital or surgical department, where he is treated under the supervision of an experienced surgeon.