What are the common symptoms of hemorrhoids. How can you differentiate between hemorrhoid pain and other rectal conditions. What treatment options are available for severe hemorrhoid cases. When should you consider hemorrhoid surgery. How can you prevent hemorrhoids from developing or worsening.

Understanding Hemorrhoids: More Than Just a Pain in the Rear

Hemorrhoids, often misunderstood and misdiagnosed, are a common source of discomfort for many individuals. These swollen veins, located either inside the rectum or around the anus, can cause significant pain and distress. 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 approximately 40-50% of patients who believe they have hemorrhoids are actually experiencing other conditions. This misconception highlights the importance of seeking professional medical advice for accurate diagnosis and appropriate treatment.

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 primary source of discomfort, pain, and itching.

While internal hemorrhoids may not cause direct pain due to the lack of nerve sensors in the rectum, they can prolapse (slip outside the anus) and lead to significant bleeding. In severe cases, this blood loss can result in anemia, requiring medical intervention.

Distinguishing Hemorrhoid Pain from Other Rectal Conditions

When experiencing severe rectal pain, it’s essential to consider that hemorrhoids might not be the culprit. Dr. Hedrick identifies three primary causes of sudden and severe rectal pain:

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 described as “horribly, horribly painful.”

How can you tell if your pain is from hemorrhoids or another condition? The location, intensity, and duration of the pain can provide clues. Hemorrhoid pain is typically localized around the anus and may worsen during bowel movements. In contrast, an anal fissure often causes sharp, burning pain during and after defecation, while a perirectal abscess can cause constant, throbbing pain that intensifies over time.

Seeking Medical Attention: When to Consult a Specialist

If you’re experiencing severe rectal pain that persists, it’s crucial to seek medical attention. Rather than heading to the emergency room, Dr. Hedrick recommends contacting your primary care provider for a referral to a colorectal surgeon. Specialized clinics, such as the UVA Digestive Health Center, offer urgent appointments for severe cases, ensuring patients receive prompt and expert care.

Why is seeing a specialist important? Colorectal surgeons have extensive experience in diagnosing and treating a wide range of anorectal conditions. They can accurately differentiate between hemorrhoids and other issues, leading to more effective treatment plans and better outcomes for patients.

Conservative Treatment Options for Hemorrhoids

For most hemorrhoid cases, conservative treatments can provide significant relief. These approaches aim to alleviate symptoms and prevent further complications:

• Topical treatments: Over-the-counter hemorrhoid creams can help reduce pain and inflammation.
• Sitz baths: Sitting in warm water for 10-15 minutes, several times a day, can soothe discomfort and promote healing.
• Lifestyle modifications: Avoiding straining during bowel movements, staying hydrated, and increasing fiber intake can help manage symptoms and prevent recurrence.

How effective are these conservative treatments? For many patients, these methods can provide significant relief within a few days to weeks. However, it’s important to note that severe or persistent cases may require more advanced interventions.

Advanced Treatment Options: When Conservative Measures Fall Short

In cases where conservative treatments don’t provide adequate relief, more advanced options may be necessary. These can include:

• Rubber band ligation: A procedure used for small internal hemorrhoids, where a band is placed around the hemorrhoid to cut off its blood supply.
• Sclerotherapy: Injection of a chemical solution to shrink the hemorrhoid.
• Infrared coagulation: Use of infrared light to create scar tissue, reducing blood flow to the hemorrhoid.

How do these procedures compare in terms of effectiveness and recovery time? While all can be effective, the choice of procedure often depends on the specific characteristics of the hemorrhoids and the patient’s overall health. Rubber band ligation is generally considered the most effective office-based procedure for internal hemorrhoids, with a relatively quick recovery time.

Hemorrhoidectomy: When Surgery Becomes Necessary

For some patients, particularly those with large or severely symptomatic hemorrhoids, surgery may be the best option. A hemorrhoidectomy involves surgically removing the hemorrhoids and is typically recommended for cases involving:

• Persistent pain
• Significant blood loss
• Leakage of stool or mucus

Dr. Hedrick emphasizes that while most hemorrhoids don’t require surgery, it remains a common procedure. At UVA, surgeons perform between 75 to 100 hemorrhoidectomies each year.

What does the surgical process involve? The procedure is typically performed on an outpatient basis, with the surgeon using a sharp blade to remove the hemorrhoid. While other tools like lasers and staples are available, Dr. Hedrick notes that traditional excision remains the “safest and best way to prevent them from coming back.”

Recovery from Hemorrhoidectomy

Patients considering hemorrhoidectomy should be prepared for a recovery period of 2 to 4 weeks. The first week is often the most challenging, with bowel movements causing the most discomfort. To manage pain, surgeons typically provide:

• Numbing medicine that lasts 2 to 3 days
• Recommendations for over-the-counter pain relievers like acetaminophen or ibuprofen

Dr. Hedrick notes that opioids are generally avoided due to their potential to cause constipation, which can complicate recovery. While the initial recovery period can be uncomfortable, most patients report satisfaction with the results after about a month.

Preventing Hemorrhoids: Lifestyle Changes for Long-Term Health

While not all hemorrhoids can be prevented, certain lifestyle changes can significantly reduce your risk of developing them or experiencing recurrences:

• Maintain a high-fiber diet: Consume plenty of fruits, vegetables, and whole grains to promote regular bowel movements.
• Stay hydrated: Drink adequate water throughout the day to keep stools soft.
• Exercise regularly: Physical activity can help prevent constipation and reduce pressure on veins.
• Avoid straining: Don’t force bowel movements or sit on the toilet for extended periods.
• Respond promptly to bowel urges: Delaying can lead to harder stools and increased straining.

How effective are these preventive measures? While they can’t guarantee you’ll never develop hemorrhoids, they can significantly reduce your risk and help manage existing hemorrhoids. Many patients find that these lifestyle changes not only improve their digestive health but also contribute to overall well-being.

When to Seek Immediate Medical Attention

While many cases of hemorrhoids can be managed at home or with outpatient treatments, certain symptoms warrant immediate medical attention:

• Severe, persistent pain that doesn’t respond to over-the-counter treatments
• Heavy bleeding during bowel movements
• Signs of infection, such as fever or increased pain and swelling
• Inability to have a bowel movement due to pain or swelling

Why is prompt medical attention crucial in these cases? These symptoms could indicate complications or more serious underlying conditions that require immediate intervention. Timely diagnosis and treatment can prevent further complications and provide faster relief.

In conclusion, while hemorrhoids are a common and often uncomfortable condition, understanding their symptoms, causes, and treatment options can help you manage them effectively. Whether through conservative measures, advanced treatments, or surgical intervention, relief is possible. By working closely with healthcare professionals and making appropriate lifestyle changes, you can minimize the impact of hemorrhoids on your quality of life and maintain optimal digestive health.

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!

Treating hemorrhoids: Everything you wanted to know but were afraid to ask

You may be surprised to hear that everyone has hemorrhoids. In fact, I often introduce the topic to my medical students by walking around the room and pointing to unsuspecting individuals exclaiming, “I know you have hemorrhoids!”

Did you know you have #Hemorrhoids? Everyone does, but they’re practically invisible until they become inflamed.

On the #LiveWellHealthy blog, Dr. Stein shares everything you wanted to know about hemorrhoid treatment but were afraid to ask: https://bit.ly/2Tn10At.

Click to Tweet

So, what are hemorrhoids?

Hemorrhoids are a normal part of the anal canal that help us to control bowel function. There are two locations where hemorrhoids can be found. Internal hemorrhoids exist within the lining of the rectum and anal area, or the inside of the body. In contrast, external hemorrhoids are located on the outside of the body where the skin has very sensitive nerve endings.

When hemorrhoids become inflamed, they can become extremely painful, especially if they’re located externally. Unfortunately, over 10 million people suffer from inflamed hemorrhoids every year. How can something so small cause so much pain and discomfort?

Symptoms of hemorrhoids.

Hemorrhoid symptoms vary based on which ones are causing the problem.

External hemorrhoids often bring on abrupt excruciating—and sometimes debilitating—pain. Bleeding and a formed clot that stretches the skin of the anal area are the cause of the pain.

Internal hemorrhoids are graded on a scale of one to four, with painful symptoms that increase as the grade does. They’re rarely painful, although you can experience some bleeding and burning.

• Grade 1: Painless rectal bleeding
• Grade 2: Pain and discomfort from prolapsing or protruding from the anal opening
• Grade 3: Pain and discomfort from prolapsing or protruding from the anal opening that requires you to manually push them back inside
• Grade 4: Pain and discomfort from hemorrhoids that are stuck in the prolapsed position and generally require surgery

It’s important to note that some symptoms may be similar to other conditions, such as colon cancer. If you are over the age of 40 and experiencing bleeding, talk to your doctor about getting screened for colon cancer to rule out anything life-threatening.

Causes of hemorrhoids.

A lack of fiber. There are a variety of things that can cause hemorrhoids to inflame, but the most common reason is a lack of fiber in your diet. The United States Department of Agriculture (USDA) recommends that women eat a minimum of 25 grams of fiber and men consume over 30 grams of fiber every day. Yet many of us don’t eat enough fiber.

Irregular bathroom habits. Still, even if you eat enough fiber, it’s possible to develop an inflamed hemorrhoid. Constipation, straining, and irregular bowel habits are also common causes of hemorrhoids. That’s why expecting women are also prone to developing inflamed hemorrhoids—as if they don’t suffer enough uncomfortable symptoms during pregnancy. Individuals with Inflammatory Bowel Disease (IBD) may also be at an increased risk of developing hemorrhoids.

Genetics. Unfortunately, if your parents frequently developed inflamed hemorrhoids, there’s a greater likelihood that you will, too. Over fifty percent of patients with hemorrhoids have a family history of dealing with the same affliction.

Treating hemorrhoids.

Sometimes, people with inflamed hemorrhoids don’t experience any symptoms. Other times, symptoms may dissipate quickly as hemorrhoids can resolve themselves within a few days. However, for some unlucky individuals, the only way to get hemorrhoid relief is by seeking treatment from a doctor.

Request an appointment.

Treating hemorrhoids at home.

Over-the-counter medications like Preparation H may offer some pain relief for hemorrhoids. But unless you modify your fiber intake, they’ll probably keep coming back. If you have internal hemorrhoids, I will almost always recommend diet modifications to incorporate more fiber. A high-fiber diet is the best way to eliminate and prevent most cases of hemorrhoids, as fiber helps to regulate bowel movement. 70% of the time, eating more fiber will relieve symptoms of internal hemorrhoids.

Consider upping your fiber intake with the following high-fiber foods:

• Berries
• Nuts
• Legumes
• Veggies
• Whole grains

Treating hemorrhoids at the doctor.

No one dies from hemorrhoids. But if you’ve had one, you may wish that you had! Living with persistent hemorrhoid pain is miserable and there are many treatment options available so you don’t have to. Treatment options vary based on the location and severity of your hemorrhoid.

Treatment for internal hemorrhoids.

When dietary adjustments don’t relieve pain, you may benefit from a quick, in-office procedure to remove internal hemorrhoids grading one or two. Called rubber band ligation, this simple procedure involves placing a small rubber band around the hemorrhoid to help it naturally fall off within ten days. It can be uncomfortable, but it’s not painful and it’s extremely effective.

If neither diet nor rubber band ligation provide relief, there are numerous surgical options that, while painful, are effective in eliminating hemorrhoids. These include:

• Hemorrhoidectomy: When a large piece of skin is prolapsing every time you go to the bathroom, you may need surgery to remove hemorrhoids. An anesthetic will help to keep you comfortable during the procedure. However, you will likely experience pain for about two to three weeks of recovery.
• Stapled hemorrhoidopexy: This procedure pulls the hemorrhoids back into their usual position with the use of a stapling device. The recovery is significantly less painful than the classic excision.
• Hemorrhoid artery ligation: This new technique uses ultrasound to detect blood vessels supplying the hemorrhoids. Then, your doctor will suture the arteries so no blood enters the hemorrhoids, causing them to shrink.

Treatment for external hemorrhoids.

If you have an external hemorrhoid and see a doctor within three to four days of experiencing symptoms, your doctor can treat it using a procedure called thrombosis. During thrombosis, your doctor will numb the area before removing the inflamed hemorrhoid, resulting in instant relief. Unfortunately, if you’ve experienced symptoms for at least five days, the best thing to do is wait it out as the clot inside the hemorrhoid is likely already going away.

The new Surgical Pavilion at MedStar Franklin Square Medical Center.

If you need surgery for hemorrhoid relief, our new patient-centered Surgical Pavilion is now open. This 82,000-square-foot facility was designed with input from doctors, surgeons, nurses, technicians, and staff who understand the features and amenities that will make your surgery the best experience it can be. The spacious building offers ample suites for privacy, comfort, and social distancing, as well as large operating rooms equipped with state-of-the-art technology to facilitate collaboration across specialties.

While it’s important to be cautious while COVID-19 is still around, you need to take care of your health. If you have painful symptoms that suggest you may have an inflamed hemorrhoid but you’re not sure, talk to your doctor. Your doctor can help to rule out polyps or something more serious while suggesting your best treatment options if you have a confirmed hemorrhoid. If surgery is your best option, you can count on MedStar Health to provide the highest levels of care in a safe environment.

Do you have a hemorrhoid that’s causing you discomfort?
Request an appointment with a MedStar Health specialist today.

Request an appointment.

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.