Hemorrhoids: Symptoms, Causes, and Treatment

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What Are Hemorrhoids?

Hemorrhoids are vascular structures located at the junction between the rectum (the lower part of the large intestine) and the anus, extending approximately 4 centimeters in length. This area is divided by a circular anatomical boundary known as the dentate line.

Above the dentate line lies the anal canal, which lacks pain-sensitive nerve fibers. Under normal conditions, the walls of the anal canal contain vascular cushions, composed of blood vessels and smooth muscle fibers, which help maintain continence.

Mechanism of Hemorrhoid Formation

According to current medical theory, hemorrhoids develop when excessive straining during bowel movements, chronic constipation, increased intra-abdominal pressure, or the passage of large, hard stools causes these vascular cushions to gradually descend. Over time, they may protrude outside the anal canal, resulting in internal hemorrhoids.

Below the dentate line is the anal margin, which contains pain-sensitive nerve endings. When vascular cushions descend from above, they exert pressure on the blood vessels and tissues in this area, leading to the formation of external hemorrhoids, which are often painful.

Symptoms of Hemorrhoids

Fresh rectal bleeding during or after bowel movements
Protruding masses from the anus
Itching and irritation around the anal margin, often caused by mucus discharge from the lower rectum
Pain, particularly in external hemorrhoids, due to vessel tearing and nerve irritation
A sensation of discomfort when internal hemorrhoids prolapse and do not retract spontaneously

Factors Contributing to the Development of Hemorrhoids

Chronic constipation
Frequent diarrhea
Excessive straining during bowel movements
Prolonged sitting on the toilet (e.g., reading or using a mobile phone)
Overuse of laxatives or enemas
Pregnancy, which increases abdominal pressure and affects bowel movement
Liver disease causing venous congestion and dilation around the rectum and anus
Aging, leading to weakening of supporting muscles and descent of vascular cushions
Family history of hemorrhoids, increasing individual susceptibility

Stages of Hemorrhoids and Treatment Options

Stage 1

Hemorrhoids remain internal and may cause bleeding.
Treatment options: Sclerotherapy (hemorrhoid injection), oral medications.

Stage 2

Hemorrhoids prolapse during bowel movements but retract spontaneously.
Treatment options: Rubber band ligation or stapled hemorrhoidectomy using an automated stapler device.

Stage 3

Hemorrhoids prolapse and require manual reduction.
Treatment options: Conventional surgical excision, stapled hemorrhoidectomy, or rubber band ligation.

Stage 4

Hemorrhoids are permanently prolapsed and cannot be manually reduced.
Treatment options: Conventional surgical excision or advanced techniques such as the Ligasure device.

What Should You Do If You Suspect Hemorrhoids?

Treatment depends on the severity of the condition. It is recommended to consult a surgeon for proper evaluation and individualized treatment planning. Management options may include:

Lifestyle modification and improved bowel habits
Medications such as oral drugs, laxatives, suppositories, and topical ointments (commonly used in early stages)
Sclerotherapy (hemorrhoid injection)
Rubber band ligation
Suture ligation
Surgical excision for stage 1–3 hemorrhoids using conventional or stapled techniques
Surgical management for stage 4 hemorrhoids using conventional excision or advanced devices such as Ligasure, which offer shorter hospital stays, faster recovery, and reduced intraoperative bleeding

How the Automated Stapler Device Works

This innovative surgical technique repositions prolapsed hemorrhoidal tissue back to its original anatomical location. The procedure flattens external hemorrhoids while lifting and suturing internal hemorrhoids, effectively preventing future prolapse.

Advantages of the Automated Stapler Device

Complete treatment of severe hemorrhoids with minimal residual tissue, significantly reducing recurrence risk
Reduced postoperative pain
No requirement for warm sitz baths for wound care
No need for gauze packing or management of excessive discharge
Shorter operative time
Reduced hospital stay
Faster recovery and earlier return to daily activities