Hemorrhoids: Symptoms, Causes, and Treatment

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Hemorrhoids

Mechanism of Hemorrhoid Formation

Hemorrhoids are vascular structures located at the junction between the rectum (the lower part of the large intestine) and the anus, measuring approximately 4 centimeters in length. This region is divided by a circular boundary called the dentate line. Above the dentate line is the anal canal, which does not contain nerve fibers sensitive to pain. Normally, the anal canal walls contain vascular cushions composed of blood vessels and smooth muscle fibers.

According to the current theory of hemorrhoid formation, excessive straining during bowel movements, chronic constipation, increased abdominal pressure, and the passage of large fecal masses cause these vascular cushions to gradually descend and eventually protrude outside the anal canal, forming internal hemorrhoids. Below the dentate line lies the anal margin, which contains nerve fibers sensitive to pain. When the vascular cushions descend from above, they push blood vessels and tissues of the anal margin outward, forming external hemorrhoids.

Symptoms of Hemorrhoids

• Bleeding (fresh blood) during or after bowel movements

• Presence of protruding masses from the anus

• Itching and irritation around the anal margin, often due to mucus discharge from the lower rectum

• Pain, particularly with external hemorrhoids, caused by tearing of blood vessels and irritation of dense nerve endings

• Discomfort caused by internal hemorrhoids that protrude and fail to retract spontaneously

Factors Contributing to the Development of Hemorrhoids

1. Chronic constipation

2. Frequent diarrhea

3. Excessive straining during bowel movements

4. Prolonged sitting on the toilet (e.g., reading while defecating)

5. Excessive use of laxatives or enemas

6. Pregnancy, which can impede bowel movements

7. Liver disease causing venous congestion and dilation of veins around the rectum and anus

8. Aging, leading to weakened muscles and descent of vascular cushions

9. Family history of hemorrhoids, increasing susceptibility

Stages of Hemorrhoids and Treatment Options

• Stage 1:
  Hemorrhoids remain internal and may cause bleeding.
  Treatments: Medication injection (sclerotherapy), oral medications.

• Stage 2:
  Hemorrhoids protrude during bowel movements but retract spontaneously.
  Treatments: Rubber band ligation or stapled hemorrhoidectomy (automated stapler device).

• Stage 3:
  Hemorrhoids protrude and must be manually pushed back into place.
  Treatments: Surgical removal (conventional excision), stapled hemorrhoidectomy, or rubber band ligation.

• Stage 4:
  Hemorrhoids protrude permanently and cannot be manually reduced.
  Treatments: Surgical excision using conventional methods or an advanced device like Ligasure.

What Should You Do If You Suspect Hemorrhoids?

Treatment depends on the severity of the hemorrhoids. It is advisable to consult a surgeon for assessment and appropriate treatment recommendations, which may include:

• Improving bowel habits and lifestyle changes

• Using medications such as oral medications, laxatives, suppositories, and topical ointments (commonly prescribed during early stages)

• Sclerotherapy (hemorrhoid injection)

• Rubber band ligation

• Suture ligation

• Surgical excision for stages 1–3 hemorrhoids, either through conventional methods or using an automated stapler device (stapled hemorrhoidectomy)

• Surgical treatment in stage 4 hemorrhoids involves conventional excision or advanced techniques such as the Ligasure device, offering shorter hospital stays, quicker recovery, and reduced intraoperative bleeding.

How the Automated Stapler Device Works

An innovative surgical treatment for severe hemorrhoids involves gently repositioning hemorrhoidal tissues back to their original location. This technique effectively flattens external hemorrhoids, while internal hemorrhoids are repositioned and sutured, preventing future prolapse.

Advantages of the Automated Stapler Device

1. Complete removal of severe hemorrhoids without leaving residual tissue, significantly reducing recurrence risk

2. Reduced postoperative pain

3. No need for postoperative warm sitz baths for wound cleansing

4. No requirement for gauze pads soaked in discharge fluid

5. Shorter surgical duration

6. Reduced length of hospital stay

7. Quicker recovery period at home

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