Hemorrhoids are essentially bulging veins near the anus and lower rectum, a type of varicose veins. When hemorrhoids form inside the lower rectum, they are called internal hemorrhoids, and when hemorrhoids form under the skin around the anus, they are called external hemorrhoids.
On average, 3 to 4 out of every 10 adults will have hemorrhoids. The incidence of the disease in men is twice as high as in women, most occurring in the elderly and not in children.
Figure 1. Types of hemorrhoids
Causes and symptoms
Reason
The veins in the anorectal area tend to dilate when intra-abdominal pressure increases over a long period of time, causing varicose veins to dilate, forming hemorrhoids. Sources of increased abdominal pressure may include:
- Coughing a lot due to chronic lung diseases: bronchitis, bronchiectasis.
- Prolonged constipation or diarrhea.
- Fat.
- Pregnant.
- Carry heavy objects regularly.
- Play heavy sports such as bodybuilding, weightlifting, etc.
- Standing or sitting for long periods of time.
Cases at high risk of hemorrhoids are: pregnant women and the elderly.
Classification and symptoms
Signs and symptoms of hemorrhoids depend on the type of hemorrhoids the patient has.
Internal hemorrhoids
Hemorrhoids are located in the lower rectum, usually cannot be seen or felt, and the patient does not feel discomfort until defecation. Signs and symptoms include:
- Bleeding during defecation but not painful: in the early stages, a small amount of bright red blood will appear on toilet paper or under the toilet. After a long period of increased pressure on the abdominal wall, blood flows into drops or rays. At the late stage, other than when having a bowel movement, just walking a lot or squatting will cause the blood to flow again.
- Pain and burning when internal hemorrhoids prolapse outside the anus.
Internal hemorrhoids are classified into 4 levels:
- Grade 1 hemorrhoids: Hemorrhoids are located completely in the anal canal.
- Grade 2 hemorrhoids: Normally, the hemorrhoids lie in the anal canal and when you strain to defecate, they protrude from the anus and retract when you stand up.
- Grade 3 hemorrhoids: When defecating, doing heavy work, walking a lot, or squatting, the hemorrhoid prolapses. Using gentle pressure with your hand, it can go in or recede on its own when resting.
- Grade 4 hemorrhoids: Large hemorrhoids, often located outside the anal canal, often linked together to form ring hemorrhoids.
Figure 2. Grades of internal hemorrhoids
External hemorrhoids
Hemorrhoids are located under the skin around the anus, causing:
- Itching and burning in the anal area.
- Discomfort or pain in the anal area.
- Anal swelling.
- Bleed.
Thrombotic external hemorrhoids
When external hemorrhoids become clogged, blood stagnates to form a blood clot next to the anus, leading to:
- So hurt.
- Swelling/inflammation.
- A hard mass near the anus.
When to see a doctor?
- When bleeding during bowel movements or hemorrhoids do not improve after applying lifestyle and diet changes, see a doctor for advice.
- Don't assume that all anorectal bleeding is due to hemorrhoids, especially if you have a healthy lifestyle and have easy bowel movements. Anorectal bleeding can occur with other diseases such as bleeding rectal ulcers, rectal polyps, colon cancer or anal cancer. Go to reputable medical facilities for examination and advice.
- Go to the emergency room immediately if you have large rectal bleeding, dizziness, lightheadedness, or fainting.
Diagnosis and treatment
Diagnose
External hemorrhoids can be easily diagnosed with the naked eye. For internal hemorrhoids, diagnosis of the disease includes the following forms:
- Direct examination: The patient lies in a suitable position, the doctor will insert a lubricated gloved finger into the patient's rectum to find pathological abnormalities.
- Indications for rectal endoscopy: After examination, the doctor will prescribe rectal endoscopy to clearly determine the location and other accompanying abnormalities.
The doctor may also prescribe a complete colorectal endoscopy when:
- There are signs and symptoms suggesting that the patient may have another digestive disease.
- Patients are in the high-risk group for colorectal cancer.
- Middle-aged patients need to be screened for cancer but have never had a colonoscopy or have not had a colonoscopy rechecked in the last 2 years.
Treatment
Treatment Medical at home
Home treatment applies to subjects with uncomplicated external hemorrhoids and mild internal hemorrhoids.
After examination and diagnosis, patients will be guided to improve their lifestyle and nutrition in the area of hemorrhoid prevention, and use prescription medications to reduce symptoms.
Surgical treatment
Surgery is performed for internal hemorrhoids of grade III and IV. After applying home treatment methods, the patient does not get relief, greatly affecting their daily life. There are two surgical methods being applied at Becamex International Hospital: classic hemorrhoidectomy surgery and hemorrhoidectomy surgery using the Longo method.
Classic hemorrhoidectomy surgery involves the doctor surgically removing excess tissue that causes bleeding. It is the most effective and definitive measure to treat severe hemorrhoids or recurrent hemorrhoids. Most patients will feel pain after surgery. Pain relievers and soaking the anus in warm water can reduce this condition, making the patient more comfortable.
Hemorrhoidectomy using the Longo method, also known as hemorrhoidectomy using the stapler method, is a method of blocking blood flow to hemorrhoidal tissue. Longo surgery is usually less painful and allows patients to return to daily activities sooner. However, each surgical method has advantages and disadvantages that the surgeon will explain and advise to choose the best method for each patient.
Figure 3. Illustration of hemorrhoidectomy using a sewing machine
Surgery to remove embolized hemorrhoids:
- A blood clot clogged in an external hemorrhoid causes a lot of pain for the patient. Only when the hemorrhoid is removed can the patient get quick pain relief.
- Surgery to remove external hemorrhoids is most effective if performed within 72 hours after pain due to external hemorrhoid formation.
At Becamex International Hospital, we Are not Perform treatment with procedures such as:
-Tie hemorrhoids with elastic bands.
- Sclerosing injection for hemorrhoids.
-Remove hemorrhoids using cryotherapy, phototherapy, electrocautery...
Prevent hemorrhoids
The best way to prevent hemorrhoids is to keep stools soft and easy to pass out of the body. To prevent and reduce the symptoms of hemorrhoids, the following methods can be applied:
- Eat lots of fiber: fruits, vegetables, cereals. Fiber helps soften stools and increase stool volume, which will reduce straining during defecation, which is one of the causes of hemorrhoids. However, you should consume fiber a little at a time and divided into several times a day to avoid problems with flatulence.
- Drink a lot of water. Drink 1.5-2 liters of water daily. Do not drink drinks containing alcohol and caffeine.
- Avoid pushing. Holding in air and straining while defecating will increase pressure on the veins in the lower rectum.
- Go to the toilet as soon as possible need to solve". If you delay, the pain of defecation will pass, the stool will become drier and more difficult to defecate.
- Do exercise. Exercise helps prevent constipation and reduce excess body weight that contributes to the formation of hemorrhoids. However, you should practice gentle exercises such as yoga, walking, jogging, etc., and avoid heavy sports such as bodybuilding, weightlifting, etc.
- Avoid sitting or standing for long periods of time. Sitting too long, especially on the toilet, can increase pressure on the veins.
- Soak the anus in warm water. You can soak the anus in warm water diluted with salt for 10-15 minutes at a time, 2-3 times a day. Soaking the anus helps patients feel comfortable, reduces itching, swelling and pain in the anus. Note: soak in the bathtub or a large basin, sit with your butt down and soak, do not squat.
After applying the measures to improve lifestyle and nutrition as mentioned, if the disease still does not improve and greatly affects daily life, you should go to a reputable facility to have the disease diagnosed. and get appropriate treatment.
Frequently asked questions
1. Is hemorrhoid surgery painful?
Answer: During surgery, the patient will receive spinal anesthesia so there will be no pain during the surgery. After surgery, patients will receive active pain relief by combining painkillers, depending on each person's condition.
2. How long does it take to recover and leave the hospital after hemorrhoid surgery?
Answer: Patients after hemorrhoid surgery are required to stay in the hospital for observation. If the condition is stable, you can be discharged from the hospital after 3-5 days.
3. Does hemorrhoid surgery recur?
Answer: No matter which surgical method is chosen, there will be a certain recurrence rate. Recovery and risk of recurrence after hemorrhoid surgery depends largely on the condition of each patient and the patient's changes in lifestyle and eating habits.
4. Do hemorrhoids form during pregnancy, will they disappear after giving birth?
Answer: Hemorrhoids that form during pregnancy are due to increased abdominal pressure when the fetus grows, constipation, difficulty defecating due to pressure on the rectum, pushing a lot during birth... can usually disappear after birth. . However, in some pregnant women, hemorrhoids do not go away on their own, so it is necessary to see a doctor and get treatment immediately to avoid bad complications.
5. Can pregnant women have hemorrhoid surgery?
Answer: During pregnancy, surgical interventions on pregnant women will be minimized. The top priority is medical treatment, except in cases of serious complications requiring emergency treatment.
Notes for patients before coming to see a hemorrhoid doctor
- For patients' convenience during endoscopy, please fast from 10 p.m. before the examination and drink a little water when thirsty.
To schedule an appointment, please call 1900 2676 during office hours from Monday to Saturday. Book at least 1 day in advance.
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