HEMORRHOIDS-TREATMENTS
Hemorrhoids in which piles or clusters of dilated blood vessels in the lower rectum (internal piles) or in the anus (external piles) are formed. Pile is a traditional name used by many people for hemorrhoids.
The piles or clusters of the dilated blood vessels known as arteriovenous anastomoses present in the rectum and anus cause downward displacement of the rectal and anal cushions to form the internal and external piles respectively.
Although hemorrhoids are common and considered minor medical problems hey produce considerable discomfort and anxiety.
A proper diagnosis must be carried out before taking a conclusion for the treatments of hemorrhoids as many other pathological conditions can mimic the symptoms of hemorrhoids such as,
1.Anal abscess a small inflamed reddish boil which is caused by an infection usually of Staphylococcus
2.Cryptitis which is inflammation of the crypts usually seen in inflammatory bowel disease and Crohn's disease.
3.Anal fissure which is a small tear in the lining of the anus.
4. An anal fistula is an abnormal contact of the rectal mucosa with the skin of the anus adjacent to it.
5.A polyp which a tumor of the large intestine.
6.Colorectal cancer
All the above conditions also can cause bleeding which is similar to hemorrhoids.
Fortunately, patient reassurance and the proper administration of a few simple treatments usually improve the conditions of hemorrhoids.
Types of Hemorrhoids
1. Internal hemorrhoid is an exaggerated vascular cushion with an engorged internal hemorrhoidal plexes located above the dentate line and covered with a mucus membrane
2. An external hemorrhoid is a dilated vein of the inferior hemorrhoidal plexus located below the dentate line and covered with squamous epithelium
Causes
Hereditary may be a primary cause. But there are other acquired causes also such as
1.Situations that result in increased venous pressure in the hemorrhoidal plexes such as chronic straining of defecation during constipation; small hard stools; prolonged sitting on the toilet; heavy weight lifting jobs; and pregnancy.
2. The dilated hemorrhoidal veins are pushed downward during defecation or straining a with increase venous pressure they dilate and become engorged.
Over time the fibers that attach the hemorrhoidal veins to their underlying mucosa stretch which results in Prolapse
Symptoms
1. Painless bleeding is the most common symptom occur during defecation or bowel movements
2. Prolapse is the second most common symptom whether it may be temporary or permanent.
3. Pain is usual if thrombosis involving external tissue is present.
4. Other symptoms are discomfort; soreness; pruritus; swelling and discharge
Groups of internal hemorrhoids
1. A first degree (Grae-1) hemorrhoid does not descend or prolapse during straining during defecation.
2. A second degree (Grade-2) hemorrhoid descend but return automatically with relaxation
3. A third-degree (Grade-3) hemorrhoid require manual replacement into the rectum after prolapse
4. A fourth degree (Grade-4) hemorrhoid is permanently prolapsed.
Treatments
All treatments of hemorrhoids are based on breaking a cycle of events such as the protrusion of vascular submucosal cushion through a tight anus which becomes congested and hypertrophic which causes the mucosa to protrude further.
Treatments for minimal bleeding 1st and 2nd Grades:-
1.Advise the patient to reduce straining during defecation and to avoid sitting longer time on the toilet
2. Avoid constipation by the intake of high fiber diet, increased water drinking, use of bulk laxatives stool softeners such as docusate.
3. Use sitz baths (a bath in which a person can sit in water up to his hips) to soothe the anal mucosa by using warm water mixed with Epsom salt or ice cubes. Avoid prolonged bathing by increasing the frequency of bathing.
4.OTC hemorrhoidal ointments, creams, foams and suppositories can also help to relieve symptoms
Treatments of Higher Graded Hemorrhoids
It usually requires a doctor's supervision and special procedures.
1. Anoscope ligation watches the video above.
A rubber band ligation is employed for symptomatic hemorrhoids of grades 2 and 3.In this procedure a rubber band ligature is inserted into the anus by using an anoscope and placed on the rectal mucosa above hemorrhoid well above the dentate line. The ligated area sloughs off in a few days.
2. Infrared coagulation can be used for Grade-2, but it is less effective than the banding with large hemorrhoids. Watch the video above.
3. Sclerotherapy is the procedure in which a sclerosing agent is injected into hemorrhoids.
4.Cryotherapy in which freezing the hemorrhoids are performed.
5.Surgical hemorrhoidectomy. Watch the above video.
This invasive procedure is reserved only for Grades 3 and 4.
The main disadvantages are after this surgery performed whether by traditional or by laser, the patients often have significant discomfort and post-operative disabilities.
An external thrombosed hemorrhoid can be completely excised in an office setting, clinic, or in an operation theatre.
OTC Treatments
FDA has approved some OTC medications to alleviate the discomforts of hemorrhoids such as pain; irritations; burning; inflammations; itching and swelling. But they are not curative and their use may produce any unwanted symptoms stop them and consult the doctor.
1. Generally, ointments and creams are preferable than suppositories which may bypass the affected area.
2. Local anesthetics work by blocking the pain impulses. They can be used at the anus and the perianal level but not deep up to the rectum.
e.gs
1.Benzocaine 5% to 20%
2.Zinc sulfate monohydrate and Pramoxine HCl 1%(Anusol Plus)
3.Benzyl Alcohol 1% to 4%
4.Dibucaine HCl 0.25% to 1%
5.Dyclonine HCl 0.5% to 1%
6.Lidocaine 2% to 5%
7.Xylocaine and Tetracaine 05% to 1%
3. Vasoconstrictors have been shown to decrease mucosal perfusion in the anorectal area after topical application. However, because bleeding in this area is a sign of more serious conditions other than hemorrhoid vasoconstrictors are not approved for minor bleeding. These agents may give local anesthetic effects also for relieving itching burning etc.
e.g.
a.Ephedrine sulfate 0.1 to 0.125%
b.Ephedrine HCl 0.005% to 0.01%
c.Phenylephrine HCl 0.25%
All the above are in aqueous solutions.
Vasoconstrictors are highly contraindicated in those who have cardiovascular disease, high blood pressure, hyperthyroidism, and diabetes mellitus.
Protectants
These agents provide a physical barrier forming a protective coating over the mucosa to give a temporary comfort.
e.gs
a.Absorbents
b.Adsorbents
c.Demulcents
d.Emollients
