Hemorrhoidal Disease

They are vascular cushions filled with blood, located just inside the breech region. Being filled with blood during rest helps to keep stool (fecal continence). Hemorrhoid pads are attached to the muscle layer of the large intestine behind them. When the need to defecate arises, the blood in it empties and the anal canal opens and defecation takes place. However, in cases such as constipation, which causes difficult defecation, or diarrhea, which causes prolonged straining, the blood inside cannot be emptied by the pressure exerted by the stool, and they hang down by breaking off from the intestinal wall to which they are attached. Irritation of stool may cause bleeding.

In addition to chronic diarrhea and constipation, chronic straining, pregnancy, hereditary factors, standing for a long time can cause hemorrhoidal disease.

Epidemiology (Frequency)

According to Goligher, 45% of the population consults a physician at some point in their life due to hemorrhoid disease. According to many studies, the age at which the disease becomes symptomatic most often is between 45-65 years of age. There are more people who believe that there is no difference between the sexes in terms of incidence, but it should be emphasized that the pregnancy period in women is often the period when the disease becomes symptomatic for the first time.

Complaints and findings

Among the most common symptoms bleedingincome.

The second main finding is the hemorrhoid nipples, which are palpable after defecation and which patients try to replace.

Indirect complaints are wetting the rectum by the prolapsed mucosa, causing irritation and itching in the anus as a result of the stool overflowing, and disturbing the patient in the form of soiling the laundry. It is known that especially in cases of external hemorrhoids, stool residues cannot be cleaned sufficiently due to the recesses and protrusions of the skin folds and this causes hygienic problems such as feeling of wetness and itching in patients.

It is generally accepted that there is no pain in hemorrhoids. However, pain may be added in advanced cases. In addition, it is possible to encounter thrombosed hemorrhoids that cause patients to feel throbbing pain.


Internal hemorrhoids are examined in 4 stages and the treatment to be applied differs according to the stage.

Stage-1: Inside the anal canal

Stage-2: protruding beyond the anal canal but spontaneously regressing

Stage-3: Reversing by pushing manually, not spontaneously

3a: There are only primary (at 3-7-11) packs

3b: There are packages other than primary packages

Stage-4: Never going back

4a: There are only primary (at 3-7-11) packs

4b: There are packages other than primary packages

Examination and diagnosis

It is possible to see advanced hemorrhoids visually. However, in early stage hemorrhoids, it is necessary for the physician to examine with fingers or devices called anoscope. In elderly patients, it is necessary to examine the intestines with rectoscopy or colonoscopy in order to see that the bleeding complaint is not caused by a tumor in the rectum.


General principles in treatment

The first recommendation to patients is to consume enough fiber and water. Among vegetables and fruits, those with more pulp should be preferred instead of those with more juice. Preventing constipation with adequate fiber and water consumption usually stops the progression of the disease.

It is very effective to apply a hot water sitz bath for 10 minutes twice a day.

Non-surgical treatments (Office applications)

rubber band ligation

It is applied by placing a band on the root of the hemorrhoidal pouch in internal hemorrhoids. The band suffocates the hemorrhoid and after a while it is completely spilled, causing it to disappear. It does not have very serious side effects and can be applied in outpatient clinic conditions without requiring any anesthesia.

Hemorrhoids treatment with LASER

The basis of this method is to burn the hemorrhoids with the heat created by the laser and to ensure that the hemorrhoids shrink and adhere to the intestinal wall during the healing of the burn. It can be applied in polyclinic conditions.


It is a method based on the principle of healing the coagulation necrosis created by injecting chemical substances into the hemorrhoidal pouch and fixing the mucosa to the muscle by the formed scar tissue. Generally, phenol is used as a chemical. It may result in infection at the application site.


It is a method based on the principle that the scar tissue formed by the healing of coagulation necrosis caused by freezing the hemorrhoidal pouch, just as it is in the burning, fixes the mucosa to the muscle behind it.

Surgical treatment

It is the surgical removal of diseased hemorrhoids.

After the hemorrhoids are removed, the remaining area can be left open (Milligan Morgan) or covered with absorbable threads (Ferguson).

It is known that one of every two people in the society will have hemorrhoid complaints at any time in his life. About 10% of patients with complaints need surgical treatment. In other words, 5% of the individuals in the society have hemorrhoid surgery.

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