Hemorrhoidal Disease

What is Hemorrhoidal Disease?

Hemorrhoids are anatomical natural structures found in every human being. Deformation of these structures due to various reasons over time and causing problems in the anal region is called hemorrhoidal disease. Hemorrhoidal disease is a condition that needs to be treated. It can cause problems such as anal swelling, pain and bleeding that impair quality of life.

Hemorrhoidal Disease Symptoms

In hemorrhoidal disease, symptoms and signs may change according to the stage of the disease. In stage 1-2 disease, the first finding is rectal bleeding, while in stage 3-4 disease, anal swelling and pain may be present. In thrombosed hemorrhoidal disease, there is a hard and very painful swelling in the anal region.

Diagnosis of Hemorrhoidal Disease

In hemorrhoidal disease, patients are generally reluctant to go to the doctor. He tries to do his treatment with hearsay methods. However, there are many diseases that cause similar complaints in the anal region. A differential diagnosis must be made. About 60% of people with rectal cancer think that their complaints are caused by hemorrhoidal disease. Therefore, their treatment is delayed.

Diagnosis of hemorrhoidal disease is made by proctological examination. The problem is mostly understood with the examination of the surgeon who is experienced in the subject. However, sometimes further investigations may be required for differential diagnosis. The most important of these is colonoscopy.

Hemorrhoidal Disease Treatment

Hemorrhoidal disease, which is 90% of the time, can be treated without the need for surgery with lifestyle changes, diet, defecation training and some medications. Chronic episodes of constipation or diarrhea can trigger hemorrhoidal disease. Staying in the toilet for a long time poses a risk in terms of hemorrhoidal disease. The familial effect has an important place in the development of the disease in many patients.

Hemorrhoidal Disease Surgery

It can be applied in practice conditions in the treatment of early stage hemorrhoidal disease; It can be treated with techniques such as radiofrequency treatment, sclerotherapy, hemorrhoid band ligation and, in appropriate cases, laser treatment.

The method of ligating/attaching the hemorrhoidal arteries with Doubler is also used in the treatment.

Frequently asked questions from Prof. Dr. Bahadır EGE answers…

What Causes Hemorrhoidal Disease?

Many factors are effective in the development of hemorrhoidal disease. If we list the most factors; We can summarize it as being familial, occupation, constipation, diarrhea, defecation habits, pregnancy, stress.

Does Hemorrhoidal Disease Go By Itself?

If the hemorrhoidal disease is in its early stages, it can go away on its own. In other words, if the constipation attack, diarrhea attack have passed, if the pregnancy has ended, the hemorrhoidal disease may regress. However, treatment is required in advanced hemorrhoidal disease. Professional help should be sought for faster recovery and for the disease not to progress.

Hemorrhoidal Disease: Important Information

More than 50% of individuals over the age of 50 have hemorrhoidal problems.

An estimated 10 million people in the United States have been diagnosed with hemorrhoidal disease, corresponding to a prevalence of 4.4%.

If this rate is applied to our country, it means that 3.7 million people are treated for hemorrhoidal problems every year.

In epidemiological studies conducted in Korea, England and Austria, hemorrhoidal disease was detected in 14 to 39 percent of the population. However, most were symptom-free.

There is a cuboidal mucosa proximal to the dentate line and cushions rich in arterial, vein, lymphatic and connective tissue under the keratinized squamous epithelium distal.

Concentrating on the 3,7,11 dial, this structure

The corpus cavernosum is called hemorrhoidalis.

Ligament of Treitz (hemorrhoidal sling).

Parks ligaments.

As a result of the degeneration of the connective tissue (fibroelastic stroma), which is in the normal structure and function of the physiological hemorrhoid pads, the hemorrhoid pads protrude distally, and as a result, the disease develops.

At rest, blood coming into the anal canal via the hemorrhoidal arteries is easily carried back into the venous circulation by the venous plexus. The cavernous system does not swell.

Conditions that cause venous stasis such as straining during difficult defecation, pregnancy, and excessive defecation may lead to venous distention, mucosal edema-ischemia, thrombus and bleeding.

Progressive anatomical degeneration creates hemorrhoidal disease on the basis of genetic predisposition.

  • Internal (internal) hemorrhoid disease

  • External (external) hemorrhoid disease

Internal hemorrhoidal disease forms the basis of hemorrhoid disease.

Hemorrhoidal Disease examination should be performed under the following conditions;

An environment that respects personal rights, proctological table, appropriate light source and necessary infrastructure for differential diagnosis.

Hemorrhoidal Disease main differential diagnosis;

  • anal fissure

  • prolapse

  • Rectal cancer (52%)

Sclerotherapy (In Grade I-III Disease)

It is the injection of 3-5 ml of sclerosing substance into the apex of internal hemorrhoids.

For internal hemorrhoids targeted for treatment, 1-3 cc of sclerosing material is injected into the submucosal plane using a long intravenous 21 gauge needle or spinal needle.

A bump should be removed along with the solution. If the injection is too superficial, the area becomes tight and white and the injection should be stopped immediately to minimize the risk of mucosal necrosis.

Infrared Coagulation Method:

Infrared light waves are converted into heat resulting in protein necrosis within the hemorrhoid.

This appears as a white, bleaching effect on the mucosa about 3 mm wide and 3 mm deep.

Compared to rubber band ligation, infrared coagulation is associated with more recurrence but less complications and less post-procedure discomfort.

Over a period of one to two weeks, it causes retraction of the prolobed hemorrhoidal mucosa, leading to a shrunken or ablated area.

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