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Hemorrhoids are vascular structures in the anal canal which support with stool control. They develop pathological or piles when swollen or inflamed. In their regular state, they act as a cushion composed of arteriovenous channels and connective tissue.The indications of pathological hemorrhoids depend on the type present. Internal hemorrhoids generally present with painless rectal bleeding, while external hemorrhoids may produce few symptoms or if thrombosed significant pain and swelling in the area of the anus.
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Many people incorrectly refer to any symptom happening around the anal-rectal area as "hemorrhoids" and serious causes of the symptoms should be ruled out. While the exact cause of hemorrhoids remains unknown, a number of factors which increase intra-abdominal pressure, in particular constipationis believed to play a role in their development. Early treatment for mild to moderate disease comprises of increasing fiber intake, oral fluids to maintain hydration, NSAIDs to help with the pain, and rest. A number of minor procedures may be performed if symptoms are severe or do not improve with conservative management. Surgery is reserved for those who fail to improve following these measures. Up to half of people may experience problems with hemorrhoids at some point in their lives. Outcomes are usually good.Treat hemorrhoids only when the patient complains of them. The old adage that it is hard to make an asymptomatic patient better applies here. No matter how bad the hemorrhoids look to the practitioner, they should not be treated unless they bother the patient.Treatment of hemorrhoids is divided by the cause of symptoms, into internal and external treatments. Accurately classifying a patient's symptoms and the relation of the symptoms to internal and external hemorrhoids is important.
Internal hemorrhoids do not have cutaneous innervation and can therefore be destroyed without anesthetic, and the treatment may be surgical or nonsurgical. Internal hemorrhoid symptoms often respond to increased fiber and liquid intake and to avoidance of straining and prolonged toilet sitting. Nonoperative therapy works well for symptoms that persist despite the use of conservative therapy. Most nonsurgical procedures currently available are performed in the clinic or ambulatory setting.
The following is a quick summary of treatment for internal hemorrhoids by grade: Grade I hemorrhoids are treated with conservative medical therapy and avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) and spicy or fatty foods
Grade II or III hemorrhoids are initially treated with nonsurgical procedures Very symptomatic grade III and grade IV hemorrhoids are best treated with surgical hemorrhoidectomy
Treatment of grade IV internal hemorrhoids or any incarcerated or gangrenous tissue requires prompt surgical consultation Stapled hemorrhoid surgery, or procedure for prolapsing hemorrhoids (PPH), is an excellent alternative for treating internal hemorrhoids that have not been amenable to conservative or nonoperative approaches. Short- and medium-term results are excellent. Patients with minimal external tags and large internal hemorrhoids are easily treated with procedure for prolapsing hemorrhoids and skin tag excision. Operative resection is sometimes required to control the symptoms of internal hemorrhoids.
External hemorrhoid symptoms are generally divided into problems with Helicobacter pylori in clinical practice, acute thrombosis and hygiene/skin tag complaints. The former respond well to office excision (not enucleation), whereas operative resection is reserved for the latter. Remember Gastrointestinal Oncology, that therapy is directed solely at the symptoms, not at aesthetics.
When performed well, operative hemorrhoidectomy should have a 2-5% recurrence rate. Nonoperative techniques, such as rubber band ligation, Gastrointestinal Surgery, produce recurrence rates of 30-50% within 5-10 years. However, these recurrences can usually be addressed with further nonoperative treatments.Urologic Oncology and more. Long-term results from procedure for prolapsing hemorrhoids are unavailable at this time.
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This page was last updated on 12th Sep, 2015
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