Hemorrhoids - Prevention and Treatment

• The symptoms of hemorrhoids, tumors or colon cancer are extremely similar to one another, so seeking an expert medical diagnosis to distinguish any issue accurately is highly recommended in order for appropriate treatment.
• Seek medical attention to undergo diagnosis and treatment should you experience any of the following symptoms: a white mucus passed with dark, bloody stools; anemic episodes; frequent bowel movements; being unable to pass stools properly; a constant pain in the anus; alternating between bouts of constipation and diarrhea; a continuous reduction in stool size; sudden weight loss; or a family history of colon cancer.
• Treatment for hemorrhoids may come in either surgical or non-surgical forms depending on the severity of the symptoms, which differ significantly from case to case. As such, it is essential that a doctor prescribes the treatment.

Hemorrhoids are an increasingly common issue nowadays, although there are still many misconceptions surrounding this condition. For instance, passing bloody stools does not always point solely to hemorrhoids as this symptom could also be caused by an intestinal polyp or an undiscovered tumor in the colon.

The anus contains a large number of tiny blood vessels and, when the blood vessels in and around the anus become swollen or inflamed as the muscle connected the anus relaxes, it results in hemorrhoids developing. These can develop in a cluster or in several distinct areas. As such, hemorrhoids are generally classified into two main types, as follows:

These develop on the inside of the rectum and usually involve swollen blood vessels that are generally invisible on the outside and impossible to feel by hand, meaning that a colonoscopy is normally required to diagnose them. Such hemorrhoids are classified into the following 4 distinct stages according to their size (from smallest to largest):

Stage 1: These hemorrhoids are tiny and do not protrude from the rectum whatsoever, although they may cause bleeding during or after a bowel movement.

Stage 2: These hemorrhoids expand, protruding from the anus during bowel movements, before returning to their original position as the muscles contract upon completion of the bowel movement. They cause more frequent bleeding, with this blood often bright red in color.

Stage 3: These hemorrhoids are large and protrude from the anus during bowel movements, and fail to return to their original position without being pushed back in by the patient. These hemorrhoids lead to frequent bleeding and significant irritation.

Stage 4: At this stage, the hemorrhoids are quite large, protruding from the anus at all times, with the distinct possibility of severe pain that disturbs the daily life of the sufferer.

This type of hemorrhoid develops on the outside of the anus due to swelling of the blood vessels located in this region. They are visible from the outside and can be felt by hand, while they tend to become more painful when inflamed.

Nevertheless, it is quite common for patients to experience both internal and external hemorrhoids at the same time.

The fact that the symptoms of hemorrhoids and tumors are so similar to those associated with colon cancer means that an expert medical diagnosis should be undertaken in order to identify the condition accurately before appropriate treatment. Such a diagnosis is essential at present due to the risk that colon cancer poses to young people as well as the elderly. It is therefore crucial to be on the lookout for the following symptoms:

• A white mucus being passed with dark, bloody stools
• Anemic episodes
• Frequent bowel movements or being unable to pass stools properly
• A constant pain in the anus
• Alternating between bouts of constipation and diarrhea
• A continuous reduction in stool size
• Sudden weight loss
• A family history of colon cancer

• Constipation, passing hardened stools, or regularly exerting too much force during bowel movements
• Trying to force bowel movements too quickly or too forcefully
• Not eating enough fruit and vegetables, and only eating meat, thereby causing stools to harden and become difficult to pass
• Not drinking enough water, which can result in stools becoming dry and hard
• Spending too long on the toilet, usually when reading a book or playing on a mobile phone, which can lead to blood vessels expanding
• A pregnancy and resulting increase in uterus size causing a decrease in circulation to the pelvic floor (consulting a doctor regarding hemorrhoid treatment prior to a pregnancy is recommended)
• The aging process leading to a slackening of the muscle tissue in the anus, which can easily cause the inflammation necessary for hemorrhoids to develop

• Spend an appropriate amount of time on the toilet.
• Increase consumption of fruit and vegetables as this will increase fiber levels which, in turn, improves the digestive process and makes passing stools easier.
• Drink plenty of water to prevent hard, dry stools, thus easing bowel movements.
• Exercise regularly to improve intestine function and pass stools easily.

Treatment for hemorrhoids depends entirely on the type and severity of each case, although treatment generally takes one of the following two forms:

1. Non-surgical treatment: This option is used when treating stage 1 and 2 hemorrhoids – which are not yet large in size. There are many non-surgical techniques that can be used, as follows:

• Suppository medication may be prescribed by doctors as it can ease symptoms associated with internal hemorrhoids (suppositories cannot be used to treat external hemorrhoids).
• Injections into the region affected by hemorrhoids can reduce their size. Injections should be carried out every 2–4 weeks for the best results.
• Rubber band ligation can be applied to the tip of the hemorrhoids, starving them of blood supply until they fall off. However, such a method of treatment must only be carried out under the supervision of a trained specialist because there is a risk of infection and other associated side effects. This form of treatment cannot be used to treat patients who take anticoagulant medication as it could lead to severe bleeding or a hemorrhage occurring.

2. Surgical treatment: Suitable for treatment of stage 3 and 4 internal hemorrhoids.

• Traditional hemorrhoid surgery can be used to remove large and problematic hemorrhoids. This method involves cutting into the blood vessels causing the condition without damaging the anus at all. Patients can still regulate their bowel movements after surgery, and this method offers more long-term benefits than other treatments. There is also a low rate of recurrence when carried out by a specialist surgeon. It is a suitable form of treatment for those suffering with large external hemorrhoids or internal hemorrhoids that have begun protruding directly from the rectum. Moreover, recent innovations mean that an epidural block is no longer necessary, with patients instead given an intravenous anesthetic to put them to sleep before a localized anesthetic is used in the affected area. This means they feel no pain whatsoever during surgery. Dissolvable stitches are then used so that patients do not need to return to hospital for wound care. Special seating such as was used in the past is also no longer necessary following this form of surgery.
• Stapled hemorrhoidopexy using a PPH stapler is only suitable for use when treating internal hemorrhoids that are not too large in size. However, owing to the fact that most hemorrhoid sufferers tend to have both internal and external hemorrhoids at the same time, the use of this device is not widespread. Surgeons must be extremely careful when performing this procedure because if the incision is too low and some external tissue is removed, it will cause immense pain and lead to issues with the anus resealing after bowel movements due to the metal ring being permanently placed incorrectly.
• Laser hemorrhoid surgery can be used to treat less severe cases of hemorrhoids whereby the protruding tissue is small in size. It involves focusing a laser beam onto the affected blood vessels to break them down gradually. It is relatively effective, although the costs are quite high due to the cost of the device used. Furthermore, there is a high chance that the hemorrhoids may return in the long run. Also, the fact that results do not differ significantly from the much more affordable injection treatment means that laser hemorrhoid surgery is understandably unpopular.
• Doppler guided hemorrhoid artery ligation with recto-anal repair may only be used to treat smaller internal hemorrhoids. This treatment relies on ultrasound scans used to pinpoint the location of each vein supplying blood to the hemorrhoid. This then allows the stitching of that vein to take place in order to cut off the blood supply. The hemorrhoid itself is not removed as it is hoped that it will naturally reduce in size, which is why this form of treatment is only suitable for smaller hemorrhoids. Additionally, there is a risk of the hemorrhoids returning in the long-term due to the prevalence of blood vessels in that region or due to the body often being capable of replacing the destroyed veins, thus leading to inflammation to occur once more.

Should you experience any of the symptoms mentioned here and those symptoms do not improve but instead deteriorate, it is highly recommended that you seek medical diagnosis at your earliest opportunity. This will ensure that any disorder can be identified at the outset, thereby giving any subsequent treatment a much higher chance of success.

The Liver and Digestive Institute at Samitivej Hospital, Bangkok has displayed a continued commitment to raising the level of treatment we provide. We have entered into a partnership with Sano Hospital, a leading hospital from Japan noted for its high level of expertise in the field of digestive endoscopic procedures, as well as in the analysis of the digestive mucosal wall, especially through image enhanced endoscopy.