What’s a hemmoroid?
A hemorrhoid is a physiological vascular pad located in the anal canal.
Hemorrhoids, which are generally three in number, participate in excellent continence, that is to say, the ability to feel and hold its gases and stools.
This functional role explains the disorders of anal sensitivity rarely see continence that may occur temporarily after hemorrhoidal surgery.
When do hemorrhoids become pathological?
Hemorrhoids become pathological when they cause disabling symptoms.
Factors favoring hemorrhoidal pathology may be constipation, repeated efforts, prolonged standing, prolonged sitting, pregnancy, (familial) heredity.
We distinguish the hemorrhoidal crisis, chronic hemorrhoidal pathology.
The hemorrhoidal crisis is related to a sudden swelling of the hemorrhoidal pads. The factors triggering these seizures are multiple: constipation, prolonged sitting, stress, fatigue, spicy meals, pregnancy … and sometimes unidentified. The symptoms are usually bleeding, discomfort, pain, heaviness, feeling of externalization during stool or permanent. The proctological examination finds congestive hemorrhoids bleeding from the slightest contact.
The treatment of the hemorrhoidal crisis is always medical. No effective or surgical treatment is indicated.
Read also: Hemorrhoids: How to respond to a crisis?
A chronic hemorrhoidal pathology can be present outside of any crisis whose symptoms are however similar. It is at this time that the practitioner can give a grade to hemorrhoids through interrogation and proctological examination:
- Grade 1 = Hemorrhoids remain inside the anal canal
- Grade 2 = Hemorrhoids externalize with stool or exertion and re-
enter spontaneously Grade 3 = Hemorrhoids externalize to stool or exertion and require manual reintegration
- Grade 4 = Hemorrhoids are externalized permanently and can not be reinstated.
The proctological examination also looks for a sentinel polyp, scars, anal fissure or other associated pathologies.
The chronic hemorrhoidal pathology may require according to its severity a medical treatment, an effective treatment (gastroenterologist) or surgical (digestive surgeon).
How to treat a hemorrhoidal crisis?
The treatment is medically combining a mild laxative, an analgesic treatment, an anti-inflammatory treatment, a gastric protector and a local topical (ointment). A treatment of 5 to 8 days allows in most cases the resolution of symptoms.
What is hemorrhoidal thrombosis and how to treat it?
Hemorrhoidal thrombosis is the formation of a clot within external hemorrhoid located at the anal margin. The main symptom is a pain. The incision and evacuation of the clot are rarely indicated. The treatment is the same as for a hemorrhoidal crisis.
When to operate hemorrhoids?
The treatment is surgical in case of large hemorrhoids or failure of effective treatments (ligation, photocoagulation, cryotherapy).
How are the interventions done?
Hemorrhoidal surgery is performed mostly on an outpatient basis (one-day hospitalization).
Before the procedure, you follow a strict no-residue diet for three days See the strict no-residue diet. Rectal preparation is required with a Normacol enema the evening before and the next morning early.
At the beginning of the procedure, perineal analgesia is performed by the anesthesiologist to limit new pain. The surgical procedure lasts 30 ‘to 45’ depending on the technique used. A hemostatic wick is placed in the anus at the end of the system to monitor the absence of bleeding.
What are the operative sequences?
You are monitored in the recovery room and then in mobile service. The wick is removed from the anus.
The power is resumed. You can return to your home the same evening, accompanied, without sleeping alone the first night.
At home, medications are to be taken to prevent pain and constipation. Local care is needed if the anal canal is injured. The perineum must, in all cases, be kept always clean.
A work stoppage of 8 days to 1 month is prescribed according to the technique. Sports activities can be resumed from 1 month.
What can I do for my hemorrhoids?
Generally, hemorrhoids are a temporary problem. Constipation is one of the leading causes of hemorrhoids.
Prevention of constipation
- Increase the amount of fiber in your diet. The fibers soften the stool. Fresh fruits, leafy vegetables, cereals, and whole grain breads are excellent sources of fiber.
- Avoid low fiber foods, e.g. ex. Ice cream, cheeses, white bread, and meats.
- Drink plenty of liquids (except alcohol). Ideally, drink eight glasses of water a day.
- Exercise regularly.
- It may be helpful to take laxatives that increase stool volume, e.g. ex. sound, psyllium (eg Metamucil, Fibrepur, Novo-Mucilax, Prodiem [nature]) and others (Fibyrax). Other types of laxatives can cause diarrhea, which can aggravate hemorrhoids.
- The use of laxatives should be occasional unless they increase stool volume.
- If you feel the need to have a bowel movement, do not wait too long. The longer you wait, the sadder your saddle becomes hard and dry.
In the meantime, the following tips may help. Even though stores offer many hemorrhoid medications, some have not proven effective and others may be harmful if you abuse them. Consult your family doctor to find out which ones are helpful.
To relieve pain
- Take sitz baths in lukewarm water three or four times a day.
- Clean the anus after each stool by gently blotting with a damp toilet paper, a disposable washcloth (eg Tucks) or a wet baby cloth (Baby Wipes type). Rinsing in the shower can also help. Blot but do not rub the anus to clean it. See more: Tucks wipes reviews: Hemorrhoidal Pads with Witch Hazel.
- Applying ice packs will reduce swelling.
- Acetaminophen (eg Panadol, Tylenol), ibuprofen (eg Advil, Medipren, Motrin) and aspirin are effective in relieving pain.
- Apply a cream that contains witch hazel or anesthetic ointment. Creams that contain hydrocortisone against itching or pain can be used. See more: Doctor Butler’s Hemorrhoid & Fissure Ointment – Hemorrhoid Cream Review
- If the pain is too much, lie down and stay in bed for a full day.
- Avoid lifting heavy objects and intense efforts.
Do not use hemorrhoid medications without first discussing them with your family medicine.
To read also: Internal vs external hemorrhoids