Hemorrhoids and hemorrhoidal disease
Are there multiple hemorrhoids?
These normal venous anatomical structures are made up of internal hemorrhoids (HI) and external hemorrhoids (HE).
Internal hemorrhoids form a spongy bulge varying in size in the anal canal to allow going to the toilet.
External hemorrhoids are hardly visible and have no specific role for modern medicine.
What is hemorrhoidal disease?
Hemorrhoidal disease (HE) is the expression of a disorder of these venous structures:
- It is very painful during inflammation of external hemorrhoids and causes a perianal growth. The presence of a clot is common (thrombosis);
- It manifests itself by bleeding during the passage of stool, most often without pain during inflammation of internal hemorrhoids. These can be exteriorized under the effort, but return to the anal canal spontaneously or manually.
What are the factors triggers?
The most obvious contributing factors are: transit disorders such as constipation first, all sports that increase abdominal pressure, alcohol, spices and, for women, there are also pregnancies and childbirth.
Men are more concerned than women by this condition which affects 60% of the population at some point in their existence.
External hemorrhoidal disease occurs at any age while internal hemorrhoidal disease occurs mostly between 45 and 65 years old.
What can avoid them?
First, a diet rich in fiber and magnesium. In case of constipation, use of non-irritating laxatives and lubricating suppositories before stool, or even after. Herbal medicine can be a plus (red vine, etc.).
How do hemorrhoids evolve?
The pain associated with external hemorrhoid disease disappears within 5 days without treatment. There is in rare cases a skin fold called a marisque which can be considered unsightly for those, for example, who pose for pictures! To avoid this, it is necessary, within the first 72 hours, to make an incision, preferably under local anesthesia, to evacuate the clot and make the growth disappear.
The clot-free edema can be treated with a nonsteroidal anti-inflammatory drug (NSAID) and short-course oral corticosteroids for pregnant or breastfeeding women.
The inflammatory prolapse of internal hemorrhoidal disease is rare and cannot be treated with NSAIDs.
When does surgery take place?
The operation concerns only 10% of people with internal hemorrhoidal disease with too repeated bleeding, little or no reducible externalization and when medical treatment has failed.
External hemorrhoidal disease outside of the evacuation of a clot is rarely operated.
We operate when we cannot do otherwise. Before, we try simple methods. The magnetizer. Rubber band ligation would be well tolerated, it is performed in the office in 2 or 3 sessions by strangulation by means of an elastic which suppresses the vascularization and sclerosis the hemorrhoidal bundle.
The surgical techniques are: destruction using a radiofrequency or laser fiber probe (under evaluation). Ligatures are a source of frequent recurrence, but have the advantage of being minimally invasive. Total pedicle excision by thermofusion reduces postoperative pain and is found to be non-hemorrhagic compared to the electrosurgical unit (which had replaced the scissors).