FROM PAIN TO PLEASURE…………
Did you know...?

• Hemorrhoids are one of the most common ailments known.

• More than half the population will develop hemorrhoids, usually after age 30.

• The average person suffers in silence for a long period before seeking medical care.

• Today's treatment methods make some types of hemorrhoid removal much less painful.

• Some famous people i.e. Napoleon Bonaparte(emperor of France),Fumimaro Konoye ( former prime minister of Japan),Jimmy Carter (39thPresident of United States)suffered from piles

What are hemorrhoids?
Often described as "varicose veins of the anus and rectum", hemorrhoids are dilated and swollen cushions (pads of tissue) in the anal canal, they may project into the anal canal to form visible swellings. There are two types of Hemorrhoids external and internal, which refer to their location.

External (outside) hemorrhoids develop near the anus and are covered by very sensitive skin.
Internal (inside) hemorrhoids develop within the anus beneath the anal lining.

What causes hemorrhoids?
An exact cause is unknown; however, the upright posture of humans alone forces a great deal of pressure on the rectal veins, which sometimes causes them to bulge. Other contributing factors include:
•  Aging
•  Chronic constipation or diarrhea
•  Pregnancy
•  Heredity
•  Straining during bowel movements
•  Faulty bowel function due to overuse of laxatives or enemas
•  Spending long periods of time (e.g., reading) on the toilet

Whatever the cause, the tissues supporting the vessels stretch. As a result, the vessels dilate; their walls become thin and bleed. If the stretching and pressure continue, the weakened vessels protrude.

What are the symptoms?
Painless bleeding and protrusion during bowel movements, itching in the anal area are the most common symptom. However, an internal hemorrhoid can cause severe pain if it is completely "prolapsed" - protrudes from the anal opening and cannot be pushed back inside.

Four degree of hemorrhoids

First-degree hemorrhoids: Hemorrhoids that bleed but do not prolapse.

Second-degree hemorrhoids: Hemorrhoids that prolapse and retract on their own (with or without bleeding).

Third-degree hemorrhoids: Hemorrhoids that prolapse but must be pushed back in by a finger.

Fourth-degree hemorrhoids: Hemorrhoids that prolapse and cannot be pushed back in.

How are hemorrhoids treated?

General measures (home care)
1. Anal Hygiene: Proper Cleaning techniques, Avoid rubbing with toilet paper (This aggravates the hemorrhoids and irritates the skin) Avoid prolonged sitting or excessive straining while on the toilet
2. Diet: Take High Fiber Diet, beans, whole grains, bran cereals, fresh fruits, and vegetables. Limit food that have little or no fiber such as ice cream, cheese, meat, and processed foods. Avoid soda beverages, citrus juices, beer and wine, and caffeinated products. Drink 8-10 glasses of water regularly
3. Hot Sitz Bath: Fill up your bathtub with warm water and sit in it for 10-15 minutes.
Generally constipation and straining for bowel movements promote piles (hemorrhoids) and hard stools can traumatize existing hemorrhoids. Therefore, Mild symptoms can be treated by increasing fluid and fiber intake in the diet, along with eliminating straining factors

Surgical Treatment

1. Ligation - the rubber band treatment - works on internal hemorrhoids that protrude with bowel movements. A small rubber band is placed over the hemorrhoid, cutting off its blood supply. This procedure sometimes produces discomfort and bleeding and may need to be repeated for a full effect.

2. Injection and Coagulation - can also be used on bleeding hemorrhoids that do not protrude. But multiple sessions may be required.

3. Laser, infrared, or bipolar coagulation - These methods involve the destruction of internal haemorrhoids with laser or infrared light or heat. Coagulation causes the haemorrhoidal tissue to harden and degenerate, and to form scar tissue as the area heals. Technique called Haemorrhoidolysis.

4. Conventional or open Surgical Method - Surgery to remove haemorrhoids is called haemorrhoidectomy.. It involves the surgical removal of excess haemorrhoidal tissue and anal canal lining. Most anal surgeries are being done under general or regional anaesthesia. Most patients experience some degree of pain following the surgery. It is painful for 7-10 days afterwards. While surgery usually relieves the pain, swelling, bleeding, and itching caused by haemorrhoids, a drawback to this procedure is that the incisions are made in a highly sensitive area and might require stitches, which can cause the area to be tender and painful.

5. New Method or stapler haemorrhoidectomy (MIPH) - In the past, open surgery was the only option available to surgeons when they needed to see inside a patient's body or remove or repair and organ. But today, minimally invasive technology is completely changing the way doctors approach patient care. While conventional surgical haemorrhoidectomy is a safe and reliable procedure, it is often associated with significant postoperative pain. A new procedure for removing large haemorrhoids, the stapler haemorrhoidectomy, is less painful and allows patients to return to work and other normal activities much earlier than with the conventional procedure. Stapled Piles Surgery is also known as PPH (procedure for prolapse and haemorrhoids) or MIPH (Minimally invasive procedure for haemorrhoids).

This technique uses a stapling device and takes advantage of the fact that pain-sensing nerve fibres are absent higher in the anal canal. In this procedure, the mucosa above the dentate line, which contains part of the pile mass, is excised and stapled with the stapler gun, thus taking care of bleeding and prolapse - the two major components of piles. The pile masses are compressed into a cup like cavity inside the stapler. When fired, the titanium staples cut and seal simultaneously, thus causing minimal bleeding and as the cut line is above the nerves, there is reduction in post operative pain. Additionally there is no incision on the perianal skin or lower part of anal canal and the wound in the anal mucosa is also primarily closed with a stapler, thus, there is no need to do any post operative dressing. It can be done as an outpatient, using local anaesthesia with intravenous (IV) sedation. But it should be done by a surgeon who is especially trained in doing stapler surgery. This is because there are few risks associated with the unskilled hands. The risks include: damage to the rectal wall, overstretching of sphincter muscles. etc.

Advantages of MIPH (Minimally invasive procedure for haemorrhoids).

• Smaller incisions resulting in reduced pain and discomfort

• Minimal scarring

• Greater surgical precision

• Fewer complications

• Less blood loss and a decreased need for blood transfusions

• Reduced risk of infection

• Shorter hospital stays

• Faster recoveries

Prolapsed piles pulled into stapler

Post-operative picture show distance b/w dentate line & staple line
Others: Doppler Guided Haemorrhoidal Artery Ligation (DG HAL) and Recto-Anal Repair (HAL RAR) or Hemorrhoid Artery Ligation operation (HALO) is a new FDA approved operation

Do hemorrhoids lead to cancer?
No. There is no relationship between hemorrhoids and cancer. However, the symptoms of hemorrhoids, particularly bleeding, are similar to those of colorectal cancer and other diseases of the digestive system. Therefore, it is important that all symptoms are investigated by a physician specially trained in treating diseases of the colon and rectum .Don’t rely on over-the-counter medications or other self-treatments.

DR VIVEK SINGLA
Gen. & Minimal invasive surgeon
MO. 9417377858