2017 04 10
Painless surgery for haemorrhoids
Haemorrhoids is a disease associated with the social stigma. Sufferers often avoid seeing the doctor until the advanced stages of the condition. Prof. Narimantas Evaldas Samalavičius, head of the Coloproctology Centre at the Medical Diagnostic and Treatment Centre and President of the Lithuanian Society of Coloproctologists, introduces advanced haemorrhoids treatment methods that allow patients to lead a normal life.
Treatment for haemorrhoids and especially the post-operative period are still associated with severe pain and long-term incapacity for work. For this reason patients tend to delay their treatment until surgery becomes inevitable or their quality of life becomes unbearable – they suffer from pain, bleeding, itching in the anal region, and the lumps at the anal verge, all causing psychological and self-esteem issues. “Haemorrhoids must be treated as heavy bleeding may cause anaemia, moreover, haemorrhoids can be the consequence of more serious illnesses. Having assessed the condition of the patient, the doctor coloproctologist will select the most suitable treatment option. Surgery is only recommended when other less invasive treatment methods are not effective,” says coloproctologist Prof. N. E. Samalavičius. He advises not to fear post-operative pain as the most advanced treatment methods are used, and patients who have undergone a number of invasive procedures, do not feel any pain at all.
The disease affects every second 50 year-old
The cause of haemorrhoids remains unknown. “For many years haemorrhoids were defined as the swelling of the veins in the anal area. Today we have more information about this condition. It would be more correct to say that haemorrhoids are an excessive vascular tissue in the anal canal, which prolapses, gets inflamed and bleeds as it goes down along the canal,”
Prof. Samalavičius explains. There is an obvious link between being overweight and experiencing haemorrhoids. Constipation and straining too hard during bowel movements are also contributing factors. “Many coloproctologists favour the theory of anal cushions, which explains the development of haemorrhoids as the excessive mobility of the lower rectal tissue, caused by straining for bowel movements and constipation, and also encouraged by the increased anal sphincter tone,” says Prof. N. E. Samalavičius. Pregnancy and hormonal changes also predispose women to develop this condition, as do genetics and jobs involving prolonged standing.
“The true haemorrhoid prevalence rates are unknown because many sufferers do not seek medical help. It is estimated that half of the population over 50 experience haemorrhoids of some degree,” says Prof. N. E. Samalavičius.
Key symptoms – bleeding and haemorrhoid prolapse
Bleeding is usually the first symptom. “At the onset of the disease, after a bowel movement and especially if the stools are hard, patients notice a small amount of blood on the toilet tissue. As the disease progresses, bleeding increases with blood usually appearing several minutes after the bowel movement. Later, in the next stages when the prolapsed haemorrhoid appears, heavier bleeding may be no longer linked to the bowel movement,” Prof. Samalavičius observes. The doctor noted that the blood from bleeding haemorrhoids is usually bright red.
With the advancement of the disease, haemorrhoids start pushing through the anal opening. At first, the internal haemorrhoid only shows in the anal opening when patient strains too much for a bowel movement and then retracts. When the haemorrhoid bulges out during the more advanced stages of the disease, it needs to be pushed back inside using a finger. Haemorrhoid can also prolapse when lifting a heavy load, coughing or sneezing, and not just when moving the bowels. At the final stages, the haemorrhoid bulges out of the anus all the time. This can cause severe psychological discomfort; the protruding mucosa is constantly traumatised, the discharge irritates the skin in the anal opening and the anal itch occurs.
How is haemorrhoids diagnosed?
Diagnosis of haemorrhoids at the initial stage is difficult. With the advancement of the disease, the components of the external haemorrhoids or swelling of the tissue surrounding the anal opening are visible during an external examination. “The most accurate diagnostic method for haemorrhoids is an examination of the anal canal using a special device with illumination. The doctor would normally inspect the entire rectum as haemorrhoid-linked symptoms may also occur with different bowel disorders, primarily colorectal cancer”, says Prof. Samalavičius.
Individual treatment is the most effective treatment option
The vast array of current haemorrhoid treatment methods allows choosing the best treatment option for each patient individually. Sometimes patients receive a combination of several treatment methods.
First to third-degree haemorrhoids can be successfully treated with rubber band ligation. “A part of the haemorrhoid is pulled inside a special vacuum instrument and tied off with a rubber band at the base. After 4 to 6 weeks the haemorrhoid dies and falls off. With the application of the bands the symptoms of haemorrhoids disappear. This is a two-stage treatment performed 3-4 weeks apart”, says Prof. Samalavičius. In the absence of the external component, the efficiency of rubber band ligation is very close to the results of surgery. The procedure is performed in the out-patient unit, it is not painful, the complications, if any, are very rare and mild, no anaesthesia is required during the procedure and patients can continue to work.
The best option for circular haemorrhoids is a surgical treatment with mechanical sutures. Surgery involves removal of rectal mucosa and suturing, thus eliminating the factors causing the condition.
Among the most advanced surgical procedures for haemorrhoids is transanal hemorrhoidal dearterialization, involving identification and ligation of haemorrhoid feeding arteries using a special instrument. This method was initially used for successful treatment of bleeding haemorrhoids. With the advancement in technology, the transanal hemorrhoidal dearterialization is now also used for prolapsing haemorrhoids.
These surgeries were first performed several decades ago worldwide. From 2008, both transanal hemorrhoidal dearterialization and surgical treatment with mechanical sutures have been carried out at the Medical Diagnostic and Treatment Centre in Vilnius.
„Transanal hemorrhoidal dearterialization and surgical treatment with mechanical sutures are both painless surgical procedures due to the absence of sensory receptors in the rectum. The post-operative period, which as a rule is associated with prolonged severe pain, is considerably easier compared to the classic haemorrhoid surgery, patients can return to work and fully enjoy their life faster,” says head of our Coloproctology Centre Prof. N. E. Samalavičius.
A significant part of the population is confronted with symptoms of haemorrhoids as they grow older, and this is to do with the lack of activity, eating habits or other illnesses. However, by no means is this a condition that one has to put up with as haemorrhoids can be successfully treated. Therefore, patients should make an appointment with a proctologist at the first signs of bleeding, when a haemorrhoid bulges out following a bowel movement, or if experiencing discomfort in the anal area.