Hemorrhoids
Treatment Options: These are divided as medical non surgical and surgical treatment of hemorrhoids Medical treatment ; Over-the-counter topical treatments; Various creams, ointments and suppositories are available these medicines should only be used for 5 to 7 days at a time. They may irritate the sensitive skin around your anus if you use them longer than this. Any medication should be combined with the diet and self care advice discussed above. There's no evidence to suggest that one method is more effective than another. Corticosteroid cream: In case of severe inflammation use of steroidal cream is beneficial however these should not be used for more than a week as it can cause irritation and thinning of skin around anus. Painkillers: Like paracetamol can relieve pain. NSAIDS (non-steroidal anti inflammatory drugs) should be avoided as they increase the risk of bleeding. Codeine based painkillers are also avoided as they can cause constipation making the symptoms worse. Topical anesthetics can be also be used in case of painfull hemorrhoids Laxatives: If you're constipated, your GP may prescribe a laxative. Laxatives are a type of medicine that can help you empty your bowels. Non-surgical treatments; If the medication and life style modification fails to resolve the symptoms specialist advice is taken. If hemorrhoids are internal (upper 2/3 of the anus) banding or sclerotherpay is advised. Banding In this procedure a tight elastic band is tied at the base of the hemorrhoid to cut of its blood supply the hemorrhoid should then fall of a week after treatment its day procedure usually donot require admission. Mucus discharge after a week is an indicator that hemorrhoid have fallen off. Although rubber band ligation is effective in 75% of patients in the short term, it does not treat prolapsed hemorrhoids or those with a significant external component1 • Blood staining of toilet paper after banding is normal but there shouldn’t be a lot of bleeding. In case of severe bleed immediately consult emergency department. • Ulcers can occur the site of banding although they heal without needing further treatment. • severe pain during treatment occurred more often with ligation (8%) than with electro coagulation (0%), albeit treatment failure and crossovers were significantly less frequent (8% vs 38%).2 Injections (sclerotherapy): Alternative to banding , a procedure in which a chemical solution is injected in the vessel of the hemorrhoids relieving pain by numbing the nerve ending Also it cause scarring of the hemorrhoids after about 4 -6 weeks as the hemorrhoid reduce in size and shrivel up. Pain is experienced after a day procedure which can be overcome by painkillers. Recurrence rates are as high as 30%.Although minimally invasive, these treatment methods have a higher rate of post procedure pain. Impotence, urinary retention, and abscess formation have also been reported3,4 Electrotherapy: Also known as electro coagulation, an alternative to banding involving passage of electric current through the base of hemorrhoid through a special electric probe this result in thickening of blood supplying the hemorrhoid resulting in shrinkage. Usually it is used if there are more than one hemorrhoid on proctoscopic examination. It can be done outpatient setup under low electric current, high current usually require spinal or general anesthesia • Pain can be problem during and after procedure usually countered by adequate analgesia. • Rectal bleeding is another possible side effect of the procedure, but this is usually short-lived. • In a study involving 100 patients, investigators reported a 5% post procedure complication rate (3% bleeding, 2% pain; all managed conservatively) and a 6% recurrence rate at a median follow-up of 3 years. Electrotherapy is recommended by the National Institute for Health and Care Excellence (NICE), and has been shown to be an effective method of treating smaller hemorrhoids. It can also be used as an alternative to surgery for treating larger hemorrhoids, but there's less evidence for its effectiveness. Radio ablation or laser therapy: Radiowave ablation followed by suture ligation could prove to be a safe, cost-effective, and convenient way to treat prolapsing hemorrhoids5 Surgery: Although most hemorrhoids can be treated using the methods described above, around 1 in every 10 people will eventually need surgery. About 5-10% of people with hemorrhoids eventually require surgical hemorrhoidectomy. Haemorrhoidectomy It is surgical procedure involving removal or cutting out of the hemorrhoid from the root under general anesthesia. • Pain can occur for for a few weeks after surgery ehich is controlled by pain killers • After having a haemorrhoidectomy, there's around a 1 in 20 chance of the haemorrhoids returning, which is lower than with non-surgical treatments. • Adopting or continuing a high-fibre diet after surgery is recommended to reduce this risk. Haemorrhoidal artery ligation Hemorrhoid artery ligation is performed under general anesthesia in which surgeon first located the feeding vessel through an ultra sound probe then stitch the feeding vessel to cut off the blood supply to the hemorrhoids resulting in shrinkage of the swelling on following days and weeksThe stitches can also be used to reduce haemorrhoids that hang down from the anus (prolapsing). The National Institute for Health and Care Excellence (NICE) recommends haemorrhoidal artery ligation as a safe and effective alternative to a haemorrhoidectomy or stapled haemorrhoidopexy. • It causes less pain and, in terms of results, a high level of satisfaction has been reported. • The recovery time after having haemorrhoidal artery ligation is also quicker compared with other surgical procedures. • There's a low risk of bleeding, pain when passing stools, or the hemorrhoid becoming prolapsed after this procedure, but these usually improve within a few weeks. • Follow-up in the short term revealed recurrent/persistent prolapsing piles in 26% of patients, with recurrent bleeding in 21%; at long-term follow-up, 24% of patients reported prolapsing piles; 3% each, bleeding or pruritus; 2%, anal pain; and 20%, persistent mixed symptoms.6 Stapling Also known as stapled haemorrhoidopexy, is an alternative to a conventional haemorrhoidectomy. The procedure isn't carried out as often as it used to be because it has a slightly higher risk of serious complications than the alternative treatments available. During the operation, part of the anorectum – the last section of the large intestine – is stapled. This means the hemorrhoids are less likely to prolapse. It also reduces the supply of blood to the haemorrhoids, which causes them to gradually shrink. • Stapling has a shorter recovery time than a traditional haemorrhoidectomy, and you can probably return to work about a week afterwards. It also tends to be a less painful procedure. • But more people experience another prolapsed haemorrhoid after stapling compared with having a haemorrhoidectomy. • There have also been a very small number of serious complications after the stapling procedure, such as fistula to vagina in women, where a small channel develops between the anal canal and the vagina, or rectal perforation, where a hole develops in the rectum. Other treatments Other treatment options are available, including freezing and laser treatment General risks of haemorrhoid surgery Although the risk of serious problems is small, complications can occasionally occur after hemorrhoid surgery. These can include: 1. bleeding or passing blood clots, which may happen a week or so after the operation infection, which may lead to a build-up of pus (an abscess) – you may be given a short course of antibiotics after surgery to reduce this risk 2. difficulty emptying your bladder (urinary retention) 3. the involuntary passing of stools (faecal incontinence) 4. a small channel that develops between the anal canal and surface of the skin, near the anus (anal fistula) 5. narrowing of the anal canal (stenosis) – this risk is highest if you have treatment on hemorrhoids that have developed in a ring around the lining of the anal canal These problems can often be treated with medication or more surgery.