What is Haemorrhoidal disease and how to treat it?
Haemorrhoids or piles are normal vascular structures in the anal canal. They become a disease when symptoms start. Hemorrhoidal disease is characterised with dilated veins under the surface of the anal canal. They are usually not painful and do not make significant clinical symptoms. However, if they start with symptoms such as pain, bleeding or prolapse, they should be treated.
Sometimes, even though big hemorrhoidal nodes exist, they don’t necessarily cause symptoms, likewise, small hemorrhoidal nodes can cause serious problems.
Causes and types of haemorrhoids
Causes of haemorrhoidal disease are different: long-term sitting, chronic obstipation, improper diet, forced physical endeavour and others.
Hemorrhoidal disease is widespread in the population. Every fourth person has it in some period of their lives. It is considered that 50% of people above 50 years of age suffer from some of the disease symptoms. An examination is necessary to confirm the diagnosis and rule out more serious problems.
According to its position relative to the dentate line in the anal canal, haemorrhoids are classified as external and internal. For internal haemorrhoids, bleeding is the most common symptom while external haemorrhoids can be painful, due to activation of perianal innervations associated with their thrombosis.
There are four stages of the disease:
- Grade I: haemorrhoids bleed but do not prolapse;
- Grade II: haemorrhoids prolapse outside the anal canal, usually after defecation, but reduce spontaneously;
- Grade III: haemorrhoids prolapse outside the anal canal and require manual reduction;
- Grade IV: haemorrhoids are irreducible and constantly prolapsed.
Therapy of hemorrhoidal disease can by symptomatic which soothes pain and itching, or causal, which eliminates the cause of the disease.
Symptomatic therapy consists of eating food with lots of fibres and increase of fluid intake, keeping the anal area clean, regularly soaking in a warm bath, using wet toilet papers, taking oral pain remedies in case of acute pain and usage of topical treatments such as creams or suppositories.
Causal therapy includes different methods such as external haemorrhoid thrombectomy, rubber band ligation, injection (sclerotherapy), coagulation (infrared, laser or bipolar) and also different surgical procedures like THD (transanal hemorrhoidal dearterialization) or haemorrhoid removal (Ferguson or closed hemorrhoidectomy and the Milligan–Morgan or open hemorrhoidectomy).
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