Hemorrhoids Update Review
Get facts on Information of hemorrhoids symptoms,sign,diagnosis, treatment, surgery and complication and find out how you can prevent them.This website explains all you need to know about hemorrhoids.
Thrombosed external hemorrhoids
Thrombosis is a fairly common complication of hemorrhoids disease. Most patients give no history of straining or physical exertion and do not have histories of hemorrhoids disease. The complication develops with an abrupt onset of anal mass,hemorrhoids and pain that peaks within 48 hours. Usually, the pain becomes minimal after the fourth day. Occasionally, the skin overlying the hematoma becomes necrotic, causing bleeding and discharge or infection, which causes further necrosis and more pain. Treatment should be aimed at relief of severe pain, prevention of recurrent clot, and prevention of residual skin tags. If the patient is experiencing severe pain of hemorrhoids at the time of examination, excision should be performed. Conversely, if the pain is already subsiding and the clot is starting to shrink, thrombosis may be managed conservatively with warm sitz baths for comfort, proper anal hygiene, and bulk-producing agents such as bran or psyllium seed. The procedure can often be performed with the use of local anesthesia, and the wound can be left open without packing. Relief of pain is usually immediate. Postoperative care is simple and is aimed at keeping the wound clean with warm sitz baths and washing. An analgesic drug may be required during the first 24 hours. Patients must be warned of a relatively high recurrence rate about 6% after excision and 25% with noninvasive treatment.
Bipolar Diathermy in Hemorrhoids Treatment
Bipolar diathermy involves the use of electrical current to coagulate the hemorrhoids, including the mucosa and submucosa. The machine generates a 2-second pulse of energy to accomplish the treatment. This approach is applicable for small bleeding hemorrhoids and probably has no greater efficacy than sclerosing.
Other variations on the use of energy to scarify internal hemorrhoids and fix them to underlying tissues includes infrared coagulation and direct current therapy or Ultroid (Microvasive, Boston, MA) therapy. Infrared coagulation uses a tungsten halogen lamp that generates heat energy for 1.5 seconds, resulting in destruction of the mucosa and submucosa at the application site . The depth of penetration of this injury is usually 3 mm. Conversely, the Ultroid uses electrical current that is applied for up to 10 minutes per complex treated. Ultimately, these new modalities are a variation on the theme of local tissue destruction and fixation of the hemorrhoids at the appropriate level.
Stapled Hemorrhoidectomy, a New Treatment
A new entry into the arena of excisional hemorrhoidectomy is the circular stapled hemorrhoidectomy .The technique uses a circular, transanally placed pursestring suture 4 cm from the dentate line and within the enlarged internal hemorrhoids. A 31-mm stapler is then placed transanally to perform a circumferential excision of the hemorrhoidal tissue and a repositioning and fixation of the anoderm to its proper location in the anal canal. The results appear promising, with decreased postoperative pain, shorter periods of convalescence, and similar complication rates compared with other forms of excisional hemorrhoidectomy.
Sclerotherapy in Hemorrhoids Treatment
Although sclerotherapy, first advocated by Mitchell in 1871, has been used often in hemorrhoids, it is rarely performed in the United States.The purpose of sclerotherapy is to scar the submucosa, resulting in atrophy of the tissue injected and scarification with fixation of the hemorrhoidal complex within its normal location in the anal canal. A variety of solutions have been advocated, although it appears that sodium morrhuate and sodium tetradechol sulfate predominate. This modality is most effective in situations with minimal enlargement of hemorrhoidal complexes where the primary complaint is bright red rectal bleeding.
