Most people have hemorrhoids, but they do not cause complaints in everyone. Although approximately half of people over the age of fifty have hemorrhoids, as we mentioned above, a small number of these people consult a doctor due to their complaints.
Don’t let hemorrhoids disrupt your quality of life!
What is Hemorrhoid?
Hemorrhoids, a common condition in our country as well as worldwide, can impair the quality of life by causing pain and rectal bleeding. It is a health problem often concealed by patients due to its occurrence in the anal region. If detected in the early stages, this condition can be treated with medication or endoscopic interventions. However, since patients usually conceal it, surgical intervention may be necessary only when it reaches stages requiring such measures and after consulting a doctor.
Hemorrhoids are swollen blood vessels in the rectum (the last part of the large intestine near the anus) or the anal canal. Swelling and expansion of these vessels can lead to symptoms. As the vessel walls thin due to this expansion, bleeding may occur.
While many people have hemorrhoids, not everyone experiences symptoms. Although around half of people over fifty may have hemorrhoids, only a small fraction of them seek medical attention due to complaints.
Types of Hemorrhoids
There are two types of hemorrhoids based on their location. External hemorrhoids are covered with sensitive skin and are located near the anus. External hemorrhoids generally do not cause pain unless they become thrombosed (filled with blood clots). Internal hemorrhoids, on the other hand, are enlarged blood vessels located just above the anal opening in the rectum. They can enlarge and protrude outside the anus.
How to Identify Internal Hemorrhoids?
Even if you have internal hemorrhoids, they may not cause any complaints. If symptoms occur, they most commonly manifest as painless rectal bleeding. Other symptoms may include itching, a feeling of fullness or pain in the anus, or protrusion of tissue during bowel movements.
Stages of Internal Hemorrhoids
- Stage I: It usually bleeds but does not protrude from the anal canal.
- Stage II: If it protrudes during straining or bowel movements, it returns to its original position on its own.
- Stage III: It protrudes spontaneously or with straining and requires manual assistance to return to its original position.
- Stage IV: Hemorrhoids that are chronically protruding and cannot be reduced to their original position.
Causes of Hemorrhoids
- Advanced age
- Chronic constipation or diarrhea
- Hereditary factors
- Excessive straining during bowel movements
- Spending too much time on the toilet
How to Prevent Hemorrhoid Development?
Perhaps the most important treatment for hemorrhoids is preventing their development. For this:
- Maintain a high-fiber diet and drink enough water, which is necessary for regular bowel movements.
- Stool softeners may be necessary for those with constipation.
- In individuals with frequent bowel movements, anti-diarrheal treatments may be beneficial.
What to Do If You Have Hemorrhoids?
External hemorrhoids can be directly seen and recognized by a Gastroenterology or General Surgery specialist during a physical examination. In addition, a rectal examination, known as a digital rectal exam, is performed by inserting a finger to examine the anal canal and the rectum close to the anal canal. If internal hemorrhoids have protruded, they can be seen or detected during a rectal examination. In cases under fifty years old, a sigmoidoscopy, and in cases over fifty years old, a full colonoscopy performed by a Gastroenterology specialist can provide a definitive diagnosis of internal hemorrhoids, as well as rule out other pathologies that may be confused with hemorrhoids.
How Are Hemorrhoids Treated?
Most hemorrhoids can subside on their own or with some simple measures. These measures include:
- Avoid straining during bowel movements.
- Consume a high-fiber diet and drink plenty of water, and use stool softeners if needed.
- Warm sitz baths.
- Creams containing steroids to relieve pain and itching.
Despite these measures, symptoms may recur or not improve. In such cases, depending on the stage of your hemorrhoids, non-surgical endoscopic methods can be applied by a Gastroenterology specialist. However, in advanced stages or if there is no response to these endoscopic treatments, surgery may be required.
What are the Endoscopic Treatments for Hemorrhoids?
The endoscopic treatment methods frequently applied in our clinic are Rubber Band Ligation and Infrared Photocoagulation. Sclerotherapy is not preferred in our clinic due to its lower effectiveness.
Rubber Band Ligation
A special device with a band is placed around the hemorrhoids using the endoscope. This cuts off the blood supply to the hemorrhoids, and over time, the degenerated hemorrhoid structure is treated as the band falls off in days. It is generally a painless procedure, and any discomfort in the anus disappears 24 hours after the procedure. Pain relievers can be used in cases of mild pain. Warm sitz baths can also make this period more comfortable.
In this technology, a 15-volt tungsten-halogen lamp at the end of the endoscope produces infrared light. Each hemorrhoid is exposed to infrared light for an average of 1.5 seconds, three times. The heat generated destroys the hemorrhoid bundles. Although less painful than rubber band ligation, it is more effective in early-stage (Stage I) hemorrhoids.
During sclerotherapy, a special chemical agent is injected into the hemorrhoid tissue, causing the destruction of the hemorrhoid tissue. However, the effectiveness of this treatment method is not as high as the above two procedures.