Hemorrhoids

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Mechanism of Hemorrhoids Formation

Hemorrhoids are a part of the contact interface that comes from the large intestine and protrudes outside the body, measuring about 4 centimeters in length. It is divided into two halves by a circular line called the Dentate line. The upper part above the Dentate line is called the Anal canal, which does not have nerve fibers to perceive pain. The wall of the Anal canal normally has protruding cushions, which contain blood vessels and muscle fibers.

According to the latest theory on the formation of hemorrhoids, it is believed that excessive straining during bowel movements, constipation, increased pressure from straining, and the presence of large fecal masses can cause the cushions to slide down continuously until they protrude outside the Anal canal. This condition is known as internal hemorrhoids. The lower part of the hemorrhoids, below the Dentate line, has nerve fibers to perceive pain and is called the Anal margin. When the cushions slide down from the area near the Anal canal, the blood vessels and tissues of the Anal margin are pushed down and protrude on the side, forming external hemorrhoids.

Symptoms of Hemorrhoids:

• Passage of fresh blood
• Presence of protruding masses from the anus
• Itching and irritation in the Anal margin due to mucus from the lower part of the colon
• Pain, especially in external hemorrhoids, due to the tearing of blood vessels and the high density of nerve fibers
• In the case of internal hemorrhoids that have protruded and cannot retract, they may cause discomfort

Factors that contribute to the development of hemorrhoids:

1. Chronic constipation
2. Frequent diarrhea
3. Excessive straining during bowel movements to evacuate the last fecal mass
4. Prolonged sitting on the toilet, such as reading while defecating
5. Excessive use of laxatives or enemas
6. Pregnancy, which can make bowel movements difficult
7. Liver disease, which can cause venous congestion and dilation of blood vessels around the hemorrhoids
8. Aging, which leads to weakened muscles and the descent of cushions from the Anal canal
9. Family history of hemorrhoids, which increases the risk of developing the condition

Stages of Hemorrhoids and Treatment Options:

• Stage 1: The hemorrhoids are located inside the Anal canal and may cause bleeding. Treatment options include injecting medication into the bleeding site or using oral medications.
• Stage 2: The hemorrhoids protrude during bowel movements and can retract on their own. Treatment options include rubber band ligation or surgical removal using an automatic stapler device.
• Stage 3: The hemorrhoids protrude and can be manually pushed back in. Treatment options include surgical removal by hand, automatic stapler device, or rubber band ligation.
• Stage 4: The hemorrhoids protrude and cannot be pushed back in. Treatment options include surgical removal by hand or using a Ligasure device.

What should you do when you realize you have hemorrhoids?

The treatment of hemorrhoids depends on the severity, and it is recommended to seek advice from a surgeon who will consider the appropriate treatment options. These may include:

• Changing bowel movement habits.
• Using medications such as oral medications, laxatives, suppositories, and topical ointments, commonly used in the initial stages.
• Injection of hemorrhoids.
• Rubber band ligation of hemorrhoids.
• Suture ligation of hemorrhoids.
• Surgical excision, which can be performed in stages 1-3 using either an automated cutting and suturing device or conventional methods.
• Surgery in stage 4 may involve conventional excision or the use of a ligature device like Ligasure, which requires a shorter hospital stay, faster wound healing, and less bleeding during the procedure.

Working of the automated cutting and suturing device:

A new concept in the surgical treatment of severe hemorrhoids involves gently pushing the cushions back to their original position. This causes external hemorrhoids to flatten, while internal hemorrhoids are pushed back and sutured to prevent them from prolapsing again.

Advantages of using the automated cutting and suturing device:

1. Complete removal of severe hemorrhoids without leaving residual tissue, minimizing the chances of recurrence.
2. Reduced postoperative pain for patients.
3. No need for warm water sitz baths to cleanse the wound after surgery.
4. No requirement for gauze pads soaked in yellowish fluid.
5. Shorter surgical procedure time.
6. Shorter hospital stay.
7. Shorter recovery time at home.

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