Within the anus, below the mucous membrane, is an extensive network of blood vessels that create a cavernous body that can swell when they are full of blood. This way the anus can be completely closed.
Hemorrhoids are formed as a result of the dilation of these vessels, ie, are venous accumulations located in the inner part of the anal canal (the short tube connecting the rectum with the outside) in the area called the anal cushions. These pads are present in all people, their usefulness is in facilitating and cushioning the passage of feces during defecation.
The bulging of these pads means that they lose their normal consistency, become enlarged and become flaccid, so that they can produce pain, can present bleeding and can even protrude to the outside. Constipation and pregnancy, as well as defective efforts favor the appearance of hemorrhoids.
Depending on its size four degrees are defined:
Grade I: internal hemorrhoids, pain and hemorrhage with defecation.
Grade II: Pain and hemorrhage with defecation and outflow of hemorrhoids to the outside, but return to the interior at the end of defecation.
Grade III: Pain and Bleeding. Hemorrhoids should be reintroduced manually into the anal canal after defecation.
Grade IV: Pain and Bleeding. Hemorrhoids are always on the outside.
The most common are: itching, feeling of discomfort in the stools, pain and bleeding.
Any patient with persistent bleeding should be visited by a proctologist to examine hemorrhoids and rule out a rectal tumor.
Anal exploration, renal tact, anoscopy and, in some cases, colonoscopy are the necessary tests for the analysis and diagnosis of a hemorrhoidal problem.
Medical Treatment: It should be performed in patients with grade I, II and III hemorrhoids. Consists of diet with foods rich in fiber (vegetables, fruit, whole wheat bread, cereals, etc.). In addition to the intake of a liter of water daily and keep a regular meal schedule.
It is associated with the use of antihemorrhoidal creams and ointments of local action and can be used medicines that favor the blood supply.
Surgical Treatment: Surgical treatment in grade IV or grade I, II and III hemorrhoids is recommended if medical treatment has failed. There are different techniques, such as:
-La ligation with elastic bands.
- Removal of hemorrhoids according to the classic technique of Milligan and Morgan
- Removal with laser surgery.
On occasion, patients present a hemorrhoidal crisis with pain, hemorrhage and possible thrombosis, which may require urgent surgical treatment. In this situation, laser surgery is the most appropriate for resolution of the acute clinical picture.
According to our experience, the technique that offers the best results, in the short and long term, is the removal by means of laser surgery. The advantages of this surgery are less aggression of the tissues, no need to put stitches, reduction of postoperative hemorrhage, less pain and better and faster recovery.
In some cases our patients have returned to their working life 48 hours after surgery.
Anesthesia in Hemorrhoid Surgery
Anesthesia is usually regional insane (epidural anesthesia is performed, from the waist down), although in some cases general anesthesia is performed if the patient requests it or if there is any contraindication in performing epidural anesthesia. However, the patient may discuss with the anesthesiologist the type of anesthesia based on previous experiences or preferences.