What you need to know about hemorrhoids

This is an automatically translated article.

The article was written by MSc Nguyen Ngoc Khanh - Head of Department of Gastroenterology, Urology Surgery Robot & Pediatric Surgery, Vinmec Times City International General Hospital.

Hemorrhoids are normal anatomical structures, essentially a plexus of hemorrhoids located under the mucosa (internal hemorrhoids) or under the skin (external hemorrhoids) in the lower part of the rectum and anus, everyone has hemorrhoids.

1. The concept of hemorrhoids

Hemorrhoids are caused by excessive dilatation of the hemorrhoidal plexus. This is a common and fairly common disease. Internal hemorrhoids: arising in the submucosal space, above the dentate line, originating from the internal hemorrhoid plexus. External hemorrhoids: located under the skin, below the dentate line, from the external hemorrhoid plexus (lower rectal vessels).
Degree of hemorrhoids: Only applied to internal hemorrhoids, grading is done by asking the patient and has 4 degrees.
1 : Hemorrhoids are hemorrhoids, there may be bleeding (only enlarged in the anal canal). Grade 2: Prolapsed hemorrhoids when pushing, retracts after defecation. Grade 3: Prolapsed hemorrhoids when pushing, unable to pull up on their own, must be pushed up by hand. Grade 4: Frequent prolapsed hemorrhoids, including thrombosed prolapsed hemorrhoids. Hemorrhoids are caused by the transformation of the normal hemorrhoidal plexus structures in the anal canal into a pathological state. The pathogenesis of the disease has not been elucidated.
Theory of blood vessels: dynamic-venous bridge. Mechanical theory: due to the effect of increased pressure, the hemorrhoidal vessels dilate (pregnancy prone to hemorrhoids); The supporting organs of hemorrhoids are dilated and become loose (the older you are, the more likely you are to get hemorrhoids).

2. Clinical and subclinical symptoms

Bloody stools. Usually bright red blood, dripping or flowing in a stream scares the patient. Characteristic for internal hemorrhoids. Pain in the anal region, typical for external hemorrhoids, when occluded, thrombosed. Abnormal varicose veins in the anal region. Prolapsed hemorrhoids anorectal endoscopy (HM-TT) clearly shows hemorrhoids.

3. Treatment of hemorrhoids

3.1 Medical treatment Hygiene and eating:
Daily hygiene: Important because it helps you prevent hemorrhoids, prevent recurrence of hemorrhoids is to avoid sitting or standing for too long in one position. There is a funny saying about this issue: "If you don't poop in the library, don't read in the toilet." Diet: Very important because it helps you prevent hemorrhoids, prevent recurrence of hemorrhoids, help you stay away from the pharmacy and especially away from the doctor, which is to prevent constipation and diarrhea. Drug treatment: Oral systemic drugs: Daflon 500mg, topically: Proctolog rectal tablets or topical cream...
Procedures: Sclerotherapy, rubber band ligation, infrared photocoagulation, boiling water..
3.2 Surgical treatment Hemorrhoidectomy: Is the surgical method to cut directly into the hemorrhoid, for example:
Milligan-Morgan: is the surgery often used in the past, when the hemorrhoids were still independent. together. Today this surgery is applied in the treatment of single external hemorrhoids. Whitehead : Complete circumcision of the skin-mucosa of the anal-rectal canal is applied to the large ring hemorrhoids mixed with both internal and external hemorrhoids, Mixed ring hemorrhoid Toupet: The nature is similar to Whitehead Ferguson: The nature is similar to Milligan -Morgan but will sew closed, not open. Hemorrhoid hanging (Hemorrhoidopexy): This method does not cut the hemorrhoid directly but: Pull the prolapsed hemorrhoid back into the anus. This method alone has a few different improved variations such as:
Longo surgery - a common name in Vietnam or surgery for prolapse and hemorrhoids (Procedure for Prolapse and Hemorrhoids-PPH). Transanal hemorrhoidal dearterialization. Stitch removal of hemorrhoids under doppler ultrasound. Longo surgery:
In 1993, Antonio Longo - Italy performed the first time hanging hemorrhoids with a circular stapler. The principle of this surgery is to cut and suture the mucosa on the hemorrhoid with the aim of reducing blood flow to the hemorrhoidal plexus to shrink the hemorrhoid volume and pull the prolapsed hemorrhoid back to the anatomical position.
Disadvantages: high cost, consumable cost for 1 tool used once. about 10 million VND.
Advantages are fast, cosmetic surgery, reducing complications of anal stenosis, discharge due to anal closure...

Suture surgery to remove hemorrhoids:
It is a technique of suturing rectal mucosal folds on hemorrhoids (instead of cutting a mucosal segment like Longo or PPH). Also aimed at reducing blood flow to the hemorrhoidal plexus to shrink the hemorrhoid volume and pull the prolapsed hemorrhoid back into an anatomical position. This is a simple, safe method with almost no serious complications like “cut” methods.
With thousands of cases of experience, this method is safe and effective even for grade IV hemorrhoids and external hemorrhoids that can still slip. Not as limited as Longo surgery because it is hand stitched on each point, so experienced surgeons will stitch more or less according to the actual requirements of each hemorrhoid and each patient. And this is really a very aesthetic method.
The evaluation of external hemorrhoids that can still slip is extremely important because otherwise it will be easy to make 2 mistakes:
Apply hemorrhoidectomy —> Painful, not aesthetic, many troubles after surgery. Failure because hanging hemorrhoids does not go all the way, painful thrombosed hemorrhoids, sometimes having to make an incision to remove blood clots.

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