Do 3rd degree internal hemorrhoids need surgery?

The article is professionally consulted by Master, Doctor Nguyen Ngoc Thang, Department of General Surgery - Vinmec International General Hospital Da Nang.

Internal hemorrhoids are one of the problems that many people face due to poor diet and lifestyle. This has a significant impact on health and quality of life. Internal hemorrhoids are divided into 4 different levels, if you are at level 3, it means the disease is in a severe stage.

Internal hemorrhoids are diseases that appear in the submucosal space, originating from the hemorrhoidal veins in the anus. Usually, the cause of the disease often appears due to poor living habits, irritable bowel syndrome, pregnancy...
Internal hemorrhoid classification:
Grade 1: At this stage, the disease has just begun. There are no specific signs yet. Patients often have symptoms of constipation for many days, accompanied by burning pain, itching and discomfort when going to the toilet. At this time, there is bleeding but not much, only a little blood can be detected on the toilet paper. The hemorrhoid has formed but is difficult to see with the naked eye because it is in the anal canal. Grade 2: The disease begins to show signs of getting worse, as evidenced by more bleeding accompanied by burning pain and an itchy feeling in the anus. Hemorrhoids start out as a small lump of flesh that comes out during a bowel movement, but usually shrinks soon after. Level 3: The amount of blood is also more bleeding at this time. Due to the development of hemorrhoids, even without a bowel movement, the patient always feels pain and difficulty when sitting. The size of the hemorrhoid is too large to be able to retract on its own. But you can still use your hand to push in. Grade 4: At this time, the hemorrhoid is so large that even without a bowel movement, it prolapses and cannot push the hemorrhoid inside. Patients always feel pain, bleeding at any time. At this stage, in addition to hemorrhoids, the patient also faces a series of other risks. Such as infection of hemorrhoids, necrosis of hemorrhoids, anal fissure, anal abscess and even rectal cancer.

Grade 3 internal hemorrhoids tend to prolapse to the outside and do not shrink on their own, so it is easy to lead to anal obstruction, damaging the cells around the anus, especially when defecating. Depending on the case as well as the ability of the disease to develop, the doctor may prescribe the patient medical treatment or use surgical methods to reduce complications. Grade 3 internal hemorrhoids can lead to complications of inflammation, swelling and even anal infection, blood loss. However, the treatment of grade 3 internal hemorrhoids is an urgent matter and requires patients to strictly adhere to. Surgical removal of 3rd degree internal hemorrhoids is essential if the patient has symptoms of strangulation of the hemorrhoid, anal bleeding, and severe inflammation. The application of treatment of internal hemorrhoids of grade 3 by medical or surgical treatment, patients can completely treat 1 of 2 methods. However, each treatment method has its own advantages and disadvantages, so patients need to consider carefully before agreeing to treatment with them. Grade 3 hemorrhoids is a severe stage of the disease. If not treated properly, it can cause many dangerous complications. If medication does not work, the patient will be indicated for surgery. Thus, surgery is not absolutely mandatory at this stage, but if medication does not work, it must still be carried out. Determining whether to have surgery or not needs to be examined and concluded by specialists. Do not arbitrarily use any other treatment because this can make the symptoms worse. Whether it is surgical treatment or medical treatment, each has its own advantages and disadvantages, specifically:
2.1 Hemorrhoid surgery method Advantages: Fast treatment results, patients can be discharged and recover later. 1 week of surgery. Cons: On the other hand, hemorrhoidectomy also has the following disadvantages: The cost of performing the surgery is high, quite expensive, the patient needs time to rest to recover from the wound, the surgery damages the postoperative period. It is easy to leave sequelae such as infection or anal stenosis, hemorrhoids have a high risk of recurrence if not properly cared for. 2.2 Medical treatment method Advantages: Low cost, economical, safe in the treatment process and has the ability to completely treat hemorrhoids. Cons: Besides, this method also has disadvantages such as: long treatment time, very slow effect, risk of side effects when drug abuse. The surgical method is applied to cases that do not meet the conditions with medical methods or hemorrhoids have signs of life-threatening complications. Better yet, patients should go to the nearest medical facility to be examined and prescribed appropriate treatment.
The choice of surgical method also plays a very important role. For severe cases of hemorrhoids, it is necessary to choose the optimal solution, bringing the highest efficiency. Patients should not be too worried because now there are many modern surgical methods, with less pain, less bleeding and quite fast recovery.

Laser ablation: This method will affect the hemorrhoid with a laser beam through a CO2-containing lens to cut hemorrhoids without using a surgical knife. Thanks to the large amount of heat, this method also helps to evaporate the part of the hemorrhoid that contains steam. Sclerotherapy of hemorrhoids: the principle of this method is that the doctor will inject a certain amount of chemical into the hemorrhoid to create fibers in it. This makes it impossible for blood to circulate to feed the hemorrhoid and gradually the hemorrhoid will automatically shrink. Longo method: This is a modern way of treating diseases being applied today. At this time, the doctor will use a loop stitch and then cut the hemorrhoid mucosa directly on the dentate line. Thanks to these manipulations, blood circulation is reduced and hemorrhoids can easily shrink. HCPT method: This method is highly praised for its high degree of accuracy and fast recovery. The doctor will apply high-frequency waves to coagulate cells and form blood vessel knots. Finally, an electric knife will be used to cut the hemorrhoids right in the anal canal. Treatment of hemorrhoids with surgery has a very long history, is the most radical treatment method, so far, although there are many technical improvements, but in general surgery is still in two groups: Removal of individual hemorrhoids. and cut the entire mucosa. In 1998, Antonio Longo presented a new hemorrhoid treatment technique that is to cut a mucosal ring, below the mucosa of the rectum about 3cm above the dentate line, to pull the hemorrhoid and the prolapsed rectal mucosa back to the previous position at the same time. restrict the blood supply to the hemorrhoids.
Longo method is a popular treatment method today, is a modern method that brings high efficiency, limits postoperative complications, patients recover quickly.