How to treat grade 2 internal hemorrhoids?

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

Grade 2 internal hemorrhoids are hemorrhoids that prolapse when going to the toilet but still have the ability to retract on their own. Can 2nd degree internal hemorrhoids be cured? If yes, how to treat effectively and not to recur?

Hemorrhoid grading applies only to internal hemorrhoids, not to external hemorrhoids. If the hemorrhoid is fully prolapsed, it is called a prolapsed hemorrhoid.
According to the classification of internal hemorrhoids of the Ministry of Health, grade 2 internal hemorrhoids is a condition where the hemorrhoid prolapses when defecating but still retracts on its own.
Similar to other hemorrhoid grades, grade 2 internal hemorrhoids have 2 main clinical symptoms:
Bleeding: The earliest and most common symptom in hemorrhoid patients. Blood may drip, streak with stool or stream when the patient goes to the bathroom, especially when squatting. The bleeding may be fresh or clotted. Prolapsed hemorrhoids: Usually occurs more slowly, after a period of bloody stools. In grade 2 hemorrhoids, when the hemorrhoids prolapse, they can retract themselves. But if not treated, the longer the hemorrhoid is left, the more it will fall and then it will not be able to shrink up on its own. At this time, hemorrhoids have become grade 4. In addition, the patient may also be accompanied by symptoms of burning pain when going to the toilet, constipation, itching around the anus ...

There are many questions raised whether treatment of internal hemorrhoids 2nd degree requires surgery or not. The choice of treatment method depends on the classification of hemorrhoids and each stage as well as the size of the hemorrhoid.
For the treatment of grade 2 internal hemorrhoids, both medical treatment and surgical treatment can be applied.
2.1.Medical treatment Clean hemorrhoids regularly by soaking in cold water 2-3 times/day, about 15 minutes each time.
Drug use:
Drugs with venotonic agents, derived from flavonoids: increase venous tone, protect microcirculation, reduce edema through anti-inflammatory and anti-infective mechanisms. Use of topical drugs: Ointments (pommade), suppositories have anti-inflammatory, local anesthetic effects and increase intravenous derivatives. 2.2.Treatment with procedures For cases of ineffective medical treatment, it is necessary to combine both medical and surgical procedures.
Longo surgery Longo hemorrhoidectomy is a surgery that uses a loop suture machine to cut a segment of mucosa above the dentate line about 3-5cm and suture the ring with an automatic sewing machine. The principle of application of this method is Cut and suture the mucosa of the area with hemorrhoids to reduce blood flow to the hemorrhoidal plexus, thereby reducing the volume of the hemorrhoid and at the same time hanging the anal cushion into the anal canal.
Advantages of this method:
No downtime, short hospital stay. This method is good for treating rectal prolapse and internal hemorrhoids. Longo surgery uses self-dissolving sutures, so it can ensure aesthetics and limit wound infection when the sutures are exposed to the outside environment. Patients can return to normal activities and activities after a short time. Cons:
High cost. High recurrence rate, can recur in a short time. There may be some complications during surgery such as secondary bleeding, rectal perforation, secondary rectal stricture. The modified method of Longo surgery is manual suture of hemorrhoids.
Method of sclerotherapy

As a treatment method applied to grade 1 and 2 hemorrhoids, using drugs injected directly into the hemorrhoid root aims to reduce blood flow to hemorrhoids, creating a fibrous scar tissue that sticks to the submucosa muscle layer to help. Reduce symptoms of bleeding caused by hemorrhoids.
Advantages:
Simple technique, easy to implement.
The procedure is short, the procedure is quick, so there is no pressure on the operator and the patient. It is a safe method. Cons:
The technique is simple but requires a skilled specialist to give good results and avoid complications. Complications may occur such as bleeding at the injection site, prostatitis causing prostatitis, clear anus, vagina... Infrared photocoagulation The goal of use is to cause tissue to coagulate by The effect of heat to create a fibrous scar reduces blood flow to the hemorrhoid and immobilizes the hemorrhoid into the anal canal.
Advantages:
Does not affect other devices on the patient such as pacemakers or other electronic devices. Safe, and highly hemostatic. Cons:
High cost, often have to do the procedure many times. The principle of use of this method is through tying the hemorrhoid together with the skin around the anus to reduce blood flow to the hemorrhoid, creating fibrous scar tissue that sticks to the muscle layer below the mucosa. Therefore, it will fix the anal canal in accordance with the principle of preserving the anal cushion.
However, due to the technique of performing general ligation of hemorrhoids into the anal skin, this technique often causes uncomfortable burning pain for the patient. Currently, this method is not as widely used as other methods.
In addition to the above methods, there are a number of other methods that are rarely used today such as:
Mucosectomy: rarely used due to many complications and still has a high risk of recurrence and high cost. Hemorrhoidectomy only applies to grade 2 hemorrhoids when the hemorrhoids are large, multiple hemorrhoids or the patient has heavy and continuous bleeding. 2.3.Care regimen In the treatment of hemorrhoids, diet plays a very important role.
Need to practice the habit of going to the toilet regularly every day.

Adjust eating habits to avoid stimulants such as alcohol, coffee, avoid hot spicy foods, and increase fiber intake. Increase physical activity to exercise health. Treatment of chronic diseases such as bronchitis, bronchiectasis, gastrointestinal diseases such as constipation. Grade 2 internal hemorrhoids are not incurable. If the disease is detected early, it can still be completely curable while minimizing possible complications.