How To Get Rid Of Hemorrhoids Permanently Without Surgery

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How To Get Rid Of Hemorrhoids Permanently Without Surgery – Below is a comprehensive overview of how to diagnose and classify hemorrhoids, as well as how to choose the right medical or surgical treatment based on current clinical evidence.

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How To Get Rid Of Hemorrhoids Permanently Without Surgery

How To Get Rid Of Hemorrhoids Permanently Without Surgery

Aspects of modern life that can promote hemorrhoids include an increased consumption of processed foods, a sedentary lifestyle, and the use of cell phones during bowel movements, which result in time spent going to the bathroom.

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Hemorrhoids accounted for more than 3.5 million outpatient visits in the United States in 2010 and were the third leading cause of gastrointestinal-related hospitalizations.

Here we review the process of diagnosing and classifying hemorrhoids, as well as choosing medical or surgical treatment based on the latest medical evidence.

Hemorrhoids are a distal prolapse of the arteriovenous bundle, surrounding muscle fibers and connective tissue like lining below the dentate line in the anal canal. They usually appear as painless bleeding.

Diagnosis of hemorrhoids is based on history and physical examination rather than laboratory tests or imaging studies. Generally, the symptoms are painless bleeding associated with bowel movements, which often appear as bright red blood on the toilet paper or stool. Itching and discomfort in the anus are also common, especially in chronic hemorrhoids.

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A detailed patient history is important. It should include the intensity, severity and duration of symptoms, bowel frequency, associated symptoms (eg, constipation, fecal incontinence), daily eating habits and details of bowel movements. (eg bowel movement time and simultaneous phone use).

Regarding bad habits, some patients experience constipation or diarrhea throughout life. Therefore, what patients perceive as normal bowel habits may be abnormal and should be investigated.

A digital rectal exam is the second step. During the examination, look for skin folds, sphincter joints, perianal cleanliness, and syncope lesions in the anus.

How To Get Rid Of Hemorrhoids Permanently Without Surgery

Warning signs of colorectal cancer on digital rectal examination include masses with or without hemorrhoid pockets and sources of bleeding beyond the level of the internal hemorrhoid.

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Patients with recurrent fistulas, fistulas, or milia (especially cauliflower milia) should be evaluated for Crohn’s disease (Figure 1).

Because bleeding can be a sign of a number of diseases, including colon cancer, it is important to review the results of a previous colonoscopy. Patients at high risk for colon cancer should have a strict sigmoidoscopy, a flexible sigmoidoscopy, or a colonoscopy.

In our practice, we recommend endoscopic evaluation for patients over 40 years of age with bleeding, especially if they have a family history of colorectal cancer.

External hemorrhoids are characterized by the outer covering of the perianal and anal skin and their location below the dentate line. They are very painful if the hemorrhoidal sac is blocked by blood.

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Internal hemorrhoids are located above the dentate line and are covered by the transitional mucosa and the rectal column. They are classified into 4 levels

When choosing a treatment for hemorrhoids, you should consider the extent and severity of the disease, the impact on the quality of life, the level of pain it causes, and the possibility of compliance treatment, the patient and his personal preferences.

Regardless of the severity, treatment usually begins with a high-fiber diet and other lifestyle adjustments including bowel habits. This requires doctors to devote a lot of time to patient education, regardless of the type or severity of the disease.

How To Get Rid Of Hemorrhoids Permanently Without Surgery

Treatment can be divided into three categories: conservative, in-clinic, and surgery. The doctor should carefully discuss the options with the patient, emphasizing the advantages and disadvantages of each option.

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Conservative measures aim to soften stools, reduce pain and correct bad habits. In most cases, lifestyle is the main driver, and if patients do not change this, they may experience recurring symptoms in the long term.

People take their phones to the bathroom and this habit is believed to increase the time to go to the toilet, which causes pressure on the anal area and tension during urination. Some studies indicate a direct relationship between toilet time and hemorrhoids, although the exact cause and effect of cell phone use is still unclear. In general, do not spend a lot of time in the toilet, including reading.

Reported that patients with hemorrhoids spent more time on the toilet and had to push harder and more often than community and hospital controls.

Fiber draws water into the colon, increasing the water content of the stool. Daily fiber intake should be 28 g for women and 38 g for men.

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This high intake is difficult to achieve without supplements for those who follow a typical American diet with a lot of fast food.

In this meta-analysis, with fiber supplementation, the relative risk of persistent or unimproved symptoms was 0.53 (95% confidence interval [CI] 0.38–0.73) and the risk of bleeding was 0.50 (95% CI 0.28-0.89). Psyllium husks are an inexpensive dietary supplement; The optimal daily dosage is not known.

We recommend at least 28 g per day for women and 38 g for men, psyllium husk can be used as a dietary supplement.

How To Get Rid Of Hemorrhoids Permanently Without Surgery

Laxatives such as docusate are used to change bowel movements when there is an organic bowel problem rather than a nutritional problem. They can be used as a complementary treatment to improve the results of fiber therapy.

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Local anesthesia (for example, 5% lidocaine) is often used to treat low back pain, but there is no reliable data. Since most cases of hemorrhoids develop over time, you should not expect long-term improvement from topical anesthesia. However, it can be used as an adjunctive treatment in selected cases where short-term improvement is the primary goal and we recommend it based on personal experience.

Phlebotonics contains many ingredients including natural extracts such as flavonoids and synthetic products. Although the exact mechanism of action is unknown, phlebotonics are thought to increase venous and lymphatic drainage, normalize capillary permeability, and reduce inflammation in the hemorrhoid cushion.

Although phlebotonics show better results than placebo in the management of hemorrhoids in the short term, there are few long-term data. As a result, the ASCRS clinical practice guidelines make weak recommendations regarding the routine use of these agents.

Flavonoids (diosmin, hesperidin, rutoside), in a meta-analysis versus placebo in 1,514 patients, showed beneficial results in terms of bleeding (relative risk [RR] 0.33), pruritus (RR 0 0). ,65) and regression ( RR 0.53)).

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Although Preparation H is often used over the counter, there are no good data on it and it is not considered an intravenous tonic.

In-office treatments – rubber band ligation, infrared photocoagulation, and sclerotherapy – are often used for grade I, II, and III hemorrhoids that have not responded to traditional treatment. The main goal of these treatments is to reduce the blood flow in the hemorrhoidal sac.

Although clinical treatment is very effective and serious complications are rare, the recurrence rate can be high, and patients require additional treatment. In addition, infectious complications can occur, so patients should be closely monitored for fever and urinary tract infections. Pain is a common symptom after treatment in the clinic and bleeding may also occur.

How To Get Rid Of Hemorrhoids Permanently Without Surgery

The ASCRS guidelines strongly recommend outpatient treatment for patients with grade I and II hemorrhoids and for some patients with grade III hemorrhoids.

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Compression of the hemorrhoidal cushion surface blocks arterial flow and causes necrosis of the hemorrhoidal tissue (Figure 2). The ligation is performed above the tooth line, where the nerve fibers are different from those found below this line; therefore, the surgery causes less pain than expected. One or more hemorrhoidal pads can be treated at the same time, although increased pain, bleeding, and vasomotor reactions have been reported in several groups during the same procedure.

Figure 2. With a rubber band, the internal hemorrhoid is grasped with forceps (A) and pulled into the ligature tube (B). A bandage is applied to the base of the hemorrhoid (C), which cuts off the blood supply and causes it to fall off within a few days.

Reported that patients on warfarin therapy had a 9-fold increased risk of postoperative bleeding and patients on aspirin had a three-fold increased risk. Therefore, patients on anticoagulant therapy should be exposed to this method of treatment is still unclear.

This technique has been shown to be effective for grade I to III hemorrhoids, although some patients with grade III hemorrhoids may benefit more from hemorrhoidectomy with excision, which is associated with lower rate of hemorrhoidectomy than rubber band.

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We conducted a randomized controlled trial comparing hemorrhoidal artery ligation and rubber banding for symptomatic hemorrhoids in 372 patients with grade II and III hemorrhoids. Postprocedural pain on days 1 and 7 was significantly reduced with rubber ligation, but recurrence was more frequent (49% vs 30%,

In general, rubber ligation is a good choice for grade II hemorrhoids, because it is easy to do, painless, and can be used to treat recurrence.

During this procedure, an infrared probe generates heat to cause coagulation, fibrosis, and eventually necrosis of the exposed tissue.

How To Get Rid Of Hemorrhoids Permanently Without Surgery

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