The treatment of hemorrhoids depends on their own features. There are 4 different types: degree1, 2, 3 or 4, and the treatment goes as follows.
1st degree hemorrhoids: conservative treatment with dietetic and pharmacological measures. Only in cases resistant to medic therapy, it is advisable to perform an elastic ligature or sclerotherapy.
2nd degree hemorrhoids: elastic ligature, transanal hemorrhoidal dearterialization with doppler (THD), stapled hemorrhoidopexy and sclerotherapy.
3rd degree hemorrhoids: transanal hemorrhoidal dearterialization with doppler (THD), stapled hemorrhoidopexy, hemorrhoidectomy and elastic ligature.
4th degree hemorrhoids: stapled hemorrhoidopexy and hemorrhoidectomy.
Patients with second and third degree hemorrhoids are suitable for elastic ligatures, an outpatient treatment which is minimally invasive and painless. An elastic band is placed on the base of the hemorrhoids using an anoscope. After a few days, the band detaches itself spontaneously, while the tissue on the base heals. The process is painless because the ligation is located over the dentate line and it does not affect any sensitive nerve endings. Unless surgical complications, the patient is not required to stay at hospital and can return to their normal life quite soon.
Sclerotherapy consists of injecting a sclerosing solution in varicose veins in order to produce a local inflammation which eventually heals. This process reduces the blood flow to the hemorrhoids, and therefore their size is reduced. The injection of the sclerosing solution can be used as an alternative or complementary treatment to the elastic ligature, especially in the case of bleeding hemorrhoids.
In case of severe hemorrhoids (third or fourth degree), they can be treated with a traditional surgical intervention, although nowadays less painful alternative surgical treatments are more usual. There are two types of hemorrhoidectomy: open (Milligan Morgan technique) and closed (Ferguson technique). They both consist of removing the bleeding or prolapsed hemorrhoidal tissue. Hemorrhoidectomy is quite effective and the rate of relapses is very low. In order to avoid pain, the patient receives pain killers the first days after the intervention and they must stay at hospital. They can return to their normal life, but not soon after the intervention.
This was the first alternative to the hemorrhoids excision. It is known as Longo technique or PPH (procedure for prolapse and hemorrhoids) and consists of performing a hemorrhoidopexy. The prolapse is fixed by eliminating a strip of the anal canal and the hemorrhoid goes back to its original position. The stapler used in this procedure removes the unwanted mucosa and stitches the remaining one at the same time. Postoperative pain is reduced significantly because it produces no open wounds. This technique is indicated for second, third and fourth degree hemorrhoids.
Transanal hemorrhoidal dearterialization with doppler.
THD is a minimally invasive treatment for hemorrhoids consisting of a surgical intervention with no tissue excision. An anoscope equipped with a doppler identifies the distal ends from the superior hemorroidal artery. Then, they are suturated with internal stitches.
The hemorrhoidal tissue is not removed and the anatomy of the anal canal is not altered, which enables future interventions in this area. Furthermore, it enables the preservation of the sphincteric system in charge of continence. The intervention is quite painless because no tissue is eliminated and the suture is performed over the dentate line, not affecting any sensitive nerve endings. It is also associated to the pexia of the muco-hemorrhoidal prolapse, which means that in the same intervention the prolapsed mucosa is placed in its original position. Thus, we can soothe one of the typical symptoms of late-stage hemorrhoids. This method is suitable for second, third and fourth degree hemorrhoids when patients present edema, congestion, pain and rectal bleeding. The intervention takes place in the outpatient department and the patient can return to their normal life quite soon.
During the first hours after the intervention, the patient may feel a slight local pain which disappears gradually. However, it can be controlled with regular pain killers. 48 hours after the intervention the patient can return to their normal life. The rate of severe complications is very low, although it is possible to find a slight bleeding (which will disappear in a few hours) or the feeling of urgent need to defecate immediately after the intervention (which is also transitory). No special therapy is needed, but we recommend liquid fiber diets in order to favor soft stools to eliminate trauma in the anal canal. The treatment of hemorrhoids with the THD method is satisfactory in most cases. The rate of relapses is, in fact, quite low.