Hemorrhoids

Diagnosis

Hemorrhoids are diagnosed by healthcare providers through a combination of symptom assessment and physical examination. Additional procedures that may be used include:

• Digital examination: The doctor inserts a lubricated, gloved finger into the rectum to check for any abnormalities or growths.
• Visual inspection: Internal hemorrhoids, which are often too soft to be felt during a rectal exam, may be examined using an anoscope, proctoscope, or sigmoidoscope to view the lower part of the colon and rectum.

These tests can be slightly uncomfortable but are not typically painful. They are usually performed in a doctor’s office or outpatient center, and patients can go home the same day.
In some cases, a doctor may recommend a colonoscopy to examine the entire colon, particularly if:

• Symptoms suggest the possibility of another digestive system disorder.
• There are risk factors for colorectal cancer.
• The patient is middle-aged and has not had a recent colonoscopy.

A colonoscopy may be performed to confirm findings from other tests or to screen for signs of colon cancer. This procedure is done on an outpatient basis and requires anesthesia.

Treatment

In many cases, hemorrhoids tend to resolve on their own without the need for treatment. Symptoms such as discomfort and bleeding typically last around one week or slightly longer. However, if treatment is necessary, it may involve the following approaches:

• Home treatment: With home treatments, the patient can frequently reduce the minor pain, swelling, and inflammation of hemorrhoids.
• High-fiber foods: Eat more whole grains, fruits, and vegetables. By doing this, the stool will become softer, which will assist the patient avoid straining, which can exacerbate the symptoms of already-existing hemorrhoids. To avoid issues with gas, gradually add more fiber to the diet. Make an effort to consume 20 to 35 grams of fiber every day.
• Topical treatments: Apply a hydrocortisone-containing over-the-counter hemorrhoid cream or suppository or use pads with witch hazel or a numbing ingredient.
• Regular warm bath or sitz bath: two to three times a day, soak the anal area in plain, warm water for ten to fifteen minutes. The toilet may fit over a sitz bath.

Hemorrhoids symptoms typically go away with these remedies in a week. If the patient doesn’t see relief within a week, or sooner if they have extreme pain or bleeding, they should visit a healthcare provider.

• Medications: In cases of mild discomfort caused by hemorrhoids, healthcare providers may advise using over-the-counter creams, ointments, suppositories, or pads containing ingredients like witch hazel, hydrocortisone, or lidocaine to alleviate pain and itching temporarily. However, it is crucial to follow medical guidance and avoid prolonged use of over-the-counter steroid creams, as they can potentially thin the skin.
• Minimally invasive procedures: One of the various minimally invasive procedures might be suggested by the healthcare professional for hemorrhoids that are bothersome or that continue to bleed. These procedures can be carried out in a healthcare provider’s office or other outpatient location without the need for general anesthesia.
  • External hemorrhoid thrombectomy: A healthcare provider can remove the external hemorrhage if a painful blood clot (thrombosis) has developed inside of it, which can bring relief right away. The best results are obtained when this local anesthetic technique is carried out within 72 hours of the clot forming.
  • Rubber band ligation:  Involves placing small rubber bands around the base of an internal hemorrhoid to restrict blood flow and facilitate its eventual removal. While the process generally leads to the withering and shedding of the hemorrhoid within a week, it can be accompanied by discomfort and mild bleeding, typically occurring between two to four days after the procedure. Severe bleeding is rare but possible, and there is a slight risk of experiencing more serious complications.
  • Sclerotherapy injection: In order to shrink the hemorrhoid tissue, healthcare provider will inject it with a chemical solution. Although the injection is not painful, it might not be as effective as rubber band ligation.
  • Infared coagulation (laser or bipolar): Coagulation methods utilize heat, infrared light, or lasers. They make internal hemorrhoids that are tiny and bleeding stiffen and shrivel. Coagulation often produces little discomfort and has few negative side effects.
• Surgical procedures: The majority of people with hemorrhoids do not need surgery. But if previous methods haven’t worked or the patient have huge hemorrhoids, the healthcare provider can suggest one of the following:
• Hemorrhoidectomy: Large external hemorrhoids or prolapsed internal ones are removed surgically. The surgeon cuts away extra tissue that leads to bleeding using one of several ways. General anesthesia, spinal anesthesia, or local anesthesia mixed with sedation can all be used during the procedure.

The most thorough and effective method of treating severe or recurrent hemorrhoids is hemorrhoidectomy. After the procedure, the majority of patients experience some pain, which medications can alleviate. A warm bath may also be beneficial.

• Hemorrhoid stapling: An internal hemorrhoid is removed with a stapling tool. Alternately, it holds a prolapsed internal hemorrhage inside the anus. Stapled hemorrhoidopexy is a technique that stops blood flow to hemorrhoidal tissue.

Hemorrhoidectomy typically causes more discomfort than stapling, which enables a sooner return to normal activities. However, stapling has been linked to a higher incidence of recurrence and rectal prolapse, in which a portion of the rectum protrudes from the anus, compared to hemorrhoidectomy.