Hello, dear editor. I am interested in what methods there are for the treatment of internal bleeding hemorrhoids. When is surgical treatment mandatory and should it not be postponed?
Hristofor Slavchev - Lom
For an answer to our reader's question, we sought Dr. Atanas Matev, who is a surgeon and specialist in the treatment of diseases of the anus and rectum. He is the founder of a proctology practice since 1998, where 2,500 patients with hemorrhoids, anal fissures, fistulas and other diseases of the anus are treated every year. Dr. Atanas Matev is a university professor of surgery at the Faculty of Medicine, a specialist in surgery and oncology. Performs a full volume of proctological and oncological operations on hospitalized patients at the University Hospital-Stara Zagora. He routinely practices diagnostic and therapeutic gastrointestinal endoscopy and transanal endoscopic microsurgery.
Dr. Matev, what is the cause of hemorrhoids and how to recognize them?
- The specific reason for their appearance is not yet known. The upright position of the person exerts high pressure on the rectal veins, leading to their morbid expansion. Predisposing factors are chronic constipation, diarrhea, sedentary lifestyle, heredity, etc. Symptoms are bleeding during and after defecation, pain, feeling of hemorrhoids coming out, itching around the anus, presence of painful nodules.
Our reader suffers from internal hemorrhoids. What is characteristic of them?
- Internal hemorrhoids are located inside the anal canal. They bleed without pain, with clear blood and come out after defecation. They can be very painful if they get stuck in the anal canal and cannot be retracted back inside.
What are the first signs of hemorrhoid problems and when should we see a doctor?
- The appearance of blood in the stool is one of the first symptoms. Unfortunately, this can also occur with other potentially fatal diseases, and for this reason, a visit to the doctor is necessary when blood appears in the feces. Pinching, burning, itching, discomfort and constant pain are the most common symptoms. Self-medication is a waste of time and money, and it can be dangerous. Getting examined by a proctologist, making a diagnosis and ruling out other suspicions is what needs to be done.
What are the main therapies used in modern medicine in our country?
- All methods known to modern medicine are applied in Bulgaria. Before treatment methods are applied, patients themselves find out which foods harm them and begin to avoid them. I.e. following a strict diet is where it starts. Hygiene regime is also very important. When the disease progresses, bloodless methods are used, such as tightening with elastic rings of internal hemorrhoids,
infrared therapy, radiofrequency surgery
Different methods are used because there is no method that is universal for all patients with their particularities. For last-degree hemorrhoids, surgical treatment methods proven in science and practice are used with excellent results.
What is characteristic of the individual stages of internal hemorrhoids and what treatment can be applied?
- First of all, I want to clarify that these stages only apply to internal hemorrhoids and do not apply to external hemorrhoids. In the first degree, internal hemorrhoids do not come out of the anus after defecation. Symptoms are minimal and people lead normal lives. After eating spicy foods, there may be complaints that usually subside on their own. Usually, at this stage, invasive treatment is not required and the use of medication is sufficient when needed. In the second degree, internal hemorrhoids come out after defecation, but retract themselves into the anal canal. They can be felt after defecation and make hygiene difficult.
Patients in this stage usually limit their intake of hot and spicy spices and start maintaining anal hygiene. At this stage, it is possible to perform invasive bloodless procedures by a proctologist, for symptoms that do not respond to medication. In the third degree, internal hemorrhoids do not retract after defecation on their own and manual reposition is required. This means that the patient himself takes action to remove the prolapsed hemorrhoids. In the third degree, invasive bloodless procedures can be applied, and in a small number of patients surgical removal of internal hemorrhoids is required. The last fourth degree is treated operatively for best results. In fact, with a well-performed operation, the patient can be permanently cured of this disease.
The main concern of people suffering from hemorrhoids is whether they can lead to cancer. What is your opinion?
- Unfortunately, many of the symptoms of hemorrhoids and especially bleeding are also found in colon cancer and other intestinal diseases. For this reason, it is important that all symptoms be investigated by a qualified physician with experience in the treatment of diseases of the colon and rectum. But the most important thing is that
no connection between hemorrhoids and cancer
Of course, self-medication should not be relied on either, because it can mask a serious illness and only postpone the real treatment of hemorrhoids. Appropriate therapy can be selected by a colorectal surgeon.
We Bulgarians are afraid of the operation. Tell us more about the bloodless treatment methods you use
- One of the so-called bloodless methods is band-ligation, which is the interruption of the blood supply to the hemorrhoids. They dry up and fall off spontaneously. With this method, damage to the muscle of the anus is excluded.
Is a hospital stay required?
- No, the treatment is performed on an outpatient basis and only takes a few minutes. There is, of course, a recovery period of several days. After infrared therapy (another bloodless method), for example, the patient can immediately return to work if he wishes, the same day.
Why do hemorrhoids reappear in a large number of patients after a while? Is it possible and how to avoid the occurrence of relapses?
- If a specialist in the treatment of hemorrhoids with great experience, who practices various methods, chooses the most suitable one, then the recurrence of hemorrhoid complaints is impossible. In the 15 years since I first applied band ligation in 1998, I have become convinced that for each patient there is a treatment approach that is most suitable for them. It is important for the doctor to master various methods for bloodless treatment of hemorrhoids. I advise everyone to consult a specialist in time, because with the most advanced - the fourth degree - surgical removal of hemorrhoids is sometimes necessary.
What are the main problems with untreated and unligated hemorrhoids?
- Internal hemorrhoids often bleed. Sometimes the bleeding is so strong and prolonged that some patients become anemic, necessitating hospitalization and blood transfusion. Hemorrhoids progress slowly over the years, reaching a state of prolapse outside the anus, in which an unpleasant secretion is released constantly. Entrapment of hemorrhoids outside the anus is possible, which is an urgent, highly painful condition that requires immediate medical attention. Patients are bedridden unable to perform any activities.
What should patients observe to avoid the appearance of new hemorrhoids?
- Avoiding spicy foods, intake of sufficient fluids to prevent constipation, intake of more fiber through food, proper hygiene. A visit to a proctologist is necessary for blood in the stool, symptoms of discomfort and pain in the anal area. This can save a lot of worry and trouble later on.
