Dr. Milko Milushev: A new method without incisions radically solves the problem with hemorrhoids

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Dr. Milko Milushev: A new method without incisions radically solves the problem with hemorrhoids
Dr. Milko Milushev: A new method without incisions radically solves the problem with hemorrhoids
Anonim

Dr. Milushev, for which patients with hemorrhoidal disease is the THD method suitable for non-incisional (no incisions) removal of hemorrhoids?

- Transal hemorrhoidal desarterization (THD) is a relatively new method. It is suitable for patients with hemorrhoid disease from the second to the fourth stage.

We must note that the disease has four stages of development. In the first stage, hemorrhoids are very small, they do not come out of the anus, but sometimes they bleed during defecation. In the second stage, they appear when straining, and then go away on their own. In the third stage, they do not retract spontaneously, but they can be retracted with help. The fourth stage is the most severe form of the disease, when the hemorrhoids have already permanently gone outside the anal canal, with the inability to retract, there may also be prolapse (falling out) of the anal mucosa.

In the first stage, conservative treatment is applied - with pills, suppositories, ointments. In the following stages, surgical treatment is applied. Various methods have been described, each with its merits and demerits.

If such conservative treatment is applied at the first stage, can we expect to cure the disease, or does it only slow down its development?

- In principle, for the appearance of hemorrhoidal disease, there must be a congenital weakness of the connective tissue, in this case - in the wall of the blood vessels. Often, patients with hemorrhoids have varicose veins of the lower limbs and hernias. Hemorrhoids appear in the presence of additional factors such as a stagnant lifestyle, sedentary occupations, chronic constipation, persistent diarrhea, pregnancy, etc. I.e. the reasons for the appearance of the disease are complex. Conservative treatment usually slows down the process, but does not stop it for the reasons listed. Of course, for some people this process is very slow, for others - faster.

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Tell us more about the THD method

- The method uses a specially designed tool - an anal speculum, in which a Doppler echograph is built-in. With this tool, the arteries that supply blood to the hemorrhoidal nodes are found. Usually these arteries are six in number and after they are identified each of them is sutured. In this way, the blood flow to the nodes is stopped. And hemorrhoids are actually dilated blood vessels - they look like varicose veins in the legs, with the difference that hemorrhoids are not exactly veins, but sinuses that are located between arteries and veins, like pillows, filled with blood. They are related to the retention of feces and gases, protect the anal sphincters from injury and participate in the control of defecation. If the disease is in its severe stages - third and fourth, especially in the fourth, when there is prolapse (falling out) of the mucous membrane, then an additional manipulation is performed, which is called mucopexy - the excess mucous membrane is folded with a spiral suture and pulled into the intestine. In this way, two goals are achieved - liquidation of the hemorrhoidal node and, at the same time, of the mucosal prolapse. And because it works on the area where the pain receptors are and there are no incisions, the pain is minimal.

And is the procedure itself done under anesthesia?

- Yes, with spinal or general anesthesia. After surgery, there is usually transient anal discomfort and a feeling of incomplete bowel movement, which quickly resolves. In the postoperative period, it is important not to allow constipation, a diet rich in liquids and ballast substances is recommended.

Are there any patients for whom this method is contraindicated?

- Each case is assessed comprehensively after review. Contraindicated are patients with severe diseases in which the risk of surgery is greater than the expected benefit of the intervention, as well as diseases of the anus, such as carcinoma for example.

Why do men suffer from hemorrhoids more often than women?

- Men more often exercise professions associated with increased intra-abdominal pressure - lift more weights, exercise sedentary professions, such as drivers, for example, in which there is blood stagnation in the lower limbs and pelvis.

You said that a predisposition to the development of hemorrhoidal disease is a weakness of the connective tissue. Is this inherited?

- Yes, there is a congenital predisposition.

Can this weakness be prevented?

- No, it's genetic. But very important is actually the way of life.

After applying the method, is it possible for hemorrhoids to reappear?

- According to statistics, after applying this method, there is a 10% chance that hemorrhoids will reappear - there will be a relapse. But this is usually in very severe and neglected cases. The reason is that sometimes from small side branches of the six arteries that are ligated, new nodes can appear compensatory. These small arteries cannot be detected with Doppler.

Is winter the risk period for the appearance of hemorrhoids, when we lead a more stagnant lifestyle, put more emphasis on meats and snacks?

- In general, hemorrhoids is a chronic disease and lasts for years. In winter, when there are not many fresh vegetables and fruits and more emphasis is placed on dry and canned foods, the problem of constipation appears more often, which is a predisposing factor and cause of the appearance of hemorrhoids. Although constipation is more common in women, hemorrhoids are more common in men because the factors, as I said, are complex.

Many of our older readers complain of chronic constipation, which, despite the applied treatment methods, they cannot cope with. Why does this happen?

- Older people have many problems, but in this case, an important cause is atherosclerosis of the vessels. When the blood supply to the intestinal wall begins to suffer, the intestines become more sluggish. This is where stubborn constipation in the elderly appears. In this case, food rich in fiber can help - raw fruits and vegetables, nuts, the intake of more fluids, as well as an active physical regime.

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