Some common symptoms of both internal and external hemorrhoids include:
• Bleeding or blood strain during the bowel movements.
• Pain in the anal area
• Swelling around the anus
• Thrombosed hemorrhoids
The veins in the anus tend to stretch under pressure and may swell. These swollen veins (hemorrhoids/piles) can be caused by increased pressure in the rectum due to:
• Constipation or diarrhea
• Childbirth or pregnancy
• Excessive weight
• Straining during bowel movements, vomiting etc
• Sitting for long time on the toilet
• Low fiber diet
External hemorrhoids can be seen easily whereas internal hemorrhoids can be diagnosed by performing some tests such as physical examination of the anal canal and rectum through:
• Digital examination – doctor will insert a lubricated gloved finger in the rectum to feel anything unusual such as abnormal growths to determine whether further testing is required or not.
• Visual examination- doctor may examine the lower part of the colon and rectum with the help of anoscope, proctoscope or sigmoidoscope as internal hemorrhoids are often too soft to be felt during a rectal exam.
If a person has any risk factor of colorectal cancer or any signs or symptoms that may indicate another digestive system disease, then doctor may examine entire colon by using colonoscopy. Rectal bleeding can occur due to other diseases also especially if a person is over 40 years old.
Treatment for hemorrhoids or piles can depend on its type and condition. Doctor may suggest some medications, over the counter creams, ointments, suppositories etc for hemorrhoids that cause only mild discomfort. If a painful blood clot has formed within an external hemorrhoid then doctor can remove the clot with a simple incision and drainage. Painful hemorrhoids can also be treated through minimally invasive procedures that can be done as outpatient basis. These procedures are rubber band ligation, sclerotherapy, coagulation techniques, out of which the rubber band ligation proves to be more effective for many people.
Hemorrhoids or piles can be removed through surgical procedures also that can be done as outpatient or may require an overnight hospital stay. These procedures are hemorrhoidectomy and hemorrhoid stapling.
Stapled hemorrhoidectomy, also called stapled hemorrhoidopexy is typically used only for internal hemorrhoids. In this procedure, the blood flow to hemorrhoidal tissue is blocked. The surgery can be done in 30 -45 minutes under local anesthesia along with sedation, in few cases, general anesthesia may be required. Surgeon gently inserts a circular shaped stapling device into the rectum (back passage) to remove excess tissue above the hemorrhoids and then staples the remaining tissue back inside the rectum. These staples are left in the body permanently. Post operation, patient can expect small amount of bleeding and pain for which he/she will be given some pain medications. Sometimes, anal plug is also inserted which can be removed a few hours after surgery. Patient can go back to normal routine once he/she feels fine. Wearing a pad may protect the cloths from spoiling. Doctor will recommend eating high fiber foods and proper hygiene during the bowel movements.
There are many benefits of Stapling over hemorrhoidectomy that includes:
• Less pain
• Early return to normal routine
• Faster healing time
• Reduced surgery time
• Less bleeding
• Relief from discharge and itching
Stapling also involves some risks and complications such as recurrence, rectal prolapsed, unexpected bleeding, urinary retention, pain and in rare cases, sepsis.
Patient should inform doctor immediately if he/she experience:
• High fever
• Severe bleeding
• Increased pain and swelling
• Increased discharge
• Difficulty while urination
• Constipation despite of laxatives
• Vomiting or nausea