HEMMORRHOIDECTOMY

What Are Hemorrhoids?

Hemorrhoids are clumps of blood vessels of the rectum. The hemorrhoidal veins are located in the lowest area of the rectum just above the anus. Sometimes they swell when the veins enlarge and their walls become stretched, thin, and irritated by passing bowel movements. Hemorrhoids are classified into two general categories: 1) internal 2) external

1. Internal Hemorrhoids
Internal hemorrhoids- are located in the inside lining of the rectum and cannot be felt unless they are substantially enlarged. They usually are painless and make their presence known by causing bleeding with a bowel movement. Sometimes internal hemorrhoids prolapse or protrude outside the anus. If so, you may be able to see or feel them as moist pads of skin that are pinker than the surrounding area. Prolapsed hemorrhoids may hurt because the anus is dense with pain-sensing nerves. Prolapsed hemorrhoids usually recede into the rectum on their own; if they don't, they can be gently pushed back into place.

2. External Hemorrhoids
External hemorrhoids- are located underneath the skin that surrounds the anus (lower in the anus than internal hemorrhoids). They can be felt when they swell, and may cause itching, pain, or bleeding with a bowel movement. If an external hemorrhoid prolapses to the outside (usually in the course of passing a stool), you can see and feel it. Blood clots sometimes form within prolapsed external hemorrhoids, which can cause an extremely painful condition called a thrombosis. If an external hemorrhoid becomes thrombosed, it can look rather frightening, turning purple or blue, and could possibly bleed. Despite their appearance, thrombosed hemorrhoids usually are not serious though they can be very painful.

Everyone Has Hemorrhoids

Although most people think hemorrhoids are abnormal, they are present in everyone. It is only when the hemorrhoidal cushions enlarge that hemorrhoids can cause problems and be considered abnormal or a disease. Although hemorrhoids occur in everyone, they can become large and cause serious problems in about 4% of the general population. Hemorrhoids that cause problems are found equally in men and women, and their prevalence peaks between 45 and 65 years of age.

What Causes Hemorrhoids?

Researchers are not certain what causes hemorrhoids. It's likely that extreme abdominal pressure causes the veins to swell by blocking the flow of blood through them. They then become susceptible to irritation. The increased pressure can be caused by obesity, pregnancy, standing or sitting for long periods, straining on the toilet, coughing, sneezing, vomiting, and holding your breath while straining to do physical labor.

Hemorrhoids and Diet

Diet is believed to have a pivotal role in causing -- and preventing -- hemorrhoids. People who consistently eat a high-fiber diet are less likely to get hemorrhoids, while those people who prefer a diet high in processed foods are at higher risk. A low-fiber diet or inadequate fluid intake can cause constipation, which can contribute to hemorrhoids in two ways:

1. it promotes straining on the toilet; and 2. it also aggravates the hemorrhoids by producing hard

What Are the Symptoms of Hemorrhoids?

The most common symptom and sign from hemorrhoids is painless bleeding. There may be bright red blood on the outside of the stools, on the toilet paper, or dripping into the toilet. The bleeding usually is selflimiting. Bleeding with a bowel movement is never normal and should prompt a visit to a health care professional.

Stages of Hemorrhoids
Stages of Hemorrhoids:

For convenience in describing the severity of internal hemorrhoids, many physicians use a grading system:

First-degree hemorrhoids: Hemorrhoids that bleed, but do not prolapse. Second-degree hemorrhoids: Hemorrhoids that prolapse and retract on their own (with or without bleeding). Third-degree hemorrhoids: Hemorrhoids that prolapse but must be pushed back in by a finger. Fourth-degree hemorrhoids: Hemorrhoids that prolapse and cannot be pushed back in the anal canal. Fourthdegree hemorrhoids also include hemorrhoids that are thrombosed (containing blood clots) or that pull much of the lining of the rectum through the anus.

Symptoms of Prolapsed Internal Hemorrhoids

Prolapse of an internal hemorrhoid occurs when the internal hemorrhoids swell and extend from their location in the rectum through the anus. In the anal canal, the hemorrhoid is exposed to the trauma of passing stool, particularly hard stools associated with constipation. The trauma can cause bleeding and sometimes pain when stool passes. The presence of stool, inflammation, and constant moisture can lead to anal itchiness (pruritus ani), and occasionally the constant feeling of needing to have a bowel movement. The prolapsing hemorrhoid usually returns into the anal canal or rectum on its own or can be pushed back inside with a finger, but it prolapses again with

Symptoms of Thrombosed External Hemorrhoids

External hemorrhoids can be felt as bulges at the anus, but they usually cause few of the symptoms that are typical of internal hemorrhoids. External hemorrhoids can cause problems, however, when blood clots inside them. This is referred to as thrombosis. Thrombosis of an external hemorrhoid causes an anal lump that is very painful and tender, and often requires medical attention. The thrombosed hemorrhoid may heal with scarring, and leave a tag of skin protruding in the anus. Occasionally, the tag is large, which can make anal hygiene (cleaning) difficult or irritate the anus.

Hemmorrhoidectomy
Surgical

removal of hemorrhoids known as a hemorrhoidectomy or stapled hemorrhoidectomy is reserved for patients with third- or fourthdegree hemorrhoids.

Hemorrhoidectomy

During a hemorrhoidectomy, the internal hemorrhoids and external hemorrhoids are cut out. The wounds left by the removal may be sutured (stitched) together (closed technique) or left open (open technique). The results with both techniques are similar. A proctoplasty, which extends the removal of tissue higher into the anal canal so that redundant or prolapsing anal lining also is removed, is sometimes performed in addition. Postsurgical pain is a major problem with hemorrhoidectomy, and potent pain medications (narcotics) usually are required.

Stapled Hemorrhoidectomy

Stapled Hemorrhoidectomy
A newer surgical technique is rapidly becoming the treatment of choice for third-degree hemorrhoids. This surgery does not remove the hemorrhoids but, rather, the expanded hemorrhoidal supporting tissue that has allowed the hemorrhoids to prolapse downward. In this procedure, a circular, hollow tube is inserted into the anal canal and a suture (a long thread) is placed through it and woven circumferentially within the anal canal above the internal hemorrhoids. The ends of the suture are brought out of the anus through the hollow tube. The stapler is placed through the hollow tube and the ends of the suture are pulled expanding the hemorrhoidal supporting tissue into the jaws of the stapler. The hemorrhoidal cushions are pulled back up into their normal position within the anal canal. The stapler is then fired, cutting off circumferential ring of expanded hemorrhoidal supporting tissue trapped within the stapler, at the same time staples together the upper and lower edges of the cut tissue. Stapled hemorrhoidectomy is less painful and faster than a traditional hemorrhoidectomy, taking approximately 30 minutes.