Hemorrhoids

Hemorrhoids (hemorrhoid disease) are pathological dilation of the venous plexuses of the rectum. At stages I-II, it is usually managed conservatively: with a change in diet, ointments and suppositories. At stages III-IV, the ointment only alleviates the symptoms and a minimally invasive procedure or surgery becomes necessary. One main rule applies to all stages: self-medication is not allowed in case of bleeding from the anus, in this case, timely consultation with a doctor is necessary, since the same sign may indicate another, more serious disease.

What are hemorrhoids and why do they appear?

Hemorrhoids are common in all people. They are a normal anatomical structure of the anal canal. We are talking about the disease when the nodes become pathologically enlarged, bleeding begins during defecation, or the nodes fall out. They are divided into internal and external hemorrhoids.

Main risk factors:

• Chronic constipation and straining during defecation;
• prolonged sitting (office work, drivers) or heavy physical exertion;
• Pregnancy and childbirth, due to intra-abdominal pressure and hormonal changes;
• Overweight, low-fiber diet, lack of fluids;
• Hereditary predisposition to varicose veins.

Symptoms of hemorrhoids by stage

The classification of hemorrhoidal disease includes 4 stages. The stage determines whether conservative treatment will be effective or not.

The most painful complication of hemorrhoidal disease is acute thrombosis: a dense, bluish, intensely painful lump around the anus, which is managed conservatively or surgically within the first 48-72 hours.

Hemorrhoids and bleeding: when is it dangerous?

Hemorrhoids are bright red, visible on the surface of the stool or on paper, and are usually painless. But hemorrhoids are not the only cause of rectal bleeding: anal fissures, polyps, ulcerative colitis , and colorectal cancer can also cause the same symptoms. Therefore, the diagnosis of "hemorrhoids" should be made by a doctor, not by the patient.

Contact your doctor immediately if:

• The blood is dark, black, or mixed with the stool (not on the surface);
• Bleeding is heavy or lasts for several days;
• Bleeding is accompanied by weight loss, weakness, and changes in stomach function;
• You are over 45 years old and have not had a colonoscopy in the last 10 years;
• There was a family history of colorectal cancer.

In such cases, the proctologist, in addition to the examination, will prescribe a colonoscopy , and a complete blood count will show whether chronic bleeding has caused anemia.

Home Treatments: What Really Works

Home remedies are the basis of treatment for stages I-II, and for stages III-IV, they are a means of managing symptoms before and after surgery. Their effectiveness has been proven by studies, although not all of them.

What really helps:

• Fiber, 25-30 g. per day (vegetables, fruits, whole grains, bran or psyllium). This is the only home remedy that has been proven to reduce bleeding.
• Fluids, 1.5-2 liters per day , otherwise fiber will aggravate constipation.
• Defecation regimen: do not delay the urge, do not sit for more than 3-5 minutes, do not strain.
• Physical activity : walking, swimming; limit heavy lifting.

What is a myth or harmful: cold compresses to "shrink the knot", garlic/potato suppositories, sitting on the toilet while talking on the phone, prolonged use of painkillers against the background of bleeding. The latter (especially ibuprofen, aspirin) increase bleeding.

Ointment and candles

Topical medications for treating hemorrhoids are divided into several groups. There are hundreds of brands in pharmacies, but the active ingredients are few:

Practical rule: If 7 days of topical treatment do not relieve symptoms, or symptoms return within 2-3 months, this means that the stage has exceeded the capabilities of the ointment. Any medication during pregnancy should only be used in consultation with a doctor.

Hemorrhoid surgery and minimally invasive methods

In modern proctology, "surgery" is no longer a single specific intervention. The choice depends on the stage and type of nodule.

The Department of General Surgery of the Bochorishvili Clinic performs surgical treatment of hemorrhoidal disease at all stages, andthe anesthesiology service selects anesthesia depending on the type of operation. In case of purulent complications, paraproctitis, abscess, intervention is urgent; we have a separate article about this: Purulent Surgery: When Does an Abscess Need to Be Opened .

After surgery: first 7 days

• Pain : The first 2-3 days are the most intense; the doctor will prescribe analgesics on a schedule, do not wait for severe pain.
• First defecation : 1-3 days. Laxative (lactulose, macrogol) and fiber are mandatory to keep the stool soft.
• Hygiene : Bathe with warm water after each defecation, not paper; sitz baths.
• Activity : Walking from day one; no weights or cycling for 3-4 weeks.
• Return to work : 1-3 days after minimally invasive methods, 10-14 days after hemorrhoidectomy.
• Contact the clinic immediately if: there is heavy bleeding, the temperature exceeds 38 °C, you are unable to urinate for 8-12 hours.

When to see a proctologist at Bochorishvili Clinic

A visit to a proctologist is often postponed due to avoidance, but it is precisely this postponement that leads to stage I to III. The examination lasts 10-15 minutes, is performed in an individual office, and, if necessary, is completed with anoscopy or rectoscopy. These are painless procedures that do not require preparation.

Contact your doctor if:

• Blood is visible in the stool, on the toilet paper, or in the toilet bowl;
• A lump, swelling, or persistent itching has appeared in the anus area;
• Symptoms do not disappear after 7 days of self-treatment;
• The pain is severe and prevents you from sitting.

Surgeon-proctologist Levan Gulua Bochorishvili is accepting appointments daily at the clinic. Appointments: online or by calling the hotline 0322 312 112.