Haemorrhoids are normal anatomical structures that we all have. These anatomical structures
made mostly of special vascular tissue that sits on the top of the anal canal. The reason
we all have haemorrhoids is because they play an important role in the mechanism of continence.
This vascular tissue can inflate and deflate contributing to the fine closure of the anal
canal. Only when these normal anatomical structure become abnormal like this increase in size
become congested, they start producing symptoms and this is where we talked about hemorrhoidal
disease which should not be confused with haemorrhoids as such.
Haemorrhoids become abnormal when they become swollen and inflated over their normal limits.
The reason why they become abnormal could be different. Normally, generally speaking,
everything that can cause a prolonged increase pressure inside the abdomen leading to an
obstructed odd flow of the blood from the haemorrhoids can, in time, lead to abnormal
haemorrhoids. For simple things like chronic constipation, spending too long sitting on
the toilet trying to defecate can certainly contribute to the formation of haemorrhoids.
There are also relatively other common things like pregnancy can also lead to the same problem.
Patients may be predisposed more than others to this condition and in those cases also
simple standing up for a prolonged time or strenuous physical exercise may contribute
to the development of abnormal pathological haemorrhoids.
Haemorrhoids become symptomatic only when they become abnormal. By far the most common
symptom of haemorrhoids will be rectal bleeding. The bleeding normally consists of bright red
blood occurring after defecation is often not associated to pain and often pain is not
a common symptom of haemorrhoids. For more advanced stages of haemorrhoids,
when they become bigger or more swollen, they start prolapsing as well, which means they
start protruding through the anus normally, once again, after defecation. For the initial
stages, normally, the prolapse reduces spontaneously. For more advanced stages, the haemorrhoidal
polyps may require minor reduction so the patient himself or herself has to reduce the
prolapse back inside and for even more advanced stages, the prolapse may become very frequent, may
occur spontaneously, not necessarily associated to defecation and may even become very difficult
to reduce, to a point that the haemorrhoids may be protruding most of the time.
Discharge and discomfort can also be a consequence of haemorrhoids especially when they are large
and protruding regularly or more often. Severe pain only occur only when the haemorrhoids
become thrombosed which means when they become very big with a large blood clot in it.
Also, the haemorrhoids specially the early stage haemorrhoids will respond to conservative
measures and will not require surgical intervention. A surgical intervention remains most effective
treatment for the more advanced stages. Treatments like injection sclerotherapy and rubber band
ligation can also be considered although these often are only offering temporary relieve
and will have to be repeated a few times to keep symptoms under control.
For more advanced haemorrhoids, the most effective treatment remains is surgery. Conventional
surgery involves the excision of the haemorrhoids. This inevitably will leave the patients with
three large open wounds which may need several weeks to achieve a complete healing. Inevitably,
these lead into prolonged conservative recovery and pain.
More modern surgical treatment of haemorrhoids involve also a technique called THD which
I pioneered in this country and I started offering to my patients back in 2002. This
operation does not involve any excision or any removal any tissue. It’s aimed to correct
the haemorrhoids, preserving those anatomical structure and with them, the role that they play
in the mechanism of continence. The procedure consists of isolating one by
one, all the blood vessels, feeling the haemorrhoids, and applying few sutures to reduce main blood
flow to the haemorrhoids which will then shrink and go back to normal size and shape. After
that, for the largest haemorrhoids especially those were the more significant prolapse,
I will introduce another stitch which aims to lift and fix the haemorrhoids to where
they belong to prevent further sliding of the haemorrhoids and therefore eliminating
the prolapse as well. Because of the place where we position the sutures not being very
sensitive to pain, normally, the operation is associated to minimal post-operative pain,
with a quick recovery and very, very low morbidity.