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Hemorrhoid disease:Hemorrhoid tissues are normal tissues found in every person and are divided into internal and external hemorrhoids. External hemorrhoids are vascular structures located under the skin around the anus . Internal hemorrhoids, which cause hemorrhoids disease that will require treatment, are pillow-shaped structures filled with vascular balls, located approximately 1.5-2 cm inside the anus entrance, all around the intestinal wall, and 120-degree angles between them. When viewed from the anus, they are located at the 3, 7 and 11 o'clock positions. Their job is to keep the area around the anus dry by preventing the fluids in the anus from leaking out at rest. They are one of the few mechanisms that work for this purpose. With the filling of blood vessels in them, they inflate like a pillow, expanding into the intestine from 3 points and closing the exit. Internal hemorrhoid tissues are normally attached to the intestinal wall by suspending ligaments and are not visible from the outside. As a result of the stretching of these ligaments with the forces applied from the outside, the internal hemorrhoids hang outwards and become visible from the outside from time to time, and they cause bleeding as a result of the irritation of the surface on them. Externally applied forces:

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  1. The repulsive effect of stool on straining (Constipation)

  2. Prolonged gravitational effect (Occupations that require prolonged standing)

  3. prolonged cough

  4. It can be listed as external pressure on the vein system in the abdomen (Pregnancy).

 

External hemorrhoids can also enlarge by the same mechanisms as internal hemorrhoids, but they do not require treatment as much as the disease caused by internal hemorrhoids.

Treatment planning is made according to the grading of the disease. According to the patient's examination findings, hemorrhoid disease is staged from one to four (Picture 1). While drug treatment is at the forefront in the first two stages, surgical  treatment comes to the fore in the third and fourth stages. In drug treatment, drugs that reduce the pressure in the vessels inside the hemorrhoid tissue are used, as well as stool softener drugs are recommended to reduce the edema developed in the tissue and to prevent new irritations during defecation. There are multiple options for surgical treatment:

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  1. Removal of hemorrhoid tissue (Hemorrhoidectomy):The damaged hemorrhoid tissue cannot function as before, so the diseased hemorrhoid tissue is removed. Although it seems like a method that solves the problem from the root, some problems may occur due to their deficiencies, since the hemoroid tissues are not completely inoperable tissues. 

  2. Ligation/strangulation of hemorrhoids (THD/Band ligation):The veins that provide blood flow to the hemorrhoid tissues are fixed and tied with special devices, and with this method, the enlarged hemorrhoid tissues are reduced (THD). In addition, it is aimed to suffocate and shrink the enlarged hemorrhoid tissue by placing a rubber band on the roots of the hemorrhoid tissues and tightening it (band ligation).

  3. Re-suspension of hemorrhoidal tissues (Hemoridopexy):As mentioned before , hemorrhoids hanging on the intestinal wall hang outward as a result of the stretching of these ligaments. With various methods, hemorrhoids are re-suspended on the intestinal wall. For this, special staples (Longo) or laser (Laser hemorrhoidopexy) can be used.

 

In the surgical treatment of hemorrhoids, patients often stay in the hospital for one night and can go home the day after the surgery.

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