Hemorrhoids are swollen veins in the anal canal that trigger pain when passing stool. This is either internal or external depending on the site.
Internal haemorrhoids are the swollen vessels inside the rectum. They are not painful at all and you can’t really feel them since they lie far inside the rectum where there is only a few of the pain-sensing nerves. Bleeding is the only sign that can make you aware of them. Internal prolapsed or haemorrhoids can sometimes protrude outside the anal sphincters. If you see them, they appear to be pink pads of skin that are moist. If the haemorrhoids are prolapsed, it will be painful since the anus has a lot of pain-sensing nerve endings. They tend to go back inside after sometime but if it does not, you can push it back in its place.
External Hemorrhoids are painful and they are located in the anus. If the haemorrhoid prolapses, you will be able to feel and see it during defecation. Blood clots, on the other hand, may happen or may form in the prolapsed external haemorrhoids causing extreme pain. This is often referred to as Thrombosis. This condition may cause the haemorrhoids to bleed and turn blue or purple. They are usually not serious. However, they are rather very painful. This will resolve on its own in weeks but if the pain really bothers you, you can let medical professionals excise it.
Haemorrhoids are created by extreme pressure that is caused by pregnancy, obesity, coughing, straining during bowel movements, sneezing, sitting or standing for long hours, vomiting, and holding your breath while doing physical work. People who eat high fibrous foods tend to have no haemorrhoidal problems while those who eat high processed foods, low fiber foods and have inadequate fluid intake have more chances of suffering constipation that may lead to straining. Straining leads to pressure and constipation produces hard stools; thus, making the haemorrhoids irritated.
Transanal Hemorrhoidal Dearterialization is the surgical procedure of removing internal haemorrhoids. It is done with the use of the special Anoscope paired with the Doppler transducer to see the hemorrhoidal arteries 2-3 centimeters above the so called pectinate line. When the superior rectal arteries are seen with the Doppler, to decrease the blood flow to the hemorrhoidal plexus, a suture ligation is done. If there is repeated prolapse, the prolapsed membrane is sutured and lifted while repositioning the hemorrhoidal cushions.
Hemorrhoidectomy and Transanal Hemorrhoidal Dearterialization are different from each other. Hemorrhoidectomy is the excision of haemorrhoid bundles while in Transanal Hemorrhoidal Dearterialization, there is no tissue that needs to be extracted. In this procedure, the suture line is above the pectinate line; thus, making the pain during post-operation minimal. This method can be done with the use of general anesthesia, local anesthesia and conscious sedation. There has been low complication rates and post-operative pains associated with this procedure.
However, the reported complications that are arising are bleeding, thrombosis, hematoma and urinary retention to name a few. In anal fissure, there is still uncertainty with the efficacy of this treatment since there is little to almost no hard evidence on this topic.
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