How to treat haemorrhoids
Haemorrhoid treatments can be divided into three broad categories:
- preventive and conservative therapies
- outpatient treatments
- surgical treatments
The choice of the most suitable treatment depends on the symptoms and on the stage of the disease.
Prevention and conservative therapies
Diet and lifestyle
In the initial stages of the disease or in order to prevent it, simple changes in lifestyle and hygiene-food habits can give good results.
Here are some useful tips to alleviate haemorrhoid symptoms in milder cases or to prevent their onset:
- regularise bowel function to reduce stress during defecation. For this purpose, it is important to take dietary fibre contained in fruit, vegetables, legumes and cereals or specific supplements and an adequate intake of fluids during the day (at least 1.5 litres).
- Carry-out physical activity to help the bowel function properly and prevent constipation.
- take care of intimate hygiene with dedicated products to reduce the risk of local infections and inflammations.
In the presence of mild symptoms, formulations for topical use can help alleviate the discomforts associated with haemorrhoids.
There are many topical formulations to reduce the symptoms of haemorrhoidal disease including:
- ointments and emollient and soothing creams.
- topical pharmaceutical formulations containing anaesthetics to relieve pain. The use of these formulations is usually indicated for short periods of time as it can cause local irritation.
- topical pharmaceutical formulations containing cortisone, to reduce inflammation, burning and local itching. These formulations should only be used for short periods too.
The intake of bioflavonoid-based supplements helps to improve the venous microcirculation and promotes the reduction of local swelling and inflammation.
Haemorrhoids outpatient treatments
Outpatient treatments are used in the early stages of the disease in the case of internal haemorrhoids and of more obvious symptoms.
These treatments act directly on the tissues of the haemorrhoids reducing the excess of tissue by means of different mechanisms. However, they are often non definitive treatments and require additional subsequent operations. The most common day hospital procedures are:
- Rubber band ligation:
it is one of the most used outpatient procedures. This technique involves the ligation of the base of the haemorrhoidal cushion with a small rubber band. The cushion no longer receives blood and necrotises, falling off after a few days, and the tissue at the base of the haemorrhoids heals. Possible complications include a slight malaise in the treated area which tends to resolve spontaneously, pain immediately after ligation in case of incorrect positioning of the rubber band, bleeding and haemorrhoidal thrombosis.
- Injection sclerotherapy:
it utilizes the injection of a chemical substance at the base of the haemorrhoids. The injected substance hardens the tissues reducing the volume of the haemorrhoidal cushions. Complications can include malaise in the anorectal area and mild bleeding in the days following the treatment.
much less used than rubber band ligation and sclerotherapy. Cryotherapy involves the use of very low temperatures to destroy the congested tissue and promote the reduction of the haemorrhoidal cushions. Possible complications are oedema, bleeding and infections after treatment.
There are also other less-used outpatient procedures which use different technologies, but they all share similar complications and a high recurrence rate:
- Infrared photocoagulation:
it utilizes infrared rays to trigger a coagulation process and to reduce excessive blood supply to the haemorrhoids. The haemorrhoidal cushion is necrotised and a scar forms at its base. Possible complications include severe pain and bleeding. There are also few clinical studies available on treatment efficacy and short-term follow-up.
- Laser photocoagulation:
It utilizes laser beams to interrupt the excessive blood supply to the haemorrhoids and a Doppler probe to accurately identify the haemorrhoidal arteries. As with infrared coagulation, the possible complications are pain and bleeding. Clinical evidence on treatment efficacy is limited and with short follow-ups.
- Radiofrequency coagulation:
It utilizes high frequency waves to interrupt the flow of blood to the cushions and reduce their size. Possible complications are similar to those of laser and infrared photocoagulation. There are few clinical studies available on the efficacy of the technique.
it consists in causing the thrombosis of the vessels that carry blood to the haemorrhoidal cushions in order to reduce their volume. This treatment can be very painful and cause abundant bleeding.
When to operate haemorrhoids: surgical treatments
In the advanced stages of the disease, in the presence of symptoms such as severe bleeding and prolapse, day hospital procedures do not allow to treat the disease effectively. For this reason, in the III and IV grades of the disease, the specialist will probably direct the patient towards surgical treatment.
Haemorrhoidectomy: Milligan-Morgan and Ferguson
Traditional surgery, called haemorrhoidectomy, consists in removing internal and external haemorrhoids. The most commonly used traditional surgical techniques are the Milligan-Morgan and the Ferguson techniques.
With the Milligan-Morgan technique, the wounds resulting from the removal of the haemorrhoidal cushions are left open so that they heal spontaneously. While in the Ferguson method the wounds are closed with a running suture.
If well performed, these methods are normally effective and decisive. Complications are rare, but can be severe and include faecal incontinence, severe bleeding and anal stenosis.
Furthermore, haemorrhoidectomy, in particular that performed with the Milligan-Morgan technique, causes severe discomfort during the post-operative period and this leads many patients to forego surgery. This complication is due to the presence of wounds which stretch and become irritated when the stool passes, causing intense and excruciating pain.
Stapled haemorrhoidopexy was one of the first surgical methods designed to solve the problem of prolapse without removing the haemorrhoidal cushions.
This technique involves the use of a circular stapler to cut a portion of the rectal mucosa and to reposition the haemorrhoids in their original position.
Although the haemorrhoidal cushions are not removed, this technique can lead to complications, even very serious ones, in a significant percentage of cases. The most frequent complications are post-operative haemorrhage, defecatory urgency, strong and persistent rectal-anal pain and in some cases perforation of the rectum.
THD® Doppler Method: minimally invasive surgery for haemorrhoids
The THD® Doppler method is one of the least invasive surgical techniques for the treatment of haemorrhoidal disease.
In fact, this method does not involve the removal of tissues, but only the application of internal absorbable stitches in areas with low sensitivity to pain. The stitches allow to reduce the excessive flow of blood to the haemorrhoidal cushions and to reposition them in their natural seat.
The method utilizes a specific proctoscope equipped with a special Doppler probe. Thanks to the Doppler probe, the surgeon locates the terminal branches of the arteries which carry blood to the cushions and closes them through ligation. In case of a prolapse, the surgeon performs a pexy, i.e. the lifting of the tissue to the original position. For this reason, the THD® Doppler method is also known as Doppler-guided haemorrhoidal dearterialisation with mucopexy.
For further information on the features and advantages of the THD® Doppler Method click here.