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Cartersville Surgical Associates, PC
970 Joe Frank Harris Parkway
Cartersville, GA 30120
Phone: 770.386.1261
Fax: 770.386.3873
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Hemorrhoids are one of the most common anorectal disorders affecting Americans. Almost half of the population will be affected by hemorroids at some point in their life. Hemorrhoids are the result of increases in venous pressure which result in dilation and swelling of the veins around the lower rectum and anus. Contributing factors include chronic constipation, pregnancy, aging, diarrhea, and spending long periods of time on the toilet. (e.g. reading)
Hemorrhoids are classified as internal and external. Internal hemorrhoids arise from the veins of the anal canal and lower rectum and are classified by grades I-IV:
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| Grade I: |
The hemorrhoidal swelling occurs in the anal canal and there is no prolapse of the hemorrhoids outside of the anal canal.
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| Grade II: |
The hemorrhoidal swelling occurs in the anal canal and the hemorrhoids prolapse when bowel movements occur, but spontaneously return to the anal canal after cessation of straining.
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| Grade III: |
The hemorrhoidal tissue prolapses with straining and requires manual reduction to return the hemorrhoidal tissue to the anal canal.
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| Grade IV: |
The hemorrhoidal tissue prolapses and the hemorrhoids cannot be pushed bach into the anal canal.
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External hemorrhoids develop near the anus and are covered by skin. If a blood clot develops in the hemorrhoidal tissue, a thrombosed external hemorrhoid occurs. This can be very painful. External hemorrhoids do not bleed unless they rupture.
The symptoms of hemorrhoids includes bleeding during bowel movements, protrusion during bowel movements, perianal itching, pain, and swelling. Symptomatic relief can be obtained by facilitating softer, more regular stools by staying adequately hydrated by drinking water and by taking stool softeners. Warm baths, (sitz baths) will provide symptomatic relief from the pressure and pain associated with severe hemorrhoidal flare ups. There are a number of over the counter hemorrhoidal preparations available, and if these do not provide relief, there are also prescription medications, most of which contain a topical steroid, to provide symptomatic relief. Patients with a tendency to hemorrhoidal flare-ups should also maintain a high fiber diet.
Most hemorrhoidal flare ups will subside within 2 to 7 days with these conservative measures. Severe thrombosed external hemorrhoids my be opened in the office setting to provide rather prompt relief of pain. The improvement is most pronounced if the drainage of the thrombosed hemorrhoid is done in the first couple of days of pain.
Internal hemorrhoids can be treated with conservative medical measures as noted above, or may be treated surgically. Surgical treatment options include banding, injection, operative excision of the hemorrhoid, and most recently endorectal stapling of hemorrhoids, known as PPH (procedure for prolapsed hemorrhoids). The PPH procedure is associated with less discomfort than traditional excisional surgery for hemorrhoids, and can be performed on an outpatient basis. With the PPH procedure most patients can return to work in 2-3 days.
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