Hemorrhoids are one of the most common diseases today. It is thought that as many as 50% of people have a hemorrhoid challenge at least once in their lives. They occur in both sexes, more often with men in their middle age of life.
We need to distinguish the clinical picture of hemorrhoids from the hemorrhoidal pads, which we describe as a structure consisting of: smooth muscles, connective elastic tissue and arterial venous blood vessels (similar to the tissue of the penis). In the case of defecation, the pads are temporarily moved down and after the defecation of the muscle thread from the submucosal they are returned back. They close the rectum with the help of sphincter muscles.
Besides this division in determining the degree of disease, we can also use the division by Banov (1985) into four stages:
STAGE I – Hemorrhoids only protrude into the anal canal, they bleed often but there is no prolapse,
STAGE II – hemorrhoids prolapse outside the anus only during defecation, but then spontaneously return to the anal canal
STAGE III – Hemorrhoids prolapse spontaneously or during defecation outside the anus, but can be manually returned to the anal canal,
STAGE IV – Hemorrhoids are permanently prolapsed outside the anal canal and cannot be manually returned back. They are easily complicated by thrombosis or incarceration.
Treatment is divided into symptomatic treatment (methods that regulate stool and local fats) and invasive techniques and surgical procedures.
Preparations – most often in the form of fats that have mild anesthetic and anti-inflammatory effects,
Proper nutrition – increase the intake of vegetables, fruits and cereals,
Reduce coffee and cigarette consumption – although coffee and cigarettes initially prod digestion, but if consumed in an increased amount they cause cramps and stool restraints,
Increase physical activity – in general, physical activity stimulates digestion.
Injection sclerotherapy – injection of a chemical substance (sclerosing agent) into the area of the hemorrhoids that causes narrowing of the blood vessels,
Hemorrhoid binding with a rubber ring known as Baron’s ligature. Elastic ribbons are placed on internal hemorrhoids, leading to an interruption of blood supply of the same. After few days, the mentioned ones dry out, and then during the normal discharge of the intestine they are removed,
Infrared photocoagulation of hemorrhoids. It is a specially designed device for this procedure. It gives excellent results in treatment of hemorrhoids of first and second stage. This non-surgical treatment is fast, well tolerated and without complications,
Electrotherapy with DC voltage,
Laser hemorrhoid therapy.
Occasionally severe hemorrhoidal disease should be dealt with by a surgical route called hemorrhoidectomy. There are several successful surgical procedures that should be mentioned:
Longo technique for rectum and hemorrhoid prolapse (PPH)
PPH is a technique that has been used since the early 90s. This method reduces the hemorrhoidal tissue prolapse by circular cutting of the anal mucosa using a circular stapler.
Korist PPH u odnosu na druge tehnike
manja bol u odnosu na klasični zahvat
brži povratak svakodnevnim aktivnostima
Risk of PPH technique:
If more muscle tissue is removed, the result may be a weakness in the rectal wall,
Injury of the internal sphincter, which may result in short-term or long-lasting dysfunction,
Very rarely the procedure can get complicated with sepsis,