Hemorrhoids (Piles) (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
In this Article
- Definition of hemorrhoid
- What causes hemorrhoids?
- What are the signs and symptoms of a hemorrhoid?
- What does a hemorrhoid look like?
- How is the diagnosis of hemorrhoids made?
- How are hemorrhoids treated?
- OTC medications and home remedies for hemorrhoids
- Non-surgical approaches
- Hemorrhoid surgery
- What is the prognosis for hemorrhoids?
- Pictures of Hemorrhoids - Slideshow
- Take the Hemorrhoids Quiz!
- Pictures of Inflammatory Bowel Disease (IBD) - Slideshow
- Hemorrhoids (Piles) FAQs
- Find a local Gastroenterologist in your town
Grade 2 and 3 hemorrhoids are initially treated the same way, using techniques to destroy the hemorrhoid. These include injecting the hemorrhoid vein to make it sclerose or harden, using rubber bands to choke off the blood supply and make the hemorrhoidal tissue shrivel, or other procedures that cause the mucosa to shrivel and die.
Patients who have failed conservative therapy or who have grade 4 hemorrhoids are candidates for surgery to remove the swollen hemorrhoids and the larger external hemorrhoid skin tags. Options include hemorrhoid removal with laser surgery or hemorrhoidectomy (ectomy=removal) using a scalpel. Another alternative is stapled hemorrhoidectomy, where a special staple gun is positioned to remove the hemorrhoid and surround the tissue with a ring of staples to close the area as well as controlling the bleeding.
A thrombosed external hemorrhoid indicates that a clot has formed in the hemorrhoid causing significant pain. Treatment involves cutting into the hemorrhoid to remove the clot and reduce the swelling.
What is the prognosis for hemorrhoids?
Hemorrhoids are normal tissue and only raise concern when they swell, become inflamed or bleed. Hemorrhoids will recur after non-surgical treatment about 50% of the time, while the recurrence rate after surgery is only 5%.
The goal is to control hemorrhoid inflammation by diet and hydration so that surgery is not required. In this respect, hemorrhoids are a life-long condition, to be controlled and not cured.
REFERENCE: Tintinalli JE, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th edition McGraw hill Professional. 2010
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