Hemorrhoidal disease

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Christian Toso
Professor
Christian Toso
Head of Division

The hemorrhoids are networks of small arterio-venous vessels (plexus) located at the upper level of the anal canal, for internal hemorrhoids, and at the anus, for external hemorrhoids.

Hemorrhoidal disease refers to disorders related to venous engorgement of the hemorrhoids, such as bleeding, itching (pruritus), soiling of underwear or hemorrhoidal thrombosis , which is very painful.

Internal hemorrhoids can stay in the anal canal or descend in the anus and be visible from the outside. The diagnosis is made by clinical examination and anoscopy .

Treatment depends on the stage of the hemorrhoids

Treatment depends on the stage of the disease. Symptomatic hemorrhoids but remaining in the anal canal are treated conservatively. This includes, adopting a diet rich in fiber to avoid constipation, laxatives and/or veino-tonic drugs .

If there is no improvement, or if the hemorrhoids come out of the anus, treatment aims to stop the blood supply to the hemorrhoids (sclerosis, coagulation or rubber band ligation methods). 

For more advanced cases, the treatment of choice is surgery. There are two techniques: hemorrhoidopexy , which involves moving the internal hemorrhoids up into the anal canal by shortening the underlying mucosa, and hemorrhoidectomy, which is a complete removal of hemorrhoids. 

Hemorrhoidal thrombosis of the internal hemorrhoids is best treated with painkillers and laxatives, before the hemorrhoids are surgically removed. Thrombosis of the external hemorrhoids is treated with surgical incision and thrombectomy .

Hemorrhoidal thrombosis
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Formation of a clot in the hemorrhoids
Anoscopy
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Direct visual examination of the anal canal using an anoscope (rigid tube allowing to look into the anus)
Hemorrhoidal thrombosis
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Formation of a clot in the hemorrhoids
Thrombectomy
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Excision of hemorrhoidal thrombosis
Last update : 04/01/2022