The treatment of hemorrhoids according to Western medicine

Hemorrhoids are a very common disease, accounting for the highest percentage of patients examined at the clinic anal - rectal, and tend growing up is being evaluated as a medical social nature . hemorrhoid disease does not affect the survival of diseases that are offensive, negative impact on the quality of life of patients.

In fact, "hemorrhoid" is "buffer system" of the anus, composed of tufts hemorrhoids veins that normally everyone, like a plate "mattress" help anus is closed, can not "leak" vapor, liquid or stool. Scientifically speaking, the "mattress" This helps control the autonomy of flatus or bowel. Therefore, hemorrhoids is a normal physiological structure. only when the bundle of swollen veins, to the extent possible protruding out really anal when pushing patient and / or cause other symptoms such as pain, bleeding, ... then called "hemorrhoids" .

The main goal of treating hemorrhoids is to minimize the annoying symptoms and improve quality of life for patients. A large number of patients with a good outcome after treatment, but still a small number of cases where the balance of evidence, as well as complications after treatment. Therefore, the selection of the optimal treatment method is still much debated.

Classification and grading of hemorrhoids:

 

Internal hemorrhoids are hemorrhoids bun bun comes from the veins hemorrhoids on lies inside the anus, above the comb, the excessive swelling will fall out. Depending on the severity of the bundle of internal hemorrhoids laid out that it is divided into 4 levels. - The first is the bun hemorrhoids swollen than usual but still located inside the anal canal, even when the patient is pushing hard, can cause bleeding when going to the toilet.
- Grade 2 hemorrhoids tufts size greater than 1, may be "hanging out" in the anus as strong push patients (visible) but is fully in patients with anal canal when to stop pushing.
- The third is the bun hemorrhoids bulge out completely anal patients or squat toilet, hard work, ... patients must manually pushed into the anal tufts hemorrhoids after a bowel movement.
- Level 4 is the most severe, almost regular bun hemorrhoids lie outside the anal canal, can not be taught to lie completely inside the anus.

External hemorrhoids from the venous plexus under the skin around the anus. External hemorrhoids is half in and half out the anal canal, covered a large part leather and part anal anal canal mucosa.

The harmful effects of hemorrhoids: The following condition but not dangerous to life, but also significantly affected the lives and activities of the disease: - Causing bleeding mild to severe blood stool or shoot a ray, streaming, ...
- Causing feeling of discomfort in the anal tuft by prolapsed out, can affect daily life of patients and employees.

- Can cause complications such as thrombosis causes, thrombosis, necrosis surface tufts hemorrhoids, ulcers, abscess of the anal ... As mentioned above, hemorrhoids which is just so annoying disease patients often subjective in the examination and treatment. In Vietnam, the diagnosis and treatment have not been paid adequate attention. Doctors and hospitals often cursory examination and easily overlooked untreated where to choose for patients, especially at the grassroots level.

On the other hand, due to psychological problems and patients often subtle so little talk about the disease that often sought to quietly seek treatment or not professional physicians, the "quack" treatment caused many variables aggravation of symptoms such as rectal stricture, disfiguring anal sphincter loss, ...

The issue of treatment with the current understanding of the pathogenesis of hemorrhoids, anal the school has recognized the venous plexus hemorrhoids are normal physiological state, creating cushioning in the anal canal, which helps control the self control of defecation. From this discovery, a new concept in the treatment of hemorrhoids is trying to preserve the buffer layer, so there have been many changes in treatment. There are many hemorrhoid treatment has traditionally been known, both medicine and western medicine. Currently, the school uniform anal divide the treatment of hemorrhoids in 3 main groups: medical treatment (conservative treatment), treatment of surgical and surgical treatment, depending on the application or the severity of the disease .. However, for those who unfortunately have to hemorrhoids and medical examination, what their biggest concerns is often "This disease can not be surgery, doctor?"

Conserving therapy (also known as non-invasive treatment - Non-Invasive therapy, conservative therapy): this is the first choice in the treatment of hemorrhoids, including diet, medications direction vein, located in medicine place and mode of living. Many studies (graded A in the classification of evidence Medicine), proved a diet high in fiber (vegetables and fruits) may prevent constipation and reduce the symptoms hemorrhoids.

- The oral drug user intravenous (Daflon, Ginkgo Forte, ...) can reduce the symptoms of hemorrhoids (classified according Medicine B evidence). These drugs are usually the first choice in the treatment of hemorrhoids. - Drugs and pharmaceuticals is usually topical cream is combined with oral medications. No work has demonstrated effectiveness are recognized evidence-based medicine.
- Treatment of constipation: When treatment, the physician usually pay attention to the treatment of disorders such as diarrhea, intestinal circulation and constipation. The recommended when using medications constipation is so massive drug distribution (bulking agents) and avoid the use of laxatives (laxative) and enema (purgative), because of the increased symptoms of hemorrhoids.

Do not forget to advise patients to increase water intake, reduce the stimulant drinks more like strong tea, coffee, alcohol, food ... avoid too sweet like chocolate, jam because of constipation, oral drugs have effects constipating side as non-steroid anti-inflammatory, sedative, ... As mentioned above, this does not cure hemorrhoids bun when it developed that can only prevention is key and in some cases reduced the symptoms of hemorrhoids.

Treatment with tips: With the understanding of the pathophysiology and treatment of tricks increasingly expanded with the main objective is fixed bundle of hemorrhoids in the anal canal to preserve the anal cushions. In Conference anorectal 9th ​​Asia held in Seoul, author Stanley M. Goldberg concluded in a review of the treatment of hemorrhoids: "Treatment is surgical treatment of hemorrhoids future "

There are three methods of treatment tips are worth further research has been recognized evidence-based medicine is injected drugs fiber tufts hemorrhoids, hemorrhoids bun tied with rubber band and infrared photocoagulation.

General principles of treatment is to create scar tissue muscles involved in the submucosal layer, effective hemostasis and reduced blood flow to the hemorrhoids bun, bun which gradually shrink hemorrhoids. The contraindications are internal hemorrhoids and external hemorrhoids embolism, with anal fissure, anal and empyema in patients with impaired-aged care. • Tie the bundle of hemorrhoids with rubber ring: is very good treatment for internal hemorrhoids tufts format for fast, painless (if done right technique), low cost and do not take a long time employee of the disease. These complications include severe pain tighten belts due to incorrect placement (to remove it immediately), anal fissure, and the most severe pelvic infection can result in an infection of the blood.
• Guangdong Infrared transmitter uses infrared rays to treat. The advantage is not painful, but hemostasis good buy very high cost and need to make more time to get good results.
• Inject causes fibrous tufts hemorrhoids: This method is simple, easy to learn, easy, safe and low cost, is currently being applied at the Institute of Ethnology City School of Medicine. HCM. The rare complications can occur such as pain, bleeding after injection, anal-vaginal fistula, prostatitis caused by accidentally injected, ... therefore, the implementation of this procedure is physician practice experience testing and engineering firm.

The downside of this method is time consuming (depending on the disease to be injected several times heavy or light). Fiber Injection is indicated for the treatment of internal hemorrhoids of 1, 2, and in some cases internal hemorrhoids grade 3 alone.

Surgical Treatment: There are many methods of hemorrhoid surgery has been applied at the local hospital. • Surgical Group canonical representatives of this group hemorrhoids surgical method Milligan Morgan. The advantage of this method is the high cure rate but since surgery below the anal comb is where many sensory nerves should have disadvantages are postoperative pain, recovery time is long, sometimes from 4 - 6 weeks. In addition, there are some other complication that may occur is a little leak, and distribution services, anal stenosis.
• Surgical Group nascent 1990: representing the surgical method Longo (by the Italian surgeon Antonio Longo is initiated), using sewing machine to cut a folded ring road mucosa anal comb sewing machine and press round.

The principle of operation is preserved anal block buffer, reducing blood flow to the hemorrhoids bun, bun volume shrinking hemorrhoids, while avoiding the complications of the old method.

In this group there are other methods such as hemorrhoids hanging stitch by hand (by the surgeon developed based on the principles of surgery Longo but at a lower price) and stitch column hemorrhoids arteries under the guidance of ultrasound Doppler.

The advantage of the method is Longo patients less pain, faster recovery, may be discharged after a few days and can return to the normal 3-4 days after surgery. The downside is that the cost is very high due to Longo machine imported from abroad and disposable.