These are three spongy pads positioned inside the anal canal, also known as anal cushions. They are vascular in nature. They swell and fit together depending upon the physiological needs, thereby maintaining the continence mechanism. They sometimes swell or dilate and when you pass hard stools, they get injured and cause bleeding. These are commonly known as bleeding internal piles. This bleeding is usually painless.
They cause another problem when they swell and come out of the anal canal. They are known as prolapsed piles. Initially, they return to the anal canal spontaneously but in later stages, they need to be pushed by hand into the anal canal. In the last stage, they become irreducible and can’t be pushed back into the anal canal.
When they are associated with the prolapse of the rectal mucosa along with the increased anal tone, they often get thrombosed due to congestion and cause severe pain. These episodes, generally recurrent, and defined as “acute hemorrhoidal crisis” or “hemorrhoidal strangulation”, are very painful and disabling.
During these crises, hemorrhoids do not re-enter the anus until the thrombosis and edema heal in about a week.
This is often accompanied by constipation and the formation of the anal fissure. An anal fissure is a very painful wound in the anus that causes anal burning for many hours after evacuation.
These patients are not able to retain the stools properly and are often suffering from “wet anus”. The mucus that escapes often causes an itchy, annoying, and not easy to cure bacterial dermatitis.
Medical therapies are recommended particularly in thrombosed piles. Almost all bleeding piles will require surgery in the future. Locally, creams containing anesthetic substances can be used for short periods to relieve pain. But oral pain relievers are more effective along with sitz bath and stool softeners.
Sometimes thrombosed piles need evacuation of the hematoma or the collected blood through a small surgery. No medical treatment is needed for non-symptomatic prolapsed piles. Surgery is the only option for prolapsed piles.
What are the indications for surgery?
The most important indication for the intervention is related to the severity of the symptoms, their impact on the quality of life, the age, and the general condition of the patients.
There are effective and painless solutions to the treatment of piles. It is now well known that the prolapse of piles is due to the internal prolapse of the rectum, therefore removing the piles does not cure the cause but only one of the effects of the internal prolapse. The traditional hemorrhoidectomy, which involves only removal of the piles, (Milligan Morgan operation), causes intense post-operative pain that lasts for a few weeks and requires daily medications. The surgery does not cure the internal prolapse of the rectum, it does not cure any associated constipation therefore there is a high possibility of recurrence. Removal of piles causes an inevitable weakening of continence given the physiological role that they play.
Based on the principle that the prolapse of hemorrhoids is caused by an internal prolapse of the rectum, a newer technique has been developed by Professor Antonio Longo to resect the internal prolapse of the rectum through the anal orifice using a tool (PPH), invented by him. Various modifications of this instrument have been developed by different manufacturers.
The instrument can simultaneously resect and sew rectal prolapse. Depending on the extent of the prolapse, one PPH (mucosectomy with a stapler) or two PPH (STARR surgery) can be used.
This operation is practically painless because the residual suture is inside the rectum where there are no nerve fibers that cause pain; the hemorrhoids are repositioned in the anal canal and therefore the anal continence is not compromised; only needs epidural anesthesia and one night of hospitalization; no dressings are required and work resumes in 3-4 days. A very important fact is that the technique also improves obstructed defecation or constipation. There are practically no complications or very few insignificant ones.
Many recommendations are made, but practically none of them are effective. Studies say that hemorrhoidal prolapse is more frequent in countries where nutrition is low in vegetables and fruit and where life is more hectic and stressful. Diet low in water content and fibres can cause hard stools that require effort to evacuate. Stress increases the closing tone of the anal sphincters and therefore the effort to evacuate. Both these factors cause internal prolapse of the rectum and subsequently of hemorrhoids.
Are there people who are predisposed to have piles?
The most predisposed people are those who have a sedentary lifestyle or are stressed for work or family reasons or those who sit and strain for long hours on the toilet seat.
Hemorrhoids, commonly known as piles, are swollen veins in the lower rectum or anus. They can cause discomfort, itching, pain, and sometimes bleeding. While lifestyle changes and conservative treatments can manage symptoms, severe cases often require surgical intervention. One of the most advanced and effective treatments available today is laser haemorrhoidectomy. This minimally invasive procedure offers numerous benefits over traditional surgery, making it an attractive option for patients seeking relief from hemorrhoids.
Laser haemorrhoidectomy uses a laser beam to remove or reduce hemorrhoids. The laser energy targets the hemorrhoidal tissue, causing it to shrink and eventually fall off. This method can treat both internal and external hemorrhoids with precision and minimal damage to surrounding tissues.
The procedure involves using a specialized laser device that emits a focused beam of light. The water in the hemorrhoidal tissue, causing it to vaporize, absorbs this laser energy. The heat generated by the laser seals the blood vessels, reducing bleeding and promoting faster healing.
You will be given local or general anesthesia to ensure comfort during the procedure. The type of anesthesia used depends on the severity of the hemorrhoids and the patient's overall health. The surgeon directs the laser beam at the hemorrhoidal tissue. The laser energy precisely targets the affected area, minimizing damage to the surrounding healthy tissue and reducing the risk of complications. The laser seals the blood vessels and nerve endings, which significantly reduces bleeding and postoperative pain. The treated hemorrhoidal tissue shrinks and eventually falls off, leaving behind healthy tissue. You will typically recover faster and can return to your normal activities sooner than those who undergo conventional surgery. Laser haemorrhoidectomy is often performed on an outpatient basis, allowing patients to go home the same day.
While laser haemorrhoidectomy is suitable for many patients, it may not be the best option for everyone. Ideal candidates include:
As with any medical procedure, laser haemorrhoidectomy carries some risks and potential complications, although they are generally rare and less severe than those associated with traditional surgery. Possible risks include:
After a laser haemorrhoidectomy, patients can expect a relatively smooth recovery process. You will be advised to take pain relievers to help manage any discomfort. It's crucial to avoid aspirin or other blood-thinning medications unless advised by your surgeon. You should be eating a high-fiber diet with plenty of fluids to prevent constipation. High fibre laxatives may also be given to prevent constipation. Keeping the anal area clean and dry is vital to prevent infection. Warm sitz baths can provide relief and promote healing. You should avoid indulging in strenuous activities and heavy lifting for a few weeks after the procedure. Gentle walking and light activities are encouraged to promote circulation. Regular follow-up with your surgeon is important to ensure proper healing and address any concerns that may arise.
Laser haemorrhoidectomy is a cutting-edge treatment option to treat hemorrhoids offering numerous benefits over traditional surgical methods. Its minimally invasive nature, reduced pain, and quick recovery time makes it an appealing choice for patients suffering from this common condition. If you are experiencing hemorrhoid symptoms and considering treatment options, consult with a healthcare professional to determine if laser haemorrhoidectomy is the right solution for you.
It was performed for the first time in 1993 by Professor Antonio Longo from Italy.
The principle of the surgery is simple. Since the prolapse of hemorrhoids is a consequence of the internal prolapse of the rectum, with the stapler, the prolapse is removed and at the same time, the mucosa is rejoined with titanium micro clips.
Therefore, no incision is made in the anus which regains normal anatomy and normal physiological functions.
What are the benefits of this procedure?
The operation is virtually painless if well performed and no complications arise. 80% of patients do not need any analgesic therapy. Besides, patients do not need any postoperative medication and normally resume their normal activities after 3 days. Is it indicated in all grades and types of hemorrhoids?
All hemorrhoids that need surgical therapy can be treated with this technique.
