The most common symptoms of internal hemorrhoids are bleeding, prolapse and pain. The bleeding is associated with the evacuation, not mixed with feces. Hemorrhoidal prolapse is the output of the hemorrhoid at the time of evacuation. The pain is a symptom less common in internal hemorrhoid, and generally is associated with thrombosis and gangrene.
The external hemorrhoids present as main symptoms pain and bulging, especially when associated with thrombosis. This indentation is characterized by bluish or reddish nodules, and painful to touch. Depending on the size of external thrombosis, it can be treated medically or with excision (resection) site.
Treatment
Medical Treatment
This clinical treatment is aimed at the temporary relief of symptoms, consisting of local care and guidance to the diet. Should always remember that the treatment should be prescribed by a physician after evaluation of each individual case. Locally, the patient should perform anal hygiene with water only, without the use of toilet paper, sitz baths with warm water so that there is an effect of anti-inflammatory, and ointments used analgesic and anesthetic. In cases with strong anal pain, analgesics orally can also be used. The diet should be rich in fiber, so that the feces become more viscous, reducing the effort to escape, reducing the trauma of the anal region.
Outpatient treatment
Treatment by ligation.
The outpatient treatment is the resolution of the hemorrhoid in the office physician. Such treatment brings the advantages of convenience of not requiring hospitalization, the speed with which these procedures are performed, success, and absence of postoperative pain.
There are various forms of outpatient treatment for internal hemorrhoids: ligation, sclerotherapy (injection of sclerosing substance), cryotherapy (freezing the hemorrhoid), infrared coagulation.
Rubber band ligation is an outpatient procedure most widely accepted in the medical literature for the treatment of bleeding and hemorrhoidal prolapse (grades I, II and III), besides being more effective and have fewer complications than the other methods cited outpatients. Band ligation is the application of an elastic region of the hemorrhoid, thereby causing the necrosis and fixation of the nipple. The results with ligation are so positive that there is a reduction of 80% of the indications for surgery, ie the ten patients, eight will benefit from the ligation. According to medical literature, the rate of patient satisfaction with the ligation is 90%, and the chance of cure in a single application is 60 to 70%. The method is widely accepted that to avoid the surgery to be curative not require anesthesia and be efficient.
Surgical treatment
Surgical treatment is performed in the operating room, and the procedure is performed under anesthesia. It consists of resection of the hemorrhoid, and is indicated in the Grade IV internal hemorrhoids, where the internal hemorrhoids are associated with external, in cases that develop hemorrhoidal thrombosis (due to severe pain) and when outpatient procedures were not effective. The surgery can be performed in two ways, the conventional technique or the technique with a mechanical stapler.
In the conventional technique, the hemorrhoid is excised and the vessels that caused the bleeding stitched (connected). In the technique with a mechanical stapler, the hemorrhoid is attached to the anal canal (hemorroidopexia), but no resection of the nipple. The conventional technique has the advantages can be applied to any type of hemorrhoid and be the most effective method in treating the disease. However has the disadvantage of pain in the postoperative period. The technique with mechanical stapler main advantage cause little pain in the postoperative period, and the disadvantage of being restricted to a few selected cases.
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