What are the advances in hemorrhoids treatment?
Due to this reputation of being a painful operation, advances in hemorrhoid surgery 
have focused on making it less painful.
One such operation is stapled 
hemorrhoidectomy. Using a specially-designed, single-use stapler instrument (which 
was modified from the staplers used to reconnect intestines during major abdominal 
surgery), the hemorrhoids are excised and the anus repaired from the inside, 
something which is difficult to do with traditional surgery.
The end result is that 
the surgical wound is inside, and no wound is visible outside the anus. Scientific 
studies have proven that this is less painful than traditional surgery, although with 
a small recurrence rate.

Another advanced surgical technique is Transanal Hemorrhoidal Dearterialization 
(THD).
Using a doppler ultrasound, the blood vessel supplying the hemorrhoid is 
identified and ligated with stitches.
Deprived of its blood supply, the hemorrhoid 
then shrinks and shrivels.
 Again there is no wound outside and is therefore almost 
painless.
However, because it is a new technique, not very many studies evaluating 
its long-term effectiveness have come out.
 All surgical procedures for hemorrhoids, whether traditional or innovative, may 
sometimes develop complications such as bleeding, infection and stricture. It is 
important therefore when seeking treatment, to see an expert in anal diseases.
The term hemorrhoids are associated with the symptoms when this part of the body 
becomes enlarged, inflamed, thrombosed or prolapsed.
 
Many people have them without suffering from any symptoms, and therefore these may be 
safely left alone. Treatment is usually required for those whose hemorrhoidal 
symptoms such as excruciating throbbing pain affect quality of life and daily living. 
There are many traditional remedies and non-surgical treatments for hemorrhoids. 
However, if none of these work, surgical procedures may be required as a last resort.
 How do hemorrhoids look and feel?
Hemorrhoidal cushions are skin, vascular and soft tissues that line the anal canal, 
playing a small role in defecation and continence.
Everyone has them, although with 
our daily travails of straining and movement, they do change over time, becoming more 
lax or loose as we age. 
Hemorrhoidal disease occurs when these changes result in bothersome symptoms such as 
bleeding, prolapsed, or pain.
Almost everyone may develop symptoms at some point in 
their life, but these are not life-threatening, and may be safely observed. Treatment 
is usually required for those whose hemorrhoidal symptoms impact on quality of life 
and daily living.
 
What are the symptoms of hemorrhoids? 

Bleeding from hemorrhoids is usually bright red, often dripping into the toilet bowl, 
or noticed when wiping. The stools themselves are normal looking, indicating that the 
bleeding is originating only from the anorectal area.
Sludge of dark blood and stool 
mixed thoroughly together is usually from a source within the small and large 
intestines and not hemorrhoids. Hemorrhoidal bleeding is painless, and this 
differentiates it from anal fissures, which is also a very common anal condition that 
presents with similar bright red bleeding during defecation, but with anal pain.
Hemorrhoids only become painful when they thrombosed or incarcerated.
Thrombosed 
hemorrhoids occur when blood clots within the hemorrhoids, causing very obvious 
swelling and pain.
While surgery for this may be effective during the first 4 days 
of the attack, if left alone the swelling and pain gradually subside and disappear 
after 2 weeks.
Usually this occurs just once or twice in a person’s lifetime, and it 
is uncommon to have repeated episodes of thrombosis. 
Doctors often classify patients as to having either external or internal hemorrhoids.

External hemorrhoids are located just outside the anus, and hence are always visible 
on routine inspection.
Many people have them without suffering from any symptoms, 
and therefore these may be safely left alone.
Sometimes external hemorrhoids may 
make cleaning difficult, allowing sweat and anal discharge to hide between folds, 
resulting in anal itching.
Internal hemorrhoids arise from inside the anus and are therefore only visible when, 
because of excessive laxity, they protrude outside.
This condition is called 
prolapsed, and usually occurs during defecation.
When internal hemorrhoids prolapsed 
they may either slip back inside on their own, or require manipulation by the person 
for it goes back in.
When the prolapsed hemorrhoids cannot be returned, they become 
trapped outside, resulting in pain and swelling.
This scenario is called 
incarcerated hemorrhoids.
 
What are the forms of treatment for hemorrhoids– surgical and non-surgical?
Hemorrhoids only require treatment when there are symptoms.
And the type of 
treatment depends on the severity of symptoms.
Mild symptoms may be managed just by 
eating a lot of fiber and taking in bulk laxatives such as psyllium to improve the 
consistency of stools and ease bowel movement.
Some over-the-counter creams may 
provide symptomatic relief.

Non-surgical and almost painless treatments for hemorrhoids include injection 
sclerotherapy, infrared photocoagulation (often mislabeled as “laser treatment”), and 
rubber band ligation, any of which can be done safely in the clinic as an out-patient 
procedure.
In scientific studies comparing these methods, rubber band ligation was 
found to be the most effective and cheap, which is why it is the most common non-
surgical procedure for hemorrhoids in the world today.
Non-surgical treatment is often ineffective for large, incarcerated or thrombosed 
hemorrhoids.
Surgery is usually recommended in these situations, and also when non-
surgical treatment has failed to relieve symptoms.
Traditional surgery requires 
cutting out the hemorrhoid using a variety of instruments such as scissors, knives, 
cautery, and ultrasonic dissectors. Unfortunately, any wound created in the outer 
skin of the anus results in often Sever post-operative pain, which is responsible for 
the reputation of hemorrhoid surgery being one of the most painful of operations.

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