A. GENERAL INFORMATION Normally, in humans, there are spongy vascular networks in the last part of the large intestine that opens to the outside. Hemorrhoidal disease (Hemorrhoids) occurs with the expansion of these structures, called hemorrhoidal vessels. Hemorrhoidal veins have important functions in the body: Normally, the blood accumulated in these vascular networks ensures complete closure of the anus. Thus, hemorrhoidal veins help to control defecation even if the person does not voluntarily contract the muscles that control the anus. It functions as a protective cushion layer on the muscle ring we call sphincter surrounding the anus. It prevents feces from leaking out by completely closing the anus (anus) during rest and sleep. Hemorrhoidal veins are divided into two as external and internal according to their location. External hemorrhoids are located around the anus and are covered with thin skin. WHAT IS HEMORRHOIDAL DISEASE (HEMOROUS)? Hemorrhoidal disease is when the spongy hemorrhoidal veins in the anus and rectum expand excessively and sometimes protrude from the anus. Hemorrhoidal disease (Hemorrhoids) may occur separately in external and internal hemorrhoids. If clotting (thrombosis) occurs in external hemorrhoids, the patient feels great pain. Internal hemorrhoids, on the other hand, manifest themselves with more bleeding. CAUSES OF HEMORRHOIDAL DISEASE (Hemorrhoids) One of the main causes of the disease is straining. Straining causes blood to fill this area at high pressure. Apart from straining, other factors that increase intra-abdominal pressure can also cause hemorrhoidal disease (Hemorrhoids), for example: Constipation Chronic cough Pregnancy Obesity Heavy lifting Prostate disease B. SYMPTOMS OF HEMORRHOIDAL DISEASE (Hemorrhoids) Bleeding during defecation (defecation) is the most common symptom. It is bright red in color, often fresh in drops. Above the feces and clean Blood may be noticed during bleeding. Protrusion of the anus during defecation (defecation), palpable swelling. The patient complains of a soft swelling or mass protruding from the anus. Some patients can push this protruding swelling back into the anus. Itching in the anal area (anus) When hemorrhoidal veins cannot perform their normal functions, the hygiene of the anal area is deteriorated. When the anus does not close completely, feces and discharge leakage occurs. This causes itching. Pain: Patients cannot fully express these complaints. They may describe it as a feeling of pain, stinging or burning. Especially thrombosis (blood clot formation in the vein) of external hemorrhoids causes severe pain. Swellings that constantly remain outside the anal canal (anus) and are painful to touch may develop as a result of internal hemorrhoids protruding from the anus, or they may occur due to thrombosis of external hemorrhoids. STAGES OF THE DISEASE: Stage 1: Bleeding occurs. Stage 2: In addition to bleeding, internal hemorrhoids (piles) come out after defecation (defecation) and go in on their own after a while. Stage 3: In addition to bleeding, internal hemorrhoids (piles) come out after defecation (defecation) and it is necessary to push them in with the help of the hand. Stage 4: In addition to bleeding, internal hemorrhoids (piles) are constantly external. C. EXAMINATION AND DIAGNOSIS HEMORRHOID (Hemorrhoids) EXAMINATION The patient's anal area is first visually examined by the doctor while he is leaning forward on his knees or lying on his side, and then the examination is completed by inserting his finger into the anus. This examination is usually sufficient to diagnose hemorrhoidal disease (piles). However, is it because hemorrhoid-like complaints can also be seen in diseases such as colon cancer and there may be other diseases along with hemorrhoids that cannot be detected during examination? A sigmoidoscopy or colonoscopy is also required. Many disorders may occur with bleeding during defecation as the first symptom. Large intestine cancer (colon and rectum cancer), large intestine polyps, anal fissure, inflammation (abscess), fistula formation, inflammatory bowel disease (ulcerative colitis and Crohn's Disease), intestinal prolapse (prolapse), fecal incontinence ( incontinence), itchy rectal disease, irritable bowel syndrome, sexually transmitted diseases and many other conditions can affect this area. Therefore, differential diagnosis is very important and should be made by a specialist doctor. D. HEMORRHOIDS TREATMENT Treatment of hemorrhoidal disease varies depending on the patient's complaints and the stage of the disease. There are many alternatives in treatment. However, the ideal is to choose the method suitable for the patient. First of all, defecation and eating habits need to be regulated. � � Regulation of defecation habit Regular defecation habit is important for treatment. Sitting on the toilet for long periods of time (smoking, reading newspapers, etc.) and avoiding excessive straining reduces the tension and pressure on the hemorrhoidal veins, thus preventing hemorrhoids from coming out of the anus. – Regulating the diet, increasing the proportion of fiber (fibre) foods in meals and acquiring regular defecation habits may help. Another important issue is drinking enough water. You should drink at least 10-12 large glasses of water a day. Fruit juice, coffee and tea do not replace water. Medical Treatments 1. Sitz bath Sitting in warm water for 10 minutes several times a day reduces symptoms. After the sit bath, the anal area should not be left wet and should be kept dry. With this treatment, even in the most severe hemorrhoids, the pain decreases within 2-7 days and the palpable sensation around the anus disappears. RT swelling subsides within 4-6 weeks. 2. Cream applications There are many pomades used in the treatment of hemorrhoidal disease. Your doctor may recommend you a pomade depending on the condition of the disease. 3. Medications There are medications that control the blood flow of the veins in the anal area and prevent excessive swelling, making it easier for hemorrhoidal disease to return to normal in a short time. These drugs should be used under the supervision of a doctor. Surgical Treatments 1. Laser method is a method that has been increasingly used in recent years. Very good results are obtained when applied to appropriate patients and by a suitably experienced team. There is almost no pain after the procedure. You can stand up immediately, no need to lie down. 2. Hemorrhoidectomy - Classical Surgical method is the removal of hemorrhoids. This process can be done using classical methods, as well as using tools such as ligasure, cautery, and ultrasonic scalpel. Recovery time can take up to three weeks depending on the extent of the surgical procedure performed. 3. Stapler (Longo) method (Stapler hemorrhoidopexy, Staple hemorrhoid surgery) It is a method that has developed in recent years. It is a less painful method, recovery and return to daily life are quicker. It is a surgery performed using disposable instruments called staplers.
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