Everyone has hemorrhoids, but they are different inside and outside. How should hemorrhoids be treated?

Author: Kou Yuming, Chief Physician, Guang'anmen Hospital, China Academy of Chinese Medical Sciences

Executive Director of the Anorectal Professional Committee of the Chinese Association of Traditional Chinese Medicine

Reviewer: Rong Long, Chief Physician, Peking University First Hospital

Do you suffer from hemorrhoids?

Even if you don't have hemorrhoids, you're sure to have a family member or friend who does.

In clinical practice, hemorrhoids is a very common disease.

1. What exactly is hemorrhoids?

Hemorrhoids are varicose veins that form in the lower rectum.

Figure 1 Original copyright image, no permission to reprint

Normally, the arteries and veins in our body are anastomosed through capillaries, but some arteries and veins in the anus are directly anastomosed, so the blood from hemorrhoids is neither arterial blood nor venous blood, but blood from anastomosed blood vessels. Direct arteriovenous anastomosis is the main factor causing hemorrhoids.

In addition, there is also the varicose vein theory for the pathogenesis of hemorrhoids. In clinical practice, it has been observed that hemorrhoidal tissue is a mixture of dilated blood vessels and connective tissue.

From an anatomical point of view, hemorrhoids are like a "cushion" "built into" the anus. When the cushion moves downward, the hemorrhoids will prolapse. People with loose anuses are more likely to have prolapsed hemorrhoids.

According to the location, hemorrhoids are divided into internal hemorrhoids, external hemorrhoids and mixed hemorrhoids.

There is a structure in the anus called the dentate line. Peripheral nerves are distributed below the dentate line, and you will feel pain when you receive harmful stimuli. Autonomic nerves are mainly distributed above the dentate line, and you will not feel pain even if you prick it with a needle.

Simply put, hemorrhoids that grow below the dentate line are called external hemorrhoids, those that grow above the dentate line are called internal hemorrhoids, and those that grow both above and below the dentate line are called mixed hemorrhoids, also called internal and external hemorrhoids.

Figure 2 Original copyright image, no permission to reprint

The incidence of hemorrhoids is high, and it is said that "nine out of ten people have hemorrhoids". Relatively speaking, there are more female patients. However, if we talk strictly, most people have hemorrhoids, because it is the downward displacement of the anal lining, which originates from a normal structure.

Many people have hemorrhoids, but not everyone has symptoms. Only about 50% of people have symptoms, and young and middle-aged patients aged 20-40 are more likely to have symptoms.

2. Can hemorrhoids be detected early?

Yes, because some hemorrhoids have early symptoms.

First, local itching in the anus. Second, local moisture and discomfort in the anus. Third, blood in the stool.

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Therefore, when the anus becomes moist or itchy, or when blood in the stool occurs, you should go to a specialist hospital in time. It is safest to see a doctor with professional knowledge.

After arriving at the hospital, the anorectal doctor often has to do three examinations: visual examination, digital examination, and anoscopy. The doctor uses visual examination, that is, to observe the appearance and structure of the anus with his eyes. At the same time, he also uses his fingers to touch, that is, to judge whether there is any abnormality inside the anus through digital examination. In addition, for some problems inside the anus, we also need to do anoscopy. After these three examinations, the doctor can make a general diagnosis.

If the diagnosis cannot be confirmed after the above examinations and intestinal problems need to be ruled out, a colonoscopy, tumor marker test, stool test, etc. may be required.

3. What are the dangers of hemorrhoids?

Hemorrhoids are not fatal and are certainly not as harmful as tumors, but they can affect the quality of life and can be harmful to physical and mental health.

The first harm of hemorrhoids is that there will be secretions in the anus. In the early stage, there will be itching and mucus. It will also affect a person's work, life and mental health. The anus is always itchy, sticky and wet, which is definitely uncomfortable.

In addition, repeated bleeding from hemorrhoids can cause anemia. Often, patients go to the hospital for treatment only when their anemia is very severe. It is actually too late to have surgery at this time.

Figure 4 Original copyright image, no permission to reprint

And if there is long-term irritation of hemorrhoids around the anus, the patient will also be under great psychological pressure. Many people think that it doesn’t matter if you delay it, but it’s not true.

We believe that the disease should be treated early. If it is a mild hemorrhoid, it can be solved through a simple operation. At this time, the treatment cost is low, the operation is simple, and there is no pain. So we should not wait until the disease is very serious before seeking treatment.

4. How to treat hemorrhoids?

There is currently no effective medicine that can completely remove external hemorrhoids, so if you want to completely remove them, the only treatment method in the world so far is surgical removal.

There are many treatments for internal hemorrhoids. There are injection therapy, ligation therapy, stapler removal, electrochemical therapy, etc. In the early days of our country, alum injection was used to treat internal hemorrhoids. In layman's terms, it was to inject a necrosis agent to make the hemorrhoids rot. Now the injection treatment technology for internal hemorrhoids has become very popular and is used almost all over the world, but the injected drugs are different.

Other treatments for internal hemorrhoids and mixed hemorrhoids include band ligation and hemorrhoidal circumcision (PPH). Currently, endoscopic band ligation and injection are also very effective.

Currently, there are two types of injectable drugs for the treatment of internal hemorrhoids, one is a necrotizing agent and the other is a sclerosing agent.

The therapeutic principle of sclerosant is to shrink blood vessels. Because internal hemorrhoids are caused by vasodilation, as long as the sclerosant is injected to shrink the blood vessels, the purpose of treatment can be achieved.

The use of necrotizing agents is to make the hemorrhoids necrotize and fall off. This treatment method is very painful. If too much is used, there will be bleeding when the necrosis falls off, and it is easy to cause anal stenosis.

Figure 5 Original copyright image, no permission to reprint

We believe that necrosis agents and hardeners are not fundamentally different. When a large amount of hardener is used, exceeding the normal dosage and concentration, some of them will also achieve a necrotic effect. When the concentration of the necrosis agent is reduced, the purpose of hardening can also be achieved.

Therefore, no matter what medicine is used, injection is a good way to treat mild to moderate internal hemorrhoid bleeding. There is no need for surgery with obvious trauma, and the treatment goal can be achieved through injection therapy.