Hemorrhoids: Types, Treatment, and When to Seek Surgery - Surgery

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Hemorrhoids, commonly referred to as piles, are swollen veins in the lower rectum and anus that can cause discomfort, pain, and bleeding. They can be classified into two main types: internal and external hemorrhoids. Internal hemorrhoids are located inside the rectum and are usually not visible, while external hemorrhoids are located under the skin around the anus and can be felt or seen. There is also a subtype known as thrombosed external hemorrhoids, which occur when a blood clot forms in an external hemorrhoid, leading to increased pain and swelling.

1. Types of Hemorrhoids: The type of hemorrhoid that can be pushed back into the rectum is typically an internal hemorrhoid. External hemorrhoids, on the other hand, cannot be pushed back in once they have prolapsed (fallen out). If the doctor was able to push the "meatball" back into the anus, it is likely an internal hemorrhoid. If it is painful and has a hard lump, it may be a thrombosed external hemorrhoid.

2. Continued Swelling: If the hemorrhoid is not kept inside, it may indeed continue to swell and become more painful. The pressure from straining during bowel movements can exacerbate the condition. If the hemorrhoid is external and has prolapsed, it may not return to its original position without intervention. If the discomfort persists or worsens, it is advisable to return to the doctor sooner rather than waiting for the three-month prescription to run out.

3. Stages of Hemorrhoids: Internal hemorrhoids are classified into four stages based on their severity. Stage I hemorrhoids do not prolapse; Stage II hemorrhoids prolapse but reduce spontaneously; Stage III hemorrhoids prolapse and require manual reduction; and Stage IV hemorrhoids are permanently prolapsed and cannot be pushed back in. External hemorrhoids do not transition into internal hemorrhoids but can occur simultaneously, leading to a mixed condition.

4. Pain During Insertion: Experiencing pain when trying to push a hemorrhoid back in can be normal, especially if it is thrombosed or inflamed. However, significant pain may indicate that the hemorrhoid is not just swollen but may also be thrombosed or infected. If the pain is severe, it is essential to consult a healthcare provider.

5. Surgical Consideration: If the hemorrhoid does not reduce in size, continues to cause pain, or if there is significant bleeding, surgical intervention may be necessary. Non-surgical treatments include dietary changes, topical treatments, and sitz baths, but if these do not provide relief, procedures such as rubber band ligation, sclerotherapy, or hemorrhoidectomy may be considered.

In summary, it is crucial to monitor the symptoms and seek medical advice if the condition does not improve or worsens. Hemorrhoids can often be managed with conservative treatments, but persistent or severe cases may require surgical intervention. Regular follow-ups with a healthcare provider are essential to ensure proper management and to discuss any concerns regarding the diagnosis and treatment plan.