Hemorrhoids: When to Seek Surgical Intervention - Surgery

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When it comes to understanding hemorrhoids and determining when surgical intervention may be necessary, it’s important to first grasp what hemorrhoids are and the symptoms associated with them. Hemorrhoids are swollen veins in the lower rectum and anus, similar to varicose veins. They can be classified into two main types: internal hemorrhoids, which occur inside the rectum, and external hemorrhoids, which develop under the skin around the anus.
Your description indicates that you have been experiencing symptoms related to hemorrhoids for a long time, particularly exacerbated by constipation and prolonged sitting. The presence of pain, bleeding, and the discovery of wounds on the hemorrhoids suggests that your condition may have progressed. The fact that you have experienced significant pain and bleeding, especially after prolonged sitting, indicates that your hemorrhoids may be more severe than typical cases.

In general, hemorrhoids can cause discomfort, pain, and bleeding, particularly during bowel movements. If you notice bright red blood on the toilet paper or in the toilet bowl, it is usually a sign of bleeding from hemorrhoids. However, persistent bleeding, especially if it is accompanied by severe pain or the presence of wounds, should not be ignored.


When to Seek Surgical Intervention
1. Persistent Symptoms: If you have been experiencing severe pain and bleeding for five days without improvement, it is advisable to seek medical attention. While some hemorrhoids can resolve on their own, persistent symptoms may indicate a more serious condition or complications such as thrombosed hemorrhoids, which occur when a blood clot forms in an external hemorrhoid.

2. Wounds or Ulceration: The presence of wounds or ulceration on the hemorrhoids, as you described, is concerning. This could indicate a thrombosed hemorrhoid or an infection, both of which may require medical intervention.
3. Impact on Daily Life: If your symptoms are significantly affecting your daily activities, such as sitting or working, it is a strong indicator that you should consult a healthcare provider.
4. Failure of Conservative Treatments: If you have tried over-the-counter treatments, dietary changes, or lifestyle modifications (such as increased fiber intake and hydration) without relief, it may be time to consider surgical options.


Surgical Options
If surgical intervention is deemed necessary, there are several options available:
- Rubber Band Ligation: This is a common procedure for treating internal hemorrhoids. A rubber band is placed around the base of the hemorrhoid to cut off its blood supply, causing it to shrink and fall off.

- Hemorrhoidectomy: This is a surgical procedure to remove hemorrhoids. It is typically reserved for severe cases or when other treatments have failed.

- Sclerotherapy: This involves injecting a solution into the hemorrhoid tissue to shrink it.

- Infrared Coagulation: This technique uses infrared light to coagulate the blood vessels supplying the hemorrhoid, causing it to shrink.


Conclusion
Given your symptoms, it is highly recommended that you consult a healthcare provider, preferably a colorectal surgeon, who can evaluate your condition and discuss the most appropriate treatment options. While it may feel uncomfortable to seek help for such a personal issue, addressing it sooner rather than later can prevent further complications and improve your quality of life. Remember, many people experience similar issues, and healthcare professionals are trained to handle them with sensitivity and care.