Hemorrhoids: When to Consider Surgery and Treatment Options - Surgery

More Info

---

Hemorrhoids, commonly known 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 hemorrhoids, which occur inside the rectum, and external hemorrhoids, which develop under the skin around the anus. Your situation, where you have experienced a flare-up of an existing internal hemorrhoid, raises several important considerations regarding treatment options and the potential need for surgery.

Given your description, it seems that you are dealing with an internal hemorrhoid that has become significantly swollen, possibly due to straining during bowel movements or prolonged diarrhea. The fact that it has not reduced in size over two weeks and is causing discomfort suggests that it may be inflamed. The presence of a "small water balloon" sensation could indicate a thrombosed hemorrhoid, where a blood clot forms within the hemorrhoid, leading to increased pain and swelling.

In terms of treatment, conservative measures are typically the first line of action for hemorrhoids. These include:
1. Dietary Changes: Increasing fiber intake can help soften stools and reduce straining during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Additionally, staying well-hydrated is crucial.

2. Topical Treatments: Over-the-counter creams and ointments can provide relief from itching and discomfort. These may contain hydrocortisone or witch hazel, which can help reduce inflammation.

3. Warm Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help soothe the area and reduce swelling.

4. Pain Relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help alleviate pain and inflammation.

If these conservative measures do not provide relief, and the hemorrhoid remains swollen and painful, surgical options may need to be considered. Surgical intervention is typically recommended in the following scenarios:
- Persistent Symptoms: If the hemorrhoid does not respond to conservative treatments after several weeks.

- Severe Pain or Thrombosis: If the hemorrhoid becomes thrombosed and causes significant pain.

- Bleeding: If there is recurrent bleeding that cannot be managed with conservative measures.

In your case, the suggestion from your doctor to consider surgical removal under local anesthesia is a valid option, especially if the hemorrhoid is not improving. However, your concern regarding anesthesia due to your underlying condition (myasthenia gravis) is understandable. It is crucial to discuss these concerns with your healthcare provider, as they can assess the risks and benefits of surgery in your specific situation.

Regarding whether your condition has progressed to an external hemorrhoid or remains an internal one, it is possible for an internal hemorrhoid to become thrombosed and protrude slightly, giving the sensation of an external hemorrhoid. However, if it has not fallen out or become fully external, it may still be classified as an internal hemorrhoid.

Ultimately, the decision to proceed with surgery should be made collaboratively with your healthcare provider, considering your symptoms, the impact on your quality of life, and your medical history. If you are uncomfortable with the current treatment plan or have concerns about the surgical approach, seeking a second opinion from another specialist may provide additional insights and options.

In conclusion, while conservative management is often effective for hemorrhoids, persistent symptoms or complications may necessitate surgical intervention. Open communication with your healthcare provider about your fears and preferences is essential in making an informed decision regarding your treatment.