Hemorrhoids: When to Consider Surgery and Treatment Options - Surgery

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Hemorrhoids, also 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. The symptoms can vary from mild discomfort to severe pain, and they can significantly affect one's quality of life.

In your case, it appears that your hemorrhoids have progressed from being reducible (able to be pushed back into the rectum) to a state where they cannot be reduced after bowel movements. This change can indicate a worsening of the condition, and while it is a common issue, it is essential to evaluate the situation carefully.


When to Consider Surgery
Surgery for hemorrhoids is typically considered when:
1. Persistent Symptoms: If you experience ongoing pain, discomfort, or bleeding that does not improve with conservative treatments, surgical options may be warranted.


2. Prolapsed Hemorrhoids: If the hemorrhoids protrude outside the anus and cannot be pushed back in, this is known as prolapse. Surgical intervention may be necessary to alleviate symptoms and prevent complications.

3. Thrombosed Hemorrhoids: If a blood clot forms in an external hemorrhoid, it can cause severe pain and swelling. In such cases, surgical removal of the clot may be recommended.

4. Recurrent Issues: If you have had multiple episodes of hemorrhoids that require treatment, surgery may provide a more permanent solution.


Treatment Options
Before considering surgery, there are several non-surgical treatment options that you can explore:
1. Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements. Staying hydrated is also crucial.

2. Over-the-Counter Medications: Topical treatments, such as creams or ointments containing hydrocortisone or witch hazel, can help relieve itching and discomfort. Oral pain relievers like acetaminophen or ibuprofen can also be beneficial.

3. Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help reduce swelling and relieve discomfort.

4. Rubber Band Ligation: This is a minimally invasive procedure where a rubber band is placed around the base of the hemorrhoid to cut off its blood supply, causing it to shrink and fall off.

5. Sclerotherapy: A chemical solution is injected into the hemorrhoid tissue to shrink it.

6. Infrared Coagulation: This technique uses infrared light to coagulate the blood vessels supplying the hemorrhoid, leading to its shrinkage.


Surgical Options
If conservative treatments fail, surgical options include:
1. Hemorrhoidectomy: This is the surgical removal of hemorrhoids and is typically reserved for severe cases. It can provide long-term relief but may involve a longer recovery period.

2. Stapled Hemorrhoidopexy: This procedure involves using a stapling device to reposition and remove excess tissue, which can reduce blood flow to the hemorrhoids.


Conclusion
Given your current symptoms, it is advisable to consult with a healthcare professional, preferably a gastroenterologist or a colorectal surgeon, who can assess your condition and recommend the most appropriate treatment plan. They will consider factors such as the severity of your symptoms, your overall health, and your preferences regarding treatment options. While surgery can be effective, many patients find relief through conservative measures, so it is essential to explore all avenues before making a decision.