Fourth-Degree Hemorrhoids: Treatment Options and Risks

Q: Fourth-Degree Hemorrhoids: Treatment Options and Risks

Hello, in response to your question： Hemorrhoids can be classified into four grades based on symptoms. <br>Grade I has symptoms but does not prolapse; Grade II prolapses but can retract on its own; Grade III prolapses and can be pushed back manually; Grade IV prolapses and cannot

Regarding hemorrhoids issues?

Hello Doctor: I went to see a physician and the result was that I have fourth-degree hemorrhoids.
The doctor recommended surgical treatment, but I declined.
However, I still need to return for a follow-up appointment.
Currently, I am only using an ointment.
Should I agree to the surgery? What is the surgical procedure like? I do not want to pursue aggressive treatment, but the doctor informed me that hemorrhoids will not resolve without treatment.
What should I do? What are the consequences of not undergoing surgical treatment? Thank you for taking the time to answer my questions!

Xiao Feng, 20~29 year old female. Ask Date: 2009/12/27

Dr. Ke Fangxu reply Surgery

Hello, in response to your question: Hemorrhoids can be classified into four grades based on symptoms.
Grade I has symptoms but does not prolapse; Grade II prolapses but can retract on its own; Grade III prolapses and can be pushed back manually; Grade IV prolapses and cannot be pushed back manually.
Generally, Grade IV hemorrhoids are best treated surgically.
However, if there is no discomfort and it does not affect daily life, surgery may not be necessary.
Some physicians may classify small external hemorrhoids as Grade IV, but this classification is primarily intended for internal or mixed hemorrhoids, meaning it must include a portion of internal hemorrhoids to be applicable.
Therefore, even very small external hemorrhoids, which are located outside the anal canal and cannot be pushed back, do not strictly fit this classification.

So the key question is: what type of hemorrhoid do you have? If it is a small external hemorrhoid and there is no discomfort, surgery may not be required.
If the hemorrhoid is quite large and requires significant effort to push back each time it prolapses, I generally recommend surgical treatment for a more definitive solution.
The surgical procedure can be performed under either spinal or general anesthesia, lasts about one hour, and requires a three-day hospital stay.
Post-surgery, there may be one to two weeks of bleeding and pain.
If it does not significantly impact quality of life or pose a life-threatening risk (such as anemia), I usually recommend starting with medication.
If the effectiveness is not satisfactory, then considering surgery would not be too late.

Reply Date: 2009/12/27

More Info

Fourth-degree hemorrhoids represent the most severe form of hemorrhoidal disease, characterized by the inability to reduce the hemorrhoids back into the anal canal. This condition often leads to significant discomfort, pain, and complications such as thrombosis, bleeding, and infection. The treatment options for fourth-degree hemorrhoids primarily include surgical intervention, as conservative measures like topical medications and lifestyle modifications are typically insufficient for managing this advanced stage.

Treatment Options
1. Surgical Intervention: The most common surgical procedure for fourth-degree hemorrhoids is hemorrhoidectomy, which involves the excision of the hemorrhoidal tissue. This procedure can be performed under local or general anesthesia, depending on the severity of the condition and the patient's overall health. The surgery typically involves the following steps:
- Anesthesia: The patient is given anesthesia to ensure comfort during the procedure.

- Excision: The surgeon removes the hemorrhoidal tissue, which may involve cutting away the excess skin and tissue.

- Closure: The surgical site is then closed, either with sutures or staples, depending on the technique used.

Post-operative care is crucial, as patients may experience pain and discomfort during the recovery period. Pain management, stool softeners, and dietary modifications are often recommended to facilitate healing.

2. Non-Surgical Options: While surgery is the definitive treatment for fourth-degree hemorrhoids, some patients may initially consider non-surgical options, such as:
- Topical Treatments: Over-the-counter creams and ointments can provide temporary relief from symptoms but will not resolve the underlying issue.

- Lifestyle Modifications: Increasing fiber intake, staying hydrated, and avoiding prolonged sitting can help alleviate symptoms but are unlikely to reverse the condition.

Risks of Not Undergoing Surgery
Choosing not to undergo surgery for fourth-degree hemorrhoids can lead to several complications, including:
- Persistent Symptoms: The hemorrhoids will not resolve on their own and may continue to cause pain, bleeding, and discomfort.

- Thrombosis: The risk of thrombosed hemorrhoids increases, leading to severe pain and potential complications requiring emergency treatment.

- Infection: Prolapsed hemorrhoids can become infected, leading to further complications and the need for more extensive treatment.

- Quality of Life: Chronic pain and discomfort can significantly impact daily activities and overall quality of life.

Conclusion
While it is understandable to have reservations about surgical treatment, especially if you prefer to avoid invasive procedures, it is essential to weigh the risks and benefits carefully. Discussing your concerns with your healthcare provider can help you make an informed decision. They may also provide alternative management strategies or refer you to a specialist for further evaluation.

If you choose to delay surgery, it is crucial to monitor your symptoms closely and maintain regular follow-up appointments with your doctor. This will ensure that any changes in your condition are addressed promptly, and you can receive appropriate care as needed. Ultimately, the decision should be based on a thorough understanding of your condition, treatment options, and personal preferences.

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