Hemorrhoids: Causes, Treatments, and Surgical Options Explained - Surgery

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Hemorrhoids, commonly known as piles, are swollen veins in the lower rectum and anus that can cause discomfort, itching, 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. Understanding the causes, treatments, and surgical options for hemorrhoids is essential for effective management.


Causes of Hemorrhoids
Hemorrhoids can develop due to increased pressure in the lower rectum, which can be caused by several factors:
1. Straining during bowel movements: This is often due to constipation or diarrhea.

2. Sitting for long periods: Especially on the toilet, which can increase pressure in the anal area.

3. Pregnancy: The weight of the fetus can put pressure on the pelvic veins, leading to hemorrhoids.

4. Obesity: Excess weight can increase pressure on the pelvic veins.

5. Aging: As we age, the tissues that support the veins in the rectum and anus can weaken.


Why Hemorrhoids May Swell with Certain Toilet Styles
Your observation that hemorrhoids only swell when using a sitting toilet but not a squatting one is interesting and can be explained by the anatomy of the rectum and the mechanics of bowel movements. When you sit, the angle of the rectum changes, which can create more pressure on the hemorrhoidal veins. In contrast, squatting can align the rectum in a way that reduces this pressure, allowing for easier passage of stool and less straining.


Effects of Pregnancy and Weight Loss on Hemorrhoids
Pregnancy can lead to the development of hemorrhoids due to hormonal changes and increased pressure from the growing uterus. However, after childbirth, many women find that their hemorrhoids shrink or disappear as the pressure is relieved. Similarly, weight loss can alleviate the pressure on the pelvic veins, potentially leading to an improvement in hemorrhoidal symptoms. Therefore, maintaining a healthy weight and diet can be beneficial in managing and preventing hemorrhoids.


Treatment Options for Hemorrhoids
1. Conservative Treatments: These include dietary changes (increasing fiber intake), hydration, and over-the-counter topical treatments to relieve symptoms.

2. Minimally Invasive Procedures: These include rubber band ligation, sclerotherapy, and infrared coagulation. These methods are effective for treating internal hemorrhoids and can be performed in a doctor's office.

3. Surgical Options: Traditional hemorrhoidectomy is a surgical procedure to remove hemorrhoids. While effective, it can be associated with pain and a longer recovery time.


Ultrasound-Guided Vascular Ligation
The technique you mentioned, ultrasound-guided vascular ligation, is a newer minimally invasive procedure that has shown promise in treating hemorrhoids. This method involves using ultrasound to locate the blood vessels supplying the hemorrhoids and then ligating them to reduce blood flow, leading to shrinkage of the hemorrhoids. While this technique is gaining traction in some countries, including Japan, its availability and expertise may vary by region. It is essential to consult with a qualified colorectal surgeon who is experienced in this technique to determine if it is suitable for your specific case.


Conclusion
In summary, hemorrhoids are a common condition that can be managed through various methods, including lifestyle changes, minimally invasive procedures, and surgical options. Understanding the underlying causes and treatment options can help individuals make informed decisions about their care. If you are experiencing symptoms or have concerns about hemorrhoids, it is advisable to consult a healthcare professional for a thorough evaluation and personalized treatment plan.