Hemorrhoids
What are hemorrhoids?
Hemorrhoids are a dilatation of veins in the anus as a result of increased blood flow in the arteriovenous system in this area. The enlargement of the vascular network causes a loop that feeds itself resulting in venous insufficiency and the development of hemorrhoids.
There are two types of hemorrhoids – internal (deep) and external (superficial, adjacent to the anus).
What is the Prevalence of Hemorrhoids?
Hemorrhoids are very common and effect approximately 30% of the population.
What are the common symptoms?
- Symptoms usually depend on the type of hemorrhoids.
In external hemorrhoids: - Itching and uneasiness in the anal area
- Pain
- Swelling
- Bleeding
- Occasionally, blood clots inside them which causes significant pain, swelling and inflammation.
- Esthetic problem
Internal hemorrhoids:
Usually cannot be seen or felt but may cause the following:
- Fecal bleeding
- Pain if the hemorrhoids are pushed out of the anus
What are the available treatment methods?
- Conservative treatment with ointments and bathing.
Surgical treatment that includes ligation – the hemorrhoids are tied to prevent blood flow and eventually fall off, or surgery – where the anus is cut and hemorrhoids are removed. - Minimally-invasive surgery – the most innovative treatment today that includes catheterization and closure of the arteries that supply blood to the hemorrhoids. This method is performed under local anesthesia, a small incision in the groin area or the arm, and imaging of all the arterial branches that feed the hemorrhoids. This allows better embolization and therefore, best results. After locating the pathologic arteries, they are blocked by coils.
What are the benefits of minimally-invasive procedure over surgery?
- Quick recovery and resuming normal activity – the patient is discharged on day of procedure.
- Painless procedure and as opposed to surgery there is no recovery period.
- Avoiding anesthesia
- Low complication rate.
- Complete embolization of all the arterial branches that cause hemorrhoids.
- Success rate of approximately 70%, identical to surgery.
- Possibility of treating both internal and external hemorrhoids.
Who is a suitable candidate for this procedure?
Any patient who has symptoms that do not improve with medication and/or conservative treatment, and do not wish or cannot undergo invasive surgical procedures, candidates for embolization. Candidates must present with adequate renal function.
How is the procedure performed?
The patient, lying down, is monitored for pulse, blood pressure and oxygen levels. The procedure is performed by an interventional radiologist after local anesthesia, usually in the groin area. Mild relaxation medication may also be administered. The doctor will then make a tiny incision and through it insert a thin tube (catheter) to the artery and maneuver it to the treatment site. A small amount of contrast agent is injected for the radiologist to properly view, by imaging, the arteries that supply blood to the afflicted area and locate where to apply embolization (obstruct them). The surgeon then emits tiny particles that cause an obstruction of the indicated arteries. This reduces the blood flow and causes the hemorrhoids to shrink and disappear.
At the end of the procedure, the catheter is removed and pressure is applied to the incision area. There are no visible sutures, the incision is covered with a dressing. This procedure is usually completed within 2 hours.
What is the recovery process?
After the embolization, the patient is discharged the same day of surgery, and may resume normal activity within several days. The hemorrhoids disappear in the course of several months with significant improvement and even the disappearance of symptoms.
