Hemorrhoid disease is one of the most common benign diseases of the lower gastrointestinal tract. Hemorrhoids are vascular cushions that form an airtight seal at the anorectal junction and contribute to the physiological continence mechanism. An enlargement of these hemorrhoidal cushions and subsequent sliding into the anal canal or out through the anus cause clinical symptoms such as bleeding, mucosal discharge, itching or pain. Hemorrhoidal disease prevention includes loose stools, a high-fiber diet, adequate fluid intake, and avoiding excessive straining during bowel movements. Conservative treatment with medication (suppositories, ointments, creams, flavonoids) can reduce hemorrhoid symptoms. Surgical treatments include sclerotherapy injections and rubber band ligatures for smaller hemorrhoids. With higher levels of hemorrhoid disease, more invasive treatments are required:
- Laser hemorrhoidoplasty
- Bracket-Hemorrhoidopexy (Longo)
- Doppler-guided hemorrhoid artery ligation (HAL)
- Removal of hemorrhoids with a sealing scalpel.
The optimal treatment will depend on the degree of hemorrhoids, the patient’s expectation, and the surgeon’s training in the various techniques.