WHAT IS HEMORRHOID? - Dr.Adem Dervişoğlu, MD, Professor

Dr.Adem Dervişoğlu, MD, Professor


Hemorrhoidal venous cushions are normal structures located in the anal region. When they become prominent, engorge, and prolapse; they cause the disease called hemorrhoids.

Since these disorders occur commonly and patients feel intimidated due to the location of the complaints, patients avoid consulting a physician but apply traditional alternative healing methods instead. Especially the so-called “herbal treatment products” are commonly available in the market. Unfortunately; they cause delays in the diagnosis of the cancers of the perianal region or rectum, affecting the lives of patients unfavorably.

Hemorrhoids (piles) are the most common complaints associated with the anorectal area worldwide. The frequency of hemorrhoids is equal in males and females, and it is most common in the age range from 45 to 65 years of age.


Factors leading to hemorrhoids development include irregular bowel habits (chronic constipation, diarrhea), long-term straining habits, long defecation episodes, the poor fiber content in the diet, low water intake, diarrhea, obesity, and familial predisposition. Pregnancy may both mechanically and hormonally engorge the hemorrhoidal venous cushions and cause them to prolapse. The disease is more common in individuals spending a considerable time while standing or sitting.


Patients usually complain of bleeding, painful mass, swollen piles, and feeling of discomfort in the anal area; anal discharge, and hygienic problems. Bleeding is often fresh and in bright red color. It is painless and occurs during or after defecation. Some patients complain of soft swollen lumps or mammillae in the anal area.


The diagnosis of the disease is made by physical examination. In the physical examination, first of all, the anal region of the patients should be examined visually and by finger, if there is no painful condition. In particular, patients applied with rectal bleeding, perianal pain and perianal mass should be evaluated for colorectal and anal cancer, inflammatory bowel disease. Flexible sigmoidoscopy or colonoscopy should absolutely be used in the differential diagnosis of malignant or inflammatory bowel diseases.

The specialist should decide the treatment methods according to the symptoms of the patient, the type of the disease (internal or external hemorrhoidal disease), the severity and the complications. It should be remembered during the treatment that the disease progresses with relief-repetition. Also, it is useful to know that treatments offering healing guarantees are not real. Approaches such as “definitive solution in the treatment of hemorrhoid disease”, “permanent or guaranteed solution in 5-10 minutes”, “100% success”, “end to hemorrhoids” are both impossible and include medical and ethical problems.

Treatment methods can be investigated in two parts as conservative and interventional methods. 1. Conservative treatment approaches 2. Interventional treatments

Changes in vital habits and diet in conservative treatment are an important part of the treatment. The main rule of conservative methods is the hygiene of the anal region, taking lots of foods containing fiber, and consuming water with diet, and defecation in soft consistency.

Various creams and medicines are widely used in hemorrhoidal disease. The choice of oral medication based on the experience of the physician is important.

Methods such as rubber band method, sclerotherapy, heat coagulation, and rubber band implementation can be used for early-stage patients (Grades I and II ) in outpatient conditions. It should be applied in patients with large external or stage III-IV hemorrhoids in cases where other methods fail. Surgical methods should be chosen according to the clinical condition of the patient. Although surgery with classical surgical methods (Milligan Morgan, Ferguson, Parks) is performed frequently, it is recommended to perform surgery with “Ligasure” and “Harmonic” devices that are powered, to reduce post-operative pain and in order to return to normal life and work early. The aim of the excision performed with these devices is less tissue damage, less discomfort, and faster recovery. Laser method is another recommended method. It is aimed to completely burn and eliminate hemorrhoidal lumps by means of laser. It gives successful results especially in patients who are not in advanced stage. Hemorrhoid lumps can be removed by conventional surgical methods or by a special instrument called stapler (Longo technique). It should be preferred especially in stage III and stage IV patients whose lump can be pushed in the rectum during the operation. The recurrence of the disease after surgical treatment is not as high as patients think. Generally, the average recurrence frequency is 5-10%. As a result of the operations performed by experienced surgeons, the selection of the appropriate method will reduce the possibility of recurrence.

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