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what is the treatment for internal hemorrhoids

TREATMENT FOR INTERNAL

Grade 1 and 2 hemorrhoids are predominantly treated conservatively, while grade 3 and 4 hemorrhoids are usually operated on. Conservative treatments should primarily reduce the symptoms and achieve a regression of the pad. Surgical treatment aims at complete removal of hemorrhoid. An enlargement of the hemorrhoid pad without discomfort is usually not treated.

In parallel with treatment, patients should change their lifestyle permanently. This can improve the chances of success of therapy and reduce the risk of new hemorrhoids forming.

what is the treatment for internal hemorrhoids

CONSERVATIVE THERAPY

Mild to moderate discomfort can be alleviated with ointments or suppositories. However, short-term improvement in symptoms should not hide the fact that these medications can not remedy the condition itself. The preparations contain individually or in combination, for example, anti-inflammatory agents such as witch hazel (vegetable), bufexamac or cortisone-containing substances.

Care should be taken with cortisone-containing ointments: they facilitate the development of fungal infections of the intestine. The itching and pain are locally anesthetized with benzocaine, cinchocaine or lidocaine. Also, sitz baths with anti-inflammatory tannins, such as oak bark or camomile, can provide relief.

If the sphincter muscles are very tense, the muscles can be loosened by the application of anal tendons and better blood circulation. This can also alleviate the symptoms.

The removal of haemorrhoids of the first and second degree takes place predominantly with the so-called sclerotherapy , ie the sclerotherapy by injection of appropriate substances. The hemorrhoid pad becomes smaller due to the death of the treated tissue and can revert back to the rectum. In the case of pregnant women as well as patients with acutely inflamed hemorrhoids, hypertension or a tendency to thrombosis, the doctor will usually choose a different form of treatment.

Alternatively, the rubber band ligation is increasingly being used. The doctor absorbs the hemorrhoids and then laces them with rubber bands. The constricted tissue is then repelled by the body after a few days . This procedure is not only useful in the second, but in some cases even in the third stage of hemorrhoids. Both the sclerosis and the rubber band ligation are painless treatment methods.

Further treatment methods are sclerotherapy with the help of infrared radiation ( infrared coagulation ) as well as icing with nitrous oxide or liquid nitrogen ( cryohemorrhoidectomy ). These are considered less successful.

MODERN, GENTLER PROCEDURES
In the case of hemorrhoids (prolapse), which have come out of the anus and can easily be pushed back into the anus, there is an OP to Longowhich is a newer, less painful procedure without excision of hemorrhoid tissue. In this case, a special stapling device gathers intestinal mucosa above the hemorrhoid area and thereby eliminates the prolapse.

Experts also refer to the Longo method as “anal lifting”, as the doctor uses this method to fix the anal canal, which has come out, back up to its actual place. Since only the excess hemorrhoidal parts are removed during the surgery after Longo, ideally a normal large hemorrhoids region remains. Thus, the hemorrhoids remain in their function as erectile tissue, with the advantage that mucus and air later do not go unchecked.

However, defecation disorders, incontinence, and other serious complications may occur. Basically, the surgical suture in the Longo method is above the pain-sensitive anal canal, which saves the patient pain after surgery. Overall, patients undergoing surgery for Longo require significantly fewer painkillers than those undergoing conventional procedures (eg Milligan-Morgan procedures). Those treated to Longo can leave the hospital much earlier and become fit to work sooner.

The gentle HAL method (hemorrhoidal arteries ligature) can only be used by the doctor if the outward-appearing hemorrhoids (prolapse) can still be pushed back – or as experts put it: if they can still be repositioned. In doing so, the doctor senses the hemorrhoidal nodules with an ultrasound device and wraps around them to throttle the blood supply. The arteries are sutured with sutures, which reduces blood supply. As a result, the hemorrhoids collapse and any bleeding stops. After a few weeks, the hemorrhoid stunt without forming wounds. The patient does not need anesthesia for this procedure and can often return to work the day after the operation.

A virtually painless, minimally invasive hemorrhoid treatment that is particularly suitable for stage II and III, presents the rectal anal pexie (abbreviated as RAR from English rectal anal repair )which is also referred to as Doppler ultrasound-targeted mucocutia (DGM). As with the HAL method, the afferent vessels in the rectum, which is only slightly sensitive to pain, are visited and stopped with a special ultrasound probe. Then the mucosa is tightened with a suture far inside. The tissue prolapse from the anus is pulled inward, causing the hemorrhoids to disappear.

This process is repeated several times until the hemorrhoids are treated throughout the rounding of the anus. The RAR method is considered to be particularly gentle because unlike conventional surgery, there is no open, weeping and painful wound. Most patients experience a slight pull just days after surgery, and the wound may still bleed easily in the first week.

Within a few weeks, the previously pathologically dilated venous pelvis completely withdraw. Rectal anal plexie (RAR) should not be confused with LONGO surgery, which involves ligature of the vessels with a mechanical stapler and may result in defecation, incontinence and other serious complications. Damage to the sphincter muscle is practically impossible with the RAR. A short hospital stays, no post-op restrictions, and return to normal activity within 24-48 hours are other benefits of the RAR method. in which the ligation of the vessels with a mechanical stapler and stool emptying disorders, incontinence and other serious complications may occur.

Damage to the sphincter muscle is practically impossible with the RAR. A short hospital stays, no post-op restrictions, and return to normal activity within 24-48 hours are other benefits of the RAR method. in which the ligation of the vessels with a mechanical stapler and stool emptying disorders, incontinence and other serious complications may occur. Damage to the sphincter muscle is practically impossible with the RAR. A short hospital stays, no post-op restrictions, and return to normal activity within 24-48 hours are other benefits of the RAR method.

SURGICAL TREATMENT

In the case of persistent complaints as well as third and fourth degree haemorrhoids, it is usually only the surgical removal that necessitates inpatient hospitalization. Different surgical procedures are used, the aim of which is the complete removal of the hemorrhoids with their blood supplying vessels.

A new surgical procedure is the forklift method . With the help of a stapler – the stapler – the hemorrhoids can be removed more painfully and gently than with conventional methods. Both the surgery time and the hospital stay are shorter than with the classic surgical methods.

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  3. Current treatment of internal hemorrhoids based on their severity and degree of prolapse. DG-HAL: Doppler-guided hemorrhoidal artery ligation; SH: Stapled hemorrhoidopexy; PPH: Procedure for prolapse and hemorrhoids.

  4. Internal hemorrhoids are deep inside the rectum and not visible from outside. They are normally painless. Often, the first sign that internal hemorrhoids are present is rectal bleeding.

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