HEMMORRHOIDECTOMY

8/13/2019 HEMMORRHOIDECTOMY

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HEMMORRHOIDECTOMY


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What Are Hemorrhoids? Hemorrhoidsare clumps of

blood vessels of the rectum.The hemorrhoidal veins arelocated in the lowest area ofthe rectum just above theanus. Sometimes they swellwhen the veins enlarge andtheir walls become stretched,thin, and irritated by passingbowel movements.

Hemorrhoids are classifiedinto two general categories:

1) internal

2) external


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1. Internal Hemorrhoids

Internal hemorrhoids- arelocated in the inside lining ofthe rectum and cannot be feltunless they are substantiallyenlarged. They usually arepainless and make theirpresence known by causing

bleeding with a bowelmovement. Sometimes internalhemorrhoids prolapse orprotrude outside the anus. If so,you may be able to see or feelthem as moist pads of skin thatare pinker than the surrounding

area. Prolapsed hemorrhoidsmay hurt because the anus isdense with pain-sensing nerves.Prolapsed hemorrhoids usuallyrecede into the rectum on theirown; if they don't, they can begently pushed back into place.


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2. External Hemorrhoids

External hemorrhoidsare locatedunderneath the skin that surroundsthe anus (lower in the anus thaninternal hemorrhoids). They can befelt when they swell, and maycause itching, pain, or bleeding

with a bowel movement.If anexternal hemorrhoid prolapses tothe outside (usually in the courseof passing a stool), you can seeand feel it. Blood clots sometimesform within prolapsed externalhemorrhoids, which can cause anextremely painful condition calleda thrombosis. If an externalhemorrhoid becomesthrombosed, it can look ratherfrightening, turning purple or blue,and could possibly bleed. Despitetheir appearance, thrombosedhemorrhoids usually are not serious

though they can be very painful.


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Everyone Has Hemorrhoids

Although most people thinkhemorrhoids are abnormal, theyare present in everyone. It is onlywhen the hemorrhoidal cushions

enlarge that hemorrhoids cancause problems and beconsidered abnormal or adisease.

Although hemorrhoids occur in

everyone, they can becomelarge and cause seriousproblems in about 4% of thegeneral population. Hemorrhoidsthat cause problems are foundequally in menand women, and

their prevalence peaks between45 and 65 years of age.


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What Causes Hemorrhoids?

Researchers are not certainwhat causes hemorrhoids.It's likely that extremeabdominal pressure causesthe veins to swell by

blocking the flow of bloodthrough them. They thenbecome susceptible toirritation. The increasedpressure can be caused by

obesity, pregnancy,standing or sitting for longperiods, straining on thetoilet, coughing, sneezing,vomiting, and holding your

breath while straining to dophysical labor.


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Hemorrhoids and Diet

Diet is believed to have apivotal role in causing -- andpreventing -- hemorrhoids.People who consistently eat ahigh-fiber diet are less likely to

get hemorrhoids, while thosepeople who prefer a diet high inprocessed foods are at higherrisk. A low-fiber diet orinadequate fluid intake cancause constipation, which can

contribute to hemorrhoids intwo ways:

1. it promotes straining on thetoilet; and

2. it also aggravates thehemorrhoids by producing hard


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What Are the Symptoms of Hemorrhoids?

The most common

symptom and sign from

hemorrhoids is painless

bleeding. There may be

bright red blood on theoutside of the stools, on

the toilet paper, or

dripping into the toilet. The

bleeding usually is self-

limiting. Bleeding with abowel movement is never

normal and should prompt

a visit to a health care

professional.


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Stages of Hemorrhoids

Stages of Hemorrhoids:

For convenience in describing the severity ofinternal hemorrhoids, many physicians use agrading system:

First-degree hemorrhoids: Hemorrhoidsthat bleed, but do not prolapse.

Second-degree hemorrhoids:Hemorrhoids that prolapse and retract ontheir own (with or without bleeding).

Third-degree hemorrhoids: Hemorrhoidsthat prolapse but must be pushed back in

by a finger. Fourth-degree hemorrhoids:

Hemorrhoids that prolapse and cannot bepushed back in the anal canal. Fourth-degree hemorrhoids also includehemorrhoids that are thrombosed(containing blood clots) or that pull muchof the lining of the rectum through theanus.


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Symptoms of Prolapsed Internal Hemorrhoids

Prolapse of an internal hemorrhoid

occurs when the internal

hemorrhoids swell and extend from

their location in the rectum through

the anus. In the anal canal, the

hemorrhoid is exposed to thetrauma of passing stool, particularly

hard stools associated with

constipation. The trauma can cause

bleeding and sometimes pain when

stool passes. The presence of stool,

inflammation, and constant

moisture can lead to anal itchiness(pruritus ani), and occasionally the

constant feeling of needing to have

a bowel movement. The prolapsing

hemorrhoid usually returns into the

anal canal or rectum on its own or

can be pushed back inside with a

finger, but it prolapses again with


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Symptoms of Thrombosed External Hemorrhoids

External hemorrhoids can be feltas bulges at the anus, but theyusually cause few of thesymptoms that are typical ofinternal hemorrhoids. Externalhemorrhoids can causeproblems, however, when bloodclots inside them. This is referredto as thrombosis. Thrombosis ofan external hemorrhoid causesan anal lump that is very painfuland tender, and often requires

medical attention. Thethrombosed hemorrhoid mayheal with scarring, and leave atag of skin protruding in the anus.Occasionally, the tag is large,which can make anal hygiene(cleaning) difficult or irritate the

anus.


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Hemmorrhoidectomy

Surgical removal ofhemorrhoids known asa hemorrhoidectomy orstapledhemorrhoidectomy isreserved for patientswith third- or fourth-degree hemorrhoids.


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Hemorrhoidectomy

During a hemorrhoidectomy,the internal hemorrhoids andexternal hemorrhoids are cutout. The wounds left by theremoval may be sutured(stitched) together (closed

technique) or left open (opentechnique). The results withboth techniques are similar. Aproctoplasty, which extendsthe removal of tissue higherinto the anal canal so thatredundant or prolapsing anal

lining also is removed, issometimes performed inaddition. Postsurgical pain is amajor problem withhemorrhoidectomy, andpotent pain medications(narcotics) usually are

required.


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Stapled Hemorrhoidectomy


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Stapled Hemorrhoidectomy

A newer surgical technique is rapidly becoming the treatment ofchoice for third-degree hemorrhoids. This surgery does not remove thehemorrhoids but, rather, the expanded hemorrhoidal supporting tissuethat has allowed the hemorrhoids to prolapse downward. In this

procedure, a circular, hollow tube is inserted into the anal canal anda suture (a long thread) is placed through it and wovencircumferentially within the anal canal above the internalhemorrhoids. The ends of the suture are brought out of the anusthrough the hollow tube. The stapler is placed through the hollow tubeand the ends of the suture are pulled expanding the hemorrhoidal

supporting tissue into the jaws of the stapler. The hemorrhoidalcushions are pulled back up into their normal position within the analcanal. The stapler is then fired, cutting off circumferential ring ofexpanded hemorrhoidal supporting tissue trapped within the stapler,at the same time staples together the upper and lower edges of thecut tissue. Stapled hemorrhoidectomy is less painful and faster than a

traditional hemorrhoidectomy, taking approximately 30 minutes.

HEMMORRHOIDECTOMY

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