A thorough search for inflammatory bowel disease must be performed, and any inflammatory conditions appropriately treated. Many of the symptoms of ulcerative colitis or Crohn’s disease can present similar to symptoms associated with hemorrhoidal disease. In appropriate patient populations, bleeding malignancies, as well as bleeding polyps must be searched for and treated. Anal pain must be differentiated from an anal fissure or a thrombotic external hemorrhoid. It is important that other causes of these symptoms be ruled out prior to embarking on hemorrhoidal treatment. Symptoms attributable to internal (and external) hemorrhoids include bleeding, hemorrhoidal protrusion, pain, mucous discharge, itching and/or a sensation of incomplete evacuation. However, rectal varices do occur with portal hypertension and must be differentiated from hemorrhoidal disease, as management and treatment options differ significantly. Hemorrhoidal disease is not more frequent in patients with portal hypertension. All members of the adult population have experienced one or more of these etiological associations at sometime during life, making an exact etiology of hemorrhoidal disease difficult to prove. However, factors which seem to be associated with hemorrhoidal disease include constipation, prolonged straining at defecation, diarrhea, pregnancy, heredity, aging, internal sphincter abnormalities, and gravity. No definite etiology has been proven to be the primary cause of symptomatic hemorrhoids. Indeed, the hemorrhoidal plexus can actually be circumferential. Hemorrhoidal veins can actually be much more numerous than the traditional grouping of three. It should be emphasized that although this represents the traditional anatomy of the region, the true anatomy is much more variable and can be much more extensive. It is these veins, when enlarged, which constitute the bulk of the hemorrhoidal plexus. There is a corresponding venous drainage.
Middle and inferior hemorrhoidal arteries make lesser contributions to the hemorrhoidal plexus. The main blood supply to hemorrhoids arises from the terminal branches of the superior hemorrhoidal artery. Fibers from the internal anal sphincter and conjoined longitudinal muscles anchor the submucosal plexus of hemorrhoids and serve to prevent prolapse of the plexus and overlying mucosa. Proximal to the dentate line, hemorrhoids are considered to be internal. When located distal to the dentate line, hemorrhoids are considered to be external (although they may not be visible to the eye of the examiner). Traditionally, hemorrhoidal vasculature is found in the anal canal in the right anterior, right posterior, and left lateral positions. They may remain asymptomatic or may produce symptoms of varying degrees. At birth, they are small and insignificant. Hemorrhoids are naturally occurring vascular cushions found in the anal canal. Stapled hemorrhoidectomy will then be discussed and presented as an alternative to, and an improvement on traditional surgical procedures. We will discuss the technical details of the stapled hemorrhoidectomy and then evaluate our early results using this technique. In this discussion, we will briefly review hemorrhoidal anatomy and symptomatology as well as the various treatment options. With the advent of modern surgical stapling techniques, the introduction of circular stapled hemorrhoidectomy (or stapled hemorrhoidopexy) has come to the forefront as a possible solution to this problem. This reluctance is underscored when dealing with diseases of the anal canal
Should problems arise, the post operative course may become quite complicated, painful, and permanently debilitating. This is particularly evident in the private practice setting. There exists a natural reluctance on the part of an experienced surgeon to replace a proven, albeit painful operation with one that is new. Surgical therapy has involved significant postoperative pain, with large blocks of time being spent away from work or the activities of daily living. Until recently, the surgical treatment of hemorrhoidal disease was often more debilitating than the problem itself. Watch this brief video of Hemorrhoid Treatment Options Explained by Dr.
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