Treatment of chronic haemorrhoids

Chronic haemorrhoids are a chronic disease of the vascular plexuses around the rectum, occurring with a series of exacerbations and remissions (periods with mild symptoms). Therapeutic and surgical methods are used in its treatment. Therapy is aimed at alleviating symptoms and preventing exacerbations. Surgical treatment can permanently relieve haemorrhoids.

What is haemorrhoids

Haemorrhoids are a chronic disease associated with varicose expansion of the veins of the rectum and associated impairment of blood and lymph flow. As a result of blood stagnation and overflow, the vascular plexuses around the rectum and anus (anal opening) form haemorrhoids – bumps on the walls of the anal canal.
The development of haemorrhoids occurs against the background of weakening of the connective tissue structures – due to age or hereditary factors. Triggering factors include:

• A sedentary lifestyle, desk job.
• Increased strain on the pelvic floor area.
• Constipation.

In men, haemorrhoids are often related to heavy physical labor, while in women – to pregnancy and childbirth.

Course of Haemorrhoids

Like all chronic diseases, haemorrhoids are characterized by a wave-like course – “light,” low-symptom periods alternate with flare-ups. The main symptoms of chronic haemorrhoids:

• Prolapse of haemorrhoids from the inner part of the intestine during bowel movements.
• Presence of bright red blood in the stool or drops of blood from the anus during or after bowel movements.
• Presence of nodes in the anus area.
• Feelings of moisture, discomfort in the anal area, a sensation of incomplete bowel emptying.
• Mucous discharge from the anus.
• Itching, burning in the anal area.

Acute phases are usually associated with the formation of blood clots – clots that partially or completely block the vessel lumen. They are accompanied by pain and increased bleeding. Advanced chronic haemorrhoids are often complicated by anal fissures, proctitis, and paraproctitis (inflammation of the rectum and surrounding soft tissues). In women, haemorrhoids often occur together with rectocele – a prolapse of the rectal mucosa.

Classification of chronic haemorrhoids

By form – location of the nodes – haemorrhoids can be:

• External – with nodes forming around the anus.
• Internal – with nodes appearing in the rectum area.
• Combined – in the presence of external and internal nodes.

By the nature and severity of symptoms, 4 stages of chronic haemorrhoids are distinguished:

1. Presence of bloody discharge without prolapse of haemorrhoids.
2. Nodes that prolapse under strain return to the anal canal on their own.
3. Prolapsed nodes can only be pushed back manually.
4. Impossible to push back the prolapsed nodes.

Treatment tactics depend on the form and stage of the disease.

What methods are used in the treatment of haemorrhoids

Chronic haemorrhoids are treated using both therapeutic and surgical methods. Since uncomplicated chronic haemorrhoids usually do not threaten life, the choice of treatment is up to the patient. However, it should be noted that therapy can only relieve symptoms and extend periods of remission, but does not cure the disease permanently.

Therapy

Therapy for chronic haemorrhoids aims to relieve discomfort, strengthen veins, and eliminate blood and lymph stagnation. During flare-ups, it is necessary to reduce inflammation and pain. For this, medication and physiotherapy are used. Many patients successfully complement official treatment with folk methods.

Medication Treatment

In the treatment of chronic haemorrhoids, external (for local application) and systemic (in the form of tablets, injection solutions) medications are used. Most of them act in several ways – they strengthen the walls of blood vessels, improve blood circulation in vascular plexuses, reduce pain and itching, and suppress inflammation.
The most common external medications are creams, ointments, gels, solutions, and suppositories:

• Vessel-strengthening – Troxevasin gel, Procto-Glivenol suppositories
• Local remedies with heparin and venotropic drugs have different mechanisms of action and limitations. Detralex is not an anticoagulant. Prescription depends on symptoms and contraindications; in case of bleeding, it is especially important not to start on your own drugs affecting blood clotting.
• Healing and microflora-improving – “Proktozan,” suppositories with sea buckthorn oil, with bee products (“Phyto-Propolis,” “Prostopin,” “Propolis D,” “Propolis DN”), ointments and suppositories with methyluracil.
• Anti-inflammatory (based on corticosteroid hormones) – “Relief Ultra,” ointment “Proctosedyl” and suppositories “Proctosedyl M,” “Hepatrombin G”.
• Hemostatic – “Anuzol” and “Neo-Anuzol”.
• Antimicrobial – ointments “Levomikol” and “Levosin,” ointment and suppositories “Proctosedyl,” suppositories “Baliz-2,” ointment “Baliz”.
• Pain relievers (with local anesthetics and antispasmodics) – “Relief Advance”, heparin ointment, “Ultraproct”, “Aurobin”, “Betiol”, “Proctosan”, “Proctosedyl” and “Proctosedyl M”, “Procto-Glyvenol”, “NigePan”, “Levosin”, “Anestezol”.
• Laxatives – micro-enema “Microlax”, glycerin suppositories.

Of systemic drugs in the treatment of haemorrhoids, tablets “Detralex 1000” are most often used. Their active ingredient is the micronized purified flavonoid fraction (MPFF). Flavonoids are natural pigments and antioxidants that carry a whole range of beneficial effects:

• Strengthen venous walls and valves.
• Improve local blood circulation.
• Eliminate swelling.
• Prevent the development of inflammation and the formation of blood clots.

Sometimes with haemorrhoids, it is necessary to use other tablets or medicinal suspensions for oral administration:

• Laxatives – “Duphalac”, “Forlax”, “Mucophalk”.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) – diclofenac, ketoprofen, indomethacin, and others.
• Antibiotics – penicillin, cephalosporin, macrolide groups, fluoroquinolones.

Intramuscular or intravenous injections of antibiotics and NSAIDs are prescribed by a doctor in cases of severe pain, inflammation, purulent processes, as well as in the postoperative period.

Physiotherapy and therapeutic exercise

In the physiotherapy treatment of haemorrhoids, the most common are:

• Low-intensity laser physiotherapy differs from surgical laser intervention. It should not be presented as the most effective standard treatment for haemorrhoids or a guaranteed prevention of thrombosis. The need for additional procedures is discussed with a doctor taking into account the quality of evidence; they do not replace stool normalization and treatment according to established indications.
• Ultrasound therapy and phonophoresis are considered physiotherapeutic approaches. There is insufficient evidence for their universal use in haemorrhoids; it is not possible to promise reliable elimination of inflammation, pain, or increased effectiveness of medications. When discussing such treatment, it is important to clarify the expected benefit, limitations, cost, and available methods with a more convincing evidence base.
• Ultraviolet irradiation (UVI) – enhances the body’s own defense mechanisms, has antimicrobial, anti-inflammatory, and pain-relieving effects. It is the most accessible and inexpensive method of physiotherapy.

Balneotherapy (mineral waters “Narzan”, “Bukovinskaya”, “Borjomi”), ascending showers, therapeutic mud applications, and hirudotherapy are also beneficial. To improve peristalsis and prevent the prolapse of haemorrhoids, therapeutic exercises aimed at strengthening the abdominal and pelvic floor muscles are prescribed.

Folk methods

Among patients with haemorrhoids, folk remedies are popular:

• Warm sitz baths.
• Internal use of herbal decoctions and infusions – horse chestnut, butcher’s-broom, Ginkgo biloba, knotweed, yarrow, nettle.
• External treatment – compresses and microenemas with decoctions of medicinal herbs (chamomile, St. John’s wort, sage), rubbing the nodes with honey, propolis tincture, sea buckthorn oil.

It is important that home treatment harmoniously complements, rather than hinders, official medical methods. Do not engage in self-treatment – any folk remedy, no matter how harmless it may seem to you, must be agreed upon with your attending physician.

Surgical treatment

If you frequently experience flare-ups (especially with heavy bleeding) or if the disease is very advanced, surgical intervention is unavoidable. We perform non-surgical procedures and operations of any complexity.
Minimally invasive non-surgical methods for treating haemorrhoids:

• Sclerotherapy – injection of medications into the haemorrhoidal node that cause the vascular walls to stick together. As a result, the node, deprived of blood supply, atrophies.
• Infrared photocoagulation – cauterization of the node at its base, which leads to disruption of its blood circulation and atrophy.
• Ligature with latex rings – mechanical constriction of the base of the node.
• Laser haemorrhoidectomy – cauterization of the node with a laser externally (transmucosal coagulation) or from the inside through a puncture (subdermal-transmucosal coagulation) without damaging surrounding tissues.
• Laser thrombectomy – removal of the thrombus through a puncture followed by cauterization of the bed with a laser.

Surgical operations:

• Dearterialization of haemorrhoids HAL-RAR – ligation of the supplying vessels with lifting and fixation of the vascular plexus.
• Mills-Morgan haemorrhoidectomy – excision of the haemorrhoidal node.
• Longo operation, or stapled haemorrhoidopexy, removes a ring of mucosa above the dentate line and lifts the prolapsed internal tissues; it is not equivalent to excision of all haemorrhoids. Indications, risk of recurrence, and alternatives are discussed individually.

Treatment of chronic haemorrhoids of stages I-II

In the treatment of external chronic haemorrhoids of stages I-II, the following are used:

• Ointments – strengthening blood vessels, hemostatic, preventing thrombosis.
• Any physiotherapy methods.
• Laser coagulation.

For internal and combined forms in the early stages, the following are used:

• The same therapeutic and surgical methods as for external haemorrhoids. Instead of ointments, suppositories are used.
• Latex ligation.
• Sclerotherapy.
• Infrared photocoagulation.

Treatment of haemorrhoids stages III-IV

In the late stages of haemorrhoids, the same therapy used in the early stages is applied to relieve discomfort. However, conservative treatment cannot eliminate the constant prolapse of the nodes. Surgical intervention is required for this.
For external haemorrhoids, if the stage has not gone beyond III, laser coagulation is performed. In the most severe cases, a Milligan-Morgan haemorrhoidectomy is indicated. For internal nodes, in addition to these interventions, HAL-RAR dearterialization or rubber band ligation (only up to stage III inclusive) is effective.

Treatment of exacerbations and complicated chronic haemorrhoids

In acute thrombosis of haemorrhoids, the following are used:

• Topical agents – analgesics, antimicrobial agents, and those that prevent thrombosis.
• Nonsteroidal anti-inflammatory drugs in tablets.
• Laser therapy.
• Laser thrombectomy – within the first 48-72 hours after the vessel is blocked by a thrombus.

Other methods of surgical treatment and physiotherapy can be used only after the acute inflammation has subsided. To relieve severe pain, novocaine blocks and prolonged sacral analgesia can be used – a highly effective method of pain relief, the technique of which is similar to spinal-epidural anesthesia.

• The vessel is sutured. After bleeding stops, a radical surgery is indicated in the future.
• Sclerotherapy or infrared photocoagulation is performed.
• Ligate the internal node with latex rings.

If severe haemorrhoids are combined with mucosal prolapse, a Longo surgery is indicated.

Why our patients are not afraid of surgical intervention

Five reasons to make an appointment at the Haemorrhoid Treatment Center in Kyiv:

1. We perform surgical treatment on an outpatient basis or in a day hospital – you will be home immediately or within a few hours after the operation.
2. After minimally invasive procedures, you are able to work already the next day.
3. New technologies (for example, LigaSure in Milligan-Morgan haemorrhoidectomy) significantly reduce the duration of the operation and the recovery period.
4. The use of laser equipment and performing dearterialization under ultrasound control help to avoid serious complications.
5. For pain control, regional anesthesia can be used and, as indicated, an epidural catheter. The appropriate method is chosen by the anesthesiologist taking into account the surgery, concomitant diseases, and medications being taken. Regional and general anesthesia have different contraindications; one cannot automatically be considered safer for every patient. After surgery, pain is possible, so an individualized pain management and monitoring plan is needed.

Surgical operation will permanently eliminate haemorrhoids, and its cost will ultimately be much lower than the expenses for ongoing maintenance therapy. Do not self-medicate; contact our proctology center at the first signs of concern. This will allow for a minimally invasive procedure, avoid complications, and save money.