Treatment of acute internal haemorrhoids

Acute internal haemorrhoids are a pathological condition characterized by thrombosis of the veins of the venous plexus located behind the anal opening, or by strangulation of a haemorrhoid. Without adequate and timely treatment, it leads to necrosis of the formations and surrounding tissues, the development of paraproctitis, rectal fistulas, sepsis, and massive bleeding.

Symptoms of acute internal haemorrhoids

The clinical picture of the disease includes:

• Severe pain syndrome, for which nonsteroidal anti-inflammatory drugs and opioid analgesics (morphine, promidol, tramadol) are prescribed. Pain is triggered by defecation, coughing, sneezing, straining, lifting heavy objects, physical exercises, long periods of sitting or standing.
• Itching, burning, discomfort, and unpleasant sensations in the anal area.
• Feeling of a “foreign body” in the rectum.
• Inflammation and/or thrombosis of haemorrhoids (determined visually and by palpation).
• Bleeding, the severity of which depends on the extent and severity of pathological changes.

Symptoms may be accompanied by prolapse and/or strangulation, changes in the color of formations, skin, and subcutaneous fat of the perineum, development of anemia (reduction in the number of erythrocytes and hemoglobin in blood plasma), fever, and intoxication syndrome (increased body temperature, loss of appetite, general weakness, fatigue, sleep disturbances).

Treatment features in men

Patients seek medical help when complications develop (strangulation of nodes, anemia, necrosis of the formation and surrounding tissues), which is related to the delicacy of the problem and the reluctance to share “intimate details.” For this reason, treatment is aimed at stabilizing the condition (infusion therapy, daily dressings), relieving acute symptoms (adequate pain relief, antibiotic therapy, anticoagulants), stopping bleeding (hemostatics, FFP, blood products, embolization of feeding vessels). Surgical intervention is prescribed by the decision of a medical council. Timing – up to 1-2 months.

Treatment features in women

Patients seek medical care at early stages (after difficult and prolonged labor, at the first symptoms of diseases), which is due to women’s careful attitude towards health. Treatment is symptomatic: relief of the acute condition (pain relief, sanitation of the infection focus), stopping bleeding. Duration – 1-2 weeks.

Treatment with medications

Conservative therapy:

• Venotonics (Phlebodia, Detralex). Increasing vascular tone, strengthening the venous wall, reducing tissue swelling.
• Laxatives (Bisacodyl, Regulax). Normalization of stool in constipation. Risk of electrolyte imbalance, addiction.
• NSAIDs (Paracetamol, Ibuprofen). Reducing inflammation, alleviating pain syndrome and discomfort. Possibility of acute kidney, liver and/or stomach damage, gastrointestinal bleeding.
• Anticoagulants (Heparin). Blood thinning. Does not dissolve formed clots!
• Hemostatics (Vikasol, Aminocaproic and Tranexamic acid, Ethamsylate sodium). Stopping bleeding.
• Local medications (antiseptic baths, suppositories). Reducing discomfort, relieving inflammation.

Medication treatment is aimed at eliminating the acute condition and relieving pain. It does not cure the disease, delays the timing of surgical intervention, and increases the likelihood of complications.

Effective and fast treatment of acute internal haemorrhoids

Surgical techniques used in our clinic:

• Laser treatment of internal haemorrhoids is discussed on an individual basis considering the degree of prolapse, symptoms, and external component. The specific technique, number of areas treated, and duration depend on the extent of the intervention. Pain, bleeding, and recurrent symptoms are possible; the absence of scars or complications is not guaranteed. The conditions for monitoring, discharge, and recovery are determined after assessing the patient’s condition.
• HAL-RAR surgery. Dearterialization (disconnection of the artery by stitching or ligation) of the node vessels with lifting of the rectal mucosa. Performed under ultrasound guidance. Minimally invasive technique. Indications – stages I-IV. Duration – 30-120 minutes. Advantages: effectiveness, speed, low risk of complications and recurrence.
• Longo’s operation may be considered for certain forms of prolapse of internal haemorrhoidal tissue. Complete rectal prolapse is a different condition and requires its own approach. The method is not assigned automatically based on the stage; potential benefit is weighed against the risk of recurrence, complications, and alternatives, including excision of nodes as indicated.
• Transanal dearterialization of internal nodes. Performed under ultrasound guidance with Doppler.

Pain relief techniques – general anesthesia, local or spinal-epidural anesthesia, general anesthesia. We offer regional methods: fast effect by introducing drugs into the spinal canal, maintaining painlessness during the procedure by titrating medication into the epidural space. Advantages: effectiveness, complication prevention, early client activation.

Prolonged conservative therapy increases the risk of complications: massive intestinal bleeding, strangulation and necrosis of nodes, sepsis. Surgical intervention removes the cause of severe pain that interferes with work and rest, returning the client to life without discomfort and limitations.