Treatment of internal haemorrhoids in men

Internal haemorrhoids are an enlargement of the veins in the venous plexus located behind the anal opening in the lumen of the rectum. The condition is accompanied by pain, which increases after physical exertion and defecation, discomfort and unpleasant sensations, bleeding, and prolapse of the nodes. According to statistics, 5-10% of the world’s population suffer from this pathology.

The diagnosis is established based on the medical history, patient complaints, laboratory and instrumental examination methods – anoscopy, rectosigmoidoscopy, irrigoscopy. Treatment is surgical intervention or conservative therapy.

Causes of Internal Haemorrhoids in Men

Triggering factors:

• varicose veins of the lower extremities, pelvis;
• increased body weight;
• arterial hypertension;
• physical inactivity;
• defecation disorders (prolonged constipation, frequent diarrhea);
• excessive physical exertion (working as a loader, professional sports activity);
• sedentary working and living conditions (programmers, long-haul truck drivers, international bus drivers, prolonged time on the toilet);
• spicy, salty food, addiction to coffee;
• bad habits (alcohol abuse, smoking);
• diet (restriction of fiber and dietary fibers);
• tumors of the gastrointestinal tract (large intestine, rectum);
• inflammatory and infectious processes of the digestive system (colitis, enteritis, gastritis, hepatitis, liver cirrhosis);
• age-related changes (atrophy of muscle fibers in elderly patients);
• burdened family history (cases of disease in parents, close relatives).

The main cause is the insufficiency of the vascular wall of the veins of the internal haemorrhoidal plexus.

Symptoms of Internal Haemorrhoids in Men

Clinical picture of the pathology:

• Bleeding. Traces of blood are found in stools and hygiene products (toilet paper, towels, napkins). As the condition progresses, anemia develops—a decrease in the number of red blood cells and hemoglobin in the blood plasma. This is accompanied by shortness of breath during physical exertion, tachycardia (rapid heartbeat), pale skin and mucous membranes, hair loss, striated nail plates, general weakness, and loss of strength.
• Prolapse of the nodes. Triggered by increased intra-abdominal pressure (sneezing, coughing, lifting heavy objects). In stages I-II, they can be reduced on their own; in stages III-IV, manual reduction is required. Risk of strangulation and necrosis of the formations and surrounding tissues, anal fissure, paraproctitis, and anal sphincter insufficiency.
• Pain syndrome. The patient experiences discomfort, unpleasant sensations, and a feeling of a “foreign body” in the rectal area. These symptoms intensify after physical exercises, sneezing, consuming spicy food and alcohol, prolonged sitting, and long walking. The severity of symptoms depends on the extent and spread of pathological changes. Complication – thrombosis of the nodes: pain increases, and body temperature rises.

Palpable formations of up to 2 centimeters are detected (in case of prolapse).

Diagnostics

The diagnosis is made based on the patient’s medical history, complaints, visual examination, and endoscopic examination methods (anoscopy, rectosigmoidoscopy, irrigoscopy). Complications are clarified with laboratory and instrumental studies (complete blood and urine tests, biochemical analysis of blood and stool, ultrasound of the abdominal cavity and rectum, CT and MRI).

Treatment of internal haemorrhoids in men

Patient management tactics – surgical intervention or conservative therapy.

Medication treatment

List of prescribed medications:

• Venotonics (Phlebodia, Detralex). They increase vessel tone, strengthen the vein walls, reduce tissue swelling, and relieve symptoms.
• Laxatives (Bisacodyl, Regulax). Indicated for constipation to normalize stool. Cause electrolyte imbalances and dependency.
• Hemostatics (Vikasol, Aminocaproic acid, Ethamsylate sodium). Stop bleeding.
• NSAIDs (nonsteroidal anti-inflammatory drugs). Paracetamol, Ibuprofen, Nimesulide. By reducing inflammation, they relieve pain and discomfort. Risk of stomach damage (NSAID-gastropathy), gastrointestinal bleeding, renal failure.
• Anticoagulants (Heparin). Thin the blood. Do not dissolve clots.
• Topical medications. Baths with antiseptics, suppositories. Reduce discomfort, relieve inflammation.

Conservative therapy is aimed at alleviating acute symptoms, relieving pain. It does not eliminate the cause of the disease, delays the timing of surgical intervention, and increases the risk of complications.

Surgical treatment

Techniques of surgical interventions used in our clinic:

• Laser treatment of internal haemorrhoids is discussed according to individual indications, taking into account the degree of prolapse, symptoms, and external component. The specific technique, number of treated areas, 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. Observation conditions, discharge, and recovery are determined after assessing the patient’s condition. More on the topic: I · II.
• HAL-RAR surgery . Dearterialization (suturing or ligation) of the vessels of the nodules with lifting (elevation) of the rectal mucosa. Performed under ultrasound guidance. Minimally invasive technique, carried out at stages I-IV of the pathology. Procedure time – 30-120 minutes. Advantages: high effectiveness, speed of execution, low likelihood of complications and recurrence.
• Longo operation — stapled haemorrhoidopexy for selected cases of internal haemorrhoidal tissue prolapse. It cannot be automatically prescribed for complete rectal prolapse or rectocele: these are different conditions with their own surgical tactics. The method does not remove external haemorrhoids. Possible benefits regarding early recovery are weighed against the risk of recurrent prolapse and complications; the duration of the operation and care are determined individually. More on the topic: III · IV.
• Transanal dearterialization of internal haemorrhoids. Performed under ultrasound control with Doppler.
• Haemorrhoidectomy by Milligan-Morgan. Indications – stage III-IV, severe and advanced cases of the disease, ineffectiveness of previous surgical interventions. Advantages – complete cure, low likelihood of postoperative complications. Disadvantage – long rehabilitation (up to 1 year). Procedure time – up to 120 minutes. The “gold standard” for internal haemorrhoid removal in proctology. We use the Liga Sure device.

For the operation, local, regional, or general anesthesia may be used. Spinal and epidural administration are different techniques, which the anesthesiologist chooses taking into account the procedure, the patient’s condition, and medications affecting coagulation. Regional anesthesia may allow the patient to remain conscious, but it does not guarantee the prevention of heart attack, stroke, pneumonia, or thromboembolism. These risks are evaluated separately, and preventive measures are prescribed if necessary. Pain control continues in the postoperative period.

Surgical procedures in our clinic are performed by male doctors. We ensure the comfortable stay of patients: they should not be anxious or worried about the delicacy of the issue.

Untimely seeking of medical help and prolonged conservative therapy increase the risks of complications: massive intestinal bleeding, strangulation and necrosis of formations and surrounding tissues, sepsis. Only surgical intervention eliminates the cause of pain and discomfort, returning the patient to a normal life without restrictions.

You can submit a request for laser removal of haemorrhoids or a consultation (check the cost when making an appointment) by phone or on the website.