Treatment of Grade II Haemorrhoids: Methods and Difference from Thrombectomy

Haemorrhoids are a disease of the rectal veins, which is accompanied by inflammation, prolapse and pinching of nodes, as well as their thrombosis. Unlike the initial stage, which is almost asymptomatic, stage 2 is accompanied by painful manifestations and requires treatment. We’ll tell you how to understand that haemorrhoids have entered the second stage, how to treat them and what methods we use in our clinic.

How does 2nd degree haemorrhoids manifest

When haemorrhoids enter the second stage, the walls of the haemorrhoidal veins become thinner, the size of the nodes increases significantly, and inflammation of the mucous membranes and submucosal layer increases.

Due to the rather large size and thinning of the walls, the nodes are easily injured by feces. They often bleed and become inflamed, causing burning and itching, and the release of mucus with feces. Also, different forms of haemorrhoids have specific symptoms.

Internal

Internal haemorrhoids of the 2nd degree at this stage are accompanied by a lot of unpleasant symptoms:

• pain;
• loss of nodes under load;
• discomfort in the anus;
• sensation of a foreign body in the rectum.

After defecation, red or purple-colored bumps are visible in the lumen of the anus. When the anus contracts, they return inside without outside help.

External

At the second stage external haemorrhoids is accompanied by the formation of a soft knot in the perianal folds. This form is often complicated by thrombosis, when the node sharply increases in size, acquires a purple or bluish tint, and responds with sharp pain when trying to sit down, strain, etc.

Combined

The combined form of haemorrhoids is the most severe, because nodes form both inside the rectum and outside. At the 2nd stage of development, the disease is accompanied by excruciating pain when trying to sit down, empty the intestines, when coughing and lifting weights.

Acute and chronic

Acute haemorrhoids are an anomaly that occurs for the first time, accompanied by intense inflammation of the mucous membranes over the nodes, their enlargement, and bleeding. Its symptoms are always strong, affecting the quality of life and overall well-being.

Repeated exacerbations of the disease indicate a chronic process. Between acute attacks there are remissions – periods when there are no symptoms of the disease.

Features of grade 2 haemorrhoids in women and men

The differences between grade 2 haemorrhoids in women and men are insignificant. They consist mainly of factors that provoke exacerbations. Thus, in men, the disease worsens after dietary violations, complicated by stool disorders, and heavy physical exertion. In women, the key point in the exacerbation of grade 2 haemorrhoids is unstable hormonal levels. In them, exacerbation often occurs simultaneously with premenstrual syndrome, during pregnancy and after childbirth.

Treatment of stage 2 haemorrhoids

Tactics for treating grade 2 haemorrhoids depend on the phase of the pathology. In the acute stage, in the presence of bleeding, inflammation and swelling, conservative treatment is recommended:

• creams, ointments, gels with venotonic, anti-inflammatory, hemostatic, and analgesic effects — Troxevasin, Relief, Posterisan, Vishnevsky ointment or Fleming ointment, ichthyol ointment;
• rectal suppositories with anti-inflammatory, healing, and analgesic effects — Proctosedyl, Natalsid, Proctosan;
• venotonics in tablets — Detralex, Phlebodia, Venarus;
• analgesics and NSAIDs in tablets and suppositories — Diclofenac, Indomethacin, Ketoprofen;
• hemostatics against bleeding — Dicynone, Vikasol.

Stool-regulating agents and constipation prevention remedies are also recommended. These include natural fiber, Lactulose, Macrogol 4000, and their analogues. Additionally, adherence to a gentle diet and abundant fluid intake is recommended.

After relieving the symptoms, minimally invasive procedures are prescribed for the removal of haemorrhoids. These include latex ligation and laser thrombectomy.

Features of Ligation

Ligation with latex rings is performed under local anesthesia (the clinic uses spinal anesthesia and blockade). During the procedure, the doctor follows the standard algorithm:

1. Inserts a vacuum ligator into the rectum.
2. Positions it near the node and draws the neoplasm into the ligator cavity.
3. Using the built-in mechanism, places a latex ring at the base of the node.
4. Removes the instrument and treats the mucosa with antiseptics.

The entire process takes no more than 15 minutes, even if several nodes need to be ligated. After the procedure, the patient can go home immediately. The haemorrhoidal node deprived of blood supply will gradually die off, scar tissue will form at its base, and the node itself will separate in 1-2 weeks and exit naturally.

Latex band ligation is used for internal haemorrhoids according to indications and is usually performed on an outpatient basis. Pain, bleeding, and other complications are possible; sometimes repeated sessions are needed. The method is not intended for the removal of external haemorrhoids. Benefits and risks are compared with alternatives before the procedure.

Advantages and Features of Laser Thrombectomy

Laser haemorrhoidoplasty (LHP) and thrombectomy are different procedures. LHP is aimed at reducing certain internal haemorrhoidal tissues using laser energy; thrombectomy means removing a thrombus, usually in a thrombosed external node. These methods cannot be combined under one name or prescribed solely based on the stage number. Indications depend on anatomy, leading symptoms, and the duration of thrombosis. After both procedures, pain, bleeding, and recurrent symptoms are possible, so a follow-up plan is required. More on the topic: internal.

Laser thrombectomy is carried out according to a single algorithm:

1. An anoscope is inserted into the rectal cavity. Using a Doppler device, the doctor identifies the location of the haemorrhoids.
2. The doctor dissects the mucous membrane over the node and opens its wall with a laser, after which he inserts an electrode into its cavity and creates a series of short pulses until the Doppler recorder detects the cessation of blood supply to the node.
3. After thrombectomy, the mucous membrane is treated with an antiseptic.

Advantages and features of laser removal of haemorrhoids:

• no open wounds;
• almost zero risk of infection and bleeding;
• instant relief of symptoms and reduction in the size of the node;
• high efficiency and long disease-free period.

In our clinic, the procedure is performed under spinal-epidural anesthesia. The patient remains conscious, but does not experience physical discomfort or pain. The intervention takes no more than half an hour, including preparation and pain relief. After removing the nodes, you can go home straight away. The anesthesia will last long enough for you to be able to carry out your usual activities and work in comfort.