Treatment of acute haemorrhoids

Acute haemorrhoids are most often a continuation of chronic ones. In its treatment, therapeutic and surgical methods are used. Their choice depends on the stage of chronic haemorrhoids and the severity of its acute form, the frequency and severity of relapses. Our proctology center uses all modern technologies to quickly and effectively overcome the disease, even in complex clinical cases. We have been successfully using minimally invasive non-surgical technologies for a long time, which eliminate haemorrhoids forever and do not require long-term recovery.

What is acute haemorrhoids

Acute haemorrhoids are thrombosis of the haemorrhoidal node. In most cases, this is an exacerbation of chronic haemorrhoids. Thrombi (blood clots) provoke an inflammatory process in the vascular walls and block the lumen of the vessel, which leads to disruption of the node’s nutrition.
The formation of blood clots in the rectal venous plexuses occurs against the background of dilation (varicose veins) of blood vessels, stagnation of blood and lymph, and increased physical activity. Acute haemorrhoids in men most often occur due to heavy physical labor, in women – during pregnancy. Risk factors for both sexes include sedentary work and a tendency to constipation.

Types of haemorrhoids

Based on the location of the affected nodes, 2 types of disease are distinguished:

• External acute haemorrhoids, in which blood clots form in the external plexuses around the anus (anus).
• Internal acute haemorrhoids – thrombosed nodes are located under the mucous membrane of the rectum.

According to the severity of the disease, there are 3 degrees of severity of acute haemorrhoids:

• I degree – thrombosis without inflammation.
• II – thrombus formation with moderate local inflammation.
• III – a common inflammatory process, severe ischemia (lack of nutrition) of the nodes, often accompanied by their necrosis (death).

During diagnostic procedures, it is important to accurately determine the type of acute haemorrhoids. Different forms of the disease require different treatment approaches.

Symptoms of acute haemorrhoids

Acute haemorrhoids are indicated by:

• Induration and pain of haemorrhoidal “bumps.”
• Pain and itching in the anal area that persists after defecation.
• Feeling of incomplete bowel movement.
• Redness and swelling of the area around the anus.

With internal acute haemorrhoids, the nodes located inside protrude outward, beyond the anus. Over time, external and internal nodes may ulcerate, become covered with purulent plaque, and turn black (which indicates necrosis).

How to treat acute haemorrhoids

Acute haemorrhoids are treated with both conservative therapeutic and surgical methods. Conservative treatment is used as an independent method or as preparation for surgery.

All therapeutic methods are aimed at temporary improvement of the condition. They do not completely eliminate the causes of thrombosis, so treatment courses have to be carried out periodically during the next exacerbation of haemorrhoids. If relapses occur infrequently and are not too severe, therapy alone may be sufficient. Independent conservative treatment is indicated for patients for whom surgery is contraindicated – with severe general diseases or pronounced disorders of the coagulation system. In cases of frequent exacerbations or severe acute haemorrhoids, we recommend surgical treatment if there are no justified contraindications. Depending on the clinical case and the chosen method, it can be performed immediately or after preparatory therapy over 3-9 (or more) days.

Common methods of conservative treatment

Conservative (therapeutic) methods are ways of treating acute haemorrhoids without surgical intervention. Medicinal therapy is particularly widely used, including the following forms of medicine:

• Rectal suppositories.
• Ointments, gels, therapeutic external suspensions, and solutions.
• Systemic drugs – tablets for oral administration.

Systemic agents have faster and more pronounced effects. Topical medications (ointments and suppositories) ) act primarily in the area of application, have fewer undesirable side effects and contraindications than systemic ones.
The best effect is achieved by combining several drugs and types of treatment: medication and physiotherapy; in the case of constant unbearable pain – a novocaine blockade. The optimal treatment plan for each patient is selected by a doctor. Self-medication often leads to complications. Special attention is required when choosing therapy in the case of acute haemorrhoids during pregnancy – a number of medications and certain procedures are contraindicated in such situations.

Tablets “Detralex 1000”

“Detralex 1000” is a modern effective natural-based drug used in the treatment of all forms of haemorrhoids, including acute stages I-II. Its active ingredients are purified flavonoids – natural pigments and antioxidants. The remedy is well tolerated by patients and has few contraindications. It is not recommended only for pregnant women and children, as well as people with individual intolerance to the active and auxiliary components of the tablet.
“Detralex” acts in several ways:

• Increases the tone of vascular walls.
• Promotes lymphatic drainage.
• Facilitates oxygen access and stimulates metabolic processes in tissues.
• Blocks the synthesis of active biological substances that trigger inflammation and thrombosis.

This contributes to the rapid elimination of inflammation symptoms, prevention of further thrombus formation, and prevention of purulent complications.

Suppositories

Rectal suppositories are a universal remedy for the treatment of acute external and internal haemorrhoids. After being introduced into the anus, they melt and turn into a healing cream that envelops the affected tissues inside and out. In the treatment of mild to moderate acute haemorrhoids, the following medications are used in the form of rectal suppositories:

• With antimicrobial agents – “Proctosedyl M.”
• With powerful anti-inflammatory drugs (corticosteroids) – “Relief Ultra”, “Hepatrombin G”, “Proctosedyl M”.
• With heparin (a substance that prevents blood clots) – “Nigepan”, “Hepatrombin G”
• With probiotics – “Posterizan”. The drug normalizes the microflora of the colon, which helps suppress infectious inflammation.
• With local anesthetics and antispasmodics, painkillers for acute haemorrhoids – “Relief Advance”, “Proctosan”, “Nigepan”, “Betiol”, “Proctosedyl M”, “Ultraproct”.

In the treatment of acute stage III thrombosis, Baliz suppositories are used with a pronounced antimicrobial, anti-inflammatory and wound-healing effect.

Ointments, gels and external mixtures

Ointments and solutions are a convenient dosage form for the treatment of acute external haemorrhoids. Most drugs in the form of suppositories have analogues in the form of ointments with a similar composition and effect.
In addition, the following ointments and gels are used in the treatment of uncomplicated acute haemorrhoids:

• Troxevasin gel and heparin ointment that prevent thrombosis.
• Aurobin is an anti-inflammatory and analgesic ointment with a local anesthetic and corticosteroid.
• Levomekol is an ointment with the antibiotic chloramphenicol and the wound-healing substance methyluracil.
• Levosin is an analogue of Levomekol ointment with the addition of a local anesthetic.

For the treatment of severe acute haemorrhoids complicated by necrosis, use Baliz-2 ointment or applications of a mixture containing trypsin, diphenhydramine, dimexide.

Physiotherapy

One of the most effective methods of treating acute haemorrhoids is laser therapy. Unlike surgical methods, treatment is carried out not with a high-energy, but with a low-energy laser that does not destroy tissue. The treatment course consists of 5-7 sessions lasting 5-7 minutes. As a result, the inflammation subsides, the nodes soften and become less painful.

Treatment of acute pain due to haemorrhoids

For intense pain that cannot be relieved by other means, the following may be used:

• Novocaine blockades. Pararectal blockade involves injecting novocaine into the intradermal layers and subcutaneous tissue. Presacral blockade involves the introduction of an anesthetic into the deeper layers of soft tissue near the nerve plexuses of the rectum. The analgesic effect occurs immediately and lasts from one to several hours. After the blockade ends, the pain is less intense and is easier to relieve with local suppositories and ointments. For more effective complex treatment of acute haemorrhoids, antibiotics and corticosteroids can be administered along with novocaine.
• Prolonged sacral analgesia is a method of pain relief by administering an anesthetic drug into the spinal canal at the level of the junction between the lumbar and sacral regions. After the procedure, pain sensitivity in the perineum is completely lost. A catheter is placed at the puncture site, through which medication can be administered as needed after the procedure. This method is used to relieve pain and relieve anal spasm in the treatment and diagnosis of acute haemorrhoids. Spinal-epidural anesthesia is conducted on the same principle and is used during surgical operations. The difference lies only in the types and dosages of the medications used.

Provided that the technologies are strictly followed, these methods are much more effective and safer for the body than the usual painkillers – nonsteroidal anti-inflammatory drugs. The proctologists at our center have mastered all techniques for anesthetizing acute haemorrhoids.

Folk treatment

Home treatment with folk methods includes:

• Warm or cold sitz baths.
• Compresses using medicinal herbs.
• Consumption of decoctions and infusions of medicinal plants internally.

As phytotherapeutic raw materials for acute haemorrhoids for internal use, kidney sorrel, nettle, yarrow, raspberry leaves, and beet juice are used. For local applications and baths, St. John’s wort, sage, chamomile, propolis, and honey are used. We do not recommend microclysters and “homemade” suppositories, which often easily injure inflamed tissues and can provoke infection or bleeding.
The use of all folk methods must be coordinated with a doctor; otherwise, self-treatment can lead to complications. For example, warm baths are fraught with the spread of the infectious process, and cold ones can cause inflammation of the genitourinary tract. In addition, the active substances of medicinal herbs do not always interact favorably with pharmaceutical drugs.

Surgical methods – the most effective treatment for acute haemorrhoids

The only way to get rid of acute haemorrhoids permanently is surgical intervention. For acute haemorrhoids of grades I-II, we usually perform minimally invasive non-surgical treatment – laser thrombectomy. The essence of the method is the extraction of the thrombus through a small puncture followed by the destruction of the capsule at the site of thrombosis using a laser. The procedure is performed on an outpatient basis (the patient is discharged home the same day) and does not require long recovery – normal daily activities can be resumed the day after the procedure. Acute pain and cosmetic defects (lumps in the anal area) disappear immediately. There are no significant restrictions after such a procedure – there is no need to follow a strict diet or significantly reduce physical activity. You can resume work immediately if you do not engage in heavy physical labor.

In more severe cases – with frequent disease relapses, persistent prolapse, and ulceration of the nodes – we conduct preparatory anti-inflammatory therapy, and then perform one of the following interventions:

• Haemorrhoidectomy. Laser coagulation – a non-surgical removal of haemorrhoids – is performed in the early stages of both external and internal forms of the disease. The Longo procedure is performed for pronounced internal haemorrhoids. If the patient has advanced internal or combined haemorrhoids, accompanied by significant irreversible changes, a classic Milligan-Morgan operation is performed – complete comprehensive removal of the nodes.
• Ligature with latex rings – a non-surgical procedure, tying off the stalk of an external or internal node, which causes its gradual atrophy.
• HAL-RAR (node dearterialization) – tying off the blood vessels supplying the affected plexus with stitching the node to the rectal mucosa. It eliminates internal haemorrhoids at any stage.

Surgical interventions are carried out using modern minimally invasive technologies – spinal-epidural anesthesia, laser, and electrosurgery. This allows:

• Making surgical treatment available to most patients, including elderly people with chronic general diseases.
• Avoiding complications and negative consequences of the operation – massive bleeding, purulent infection, haemorrhoid recurrence.
• Significantly shortening and easing the course of the recovery period.

We will completely rid you of haemorrhoids – quickly, without pain and fear.