Hemorrhoids are cushions of fibrovascular tissue in the anus helping to seal the anus and maintain anal continence. They can be easily irritated, become enlarged and form into swellings, often caused by straining and constipation.
Hemorrhoidal disease describes the swollen or inflamed state of these vascular structures inside or around the anal canal. It is the most frequent anorectal disease with 5%-40% occurrence in the population.
Hemorrhoids can be located internal at the upper part of the anal canal in the rectum or external under the skin around the anus.
What are Typical Symptoms Caused by Hemorrhoids?
Bleeding is the most common presenting symptom as hemorrhoidal tissue has increased blood supply.
When internal hemorrhoids prolapse through the anal canal the tissue can become traumatized leading to bleeding that is bright red in color
Internal Hemorrhoids may cause itching and perineal irritation
Prolapsing tissue can lead to “fecal soiling” by impeding the ability of the anal verge to seal
External Hemorrhoids are typically asymptomatic unless they become thrombosed or inflamed
External thrombosed Hemorrhoids cause a painful perianal swelling
How are Hemorrhoids Diagnosed?
Through Medical History + Physical Examination
A visual inspection of the peri-anal area will allow for the description of any external abnormalities.
Digital Rectal Examination:
Colonoscopy: Allows the endoscopic examination of the entire colon
Flexible Sigmoidoscopy: Endoscopic examination of the large intestine from the rectum up to the sigmoid (distal colon)
Anoscopy: An anal speculum (anoscope) is used for internal inspection of the lower rectum
What are The Treatment Options for Hemorrhoids?
There are several suggested treatments, according to the severity of the symptoms:
Dietary and lifestyle changes
Non-surgical minimally invasive treatments
Rubber Band Ligation
Surgery: Minimally invasive surgery
Doppler-guided hemorrhoidal ligation (DGHAL)
Alternative non-surgical treatment:
Hemorrhoidal Embolization of the Superior Rectal Arteries
Advantages of The Embolization Technique
Leaves hemorrhoidal tissue in place
No general anesthesia needed
Preserves anal continence
Does not involve the creation of rectal wounds
Good short-term results
Superior Rectal Artery Embolization:
An Interventional Radiologist performs this minimally invasive under local anesthesia and a moderate sedation in patients with internal hemorrhoids of grade one, two or three. Internal hemorrhoids are composed of a dense arteriovenous network called Corpus Cavernosum Recti (CCR). The embolization of the hemorrhoidal artery aims to reduce the blood flow in the CCR, thus reducing the venous pressure and symptoms.
The procedure is performed through a needle hole in the wrist or the groin through which a thin catheter is inserted into the rectal artery under x-ray guidance. The catheter is guided through the superior rectal artery tree to the terminal branches while the Interventional Radiologist watches the progress of the procedure using moving x-ray (fluoroscope).
Small coils and/or microspheres are placed into the terminal branches of the arteries to seal the vessels. It may be necessary to repeat the embolization for hemorrhoids on the opposite side, through the same opening and using the same catheter and microcatheter combination.
Hemorrhoidal artery coil embolization is a painless technique. The procedure is approx. 45 minutes. After the procedure, patients can return home on the same day and back to work the following day in most circumstances.
If you would like to be considered for this minimally invasive treatment, please email us at firstname.lastname@example.org