How to cure hemorrhoids: Home remedies to avoid operating room

As explained by doctors F. Bermejo San José and J. A. Álvarez Sánchez from the Carlos III Health Institute, hemorrhoids are a normal part of our body, pads made up of blood vessels that surround the anal canal, but there is talk of them as a nuisance at the popular level only when they are dilated and cause discomfort. . Until recently, hemorrhoidal disease was associated with constipation and its predisposing factors: age, low-fiber diet, and efforts to evacuate. However, they point out from the ISCIII, epidemiological studies have not shown a clear association with chronic constipation.

Thus, the cause is likely to be different for each patient: it may be due to weak connective tissue in the haemorrhoids, increased internal anal sphincter pressure, or local inflammatory conditions. They are classified in grades, from grade I (which do not exit the year) to grade IV (which are permanently out of the year and cannot be reintroduced).

Hemorrhoids can cause bleeding at the end of a bowel movement or when cleaning, anal pruritus (itching), and discomfort caused by the exit to the outside (prolapse) and the sensation of an anal "lump". In extreme cases the pain can be intense due to thrombosis and contracture of the anal sphincter. Hemorrhoids can be external or internal. The more external the hemorrhoids are, the more they bother and the more internal the more they bleed.

Most patients improve with initial conservative hygienic-dietary measures, or with minimally invasive treatments. As explained by the ISCIII and the Spanish Society of Family and Community Medicine (Semfyc), these are some of the most effective home remedies. This information is published solely for informative purposes and in no case can it replace a medical diagnosis or treatment. in case of health problems.

- adequate intake of fiber (fruits, vegetables, cereals) and sufficient fluids (at least a liter and a half of water per day) to increase and soften stools, since this reduces pain, prolapse and bleeding , and the deposition will take place without making efforts.

- Plantago ovata-type laxatives may be useful to achieve these goals if dietary fiber intake is insufficient.

- Sitz baths with warm-cold water, twice a day, are very useful for relieving the sensation of itching and local inflammation, along with proper local hygiene.

- Cortisone ointments can be administered locally in the prolapsed area, with a gentle massage, and for a short time (7-10 days); when administered for a long time, they cause skin atrophy and induce itching and scratching lesions.

- There are other ointments without corticosteroids that include topical anesthetics, vasoconstrictors or antispasmodics in their composition, and that can be used more frequently if necessary. All these ointments should be administered only when the patient presents discomfort.

- Avoid tight underwear

- Avoid toilet paper (if you use it, use a soft one, or better wipes for hemorrhoids). It is better to clean with a sponge or wet wipes. Semfyc insists that correct hygiene of the anus is fundamental and recommends the use of a neutral soap, although they point out that it is not good to wash it more than once or twice a day.

- Do physical exercise frequently, but activities such as cycling, horseback riding or rowing should be avoided.

- Avoid taking too much time to depose and avoid sitting for too long on the toilet, or making a lot of efforts to empty the intestines.

- Reduce coffee consumption

- Reduce excess salt, acids, chocolate, alcohol, spices or spicy

- Do not scratch even if it itches, because if you rub or scratch the hemorrhoids they will become more irritated.

- Apply ice if they swell for a few minutes and, "if they come out of the anus, it is best to try to return them to their usual position by applying slight pressure with your finger," they explain from Semfyc.

- Phlebotonics have been used in the treatment of hemorrhoids with mixed results.

- Diosmin (in tablets) seems to reduce the duration of bleeding in acute episodes of hemorrhoids and it has been suggested that it might decrease the number of bleeding episodes. It has few side effects and can be a good therapeutic option prior to evaluating the surgical alternative.

When should surgical treatment be considered? When the symptoms are resistant to conservative treatment or when complications appear. In general, patients with external hemorrhoids do not usually need surgical treatment, except when a thrombosis occurs, in which case, and within the first 48 hours, thrombus extraction can be performed under local anesthesia. Surgical treatment is aimed at reducing excess hemorrhoidal tissue. It is appropriate to start with minimally invasive techniques for grades I and II, leaving hemorrhoidectomy for grades III and IV or when minimally invasive techniques fail. Treatment can be by minor surgery or hemorrhoidectomy.

Within the minimally invasive techniques or minor surgery techniques, the best results in terms of recurrence and risks are achieved with elastic band ligation, which consists of placing two elastic rings at the base of the hemorrhoid to cause its thrombosis and healing (2-4 days later). This procedure is inexpensive, can be done in the office, and does not require anesthesia. The incidence of complications is between 1.5-3%, the most frequent being pain, bleeding and local infection. Other treatments, although less effective, are sclerotherapy (inject sclerosing agents directly into the hemorrhoidal tissue), infrared, bipolar diathermy, cryotherapy, and laser photocoagulation.

Hemorrhoidectomy: This surgical technique usually requires general or spinal anesthesia, although in some cases local anesthesia with sedation may be used. The most widely used technique is called Milligan and Morgan, and consists of removing the three main vessels that supply hemorrhoids. Circular hemorrhoidopexy has recently been introduced. Laser hemorrhoidectomy with ND:YAG or carbon dioxide has not shown significant advantages over other means. The results are good for most patients. The discomfort in the postoperative period and the recovery time are greater in conventional hemorrhoidectomy, however the results are the best in terms of recurrences and resolution of clinical problems.

Apart from early complications such as bleeding or pain, variables depending on the technique used, there are other potential dangers. The most important, although rare (less than 1%) is anal stenosis or narrowing. This complication requires surgical reintervention, although in some cases it can improve with dilators. Other equally important but exceptional complications are injury to the internal anal sphincter, which can affect stool continence, or fecal impaction (accumulation of hard stool in the rectum that is difficult to expel).