Hemorroides_sintomasDietetic, hygienic, postural

• Avoid obesity and constipation
• Avoid spicy foods, seasonings, spices and dressings, garlic, parsley, onion, mustard, tomato, vinegar, coffee, dark chocolate, tea and alcohol
• Avoid constant abdominal efforts; if the job requires sitting for many hours, getting up and walking for a few minutes every hour; Do not wear clothing that is too tight at the level of the abdomen, such as girdles or belts, especially in the case of pregnant women
• Exercise regularly, at least 30 minutes three times a week (walking, running or cycling on a stationary bike) in order to improve circulation

Ointments

• Corticosteroid anti-inflammatories: topical. They are inexpensive and very effective in inflammation at the beginning of thrombosis of both internal and external hemorrhoids. How to use: apply the ointment 2-3 times a day after defecation
• Contraindicated in pregnant women, bleeding hemorrhoids and for prolonged periods, and that produce local and systemic effects
• Non-steroidal anti-inflammatory drugs: also inexpensive, but slower-acting, hardly produce side effects. They are used as maintenance treatment

Oral Drugs

• Nonsteroidal anti-inflammatory drugs
• Drugs to improve venous circulation

Surgical

Hemorroidectomía

Indicated as treatment of third and fourth degree hemorrhoids, large thrombosed prolapses, patients with coagulation disorders, patients treated with anticoagulants, even if they are carriers of internal hemorrhoids, and that with ligation there is a risk of aggravating the hemorrhage

It is carried out in the operating room. Availability of an anaesthetist

Various techniques are available: scalpel, scissors, laser, etc.

The incision is left closed, open or semi-openv It is important that during the intervention a sphincter control is maintained; The so-called mucous bridges (an area of unintervened mucosa) are left between the removed hemorrhoids, since, otherwise, there is a risk of anal stenosis. Good long-term results. The patient will be warned that they may experience recurrences, although they are less frequent than with the other techniques

Do regular checks with postoperative digital rectal examination.

Elastic bands

Indicated for second- and third-degree internal hemorrhoids at a distance of 1-2 cm from the pectine line. Ligation is carried out without the need for anesthesia. It hardly requires any equipment: a special vacuum cleaner equipped with rubber bands that strangle the hemorrhoid. Ligation is carried out in the consultation. The only requirement is to have the vacuum cleaner.

Other surgical techniques

• Hemorroidectomía circunferencial.
• Longo's technique

Other techniques

Indicated in hemorrhoids of first and second degree. They are simple techniques that are carried out in the consultation.

• Sclerosing injections. Irritating chemicals are injected.
• Photocoagulation. Pedicle fibrosis with diathermy.
• Cryocoagulation. Hemorrhoid coagulation by freezing with liquid nitrogen

Treatment in emergencies

Non-thrombosed inflamed hemorrhoids

• Sitz baths with warm water 2-3 times a day
• Local anti-inflammatory ointments (corticosteroids or other local anti-inflammatories)
• Diet rich in fiber and plenty of water
• Analgesics
• Drugs that improve venous circulation

Single thrombosed hemorrhoid
Surgical debridement (removal of the clot) under local anesthesia that is injected into the base of the hemorrhoid. The incision is left open. Warn the patient that he will bleed during grooming. (A common complication is a new thrombosis within a few hours.)

Thrombosed and prolapsed (including ulcerated)
HemorrhoidsPatient evaluation. An urgent hemorrhoidectomy will often be required in the operating room.