With 70% of the American people being affected with hemorrhoids at some point in their lives, it’s important to find hemorrhoids treatment that really works. Hemorrhoids also spelt hemroids and is sometimes referred to as the “silent pain” due to peoples embarrassment to talk about it.

Internal hemroids are subepithelial vascular cushions consisting of connective tissue, smooth muscle fibers, and arteriovenous communications between terminal branches of the superior rectal artery and rectal veins.

External hemorrhoids or hemroid arise from the inferior hemroids veins located below the dentate line and are covered with squamous epithelium of the anal canal or perianal region. Hemorrhoids may become symptomatic as a result of activities that increase venous pressure, resulting in distention and engorgement. Straining at stool, constipation, prolonged sitting, pregnancy, obesity, and low-fiber diets all may contribute. With time, redundancy and enlargement of the venous cushions may develop and result in bleeding or protrusion.

Clinical Findings

A. SYMPTOMS AND SIGNS

Patients often attribute a variety of perianal complaints to “hemroids.” However, the principal problems attributable to internal hemroids are bleeding, prolapse, and mucoid discharge. Bleeding is manifested by bright red blood that may range from streaks of blood visible on toilet paper or stool to bright red blood that drips into the toilet bowl after a bowel movement. Rarely is bleeding severe enough to result in anemia.

B. EXAMINATION

External hemroids are readily visible on perianal inspection. Nonprolapsed internal hemroids are not visible but may protrude through the anus with gentle straining while the physician spreads the buttocks. Prolapsed hemroids are visible as protuberant purple nodules covered by mucosa. The perianal region should also be examined for other signs of disease such as fistulas, fissures, skin tags, or dermatitis.

Differential Diagnosis

Small volume rectal bleeding may be caused by anal fissure or fistula, neoplasms of the distal colon or rectum, ulcerative colitis or Crohn’s colitis, infectious proctitis, or rectal ulcers.

Approach for hemroid treatment

A. Conservative Measure

Most patients with early (stage I and stage II) disease can be managed with conservative treatment. To decrease straining with defecation, patients should be given instructions for a high-fiber diet and told to increase fluid intake with meals. Dietary fiber may be supplemented with bran powder or with commercial psyllium bulk laxatives. Mucoid discharge may be treated effectively by the local application of a cotton ball tucked next to the anal opening after bowel movements. For edematous, prolapsed hemorrhoids, gentle manual reduction may be supplemented by suppositories or topical pads containing witch hazel that have anesthetic and astringent properties and by warm sitz baths. This the first treatment to make hemroids relief.

B. Medical treatment

Patients with stage I, stage II, and stage III hemroids and recurrent bleeding despite conservative measures may be treated without anesthesia with injection sclerotherapy, rubber band ligation, or application of electrocoagulation (bipolar cautery or infrared photocoagulation). The choice of therapy is dictated by operator preference, but rubber band ligation increasingly is preferred due to its ease of use and high rate of efficacy.

C. Surgical Treartment

Surgical excision (hemorrhoidectomy) is reserved for < 5–10% of patients with chronic severe bleeding due to stage III or stage IV hemroids or patients with acute thrombosed stage IV hemroids. Complications of surgical hemorrhoidectomy include postoperative.