There is a lot of methods safely and simply treat most cases of symptomatic hemorrhoids, however, we do it only when we are sure that the patient complains about the symptoms of hemorrhoids, and not about the other disease. Usually after the evaluation of disease's history, clinic the patients of older age are directed to examine the large intestine and make sure that the reason of complaint is hemorrhoids.
There are not accurate data, whether local physiotherapy and pharmacological hemorrhoids treatment (baths, anesthetics, corticosteroids, ice) was significant in case of hemorrhoids. Earlier while examining, the improper methods have been used, there was not control with placebo and, therefore, the results were not reliable.
While treating hemorrhoids the popular medicines of local effect (creams or enemas are sold without prescriptions at the chemist's) are combined with corticosteroids or anesthetics. It is empirically determined that such treatment (especially the combination of corticosteroid and non-steroid inflammatory medicines) is effective to most patients. However, it is necessary to know about possible local allergic reactions and skin sensitivity using these medicines for a long period.
Several phlebotonic medicines are described in the literature. The best examined one is diosmin, registered with the title Detralex and Cyclo 3 forte. It is considered that the active components directly affect the inflammatory mediators (histamine, bradicinine, serotonine) that cause pain, itching, tingle, and other symptoms. These medicines are prescribed in the large doses when the acute attack of hemorrhoids begins. Later the supportive long-lasting treatment with smaller doses is applied. It is determined with the help of researches with patients, who have I or II attacks of hemorrhoids, that this medicine effectively reduces the duration of bleeding, as well the lower bleeding after hemorrhoidectomy is watched when these medicines are prescribed. It is proved that flavonoids are safe to use even for the pregnant women.
In most cases perianal thrombosis passes by itself, therefore, symptomatic treatment anti-inflammatory painkillers, emollients for excrements - can be sufficient. The non-steroid anti-inflammatory medicines are effective in the cases of both external and internal thrombosis of hemorrhoid nodes.
The goal of all performed non-operational and invasive procedures of hemorrhoids is to attach the falling hemorrhoid tissues to the muscle wall of anus canal or to remove them. It is possible to fix directly causing fibrosis of tissues (e.g., sclerotherapy or coagulation with infrared rays) or destroying the tissue and it causes the second fibrosis (e.g., hemorrhoidectomy).
Usually the hemorrhoid nodes are pressed with elastic rings and coagulated with infrared rays. Bipolar electro-coagulation, direct current of low voltage, sclerotherapy or frustration with cold also can be applied.
It is determined that the most effective one is the pressure of nodes with elastic rings and coagulation with infrared rays. One great international research showed that the method of rings is more effective because then it needs less repetitive symptomatic medical means when the features of disease renew comparing with the method of coagulation and sclerotherapy, however, there was more complications treating with elastic rings than with the method of coagulation.
The other research showed that the method of rings was of the similar efficiency as well as other invasive procedures, also related with the similar number of complications; however, it was more painful. It showed that doctors usually use this method to treat 1 - 3 hemorrhoid nodes. Thus, in general it can be stated that the advantage of method of elastic rings is confirmed among the non-invasive medical methods of hemorrhoids. It is necessary to pay attention - it is effective only for those patients that need such treatment.
Even though the surgical treatment is more damaging and more expensive but in the case of symptomatic hemorrhoids it is the most effective and the last remedy while treating this disease. The goal of such treatment is to remove the excess of hemorrhoid tissues and to reduce the blood flow into anorectal area. It can be performed in several ways. Fergusson hemorrhoidectomy is usually chosen in USA. The open operational method offered by Milligan and Morgan is used in most European countries. The efficiency of operation does not differ while operating hemorrhoid nodes in both ways.
Practically all surgeons agree that hemorrhoidectomy is more effective than all other medical methods; however, then the complications are more common, a part of patients do not accept pain, its bigger price.
In the clinical recommendation reasoned by the evidences it is offered to treat the non-falling bleeding and I - II hemorrhoid nodes with the coagulated procedures leaving the pressure with rings for the more strongly prolabating (III) nodes. It is also recommended so because the non-falling bleeding hemorrhoid nodes are made of small amount of tissues, they are not overthrown with rings.
The surgical hemorrhoidectomy has to be applied in the cases of IV hemorrhoid nodes and II - III nodes when they cannot be cured in other methods. However, such classification is not strict. The experienced and qualified doctor has to decide regarding the way of treatment, the decision is also influenced on the patient's wishes, characteristics of clinical case and available resources. In over 90 percent of cases the treatment of hemorrhoids does not need surgery.
Hemorrhoids are often a chronic problem worsening in the course of time. According to the data of population-based research most patients feel several exacerbations of this disease over their lives. However, it is a benign contraction of a disease; at least 90 percent of patients do not need surgical treatment of this disease.
It is worth to emphasize that at least half of patients that were treated with invasive methods more than 5-10 years have to repeat treatment or they are operated, not speaking about permanent treatment with medicines, suppositories, restriction of diet, etc.
Only clinically showing hemorrhoid nodes have to be treated. Most patients can be cured only conservatively or after one-time procedure.
Small hemorrhoid nodes are treated with medicines. The falling hemorrhoids are not cured with the conservative therapy; they are effectively treated with the method of rubber rings.
The surgical hemorrhoidectomy has to be applied in the cases of IV hemorrhoid nodes and II - III nodes when they cannot be cured in other methods.
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