Common symptoms include pain, burning and bleeding leading up to the prolapse of hemorrhoids. The symptoms of hemorrhoids can differ, as well as the remedies which vary depending on the situation, as explained by Professor Antonino Spinelli, Head of Surgery of the Colon and Rectum in Humanitas.


What are hemorrhoids?

“Hemorrhoids are constituted by a dense network of blood vessels and are located in the last part of the anal canal. They are small vascular bearings, in part responsible for our continence. There are the internal hemorrhoid plexus, located inside the anal canal, and the external hemorrhoid plexus, which is located at the level of the anal margin. In almost all cases where there are internal hemorrhoids there is a resulting disorder”.


What symptoms are manifested in the disorder?

In some cases, hemorrhoids can become symptomatic causing pain and / or burning, with possible presence of blood drops after defecation. When they enter prolapse or break they result in increased pain and an annoying itch, dampness and clutter.

Generally, hemorrhoids are classified according to the severity:

  • First stage, a slight increase in internal hemorrhoidal congestion without prolapse.
  • Second degree, moderate increase of hemorrhoidal congestion external prolapse is decreasing spontaneously.
  • Third degree, major congestion with external hemorrhoid prolapse which can be reduced only manually.
  • Fourth degree, with prolapse outside and not reducible.


How do you treat hemorrhoids?

The remedies vary according to the patient’s condition, as explained by Professor Spinelli: “For a first degree hemorrhoidal disease it is usually sufficient to drink at least two liters of water a day, follow a diet rich in fruits and vegetables, engage in physical activities, regulate your intestine, and take cyclically phlebotonic drugs to strengthen the vascular walls of the hemorrhoidal plexus.

For hemorrhoid disease of the second degree, you need to support your drug treatment with outpatient treatments such as sclerotherapy or elastic ligatures. Specifically this includes the placement of an elastic or a sclerosing substance, which reduces the vascular supply, causing the hemorrhoids to decrease in volume. These procedures, when performed properly in appropriate cases are painless and usually improve symptoms, but have a limited effect over time”.


When do we consider surgical intervention?

In the third and fourth grade disease, you may need surgery says Professor Spinelli: “The operation must lead to the best and most enduring results possible. The dearterialization of the hemorrhoids, or the interruption of arterial flow, through the use of a Doppler is indicated in cases of bleeding. It is important that the affected mucosa prolapses from being drawn towards the inside and that the hemorrhoids return to their original position. This does not involve open wounds, and is less painful post-operative and enables faster recovery.

Another technique involves the direct removal, ie closure of the hemorrhoid arterial branches, and intervention with laser and with pleating of the prolapse.

“For the fourth degree it is absolutely necessary to opt for the traditional intervention of removal of hemorrhoids, or hemorrhoidectomy. This involves the removal of fixed hemorrhoid clusters outside the anal canal, leaving the wounds to heal spontaneously within a few weeks. The pain for several days after surgery may be more intense, but it is well controlled with analgesics and this intervention significantly reduces the risk of a relapse of the disorder.”