Pain and burning as well as bleeding to the point of prolapse: the symptoms of hemorrhoids may differ, as do the remedies, which vary depending on the condition, as Professor Antonino Spinelli, Head of Colon and Rectal Surgery at Humanitas explains.


What are hemorrhoids?

Hemorrhoids consist of a dense network of blood vessels, located in the terminal part of the anal canal, responsible for vascular supply and also, in part, continence. There is the internal hemorrhoidal plexus, located in the anal canal, and the external hemorrhoidal plexus, which is found at the anal margin. Hemorrhoids in the internal hemorroidal plexus are almost always the ones to give rise to disorders”.


What symptoms characterize the disorder?

In some cases, hemorrhoids can become symptomatic, generating pain and/or anal burning, with loss of blood drops after defecation, until it reaches prolapse, or they are expelled, resulting in painful and annoying sensation of itching, moisture and encumbrance.

Hemorrhoids are usually classified according to severity:

  • First degree, with a slight increase in internal hemorrhoids congestion without prolapse.
  • Second degree, with moderate increase in hemorrhoids congestion with external prolapse that tends to decrease spontaneously.
  • Third degree, significant hemorrhoid congestion with external prolapse that can only be reduced manually.
  • Fourth degree, with external non-reducible mucous-hemorroidal external prolapse.


How are hemorrhoids treated?

The remedies vary according to the patient’s condition, as Professor Spinelli explains: “For first-degree hemorrhoids, it is generally sufficient to drink at least two liters of water per day, follow a varied diet rich in fruits and vegetables, exercise, balance the intestine and cyclically take phlebotonic drugs to strengthen the vascular walls of the hemorrhoids.

For second-degree hemorrhoids, pharmacological treatment with outpatient treatments such as elastic bands or sclero-therapy is recommended. These include, in particular, the positioning of a rubber band or a sclerosing substance, which reduce the vascular flow to the hemorrhoids, causing them to decrease in volume. These procedures, if properly performed, are painless and generally improve symptoms, but have a limited effect over time.


When should surgery be used?

In third and fourth degree of hemorrhoids, surgery may be necessary. Professor Spinelli explains: “The intervention must lead to the best possible and lasting result. Hemorroidal de-arterialization, i.e. the interruption of arterial flow, through the use of a Doppler, is indicated in cases of bleeding and can be associated with mucous prolapse. The goal of the surgery is for all the mucosa affected by prolapse to be attracted inward and for the hemorrhoids to return to their position. This surgery does not involve open wounds, so it is less painful in the post-operative process and allows faster recovery.

Another surgical technique involves obliteration, i.e. the closure of hemorrhoid arterial branches with a laser and pleating the prolapse.

The traditional removal of hemorrhoids or hemorrhoidectomy is absolutely necessary for a fourth degree severity. This consists of the removal of fixed hemorrhoids outside the anal canal, allowing wounds to heal spontaneously within a few weeks. The post-operative pain can be more intense in the first few days, but it can be well managed with analgesic drugs. Finally, this type of intervention reduces the risk of a recurrence of this disorder more than any other procedure”.