What are Hemorrhoids?

Hemorrhoids are cushions of fibrovascular tissue in the anus helping to seal the anus and maintain anal continence. They can be easily irritated, become enlarged and form into swellings, often caused by straining and constipation.

Hemorrhoidal disease describes the swollen or inflamed state of these vascular structures inside or around the anal canal. It is the most frequent anorectal disease with 5%-40% occurrence in the population.

Hemorrhoids can be located internal at the upper part of the anal canal in the rectum or external under the skin around the anus.

What are Typical Symptoms Caused by Hemorrhoids?

Bleeding is the most common presenting symptom as hemorrhoidal tissue has increased blood supply.

  • When internal hemorrhoids prolapse through the anal canal the tissue can become traumatized leading to bleeding that is bright red in color
  • Internal Hemorrhoids may cause itching and perineal irritation
  • Prolapsing tissue can lead to “fecal soiling” by impeding the ability of the anal verge toseal
  • External Hemorrhoids are typically asymptomatic unless they become thrombosed orinflamed
  • External thrombosed Hemorrhoids cause a painful perianal swelling

How are Hemorrhoids Diagnosed?

Medical History + Physical Examination

A visual inspection of the peri-anal area will allow for the description of any external abnormalities.

Digital Rectal Examination

  1. Colonoscopy: Allows the endoscopic examination of the entire colon
  2. Flexible Sigmoidoscopy: Endoscopic examination of the large intestine from the rectum
    up to the sigmoid (distal colon)
  3. Anoscopy: An anal speculum (anoscope) is used for internal inspection of the lower

Hemorrhoid Embolization

Procedural Details

An Interventional Radiologist performs this minimally invasive procedure under local anesthesia and moderate sedation in patients with internal hemorrhoids of grade one, two or three. Internal hemorrhoids are composed of a dense arteriovenous network called Corpus Cavernosum Recti (CCR). The embolization of the hemorrhoidal artery aims to reduce the blood flow in the CCR, thus reducing the venous pressure and symptoms.

The procedure is performed through a needle hole in the wrist or the groin through which a thin catheter is inserted into the rectal artery under x-ray guidance. The catheter is guided through the superior rectal artery tree to the terminal branches while the Interventional Radiologist watches the progress of the procedure using a moving x-ray (fluoroscope).

Small coils and/or microspheres are placed into the terminal branches of the arteries to seal the vessels. It may be necessary to repeat the embolization for hemorrhoids on the opposite side, through the same opening and using the same catheter and microcatheter combination.

Hemorrhoidal artery coil embolization is a painless technique. The procedure is approx. 45 minutes. After the procedure, patients can return home on the same day and back to work the following day in most circumstances.

What are The Treatment Options for Hemorrhoids?

There are several suggested treatments, according to the severity of the symptoms:

  • Dietary and lifestyle changes
  • Drug therapy
  • Non-surgical minimally invasive treatments
    • Rubber Band Ligation
    • Radiofrequency Ablation
    • Infrared Photocoagulation
    • Sclerosis Injection
  • Surgery: Minimally invasive surgery
    • Doppler-guided hemorrhoidal ligation (DGHAL)

Alternative non-surgical treatment

  • Hemorrhoidal Embolization of the Superior Rectal Arteries

Advantages of The Embolization Technique

  • Leaves hemorrhoidal tissue in place
  • No general anesthesia needed
  • Preserves anal continence
  • Does not involve the creation of rectal wounds
  • Good short-term results

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