What are hemorrhoids?
Hemorrhoids are a system of veins and arteries located in the anus. This system is present in all people, but in certain situations hemorrhoids can become enlarged and create a variety of symptoms. This condition is called hemorrhoidopathy. It occurs in about 75% of people at some point in their lives, mainly in the female population.

Causes of hemorrhoids
The causes of hemorrhoids can vary. Some of them are:

Chronic constipation
Pressure during defecation
Diet low in fiber and liquids
Hereditary predisposition
Anal sex

Categories of hemorrhoids
Hemorrhoids are divided into external and internal. External hemorrhoids are located under the skin of the anus. They often become thrombosed.. Its treatment is immediate under local anesthesia with incision and drainage of the clot.

Internal hemorrhoids can project and are divided into 4 categories:
First degree hemorrhoids: they do not protrude outwards
Secondary hemorrhoids: they protrude during bowel movements and resolve on their own
Third degree hemorrhoids: protrude during bowel movement and can only be manually retracted
Fourth-degree hemorrhoids: permanently protrude and do not retract even with the hand

Hemorrhoids – Symptoms
Pain in the anus
Bleeding (bright red blood in the stool and on the toilet paper)
Itching in the anus area
Mucus secretion
Sensation of a foreign body in the anus

Hemorrhoids- Possible complications
If hemorrhoids are not treated immediately, they may develop one of the following complications:

Heavy bleeding and anemia
Acute thrombosis of hemorrhoids
Liver infection

Hemorrhoids & treatment
The treatment of hemorrhoids is divided into conservative and surgical. Conservative treatment mainly concerns the 1st and 2nd degree stages of internal hemorrhoids. It includes a diet rich in fibers (vegetables, fruits, whole grains), at least two liters of water a day, the use of topical ointments with analgesic and anti-inflammatory effects, and the use of medicines that soften stools and relieve constipation.
Also, local washing of the anal area with warm (but not hot) water, avoiding the use of toilet paper and avoiding the consumption of alcohol and spicy foods are recommended. Surgery is mainly performed to stage 3 and 4 internal hemorrhoids and in case of failure of conservative treatment.

Hemorrhoids & How to treat them
Nowadays there are several bloodless, painless and effective operations depending on the degree, number and location of hemorrhoids.

1) Banding of hemorrhoids
This technique is the method of choice as the first treatment for hemorrhoids up to the 3rd degree in the specialized proctology centers of the USA and the UK. The great advantage of this method is that it is performed in the doctor’s office without anesthesia and is painless.
With the use of a special tool and through a proctoscope, elastic rings are placed at the base of the hemorrhoids as a result of which they cut off the blood supply to the hemorrhoids, causing them to atrophy and in less than a week the hemorrhoids disappear. According to the international literature, the success rate reaches 70%. It is the initial method of choice, because it is carried out without anaesthesia, is painless and particularly economical compared to the other methods

2) Milligan-Morgan hemorrhoidectomy
With this technique we perform a radical removal of hemorrhoids and it is ideal for hemorrhoids of the 3rd and 4th degree. It is considered the most radical method of treating hemorrhoids, with the lowest recurrence rates according to international literature. It used to be considered a painful method. Nowadays it is carried out with the help of state-of-the-art laser and ultrasound tools. Thus, postoperative pain is tolerable.
3) Stapler technique
This method is performed for 3rd degree hemorrhoids. With the help of a special tool (circular anastomator), a circular section of the intestinal mucosa above the hemorrhoids is excised and the remaining part of the intestine is simultaneously anastomosed. Thus, with this method we do not remove the hemorrhoids. On the contrary, we reduce their blood supply and also pull them back in . This technique is relatively painless and is performed under general or spinal anesthesia.
4) HAL or THD
These two methods have a similar philosophy and are essentially the same technique. Using special ultrasound tools, we locate the arteries that supply blood into the the hemorrhoids and ligate them. Thus, gradually the hemorrhoids shrink. Essentially, we don’t remove the hemorrhoids, we just destroy their blood supply. This method is relatively painless since we do not create wounds and is used for 2nd and 3rd degree hemorrhoids.
5) Laser Hemorrhoidoplasty (LHP)
This method is the most modern treatment of hemorrhoids. With this technique, through a small hole in the hemorrhoid, we insert a thin fiber that emits Laser co2 energy. This fiber cauterizes the hemorrhoid destroying it from the inside. It is a method ideal for 2nd and 3rd degree hemorrhoids. It is an excellent choice as it is completely painless and the patient immediately returns to his daily life. This method can also be performed in the doctor’s office.
6) Rafaelo operation
It is a method which has a similar philosophy to Laser. With this technique, we insert a thin fiber directly into the hemorrhoid nodule, cauterizing it with the help of radio frequency waves. In relation to the Laser, it uses less energy and causes a smaller burn in the area, therefore making the operation even more painless. The Rafaelo method is used for second and third degree hemorrhoids, is painless, and is performed in the office in 15 minutes.

What is the best operation to get rid of hemorrhoids?
The choice of operation is made after a clinical examination of the patient. Each case is different and depending on the degree, number and location of the hemorrhoids we choose the appropriate method. The bandaging of hemorrhoids is done in the doctor’s office at a particularly low cost and does not require hospitalization. In many cases both the laser method and the Rafaelo method can be performed in the office and the patient is discharged immediately. The rest of the methods are done in the clinics and the patient leaves the clinic the same day.

General Surgeon Alexandros Kyritsis with extensive experience and years of expertise in rectal surgery in leading UK and USA hospitals is at your disposal to provide you with a personalized diagnosis. If you suffer from hemorrhoids, contact your doctor to receive a special treatment plan tailored to your needs.

Should all categories of hemorrhoids be operated ?
The answer is no. Hemorrhoids that should be operated are those that cause, due to bleeding, a drop in hematocrit, or those that clot frequently causing pain in the area, or those that frequently prolapse and are repositioned with the finger. Also, in some cases it is reasonable to operate on hemorrhoids if they cause a cosmetic problem for the patient.

Can hemorrhoids turn into cancer over time?
It must be emphasized that under no circumstances can hemorrhoids cause cancer. Often the presence of red blood causes fear in the patient and a clinical examination of the anus is necessary to clarify the presence or not of hemorrhoids.

What is the best method and how long will I be in pain after the operation?
Each case is different and after a clinical examination we can to choose the appropriate operation. According to the literature, excision of hemorrhoids with Ligasure is the method with the lowest recurrence rate but also has a recovery period of 10-15 days. The less invasive methods (laser, Rafaelo and banding) have the advantage of immediate return to our activities.

Does hemorrhoid surgery require general anesthesia?
The method of banding hemorrhoids is performed without general anesthesia, while in some cases the use of the laser as well as the Rafaelo system can be performed with local anesthesia. The other methods require general or spinal anesthesia.

What diet should I follow after hemorrhoid surgery?
The diet includes at least 2 liters of fluids per day and foods rich in fiber and whole grains. At the same time, we avoid drinking alcohol and spicy foods. At the same time for two weeks we also take a syrup so that our stools are softer.

Which doctor should I visit for my hemorrhoids?
The appropriate specialty is the General Surgeon and especially one who has specialized in colorectal surgey. Specialization in proctology is now considered essential for the treatment of diseases of the anus.

What does the local conservative treatment of the area include?
The anal area is preferably cleaned with cold water. Avoid using toilet paper and use baby wipes if necessary. Baths lasting 10-15 minutes with warm water are particularly helpful in treating the symptoms. Finally, application of local analgesia creams can relieve pain for the patient. However, it must be emphasized that creams containing cortisone should not be used long-term and never for a continuous period longer than a week

How much does hemorrhoid surgery cost?
The cost depends on the method that will be chosen, the special materials that will be used as well as the type of patients insurance

Is there a risk of complications from hemorrhoid surgery?
Complications reported in the literature include postoperative bleeding, incontinence, and anal ring stenosis. In the hands of a skilled rectal surgeon, complications are extremely unlikely.

How long does it take to book a hemorrhoid operation?
The operation can be performed immediately even the day after the clinical examination.