What Are Hemorrhoids and What Treatment Options Exist?

Hemorrhoids are essentially dilated veins of the rectum and anus, similar to varicose veins but located in the anal canal. They can be:

  • Internal hemorrhoids – remain inside the anal canal.
  • External hemorrhoids – protrude through the anus, often becoming painful and bothersome.

Although embarrassing to talk about, hemorrhoids are extremely common: more than half of adults over 50 experience them at some point. Left untreated, they cause persistent discomfort and sometimes serious complications.

Causes include:

  • advancing age
  • pregnancy
  • chronic constipation
  • diets low in fiber and high in processed foods
  • certain liver conditions
  • tumors that increase pressure in the anal canal

What Do Hemorrhoids Look Like?

Appearance depends on type and stage. They may resemble:

  • swollen, bluish lumps around the anus
  • inflamed tissue that may bleed
  • abscess-like swellings in advanced cases

Symptoms of Hemorrhoids

Both internal and external hemorrhoids can cause significant discomfort. Common signs include:

  • bleeding during bowel movements (bright red blood)
  • pain with defecation
  • itching or burning around the anus
  • prolapse (tissue protruding through the anus)
  • fissures or ulcerations
  • abscesses in severe cases

Bloody stools – should I worry?
Most often, bleeding is caused by internal hemorrhoids. However, it should never be ignored. A medical consultation is essential to rule out other conditions such as colorectal cancer.

Diagnosis of Hemorrhoids

A correct diagnosis of hemorrhoids requires a thorough medical examination performed by a doctor. The evaluation allows the physician to determine the stage of the condition and to recommend the most appropriate treatment. Symptoms may include pain, itching, rectal bleeding, or the sensation of incomplete evacuation. To confirm the diagnosis, specific examinations are necessary.

  • Rectal examination – The doctor carefully examines the anal area. The stage of hemorrhoids can often be observed directly, and in some cases, instruments such as an anoscope or rectoscope are used for a more detailed evaluation.
  • Recto-colonoscopy – This procedure helps rule out other pathological conditions that may cause rectal bleeding. It provides both the patient and the doctor with a precise diagnosis, ensuring that the chosen treatment is accurate.

Complications and Risks of Untreated Hemorrhoids

Without proper treatment, hemorrhoids can lead to:

  • chronic bleeding
  • anemia due to repeated blood loss
  • severe pain
  • thrombosed hemorrhoids (clotted, extremely painful)

What Should You Eat If You Have Hemorrhoids?

A diet rich in fiber and hydration is key:

  • fresh fruits and dried fruits
  • leafy greens and vegetables
  • whole-grain bread
  • cereals and legumes

Diet After Hemorrhoid Surgery

Post-surgery, patients should eat soft, easily digestible foods that prevent constipation:

  • vegetable soups
  • pureed foods
  • steamed vegetables
  • fruits rich in fiber

Hydration is just as important — aim for at least 2 liters of fluids daily.

What Foods Should Be Avoided?

To reduce symptoms and prevent flare-ups, stay away from:

  • refined sweets
  • spicy seasonings
  • alcohol
  • excessive coffee
  • heavy, hard-to-digest meals

Preventing Hemorrhoids After 50

Simple lifestyle measures make a big difference:

  • avoid constipation by eating fiber and drinking water
  • exercise regularly, avoid long hours of sitting
  • respond promptly to the urge to defecate
  • use mild, neutral soap for hygiene
  • avoid perfumed toilet paper or alcohol-based wet wipes

Conservative Hemorrhoid Treatment

Many patients avoid treatment out of fear of pain, but most modern therapies are minimally invasive and well tolerated. Treatment is recommended when symptoms include pain, bleeding, or prolapse.

Ligasure Hemorrhoid Treatment

Ligasure is a fast, safe, and bloodless method. Blood vessels up to 7 mm in diameter are sealed and divided in seconds. Surgery time is reduced by 30–50%, with fewer complications and shorter hospital stays.

Case Study – Ligasure Method

https://infogram.com/ec05179a-3033-4dae-a77e-e060d77399d3

Longo Method (PPH Stapling)

The Longo method, named after Sicilian surgeon Dr. Antonio Longo from the University Hospital of Palermo, is also known as the PPH technique or stapled hemorrhoidectomy. It is a modern, minimally invasive procedure designed to treat prolapsed hemorrhoids effectively. 

The treatment is performed under epidural or light general anesthesia and usually takes only 15 to 20 minutes. Patients are typically discharged the same day and can return to normal activities within one week, compared to approximately three weeks with conventional surgery.

The Longo method works by repositioning the excess mucosa that has prolapsed outside the anus. A circular stapler pulls the tissue back into its normal position and excises the redundant section. This technique causes minimal pain, provides quick recovery, and is currently considered the gold standard of proctological surgery in Western Europe and the United States. Patients benefit from both reduced discomfort and faster healing when compared to traditional surgical approaches.

Hemorrhoid Vein Obliteration

Obliteration of hemorrhoidal veins works by closing the blood vessels that supply the hemorrhoids, which causes them to shrink and dry out. The procedure is performed on an outpatient basis under local anesthesia, making it simple and well tolerated. 

Cryotherapy is the most widely used method of obliteration and involves applying a metal probe cooled to -90 degrees Celsius with circulating nitrogen peroxide directly to the hemorrhoid. This process promotes the closure of small hemorrhoidal veins in a safe and controlled way.

In most cases, complete treatment requires only two to three sessions, performed at one-month intervals, since only two hemorrhoidal groups can be treated during each visit. Side effects are minimal and may include temporary sensations of incomplete bowel movements or mild intestinal spasms. 

These symptoms usually resolve quickly, allowing patients to return to daily activities without restrictions. Cryotherapy can also be used to treat anal fissures effectively, offering patients an additional therapeutic benefit.

Sclerotherapy for Hemorrhoids

Because many patients are afraid of surgery, specialists emphasize that sclerotherapy is a painless treatment method and much less unpleasant than traditional surgery. Patients should understand that hemorrhoids need early treatment with non-invasive methods to avoid traditional surgery, which becomes necessary in advanced stages. 

Sclerotherapy is particularly recommended for grade 1 and 2 hemorrhoids, and only occasionally for grade 3 hemorrhoids. Hemorrhoid treatment with sclerotherapy is both safe and effective.

Sclerotherapy can be performed without anesthesia, in just a few minutes, on an outpatient basis. A single treatment session is enough to completely resolve grade 1 and 2 hemorrhoids in 88% of patients. 

Two treatment sessions cure up to 98% of cases, offering patients quick and lasting relief. Early treatment ensures higher success rates and prevents complications associated with advanced hemorrhoids.

Steam Method for Hemorrhoids

The steam method provides an effective solution for both internal and external hemorrhoids. To benefit from this treatment, patients need a short hospitalization, usually for one night. The procedure requires either general anesthesia or spinal anesthesia, with spinal anesthesia often preferred for external hemorrhoids. In this case, traditional surgery is replaced by steam surgery, which treats and coagulates tissue without burning it.

The healing process is faster and more efficient because the tissue is preserved in better condition. In less than 10 minutes, the hemorrhoids can be treated with the steam method, which reduces hospital stay and speeds up recovery. 

Patients are not confined to bed during recovery, but it is recommended they remain relatively immobile for the first 48 hours. Normal activities can be resumed gradually afterward, with medication prescribed to prevent constipation and soften stool to avoid discomfort during bowel movements.

Advantages of the Steam Method (Cluj Clinic):

  • minimally invasive and short procedure
  • very low post-op pain
  • minimal risk of anal stenosis
  • fast recovery, sphincter function preserved

Can Hemorrhoids Recur?

Yes, recurrence is possible because veins remain in the anal canal. However, after minimally invasive treatment, recurrence rates are low. Long-term success depends heavily on patient lifestyle: maintaining a high-fiber diet, staying active, and avoiding constipation.

Medical Consultant: Dr. Vasile Bintintan