Haemorrhoids – laser treatment

What are haemorrhoids?

In a sense, everyone has haemorrhoids (or piles). They are a pillow-like cluster of veins that lie just beneath the mucous membranes lining the lowest part of the rectum and anus. What most of us have in mind when talking about haemorrhoids is a condition when the veins become swollen and distended – similar to varicose veins in the legs.

The blood vessels affected by the disorder have to constantly fight against gravity in order to pump blood back to the heart. For this reason, some believe that haemorrhoids are part of the price we pay for being upright creatures.

Types of haemorrhoids

There are two types of haemorrhoids:

• Internal haemorrhoids: occurring in the lower rectum. Usually painless, even when they produce bleeding They may prolapse outside the anal canal, causing irritation and itching. Wiping the area constantly to relieve itching can make the problem worse.
• External haemorrhoids: develop under the skin around the anus, forming visible or palpable lumps. They are more uncomfortable, as they make the skin around the anus irritated and swollen, with sudden and acute spasms of pain.

Causes of haemorrhoids

Haemorrhoids are associated with chronic constipation and straining during bowel movements, Which interfere with blood flow to and around the anus, causing blood vessels to enlarge. This also explains why this is a common condition during pregnancy, when the growing uterus presses on the veins.

More recent studies show that patients with haemorrhoids tend to have a higher resting anal canal tone. This means that the smooth muscle of the anal canal tends to be tighter than average (even when not straining).  Constipation adds to these troubles, because straining during a bowel movement increases pressure in the anal canal and pushes the haemorrhoids against the sphincter muscle. For this reason, the connective tissues that support and hold piles in place can weaken with age, causing them to bulge and prolapse.

Diagnosis of haemorrhoids

Haemorrhoids can usually be diagnosed from a simple medical history and physical exam. External haemorrhoids are generally apparent, especially if a blood clot has formed. The physician may perform a rectal exam to check for blood in the stool. She or he may also examine the anal canal with an anoscope, a short plastic tube inserted into the rectum.

If there’s evidence of rectal bleeding or microscopic blood in the stool, flexible sigmoidoscopy or colonoscopy may be performed to rule out other causes of bleeding, such as colorectal polyps or cancer, especially in people over age 45.

Home remedies for haemorrhoids

For most symptoms of haemorrhoids, simple home remedies may bring significant relief:

• Adding fibre to the diet: Adding 25-30 grams of fibre a day to the diet from food or taken as a supplement with plenty of fluid softens the stool, reducing the pressure on the haemorrhoids. High-fibre foods include broccoli, beans, wheat and oat bran, whole-grain foods, and fresh fruit. Fibre helps to decrease haemorrhoidal bleeding, inflammation, and piles.
• Moderate aerobic exercise: such as brisk walk for 20-30 minutes a day can help stimulate bowel function.
• Avoiding holding bowel movement: prevents stool back up, which may lead to increased pressure. It is also a good idea to sit on the toilet at a set time each day after a meal, to create proper bowel habits.
• Sitz bath: a warm, 20-minute water bath (the name comes from the German “sitzen,” meaning “to sit”). It can relieve itching, irritation, and spasms of the sphincter muscle. Recommended after each bowel movement and two or three times a day in addition.
• Topical relief for haemorrhoids: over-the-counter haemorrhoid creams containing a local aesthetic that can temporarily soothe pain. Their effect can be enhanced by a small ice pack placed against the anal area for a few minutes or sitting on a cushion rather than a hard surface.

Treatment of haemorrhoids

Haemorrhoids can be managed with conservative treatments, but most often these methods alone are not very effective and in the long term will require more invasive methods for a quicker recovery anyway.

One of these is is rubber band ligation (Barron method), in which a small elastic band is placed around the base of a haemorrhoid. The band causes the haemorrhoid to shrink and the surrounding tissue to scar as it heals, holding the haemorrhoid in place. The procedure alleviates the symptoms for a while, but unfortunately it is not permanent and usually other treatments have to be used later.

Other procedures for haemorrhoid treatment include laser or infra-red coagulation, sclerotherapy and cryosurgery.

Haemorrhoidectomy

In the case of large protruding haemorrhoids with unpleasant symptoms, a surgery may be required.

There are two methods of performing this surgery. In a traditional haemorrhoidectomy, a narrow incision is made around both external and internal haemorrhoid tissue and the offending blood vessels are removed. Unfortunately, this procedure carries the risk of bleeding and requires a rather long recovery time due to damaged tissues.

An alternative to conventional haemorrhoidectomy is the so-called stapled haemorrhoidopexy. This technique most commonly used to treat grade 3 haemorrhoids. The surgery does not remove the haemorrhoids, but the loose supporting tissue that allows the haemorrhoids to drop down.

Laser treatment of haemorrhoids

At Mediqpol, we offer the Haemorrhoid Laser Procedure (HeLP) for the treatment of advanced haemorrhoids, which is painless and minimally invasive. It involves closing the haemorrhoid arterioles without the use of sutures or clips, using instead laser energy delivered into the interstitial tissue of the haemorrhoid via a radial fibre optic. It is a great alternative for people who are afraid of painful surgical procedures in delicate areas of the body. The procedure is performed with the Leonardo Dual Biolitec laser, using unique patented fibre optics.

Only one session is required. The first step is a consultation with an anaesthesiologist and a blood test. The patient is not allowed anything to eat or drink before the procedure. After the procedure, he or she stays under the care of qualified staff. The patient should plan one day off for the whole procedure.

Is laser treatment of haemorrhoids effective?

Compared to other commercially available treatment methods for haemorrhoids, laser treatment is quite expensive. At the same time, it is significantly more effective. This is confirmed by scientific research carried out in two Italian clinical centres, involving follow-up of 60 patients with grade II or III haemorrhoids. Pain, symptoms and overall well-being were assessed six months following treatment.

The research results unequivocally proved that laser treatment for rectal haemorrhoids yields better results than rubber band ligation. Patients rated post-operative pain following laser treatment as almost three times less severe, while the reduction of symptoms six months later was observed in 90 % of patients (compared to 53 % as a result of rubber band ligation). In addition, patients also reported a significant improvement in their overall well-being.

Source: Harvard Medical School; Raffaele Salfi, Coloproctology 2009; “Nowa Medycyna” 1/2019; “Diseases of the Colon&Rectum” 2018