Hemorrhoid surgery: surgical treatment procedure at the Charcot clinic in Lyon l Dr Chopin-Laly, Dr Guedj and Dr Thievenaz

Hemorrhoids are physiological anatomical structures located in the anus. They represent blood lakes that associate with small arterial and venous vessels. For a better understanding, painful venous dilatations are often mentioned. They are present in a normal way in all people from birth.

When hemorrhoids are located on the lower walls of the rectum or in the anus, they are called internal hemorrhoids. When they are located immediately outside the anus, we talk about external hemorrhoids.

In the current state of knowledge, we do not know with certainty what triggers a hemorrhoidal crisis. Of the many factors mentioned, few have been the subject of scientific studies. The medical literature often evokes a family background.
However, the best documented causes revolve around:

• transit disorders (both constipation and diarrhoea);
• physical exertion;
• stress;
• certain medicines (laxatives);
• too spicy a diet;
• the period ;
• the pregnancy ;
• childbirth;

Sitting (sedentary lifestyle) would also be a factor favoring hemorrhoidal flare-ups.

Drinking plenty of water regularly, having a diet rich in fiber and avoiding spices can help limit the risk of hemorrhoidal crisis.

Anal intercourse does not trigger hemorrhoidal disease.

One of the common complications of a hemorrhoid is bleeding. In times of inflammation and during defecation, the blood vessels rupture and xthese hemorrhoids can bleed more or less profusely.

In the event of a crisis, the passage of stool causes dilation of the veins and then bleeding. Some bleeding will remain completely invisible, others will be found on the toilet paper. The most complicated cases can stain the toilet bowl, or even drip.

In an early stage, the symptoms of hemorrhoids are discomfort (irritating pain), tightness and/or anal burning.
A hemorrhoidal crisis presents itself in the form of a feeling of heat/heaviness when passing the stool, or during physical exercise. It usually lasts 2 to 4 days.

In a later stage, the hemorrhoidal disease evolving for several years can give daily pain. It may happen that the bleeding is heavy, and is the cause of anemia.

Important: hemorrhoidal disease is not a risk factor for colorectal cancer.

Hemorrhoidal thrombosis

This complication takes the form of a bluish swelling. It sits mainly in the radial folds of the anus and is very quickly accompanied by edema and inflammation of the area. Hemorrhoidal thrombosis causes much more intense pain. It occurs suddenly and disappears naturally after 2 to 3 weeks.
There are two kinds of hemorrhoidal thrombosis:

• external hemorrhoidal thrombosis located at the level of the radial folds of the anus. This is the most common condition. In certain specific cases, it can be treated by incision or excision under local anesthesia. The relief is then immediate;
• internal hemorrhoidal thrombosis. It is located inside the anal canal.

hemorrhoidal prolapse

A non-painful phenomenon, it can sometimes be impressive. It is a total externalization, intermittently or permanently, of the internal hemorrhoids. Some patients reintegrate their prolapse themselves.
Appearing in adulthood, this complication is often chronic. It often occurs in an array of chronic constipation.

The anal mask

The evolution after hemorrhoidal flare or hemorrhoidal surgery can be the formation of marisques which correspond to cutaneous folds on the anal margin which are not serious. Unsightly, the anal marisques are not painful.

75% of patients followed consult a general practitioner while the remaining 25% consult a gastroenterologist.

In your course of care, first contact your general practitioner who will redirect you. However, it is preferable to consult a gastroenterologist: this doctor specializes in diseases of the digestive tract, stomach and rectum. However, it may be justified to consult a proctologist (medicine or surgery).

If the diagnosis is confirmed, your doctor will advise you on drug treatments or instrumental treatments.

In some cases, treatment by surgery will be advised.

First of all, we strongly advise you to start a high fiber diet.

Don’t wait too long to see a doctor. On average, the majority of patients consult for the first time 18 months after the onset of the first symptoms.

Your surgeon will confirm that you will need surgery.

He will base his decision on your general state of health, taking into account a benefit/risk factor.

He will detail with you the procedure and the risks of surgery for hemorrhoids. This will be an opportunity for you to ask any questions you deem useful. Your surgeon will answer all of your questions.

Note: a colonoscopy will often be performed to ensure that the bleeding is indeed caused by a hemorrhoidal disease.

After meeting your surgeon, who has confirmed that your hemorrhoids must be surgically treated, you will meet your anesthesiologist. A specialist doctor, the latter will ensure that anesthesia is possible.

Communicate to your anesthetist the complete list of the medications you take on a daily basis (including aspirin and medication to thin the blood).

The day before the operation, you must be fasting from midnight. If you take medication on a daily basis, you should discuss this with your surgeon and anesthesiologist. They may want you to take some of your medications the morning of the procedure with a background of water.