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Dubai Hemorrhoids Clinic - at Dr. Rami Hamed Center - provides the latest minimally invasive techniques to treat hemorrhoids or piles and rectal prolapse.

Dr. Valentina is our expert female proctologist, proud to bring latest treatments from Italy.

 

What are hemorrhoids or piles?

Hemorrhoids, also known as” piles”, are natural cushions of tissue and veins located at the junction between rectum and anus. Hemorrhoids play a significant physiologic role in protecting the anal sphincter muscles and work with them to close the anal canal when abdominal pressure increases (e.g., coughing, sneezing) to prevent incontinence and contribute 15 to 20% of the resting anal canal pressure. This tissue is also thought to help differentiate stool, liquid and gas in the anal canal. Everyone has them, even newborns; problems only arise when they prolapse and become larger than they should. In fact, when Parks ligaments become loose for different reasons (pregnancies, childbirth, chronic constipation.), hemorrhoids prolapse down to the anal verge, get enlarged, the overlying tissue becomes thinner and prone to bleed. For this reason is more correct to call the disease ‘hemorrhoidal prolapse’ or simply ‘prolapse’, since hemorrhoids are present in the normal anal canal.

According to the Goligher classification, hemorrhoids can be of 4 grades

  • Grade 1 internal hemorrhoids that stay inside the anal canal
  • Grade 2 internal hemorrhoids that are protruding out the anus after defecation but are spontaneously reducing
  • Grade 3 internal hemorrhoids that are protruding out the anus after defecation and need manual help to be reduced
  • Grade 4 external hemorrhoids that are permanently protruding out the anus and cannot be replaced in the anal canal

 hemorrhoids grades

Symptoms of hemorrhoidal prolapse:

  • Bleeding during bowel movements; usually in the form of bright red blood on the toilet paper after a bowel movement, in advanced cases blood can be seen even on the toilet
  • Swelling protruding from the anus: hemorrhoids might feel like smaller or bigger lumps in the anus after straining on the toilet; in more severe cases, swellings will be constantly visible
  • Hemorrhoids can cause perianal skin irritation and intense itching
  • When one of hemorrhoids gets thrombosed (dark purple color and hard consistency), hemorrhoids may cause dull pain

 Hemorrhoids treatment:

As a general rule: most hemorrhoidal prolapses require only medications and lifestyle modifications, but some of them are best treated with surgery.

Traditional methods like Ferguson and Milligan-Morgan procedures require surgical asportation of the 3 hemorrhoidal packages, with a very painful postoperative course.

Conversely, we believe in modern hemorrhoids treatment surgery, with the aim of guaranteeing to the patients a smooth and quick recovery after surgery. 

So either we use the Doppler ligation of the vessels feeding the hemorrhoids and a pexy of the redundant tissue or we definitely resect the prolapse with a circular stapler, therefore repositioning the hemorrhoids in the normal anatomical position (Longo technique and STARR)

Hemorrhoidal Artery Ligation and Recto Anal Repair Systems (HAL-RAR) is a Day Case procedure, with no cutting, no removal of tissue and no open wounds, with a short procedure time and quick return to daily activities.

Longo and Stapled TransAnal Rectal Resection (STARR) techniques are normally used for 4th degree prolapses or in women patients with a descending perineum and the presence of rectocele.

 

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