Everyone has had a normal hemorrhoidal tissue in their rectum and anus. It’s only when your hemorrhoidal veins enlarge and become varicose veins that they’re considered abnormal or diseased. There are three types of hemorrhoids – internal, external, and mixed. Internal hemorrhoids form above the dentate line, while external hemorrhoids form below the dentate line. Mixed hemorrhoids can either refer to lesions formed at the dentate line, or to the presence of both internal and external hemorrhoids.
External hemorrhoids are those occur outside the anal verge. External hemorrhoids usually affect the cleansing after the bowel movement and cause the skin irritation and itching. The thrombosed external hemorrhoids are sometimes very painful if the varicose veins rupture and the blood clots develop, it is often accompanied by swelling and irritation. These hemorrhoids are typically treated with either incision and removal of the clot or with external hemorrhoidectomy. Simply draining the clot can lead to recurrence, so it is generally recommended to completely excise the thrombosed hemorrhoids.
Internal hemorrhoids are graded from I to IV based on the degree of prolapse. Grade I hemorrhoids have no prolapse. Grade II lesions bulge with defecation but then recede spontaneously. Grade III hemorrhoids require digital replacement after prolapsing, while grade IV hemorrhoids cannot be replaced once prolapsed.
There are many treatment options for the internal hemorrhoids. Very early hemorrhoids can often be effectively dealt with by dietary and lifestyle changes. The lifestyle changes should also be part of treatment plan for the more advanced hemorrhoids. Infra-Red Coagulation (IRC) has become the world’s leading office treatment for hemorrhoids. This non-surgical treatment is fast, well tolerated, and remarkably complication-free. The infrared light quickly coagulates the vessels that provide the hemorrhoid with blood, causing the hemorrhoids to shrink and recede. Rubber band ligation is widely used for the treatment of more advanced (more prolapsed) internal hemorrhoids. The ligated tissue dies-off after rubber bands are placed around the hemorrhoid tissue. Rubber band ligation downgrades the hemorrhoids to grade 1 or 2, most patients usually need to do IRC treatments after rubber band ligation. In the severe cases, a hemorrhoidectomy surgically removes the tissue that causes bleeding or protrusion.