Hemorrhoids, commonly known as "basur" in Turkish, refer to a condition characterized by the enlargement of hemorrhoidal veins located at the bottom of the rectum and anus, which is the end part of the colon.
These enlarged veins are colloquially referred to as hemorrhoids, basur, mayasıl, or hemorrhoid membrane. Hemorrhoids are categorized as internal and external based on their localization. Internal hemorrhoids are typically located inside the rectum and are not easily visible or felt.
Due to their deep location, patients with internal hemorrhoids usually do not complain of significant pain or discomfort. The most common symptom is bleeding.
If internal hemorrhoids grow significantly, they can become visible from outside the anus. These hemorrhoids can either retract on their own or can be gently pushed back in with minimal effort.
External hemorrhoids, on the other hand, result from the enlargement of veins just beneath the skin outside the anus. Patients with external hemorrhoids often experience symptoms such as pain, bleeding, palpable swelling, and itching.
In some cases of hemorrhoids, the condition known as thrombosed hemorrhoid occurs when the blood entering the enlarged vein clots. In this situation, patients describe symptoms such as extremely painful, palpable, firm swellings, bleeding, and itching.
In severe cases, surgical intervention may be required for thrombosed hemorrhoids. The goal here is to remove the clot causing the pain. Alternatively, the clot may dissolve on its own, but the skin fold created by the hemorrhoid condition may persist.
Hemorrhoids, also known as "basur" in Turkish, result from the obstruction of blood flow due to excess pressure in the anus and the last part of the colon, the rectum. Factors contributing to the development of hemorrhoids include excessive straining during bowel movements, heavy lifting, obesity, and conditions such as pregnancy.
The most common cause of hemorrhoid formation is constipation. Additionally, prolonged bouts of diarrhea can also lead to the development of the condition known as hemorrhoids. In clinical practice, constipation is the most frequently encountered issue. Proper definition of constipation is essential. It should be described not in terms of the frequency of bowel movements but rather as difficult or hard bowel movements, and patients should be educated accordingly.
There are many factors contributing to the development of hemorrhoids. The majority of hemorrhoids are associated with chronic constipation, prolonged diarrhea, sitting on the toilet for extended periods, straining and exertion during bowel movements. All of these factors affect blood flow in the region, leading to the enlargement and ballooning of hemorrhoids.
During pregnancy, the growing uterus applies pressure to the blood vessels, leading to the emergence of hemorrhoids. With aging, the connective tissue around the anus weakens, increasing susceptibility to hemorrhoids.
The diagnosis of hemorrhoids is made through a physical examination. Based on the assessment during the examination, further investigations may be necessary. In such cases, imaging methods such as proctoscopy, sigmoidoscopy, and colonoscopy may be employed. However, the majority of diagnoses are established through a physical examination.
Hemorrhoids are classified into 4 degrees as a disease, and the severity of symptoms increases with the degree. The choice of treatment is also crucially influenced by the degree of the disease.
The most common complaints in patients with hemorrhoids are bleeding and pain. Even if bleeding is detected during the examination, other conditions that could cause bleeding should be investigated and ruled out. This ensures that any possible diseases other than hemorrhoids are not overlooked.
The diagnosis of hemorrhoids is made through a doctor-patient discussion, where the patient's history related to the disease is explored. After explaining the examination to the patient, the physical examination is performed. If deemed necessary by the examining doctor, further tests may be requested after the examination.
The treatment of hemorrhoids is tailored based on the severity of the disease and the intensity of symptoms. Initially, efforts are made to treat the patient with lifestyle and dietary adjustments. If there is an underlying condition such as constipation or diarrhea, its treatment should be planned in conjunction with hemorrhoid treatment. If a response is not obtained from conservative treatment or in advanced cases of hemorrhoids, surgical treatment methods may be applied.
After the patient has recovered from the applied treatment, it is essential to educate them on lifestyle changes, dietary habits, the importance of physical activities, and the avoidance of prolonged toilet use to prevent the recurrence of the disease.
Patients should ensure an adequate intake of fluids, consume fiber-rich foods, and use medical treatments as recommended by the physician. Additionally, warm water baths, as suggested by the doctor, can be helpful.
Hemorrhoid disease can impact a person's social life, leading to a decrease in the quality of life. Patients often delay seeking medical attention due to feelings of embarrassment and social discomfort. However, once patients overcome this barrier and consult a doctor early on, they can often resolve the issue without the need for surgery. If left untreated, problems that could initially be resolved with non-surgical medical treatment may progress and eventually require surgical intervention.
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Prof. Dr. Sezai AydınGeneral Surgery Turkey
PROF. DR. SEZAI AYDIN
