What Is Hemorrhoidal Disease (Hemorrhoids)?

Hemorrhoidal disease refers to the condition in which the normal hemorrhoidal vascular cushions located in the anal region become enlarged, swollen, and prolapsed.

Due to the common nature of this disease and the “sense of embarrassment” many patients feel, they often avoid medical examination. As a result, diagnosis may be delayed. This can also delay the detection of perianal or rectal cancer.

What Causes It?

Irregular bowel habits (chronic constipation, diarrhea), prolonged straining, spending too much time on the toilet, low-fiber diet, insufficient water intake, diarrhea, obesity, and a family history of hemorrhoids are factors that contribute to the formation of the disease.
During pregnancy, in addition to mechanical pressure, hormonal changes can cause enlargement and prolapse of the vascular cushions.
The condition is more common in individuals who stand or sit for long periods.

What Symptoms Does It Cause?

Patients typically describe symptoms such as:

Bleeding is usually fresh, bright red, and painless. It occurs during or after defecation. Some patients complain about soft swellings or “hemorrhoid piles” around the anus.

How Should Diagnosis and Treatment Be Approached?

Diagnosis is made through physical examination. If no severe pain is present, visual inspection of the anal region and digital rectal examination should be performed.

Patients presenting with rectal bleeding, perianal pain, or a perianal mass should be evaluated for colorectal and anal cancer and inflammatory bowel disease.
Flexible sigmoidoscopy or colonoscopy must be used for the differential diagnosis of malignant diseases and inflammatory bowel conditions.

The specialist physician should determine the treatment methods based on the patient’s symptoms, the type of hemorrhoidal disease (internal or external), its grade, and any complications.
It should be remembered that the disease often follows a pattern of relief and recurrence during treatment.

Treatment is divided into two main categories:

Conservative Treatment Approaches

Lifestyle modifications and dietary changes are essential components of treatment.
The main principles include:

Today, various hemorrhoid creams and medications are commonly used. The specialist’s experience is important when selecting oral medications.

Interventional Treatments

In second- and third-degree hemorrhoids that do not respond to medication, non-surgical procedures are used.
These include:

Both procedures can be performed under outpatient clinic conditions. They do not require general anesthesia or hospitalization, and patients do not need to take time off work. These procedures are generally painless.

We prefer sclerotherapy in Our Clinic

In this method, medication is injected into the base of the hemorrhoid pile.
This medication shrinks the vessel by reducing blood flow and causes the hemorrhoidal tissue to regress.

We usually perform three sessions.

Surgical Treatment

Surgery is recommended when other methods fail, or in patients with large external hemorrhoids or grade III–IV hemorrhoids.
The surgical technique should be selected based on the patient’s clinical condition.

Common surgical methods include:

Laser treatment is also used in some centers.

Why We Do Not Recommend Laser Hemorrhoid Surgery

We encounter patients in our clinic who previously underwent laser hemorrhoid treatment elsewhere and later developed:

Revision surgery for these patients is more difficult than the initial hemorrhoid surgery.
Therefore, we do not recommend laser hemorrhoid surgery or the use of energy devices for hemorrhoid procedures.

Our Preferred Method: Ferguson Hemorrhoidectomy (Closed Technique)

In this method, the excessive hemorrhoidal tissue is removed through an elliptical incision.
The wound is then closed with a continuous absorbable suture.

Avoiding inclusion of the sphincter muscle in the suture line is crucial for

For patients who have both hemorrhoids and anal fissure, we perform surgical techniques that treat both conditions in the same session.