Haemorrhoidal crisis: what it is, duration and treatments
- What are haemorrhoids?
- What causes a haemorrhoidal crisis?
- What is the duration of a haemorrhoidal crisis?
- What treatments are available for haemorrhoids?
- Bibliography
- Frequent Questions
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What are haemorrhoids?
Haemorrhoids or piles are a cushion-like structure of blood vessels consisting of venules, arterioles, arteriovenous communications, with connective and elastic tissue and smooth muscle, in the anal canal.
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The development of problems is generally due to straining, causing the haemorrhoids to slide out of the anal canal and, with this, complications appear.
Haemorrhoidal crises can be solved by means of different treatments, in the case of the mildest ones, with the use of drugs such as creams or ointments, and in the most serious stages, by means of surgery.
What causes a haemorrhoidal crisis?
A haemorrhoidal crisis may also be referred to as:
- Acute haemorrhoidal disease.
- Thrombosed haemorrhoidal prolapse.
- Grade IV prolapse with strangulation or acute strangulated haemorrhoids.
- Haemorrhoidal flare-up.
This is the most painful acute complication of haemorrhoids, caused by an inflammatory process that causes clots to form in the internal and external haemorrhoids, which may cover all or part of the anal circumference and may affect one or several bundles.
During the development of this type of haemorrhoid disorder, areas of necrosis and severe to moderate oedema of the involved external and internal prolapsed haemorrhoidal bundles can be observed.
Grade 3 and 4 haemorrhoids are the most likely to require surgical treatment to eliminate the problem permanently.
Risk factors
- Diarrhoea.
- Constipation or difficulty to defecate regularly.
- Increased intra-abdominal pressure.
- Intense physical exertion.
- Dietary abuse: alcohol, spicy foods.
- Hormonal alterations during menstruation and pregnancy.
Symptoms of haemorrhoidal crisis
- Bleeding at the time of defecation or when wiping with toilet paper.
- Pain accompanied by throbbing discomfort, burning in the area and stinging.
- Thrombosis in the external haemorrhoid or clot formation in the external haemorrhoid. This can cause great pain at first, for about three days, which then subsides. In addition, a lump is noticeable, more or less stiff, and the lump is bluish-violet in appearance.
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What is the duration of a haemorrhoidal crisis?
Haemorrhoidal attacks do not usually last more than 4 days. If the attack lasts longer or if the symptoms do not improve after a week, it is necessary to seek professional help.
During this time, some of the most common recommendations to alleviate the haemorrhoidal crisis are:
- Bed rest with the pelvis raised a few centimetres above the trunk.
- Sitz baths: cold for the first three days, then with lukewarm water and also with ice packs.
- It is recommended to avoid constipation by following a diet rich in fibre (fruit, vegetables, legumes, wholemeal products, etc.) and ensuring adequate water intake (about two litres a day).
What treatments are available for haemorrhoids?
Medical treatment
Low grade haemorrhoids can be treated with topical treatments in the form of ointments containing local anaesthetics and anti-inflammatories.
In some cases, treatment with oral venotonics may be advised, as they strengthen the vein wall.
Surgical treatment
Larger haemorrhoids do not usually resolve with medical treatment and interventional techniques are necessary.
- Band ligation: this type of treatment consists of applying an elastic band around the neck of the haemorrhoid in order to cut off the blood supply to the area, causing them to fall off without injury. The postoperative period lasts 10-15 days, until full recovery is achieved.
- Transanal haemorrhoidal dearterialisation (THD): this is a technique in which an anoscope equipped with a Doppler guide is used to locate the terminal branches of the superior haemorrhoidal artery and suture them with internal stitches. Postoperative recovery is usually uneventful and lasts only 1-2 days.
- Excision surgery: during the surgical procedure the haemorrhoids, usually grades III and IV, are removed. This type of treatment can be performed using the conventional technique as well as the less aggressive laser technique. Recovery after surgery lasts only 2 weeks, provided that all post-operative instructions are followed.
Bibliography
- De Conte Vila, O., & Batlle Edo, C. (2017). Hemorroides. Clínica y tratamiento. Farmacia Profesional. Economía y Gestión, 17(11), 60-65. https://www.elsevier.es/es-revista-farmacia-profesional-3-pdf-13056236
- Dres. Palacios/de la Portilla. (2011, enero). Guía rápida sobre manejo de la patología hemorroidal. Unidad de Coloproctología. Hospital Universitario Virgen del Rocío Sevilla. http://www.ucpsevilla.es/files/proto/PATOLOGIA%20HEMORROIDAL.pdf
- Auspicia Sociedad Cubana de Coloproctología. (2011, noviembre). Consenso de Hemorroides Agudas. https://files.sld.cu/coloproctologia/files/2011/05/consenso-nacional-de-hemorroides-agudas-2011.pdf
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Medical disclaimer: All the published content in Operarme is intended to disseminate reliable medical information to the general public, and is reviewed by healthcare professionals. In any case should this information be used to perform a diagnosis, indicate a treatment, or replace the medical assessment of a professional in a face to face consultation. Find more information in the links below:
Frequent Questions
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How many grades of haemorrhoids are there?
Internal haemorrhoids are classified into 4 grades:
- Grade I: when defecating there is only bleeding.
- Grade II: they protrude when defecating but are reintroduced spontaneously when defecation is stopped.
- Grade III: protrude on defecation but must be manually introduced.
- Grade IV: irreducible and always prolapsed. Requires immediate surgery.
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How is haemorrhoidal thrombosis cured?
If the patient consults immediately, the clot can be drained with a small incision, which relieves the pain, but the oedematous skin and underlying disease persist, usually leaving external plicomas.
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What is the postoperative period after a haemorrhoidectomy?
Some of the most common indications are:
- Bed rest with the legs elevated.
- A soft diet for the first few days, until the rest of the food intake is indicated.
- Taking analgesics, under prescription, to soothe and eliminate pain.
- Sitz baths with warm water two or three times a day, drying the area well. Read more
