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The anus is the exit point of the digestive system, connecting directly to the rectum and measuring about 4 centimeters in length. It is divided into two sections by a line known as the dentate line.
 
 
Above the dentate line lies the anal canal, which does not have pain-sensing nerves. The walls of the anal canal are supported by structures called cushions, which are groups of blood vessels and muscles that bulge outward. These cushions play a crucial role in maintaining continence.
 
 
Recent theories suggest that hemorrhoids develop due to excessive straining during bowel movements. Factors such as constipation, increased pressure from straining, and large stool masses can cause these cushions to slide down and protrude outside the anus. This condition is known as internal hemorrhoids.
 
 
Below the dentate line is the anal margin, which is sensitive to pain because it has nerve endings. When the cushions from the anal canal move downward and reach the anal margin, they can push blood vessels and tissue outwards, forming noticeable lumps at the anus. These are referred to as external hemorrhoids.
&nbsp;
<h2>Symptoms of Hemorrhoids</h2>
Hemorrhoids can be uncomfortable and painful, and they may present with various symptoms, including: 

<ol>
<li>Bright red blood during bowel movements</li>
<li>Lumps protruding from the anus while passing stool</li>
<li>Moisture around the anal area and itching near the anus</li>
<li>Pain in the anal region, especially during bowel movements</li>
<li>Palpable lumps around the anus</li>
</ol>
&nbsp;
<h2>Causes of Hemorrhoids</h2>
Several factors can contribute to the development of hemorrhoids, including: 

<ol>
<li>Chronic constipation: Straining during bowel movements can worsen the condition.</li>
<li>Frequent diarrhea: Regular bowel movements can irritate the anal area.</li>
<li>Excessive straining: Trying hard to pass a large stool can cause hemorrhoids.</li>
<li>Prolonged sitting: Spending too much time on the toilet, such as reading, can increase pressure.</li>
<li>Overuse of laxatives: Frequent use of enemas or laxatives can lead to dependency and irritation.</li>
<li>Pregnancy: Hormonal changes and pressure from the growing uterus can make bowel movements uncomfortable.</li>
<li>Liver disease: Conditions like cirrhosis can lead to increased pressure in the blood vessels around the anus.</li>
<li>Age: Older adults may experience weakened muscles, allowing cushions to protrude.</li>
<li>Family history: A genetic predisposition may increase the likelihood of developing hemorrhoids.</li>
</ol>
&nbsp;
<h2>Stages and Treatment of Hemorrhoids</h2>
<ul>
<li>Stage 1: Hemorrhoids remain inside the anal canal and often cause bleeding. Treatment may involve medication or injections to stop the bleeding. 
</li>
<li>Stage 2: Hemorrhoids may protrude during bowel movements but retract on their own. They can be treated with rubber band ligation, which cuts off blood supply, causing the hemorrhoid to shrink.</li>
<li>Stages 3 and 4: Hemorrhoids become large and cannot retract on their own. Surgery may be necessary, either through traditional methods or using a new technique called the Procedure for Prolapse and Hemorrhoids (PPH).</li>
</ul>
&nbsp;
<h2>The PPH Technique</h2>
 
The PPH method involves pushing the hemorrhoidal cushions back into their proper place. This causes external hemorrhoids to flatten and internal ones to be repositioned and secured, preventing them from sliding down again. The remaining tissue is then trimmed using an automatic stapling device positioned above the dentate line, resulting in minimal pain.
<h2> 
Benefits of the PPH Technique</h2>
<ol>
<li>Complete removal of hemorrhoids without causing anal stenosis (narrowing of the anal canal)</li>
<li>Less postoperative pain compared to traditional surgery</li>
<li>No external wounds, reducing the need for prolonged care</li>
<li>No need for sitz baths or absorbent pads post-surgery</li>
<li>Shorter surgical time and hospital stay</li>
<li>Faster recovery at home</li>
</ol>
&nbsp;
<h2>Prevention and Seeking Help</h2>
 
To reduce the risk of hemorrhoids, it’s essential to adopt healthier habits. If you experience symptoms, seek medical advice promptly to rule out more serious conditions. Phyathai 3 Hospital offers modern technology and specialized care to help you return to your normal life. 

 
               Dr. Narasara Vittayapipat 
                 Specialist in Minimally Invasive Surgery 
         Phyathai 3 Hospital

The anus is the exit point of the digestive system, connecting directly to the rectum and measuring about 4 centimeters in length. It is divided into two sections by a line known as the dentate line.

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