The word hemorrhoid comes from the Greek " haemorrhoides ", which means flow of blood ( haem = blood, rhoos = flow). Hemorrhoid disease, which we know as hemorrhoids or hemorrhoids, is a disease in which hemorrhoid tissue enlarges and protrudes out of the anus, where hemorrhoids are tissue containing blood vessels, which are normally found in the anal area. Hemorrhoids function as a cushion and sensation during the defecation process.
According to 2015 data from the Department of Health (DEPKES), the prevalence of hemorrhoids in Indonesia is 5.7 percent of the total population, or around 10 million people. 2007 RISKESDAS (Basic Health Research) data stated that 12.5 million Indonesians had hemorrhoids. Johanson et al in 1990, showed that there were 10 million people in America who suffered from hemorrhoid disorders, with a prevalence rate of 4.4%, aged 45-65 years. In England, hemorrhoids are reported in 13% - 35% of the total population.
The main risk factors for hemorrhoid disorders are constipation and frequent straining for a long time. Several other factors that also influence are diarrhea, pregnancy, increased pressure in the stomach, age and genetics.
Hemorrhoids are generally classified into 2, namely internal and external hemorrhoids, and for practical purposes, internal hemorrhoids are further divided into 4 grades (Goligher's Classification): Grade 1, hemorrhoids bleed but do not protrude out of the anus; Grade 2, the hemorrhoid protrudes out of the anus, but can still enter spontaneously; Grade 3, hemorrhoids protrude from the anus and cannot enter spontaneously; and Grade 4, hemorrhoids come out through the anus and cannot go back in.
Treatment for hemorrhoids is divided into two, namely conservative or surgical. Grade 1 and 2 hemorrhoids can generally be treated conservatively, by modifying lifestyle, administering medication, changing defecation habits, and improving diet patterns. Meanwhile, grade 3 and 4 hemorrhoids are usually treated with surgery.
With the rapid development of medical science, there are now many known surgical techniques for hemorrhoids using minimally invasive principles. One of them is the HAL-RAR (Hemorrhoid Arterial Ligation and Recto Anal Repair) technique. The HAL-RAR technique was first applied by Dr. Kazumassa Morinaga in Japan, in 1995. In this method, the doctor uses a special Doppler ultrasound device to detect hemorrhoid blood vessels, so that sutures can be carried out and it is hoped that the hemorrhoid tissue will shrink. Then proceed with the RAR procedure, where the mucosal layer of the hemorrhoid is stitched and tied up, so that it can function normally again.
The HAL-RAR procedure has many advantages compared to other hemorrhoid surgery techniques. These include very light pain because the operation is carried out without using a knife, hemorrhoid tissue is not removed so its function is not lost, the operation process is fast, the hospital stay is short, and 24-48 hours after the operation the patient can carry out activities. Complications of surgery that may occur are bleeding, feeling unable to pass a stool after defecating (tenesmus), difficulty urinating, and pain. However, these complications are usually very mild and can be treated with treatment. Advice for patients after surgery is to eat foods high in fiber, sitz baths to reduce discomfort, and keep the anal area clean.
Article written by dr. Felmond Limanu, Sp.B.SubBDig (Surgery Specialist - Digestive Surgery Subspecialist EMC Pekayon Hospital).