Hemorrhoid disease

By Dr. Paulo Vieira de Sousa [email protected]

Dr. Paulo Vieira de Sousa is a general surgeon and clinical director at the Hospital Particular do Algarve in Faro, specialising in local and keyhole surgery. He was a former assistant surgeon at the Hospital Egas Moniz in Lisbon and assistant of the surgery department at the Medical University of Lisbon.

Hemorrhoid disease is a very annoying pathology that occurs very frequently in both men and women.

They can start giving problems at a very young age, more frequently in women during pregnancy and, by the age of 50, they affect more than 50 per cent of the population.

It’s reported that about 90 per cent of the American population has had hemorrhoid complications once in their lives.

It’s not a very aggressive disease, although sometimes it can cause incapacity or anemia due to severe bleeding.

The main symptoms of hemorrhoid disease are pain, itching and red fresh bleeding in the anal region, but they can also cause thrombosis and painful swelling in the anal area.

It has affected well known historic personalities such as Napoleon and President Jimmy Carter, and throughout history several medical treatments have been advocated.

Some are applied locally, such as creams and ointments, some drugs and other less invasive procedures have been attempted but surgery remains the final and long lasting option.

Not all hemorrhoids need medical treatment. In most cases, it’s a temporary condition, associated with bowel changes, vascular problems or changes in the diet or eating habits. 

When the distressing factor ceases, they return to normal.

Unfortunately, in some patients, this does not happen and the problems associated with hemorrhoids assume a continuous pattern, causing serious medical complications and loss of quality of life for the patient.

Other diseases such as fistulas, anal fissure and polyps all cause similar symptoms and must be ruled out by your doctor before assuming that you have hemorrhoids.

Also (red) bleeding from the anus shouldn’t always be considered as a result of hemorrhoids and anyone suffering from these symptoms should always undergo a colonoscopy to exclude other more serious diseases which may also cause rectal bleeding.

In the first stages of the disease, in a patient with mild symptoms, medical options such as treatment with creams and drugs e.g. ‘Daflon’, together with an adequate diet, may contribute to easing the symptoms but in Type III or IV (prolapsed hemorrhoids) the results aren’t as good as in the first stages of the disease.


At this point, only more aggressive treatments can help the patient and they start sometimes with rubber ligation, sclerosing injections and arterial ligation and, as a final and definitive option, surgical hemorrhoidectomy.

Hemorrhoidectomies have been performed for centuries and implied the identification of the affected hemorrhoidal veins, ligation and excision, leaving the wound open for 3 or 4 weeks for secondary closing.

Although very good results were achieved with this option, it’s known that it caused post operative discomfort and some bleeding and was associated with long term recovery before normal activities were possible.  

Fortunately, in the 90s, a new technique was developed that removes the hemorrhoids and re-sutures the anal mucosa allowing a faster and painless recovery period. It’s the “Longo Technique» that removes the hemorrhoids and exceeding mucosa, reorganizes the normal anatomical position of anal mucosa, thereby reducing the rate of recurrence of the disease.

This type of surgery is also indicated in certain forms of anal prolapse but it has no effect in recto cell or anal incontinence.

It’s a new and reliable option for the treatment of hemorrhoids, which in some cases can be performed as an outpatient procedure, under sedation or spinal blockage anesthesia.

This procedure has been performed at the Hospital Particular do Algarve for some years, with very good results; a quick and fast recovery is possible, with excellent patient prognosis.