Hemorrhoidal disease is one of the more common problems encountered by physicians. At least 5% of the general population suffers from symptoms related to hemorrhoids. The incidence of hemorrhoids increases with age, and it seems that at least 50% of People over the age of 50 have some degree of hemorrhoidal disease. The disease is not confined to older individuals and may be present at any age, including childhood. Men seem to be affected approximately twice as frequently as women are. The prevalence of hemorrhoids is highest in affluent countries in the Western World, lowest among people living traditionally in developing countries, and intermediate in countries with standards between these extremes. It is believed that fiber-depleted diets are the fundamental cause of constipation. Constipation results in straining during evacuation of firm feces, causing an engorgement of the normal-occurring hemorrhoidal cushions, thus causing hemorrhoidal disease as a result of continued straining. Once these cushions stretch the point of falling outside of the anus, hemorrhoidal disease usually becomes symptomatic.

The usual symptoms of hemorrhoids are pain and ache around the anus and bleeding during defecation. In more advanced stages, there is a feeling of a bulge or a lump, either coming outside of the anus or being in the anus. Sometimes the hemorrhoidal cushion develops a clot and that leads to particularly tender, hard lump, which might make sitting uncomfortable.

The goal of treatment to avoid straining on defecation is usually achieved by dietary manipulation which leads to an easy bowel movement. The most common dietary manipulation is an increased of intake of fiber-rich foods, such as whole grains, vegetables, fruits, and nuts. Wheat bran is sold in most health food stores and can be added to the diet directly. Some people do not tolerate wheat bran well, and for them, psyllium seed compounds may be preferable. Local ointments provide more immediate pain relief.

If the symptoms are severe or persistent despite change in the diet and over-the-counter remedies, hemorrhoidectomy is indicated. Because the anal area is very sensitive, several modalities have been tried in the past to reduce pain that is associated with hemorrhoidectomy. A prospective comparison between laser hemorrhoidectomy, sclero- therapy, rubber band ligation, and simple traditional resection of the hemorrhoids showed no distinct advantage to either method in terms of either postoperative bleeding or postoperative pain.

The harmonic scalpel is an ultrasonically activated instrument, which vibrates at 50,000 revolutions per second. It is remarkable in its ability to coagulate small and medium-sized vessels without any collateral damage, thus, minimizing postoperative swelling and damage to surrounding tissues. The harmonic scalpel was initially used in laparoscopic surgeries, but its effectiveness in achieving a bloodless field is now being used in the performance of hemorrhoidectomy. The reduction in bleeding and swelling leads to pain reduction.

All hemorrhoidectomies are performed on an outpatient basis. Preoperatively, the patients are started on wheat bran or Fibercon. The procedure is performed with the patient under general anesthesia. The hemorrhoid pile is picked, and its base is simply cut with the harmonic scalpel. 5% Xylocaine ointment is applied generously into the anal canal. Postoperatively, the patients are encouraged to use the ointment liberally. Most patients are able to return to sedentary jobs in about one week, and patients who do experience some initial constipation postoperatively are usually satisfied with the results in about two weeks.

Many patients experience prolapse of a hemorrhoid, which necessitates returning the hemorrhoid into the anal canal after bowel movements. A unique procedure has been developed recently to resolve this problem.

Instead of excising the prolapsed tissue, this new procedure excises a band of prolapse anal mucosa above the hemorrhoids utilizing a circular stapling device. This procedure is performed at the anal canal and, thus, restores the prolapsed hemorrhoidal tissue back to its original anatomical position. The blood supply to the hemorrhoidal piles is cut, reducing the size of the hemorrhoids.

The main benefit of this procedure for Prolapsed Hemorrhoids is that patients experience less pain since the surgery is not done at the anus itself.