AND HEMORRHOIDS ARE ONLY THE TIP OF THE ICEBERG

Hemorrhoids and the evolution of the human being  and defecation posture |  Hemorrhoids The underlying

mechanisim  |Hemorrhoids Diverticulosis coli | Hemorrhoids Hiatus hernia | Hemorrhoids Cardiovascular

events at defecation | Instructions |  Hemorrhoids Video of a new squatting device | Hemorrhoids Bran diet

hypothesis isn't relevant | Hemorrhoids 150 years to sitting toilet bowl |Squatting for the Prevention of Hemorrhoids  The Prevalence of hemorrhoids  |

Treatment of hemorrhoids (anal dilatation)

Lord has suggested that in patients with hemorrhoids there is an abnormal amount of fibrous tissue
in the anal canal, which interferes in some way with normal defecation,
leading to abnormal rising of the intrarectal pressure during the
act and to consequent venous congestion (1, 2). However there was
not confirmed that such anatomical abnormality exist.
Nevertheless Lord admits that fibrous bands are not discernible when the
anorectum is palpated with one finger, but maintains that they can be felt regularly
when one or two fingers of both hands are inserted simultaneously into the lower
rectum under a general anesthetic. Lord further claims, that, if these bands are broken
down under anesthesia by vigorous stretching of the anal canal and lower rectum with the
four fingers of both hands inserted as far as possible into the bowel the hemorrhoids
can be corrected .As soon as the dilatation has been completed a moistened

plastic sponge is immediately packed into the anus and lower rectum to prevent the development of a submucous haematoma.

It is left in situ whilst the patient returns to the recovery room, and is removed
an hour later. After full recovery from the anesthetic the patient is allowed to go home, but takes
with him anal dilator 4cm in diameter at its widest part. The patient is instructed to pass the
anal dilator regularly to its fullest extent for at least one minute, at first daily and
then less frequently, but to continue using it occasionally for several months.

Lord (1969) and his colleagues have used this method on several hundred patients and he claims very satisfactory results.
Three complications have been encountered, though only in a small proportion of the cases:
1 Splitting of the anal and perianal skin.

2 Mucosal prolapse in some patients who have had- third degree piles.3 Anal incontinence.

Macintyre and Balfour  on a one-year follow –up assessment of 55 patients treated
by the Lord procedure, found that 80% were symptom-free, but on proctoscopic examination
75% still had significant hemorrhoids, 22% of the cases complained of incontinence for flatus
and 36% for faeces (3).

McCaffrey was impressed by the fact that 20 of 50 patients
treated by manual dilatation suffered incontinence for flatus and mucus (4).
Chant et al. conducted a controlled trial of manual dilatation versus haemorrhoidectomy
in 51 patients (5).

There were no failures in the 24 patients who had haemorrhoidectomy,
but in the 27 who had anal stretching, 5 complained of continued bleeding, 11 of continued
or aggravated prolapse, and 3 of aggravation of soiling or irritation.
Ortiz et al were unfavorably impressed by the frequency of prolapse and incontinence after manual dilatation compared with a standard hemorrhoidectomy (6).

References

1 Lord, P.H   A new regime for treatment of hemorrhoids. Proc. R. Soc.Med. 61, 935; 1968

2 Lord P.H. A day-case procedure for the cure of third-degree hemorrhoids. Br. J. Surg., 56, 747 1969

3 Macintyre I..M, Balfour T.W. Results of the Lord non-operative treatment for hemorrhoids. Lancet 1, 1094, 1972.

4 McCaffrey, J Lord treatment of hemorrhoids. Four –year follow-up of 50 patients. Lancet 1, 133, 1975

5 Chant, A.D. et al. Hemorrhoidectomy versus manual dilatation of the anus. Lancet, 2, 398; 1972

6 Ortiz H. et al. Lord’s procedure: a critical study of its basic principle. Br. J. Surg., 65, 281; 1978

      Notes: In my practice all patient that undergone Lord’s anal dilatation, have suffered from flatus and faeces incontinence and were vary unhappy. The force majeure elegant anatomical elements and associated physiological functions, providing so important vital factor as anal continence, are destroyed by cruel Lord’s procedure, which does not have any scientific basis.

          For great majority of people, able to assume the squatting posture the only procedure that has to be done to avoid hemorrhoids is to change the sitting to squatting defecation posture. See the article , the underlying mechanism and instructions on this site.