Hemorrhoids consist of a network of vessels forming a plexus in the mucosa of the lower rectum and anus. The main role of this vascular plexus is that it acts as a cushion protecting the anal sphincter muscles during defecation. The muscles relax, hemorrhoids emptied of blood and stool pass through the anus. After defecation sphincter muscles contract and hemorrhoid plexus refill with blood, ensuring continence.


When these veins get swollen, hemorrhoids are formed, which is something similar to varicose veins of the legs. Depending on their location to the rectum , hemorrhoids are categorized as internal or external. The external are visible at the anus. The internal do not unless they get sufficiently swollen to protrude outward the rectum through the anus.


  • Inadequate intake of fiber
  • Constipation
  • Prolonged sitting
  • Weight lifting
  • Pregnancy
  • Age


  • Blood in the stool or on the toilet paper
  • Pain at the anal area
  • Mucus secretion
  • Local irritation, itching
  • Feeling of incomplete defecation



  • Diet rich in fiber
  • Sitz baths – local hygiene
  • Use of stool softeners
  • Local ointments


Various surgical techniques have been developed for the treatment of hemorrhoids. From the classic procedure of Milligan-Morgan to sclerotherapy and hemorrhoid ligation under ultrasound guidance. One of the latest methods with excellent results and without the complication of postoperative pain is the HAL RAR technique.
HAL RAR or THD Hemorrhoidectomy
A modern and bloodless method for treating hemorrhoid disease is the technique of ligating the hemorrhoid vessels by the HAL-RAL or THD method.
With the use of a special anoscope which carries on an ultrasound transducer, the surgeon can identify all the blood vessels that supply the hemorrhoids. By ligating the hemorrhoid vessels (using sutures) the blood flow to the hemorrhoids is cut off, thus the hemorrhoidal cushions shrink back to their normal size. If there is also hemorrhoidal prolapse, the surgeon performs simultaneously mucopexy so as the cushions to go back to their normal anatomic site .
The advantages of this method are:
It is minimally invasive
It is bloodless
Anatomy of the rectum is not disturbed
It is less painlful than other methods since the arteries are ligated into an area of the anus where there are no nerve pain receptors
There are no major complications like infection
It stops immediately the bleeding from the hemorrhoids