Hemorrhoids and Treatments

It's True

More than ten million people visit a physician in the United States each year with symptoms of hemorrhoids. Three out of four people will develop hemorrhoids at some time in their lives. While many people associate hemorrhoids with painful surgery, only a small percentage of patients actually require surgery. New comfortable office treatments have taken the fear out of hemorrhoids. This information has been prepared to help you understand them.

What Are Hemorrhoids And Who Gets Them?

Hemorrhoids are swelling in the rectum or anal area that may protrude through the anus on straining. They usually contain enlarged veins and are most common in people over the age of 50.

What are the Symptoms?

Hemorrhoids can often be felt as a swelling in the area of the anus. There may be soreness, bleeding, discharge or itching.

What Causes Hemorrhoids?

We don't know for sure, but hemorrhoids are often found in people who either sit or stand a lot or who have low fiber diets or poor bowel habits.

Are Hemorrhoids Preventable?

No one knows for sure. Avoid straining or extensive sitting on the toilet. A diet rich in fluids, fruits, vegetables and fiber is desirable. If symptoms develop, it is important to see your doctor without delay to be sure that any symptoms you may have are really due to hemorrhoids and not due to another more serious condition such as cancer.

Are There Different Kinds Of Hemorrhoids?

Yes- the come in two varieties. Internal hemorrhoids develop inside the anus. The most common symptoms are bleeding during bowel movements or protrusion through the anus upon straining. External hemorrhoids develop around the anus and can be very painful, especially if a blood clot develops within them. They can be felt as a firm lump or lumps around the anus.

How Are Hemorrhoids Treated?

When treated early, hemorrhoids usually disappear within a week or two. By increasing fiber and fluids in your diet, your stool will soften thereby promoting more regular bowel movements. It also helps to eliminate excessive straining and to take warm baths.

Most painful external hemorrhoids will respond to rest and warm sitz baths. Within a week the pain should subside. The firm lump should completely recede within 4-6 weeks. If pain is severe, the physician may decide to make a small incision under anesthesia and remove the clot to provide immediate relief.

What is Rubber Band Ligature?

Internal hemorrhoids can be treated in the doctor's office by ligation. A small rubber band is placed around the tissue above the hemorrhoid to cut off its blood supply. The hemorrhoid tissue and band slough off a few days later and the sore that is left will heal. This method produces mild discomfort and slight bleeding.

What Is Infrared Coagulation?

Infrared Coagulation (IRC) has quickly become the most widely used office treatment for hemorrhoids and is preferred over other methods because it is fast, well-tolerated by patients, and virtually problem-free. A small probe contacts the area above the hemorrhoid, exposing the tissue to a burst of infrared light for about one second. This coagulates the veins above the hemorrhoid causing it to shrink and recede. There is no laxative preparation or need for fasting before this procedure. You don't need a driver to accompany you. After changing into a patient gown and signing a permission form, you will be asked to lie on your left side on the padded exam table. After examining the rectum with a lubricated glove, the doctor will insert a short plastic scope called an anoscope. This is not painful but will cause a feeling of fullness in the anal area. The doctor can now view the hemorrhoids directly. Once the "target" is identified, he will pass a small infrared probe above the hemorrhoids. He will then apply 5 - 10 short bursts of Infrared light. Much like a laser, this generates heat which destroys these "feeder" veins.

Are There Any After Effect?

Generally not. Most patients return to a normal lifestyle the same day. There may be slight spot bleeding a few days later. Heavy straining or lifting should be avoided and aspirin should not be taken for a few days.

How Many Visits Are Required?

Many patients have more than one hemorrhoid. Therefore, most physicians recommend two or three visits at two week intervals, treating a different portion of the hemorrhoid tissue each visit.

Will the Hemorrhoids Come Back?

Millions of patients have been treated with IRC. Experience tells us that hemorrhoids treated with IRC generally do not recur. A sinsible diet, moderate exercise and proper bowel habits will also help.

Other Procedures

	Excision For the patient with small, external hemorrhoids, where there is severe pain, clot formation, and danger of infection, simple excision of the clot may be all that is necessary. This means that after the hemorrhoidal area has been anethesized, a small incisioin is made in the skin directly over the blood clot. The clot is then gently squeezed out with thumb and forefinger.

	Injection This works best for small, internal hemorrhoids that are not prolapsed and where intermittent bleeding is the only symptom. A special solutions is injected into the tissue surrounding the hemorrhoid. This solution causes the blood in the swollen veins to clot; the clot eventually dissolves and pain and bleeding soon disappear.

	Banding If the hemorrhoids are too large to respond satisfactorily to injection, and if they are not permanently prolapsed, the banding technique offers a safe, effective, and painless alternative to surgery. In this procedure, rubber bands are placed around the base of the hemorrhoidal mass. In about seven days, the hemorrhoid dries up and sloughs off.

	Hemorrhoidectomy The only method for complete cure of large, permanently protruding hemorrhoids is surgical removal. This is especially true if other measures have failed to relieve symptoms. In this operation, all of the hemorrhoidal tissue is removed from beneath the skin and mucous membrane. The incision is then closed with sutures. The patient can usually leave the hospital in six or seven days. Final healting takes three to four weeks.

Illustrations by Benjamin R. Goode	© Romaine Pierson Pubs, Inc.