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As evidenced by the many television commericials that advertise products to relieve hemorrhoids, these cushions of vascular tissue found in the anal canal can cause uncomfortable conditions for many people. The American Society of Colon and Rectal Surgeons reports that 50 percent of all Americans will experience symptomatic hemorrhoids during their lifetime. Painful hemorrhoids are very common in both men and women. While hemorrhoids are usually not dangerous, there are more serious medical problems with symptoms that mimic hemorrhoids, including infection, anal fissures and some cancers. “Some signs of hemorrhoids are also signs of cancers and other conditions,” says Debra Tarantino, M.D., attending colon and rectal surgeon with Saint Barnabas Medical Center. “You need to visit your physician to make sure that you are not ignoring something more serious.” Many women will suffer from hemorrhoids for the first time during their pregnancy. The pressure of the fetus in the abdomen and changes in bowel habits, particularly constipation, can cause enlargement and pathologic changes in the hemorrhoid tissue,” says Dr. Tarantino. For most women, hemorrhoids as a result of pregnancy are a temporary problem. Medical Management for Hemorrhoids Symptoms of hemorrhoids include burning, itching, discomfort and painless bleeding.
Office-Based Intervention Only about 10-15 percent of those who have problematic hemorrhoids require hemorrhoidectomy— surgical removal of extensive or severe internal or external hemorrhoids. If medical management fails, many internal hemorrhoids can be treated with an office-based procedure first, such as rubber band ligation, infra-red coagulation or sclerotherapy. The most common office-based procedure is rubber band ligation. Dr. Tarantino uses this procedure when indicated for internal hemorrhoids prior to recommending surgery. A rubber band is placed around the base of the hemorrhoid inside the rectum, cutting off the blood flow to the hemorrhoid. The hemorrhoid shrinks and dies and, in about a week, falls off. This is a painless, quick method and the hemorrhoid disappears over 4-7 days,” reports Dr. Tarantino. “While it is not a permanent fix, rubber band ligation is one of the best office-based procedures to treat painful hemorrhoids.” In one study, up to 80 percent of people who had rubber band ligation said their symptoms improved. Infrared Coagulation (IRC) is also becoming a widely used office treatment for hemorrhoids. 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. Injection sclerotherapy is a medical procedure used to treat small internal hemorrhoids. A chemical is injected into the vein within a hemorrhoid, which causes the vein to harden and the hemorrhoid tissue to die. A scar forms in place of the hemorrhoid on the wall of the anal canal. Hemorrhoid Surgery Sometimes a hemorrhoid sufferer is not helped by the banding procedure and the large hemorrhoid continues to bleed heavily, often leading to anemia. Also many people suffer from external hemorrhoids which are not amenable to banding therapy. In these cases it may be necessary for the surgeon to remove the hemorrhoids, either through traditional surgery or with a stapled hemorrhoidopexy (PPH Procedure). Patients are carefully selected for the various surgeries based on their symptoms and findings on a physical exam. In traditional surgery, the three major hemorrhoidal cushions are excised. This procedure is performed as an outpatient. The recovery can be difficult due to the pain that patients experience post operatively. However, surgery is very effective in addressing the condition. PPH (Procedure for Prolapse and Hemorrhoids) is a technique that reduces the enlargement of hemorrhoidal tissue and restores hemorrhoids to their normal anatomic position in the anal canal. The PPH procedure reduces blood flow to the internal hemorrhoids. These internal hemorrhoids typically shrink within four to six weeks. Dr. Tarantino reports that the PPH procedure results in less pain than a traditional hemorrhoidectomy. “The post-recovery is less painful with PPH and the patient experiences only minimal discomfort for a few days following the procedure,” says Dr. Tarantino. “Once the surgery is done they are very happy with the results.” For a referral to a colon and rectal surgeon, please call [ top ] |
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