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Band ligation or banding is an outpatient office-based technique. The basically the physician will have a banding device attached to a short proctoscope, or they can place it on the tip of a colonoscope depending and insert it into the anorectal canal. Generally when you do banding, it’s primarily for internal hemorrhoids because as I mentioned earlier, the innovation, the nerves of the internal hemorrhoids is different than external. So you could safely place a rubber band around the dilated vein for an internal hemorrhoid, and it will ultimately cut through the vein and you’ll just pass it in several days as if you are having a bowel movement. And so you can literally have your hemorrhoidal internal vein destroyed by this process.
Hemorrhoidal banding or band ligation is an outpatient procedure, and we primarily band internal hemorrhoids because of the innervation pattern for internal hemorrhoids versus external hemorrhoids. If you band an internal hemorrhoid, it’s not exactly painful. However, if you ban an external hemorrhoid because the nerve supply to an external hemorrhoid is very similar to what you have in your skin, and so it’d be like pinching your skin to skin fell off. So that’s why we don’t generally band external hemorrhoids. Now, in the banding band gradually cuts through the ligated hemorrhoidal vein, and it will actually slough off or pass when you’re having a bowel movement, generally within five days. Now, there may be a small ulceration or defect in the region. And so you may notice a little discomfort or even some blood streaking for a few days after the band has passed. However, this is generally a benign circumstance. And with good anal hygiene shouldn’t be a problem.
Hemorrhoids, as I mentioned earlier, are generally a benign condition and in and of themselves do not predispose a patient to developing colon cancer. However, patients who experienced blood per rectum may be confused, oftentimes attributing the blood to hemorrhoids. Since hemorrhoids are blood vessels, veins, which can easily bleed. On a similar fashion, a tumor or a cancer in the rectum can also bleed. And so, basically the patient sees blood per rectum and may be confused. So to answer your question, quite simply, hemorrhoids don’t cause cancer, but rectal bleeding may be a sign of hemorrhoids. It may also be a sign of colon cancer.
Thermal ablation techniques such as laser therapy or thermal ablation or cryotherapy are techniques, which are topical, can be applied in the outpatient setting, and basically you’re applying some form of energy to destroy the hemorrhoidal vein. If it’s a thermal technique, naturally you’re applying heat. If it’s a cryotherapy technique, you’re applying cold to freeze and or destroy the hemorrhoidal vein.
When the patient arrives at the doctor’s office, the physician will ask questions concerning their bowel habits, how many times a day they have a bowel movement, or if they see any rectal bleeding or have pain. And then, the physician will probably do a rectal exam by placing a lubricated finger into the anorectal region to see if they can feel any masses, any hemorrhoids, any fissures, or cracks, or possible sources of bleeding. Depending upon the results of that physical examination, the physician may then insert an anusscope, which is a very small device which goes a very short distance into the anorectal canal to look for growth or hemorrhoids, dilated veins, or fissures, cracks. Patient may then be recommended to have a proctoscope, which is a longer devices several inches long. Oftentimes patients may have to take some rectal enemas to remove any fecal material prior to having a proctoscope inserted. And then if the physician deems it necessary to assess the colon further up, the patient may be scheduled for a colonoscopy at a later date, which would require the taking of a laxative prep, given sedation, and then a formal colonoscopic exam to look for hemorrhoids, polyps, or tumors.
Hemorrhoidectomy is a surgical removal of the hemorrhoidal veins. Now, this is naturally a more invasive procedure performed by surgeons. And so if one is concerned, what are the possible side effects? One should sit down with the surgeon. I’m sure they will be very happy to explain the ins and outs, as well as the possible adverse effects. In a very small number of cases, the anal sphincter may be compromised such that a patient may experience some seepage of stool or even anal incontinence. But mind you, that’s in a very small number of cases, but one should be aware of that. And I would encourage you to, as always, prior to a surgical procedure, sit down with your surgeon such that they can perform an informed consent so they can give you the pros and the cons and what to expect, what’s the appropriate recovery time given your medical history and background.
Individuals who are most at risk for developing hemorrhoids are folks who are a little bit older from age 45 to 65 or beyond. Patients who don’t consume enough fluids such that they become constipated. In a similar vein, folks who don’t consume enough fiber in their diet, who subsequently become constipated, these are individuals at greater risk. And I guess there’s a really great reason for having Mother’s Day because the great majority of ladies who become pregnant, the increased intraabdominal pressure, which is then translated down towards the legs. And ultimately the pelvic and rectal regions oftentimes experience hemorrhoids. And so those types of individuals are at greater risk. I should also mention that athletic males, one out of three, may experience hemorrhoids at some point in time. But those are the types of individuals at greatest risk for hemorrhoids.
Some simple ways to prevent hemorrhoids from developing are to one, consume enough fiber in your diet anywhere from 20 to 35 grams of fiber in a given day. Make sure you consume enough liquids. Okay. This will help you avoid becoming constipated. When you are on the commode doing your business, don’t stay for prolonged periods of time, avoid straining. If necessary, you may need to use some stool softeners, but these are some very basic things that you can do to avoid having issues with hemorrhoids.
There are a number of safe approaches that a woman can take during pregnancy. Obviously to consume, a sufficient amount of fiber in the diet, a sufficient amount of fluids to avoid straining when she’s doing her business on the commode. Taking a stool softeners, topical therapies for protruding hemorrhoids, as well as hemorrhoidal band ligation all may be appropriate for the treatment of hemorrhoids in a pregnant woman. However, as is always the case, anytime a pregnant woman wants to embark on a particular form of treatment during her pregnancy, she should always seek the counsel of her OBGYN physician first.
A Sitz bath is a form of a topical therapy actually for treating dilated painful hemorrhoids. Basically what it entails is that a patient sits in two to three inches of warm water, oftentimes in a bathtub, and they can do this for 10 to 15 minutes, two to three times a day. And the way it works is as follows. The warm, gentle water actually enhances circulation in the hemorrhoidal veins. But then also it causes the rectal area of muscles to relax such that these dilated, oftentimes protruded veins can recede back. And so it helps to minimize pain from dilated protruding hemorrhoids. Now it’s important to keep in mind that you really shouldn’t add anything to the water, so you’re just sitting in the water. Don’t add bubble bath. Don’t add anything else.
Some other home remedies one could try would be to apply Vaseline or petroleum jelly to the toilet tissue so that when you wipe yourself after each bowel movement, you’ve applied a lubricant, which could also heal an inflamed or irritated area. And then let’s say after you’ve already done your business on the commode and applied this a petroleum jelly, you might want to sit on a firm surface for anywhere from 30 seconds to a minute. That may help reduce, or pop your protruding hemorrhoids back into place. You could also try some witch hazel, which is an astringent, which may help soothe inflammation, but then also helps shrink protruding hemorrhoidal veins.
There are several different types of topical treatments for hemorrhoids. Oftentimes, one can use an ointment, which helps to soothe an irritated area, may have some anti-inflammatory property, or it may have some pain relief components such as Lidocaine. There are also over the counter preparations, which actually contain a corticosteroid. And one word of advice is that you should always use these medications according to guidelines on the box or on the label. And you should not use any steroid preparation for no longer than five to seven days because they can have significant side effects with prolonged usage.
Sclerotherapy is a form of treatment for protruding or dilated hemorrhoidal veins. Basically, the physician would inject a needle into a vein, and then infuse a sclerosing agent. Now, this particular agent will cause scarring within the vein such that the dilated vein gradually shrinks. Now, this is an older form of a hemorrhoidal treatment. Again, it can be performed in the outpatient setting. However, what has to be careful, because it may leave residual scars. In some instances, sometimes these scars can cause ulceration in the region of the hemorrhoidal vein, and/or in some small number of cases, it may have an effect on the anal sphincter, such that a patient may subsequently experience episodes of incontinence or the seepage of stool.
General indications for surgery are complicated or more serious hemorrhoidal conditions, or if a patient, for whatever reason, does not want to go through a course of medical therapy for their hemorrhoids.
In reference to a cure for hemorrhoids, technically, yes, there are cures for hemorrhoids in that, if one considers that the hemorrhoid is a dilated vein, and if you destroy the vein or remove the vein, therefore hemorrhoids can occur. But oftentimes that’s not necessary because there are effective treatments for hemorrhoids. For example, if a patient can avoid becoming constipated by consuming a high-fiber diet or taking in sufficient fluids, that’s a very effective way of avoiding the development of hemorrhoids are also some medications which can be used.
To summarize, hemorrhoids are dilated veins. And some of the simple things that one can do to help relieve the symptoms are one, avoid being constipated. Therefore, it’s important to consume a sufficient amount of fluids per day. Also, it’s important to consume a certain amount of fiber. Anywhere from 20 to 35 grams of fiber per day should do the trick. There are a number of over the counter remedies for simple hemorrhoids. You can apply topical ointments to help relieve pain and inflammation. There are also some categories of agents which contain steroids to treat inflamed and dilated hemorrhoids. Now mind you, it’s very important that if you use that type of over the counter medicine with steroids, you should not use it for more than a week outside of the instruction of a physician. There are other ways to treat hemorrhoids, which would actually help remove hemorrhoids. Band ligation where you place a rubber band on a dilated hemorrhoidal vein. It cuts through the vein sequentially and you ultimately pass it when you have a bowel movement. Surgical removal of hemorrhoids is a little bit more invasive procedure, and that’s usually for patients who are failures in reference to medical therapy or who, for whatever reason, either do not wish to undergo a course of medical therapy, or who cannot undergo a course of medical therapy given their particular health history.
Witch Hazel is an astringent solution. That is to say that it actually helps shrink a dilated vein when applied topically. It also has some soothing properties and it’s derived from a plant-based source. And so it is a natural treatment for dilated hemorrhoidal veins.
If a patient complains of rectal pain, and especially if this pain has been going on for one to two weeks, they should definitely bring this to the attention of their primary care physician. And if the patient notices rectal bleeding, they should definitely seek the attention of their physician at that time and not wait.
A hemorrhoid is a dilated rectal vein. As you can imagine, you have blood vessels in every part of your body, but a hemorrhoid is located primarily in the anorectal region. And most of the Times you’re not aware of veins in that area until they become inflamed or enlarged, and then they can cause pain, discomfort, and in some cases, bleeding.
Hemorrhoids are often caused by increased pressure, intra-abdominal pressure, which is transmitted down towards the a rectal region and into the veins. Most commonly, folks who suffer from hemorrhoids are constipated because they don’t take insufficient amount of fluids, or because they don’t have enough fiber in their diet, which would attract water into their intestines and colon and soften up their stool to make them less constipated, which would affect the pressure on the veins in the rectum.
The diagnosis of internal hemorrhoids versus external hemorrhoids is usually done by direct observation. In other words, the physician will place an instrument, either an anusscope, a proctoscope, into the anorectal canal. Internal hemorrhoids are located above a particular anatomic region. Okay. So they’re a little bit higher up and they have a different nerve supply. Okay. Compared to external hemorrhoids, which are right at the anal-rectal connection, and also may be more external. So it’s really an anatomic distinction.
Hemorrhoids in general, are a benign condition. They’re more of an annoyance, that is, you may experience burning, itching, in some cases, streaking of blood on the toilet tissue or in the commode. However, it’s important that if you experience bleeding, you should definitely bring this to the attention of your physician.
Anal fissures are cracks or sores in the region of the anal sphincter. And if you can imagine you have a chap lip, sometimes you may have a little crack or a fissure along the lip margin. If you have this in the area of your anal sphincter, then that’s what we would consider an anal fissure. Oftentimes, this is due to some minor irritation or inflammation. However, it’s important to note because there are some conditions, certain inflammatory bowel diseases, which are characterized by fissures, and that’s actually a topic for another discussion. But suffice it to say that patients who have simple hemorrhoidal disease may also have fissures.
In reference to symptoms, internal hemorrhoids are located a little bit higher up and their nerve supply is different from that of an external hemorrhoid. Basically, internal hemorrhoids, uncomplicated, are oftentimes painless. However, if they’re scratched or abraded, you may see some blood per rectum or on the toilet tissue. Now, external hemorrhoids, their nerve supply is different. It’s very similar to the nerve supply of your skin, and so you can imagine if you were to pinch your skin, or scratch your skin, that would be painful. And so external hemorrhoids are characterized more by pain than internal hemorrhoids, which are otherwise uncomplicated. Again, if you notice bleeding from external hemorrhoids, you should definitely bring that to the attention of your physician.
Approximately 10 million Americans suffer from hemorrhoids. That’s approximately 4 to 5%. Persons who are at greater risk of hemorrhoids tend to be a little bit older. We’re talking 45 to 65 years of age. However, in the younger age group, one out of three athletic males may experience hemorrhoids, and as far as women go, that hemorrhoids are very common during pregnancy because of increased intraabdominal pressure, which is then translated down to the a rectal area.
Some of the best treatment options for treating hemorrhoids are, number one, avoid becoming constipated. Avoid straining at the time that you’re trying to pass stool. Make sure you have sufficient fiber in your diet, and that may range anywhere from 25 to 35 grams of fiber per day. For those of you who are counting. Make sure you consume enough fluids. Now, there are also some topical medications that you can apply to hemorrhoids, some for symptom relief, but there are also certain categories of medicine which could actually help with inflammation and actual shrinkage of a dilated hemorrhoidal vein.
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