Hemorrhoids Information, Pictures, Treatments, and Cures Hemorrhoids are cushions of tissue and varicose
veins located in and around the rectal area. When they become
inflamed, hemorrhoids can itch, bleed, and cause pain. Unfortunately
a hemorrhoidal condition only tends to get worse over the
years. That is why safe, gentle, and effective treatment
for hemorrhoids is recommended as soon as they occur.
Hemorrhoids bother about 89% of all Americans at some time
in their lives. Hemorrhoids caused Napoleon to sit side-saddle,
sent President Jimmy Carter to the operating room, and benched
baseball star George Brett during the 1980 World Series.
Over two thirds of all healthy people reporting for physical
examinations have hemorrhoids.
For more information about Hemorrhoids visit the links below:
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Hemorrhoids Care Center Locations & Medical
Directors
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Pictures:
Hemorrhoids and Anal Fissure
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Internal
hemorrhoids occur higher
up in the anal canal, out of sight. Bleeding is the most
common symptom of internal hemorrhoids, and often the
only one in mild cases. View hemorrhoid gallery
for detailed photos. |
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External
hemorrhoids are visible-occurring
out side the anus. They are basically skin-covered veins
that have ballooned and appear blue. Usually they appear
without any symptoms. When inflamed, however, they become
red and tender. View hemorrhoid gallery
for detailed photos. |
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Sometimes, internal
hemorrhoids will come through the anal opening when straining
to move your bowels. This is called a prolapsed
internal hemorrhoid; it is often difficult to ease
back into the rectum, and is usually quite painful. View
hemorrhoid gallery
for detailed photos. |
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When a blood clot
forms inside an external hemorrhoid, it often causes Severe
pain. This thrombosed external hemorrhoid
can be felt as a firm, tender mass in the anal area, about
the size of a pea. View
hemorrhoid gallery
for detailed photos. |
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Anal
fissure.
A thin slit-like tear in the anal tissue, an anal fissure
is likely to cause itching, pain, and bleeding during
a bowel movement. For more detailed information, view
our page on Anal
Fissure. |
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What
Are Hemorrhoids?
The term hemorrhoids refers to a condition in which the veins
around the anus or lower rectum are swollen and inflamed.
Hemorrhoids may result from straining to move stool. Other
contributing factors include pregnancy, aging, chronic constipation
or diarrhea, and anal intercourse. Hemorrhoids are both inside
and above the anus (internal) or under the skin around the
anus (external). Hemorrhoids (piles) arise from congestion
of internal and/or external venous plexuses around the anal
canal. For more detailed about information, about the concepts
of hemorrhoidal anatomy, and how the hemorrhoidal problem
develops, view our video on Overview: Anatomy
of Prolapse and Hemorrhoids. Get > Real
Player
Hemorrhoids are classified into four degrees, depending on
severity, so that they can more easily be evaluated for possible
surgery. For more detailed information, view our page Surgical
Classification of Hemorrhoids.
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What
Are the Symptoms of Hemorrhoids?
Many anorectal problems, including fissures, fistulae, abscesses,
or irritation and itching (pruritus ani), have similar symptoms
and are incorrectly referred to as hemorrhoids. Hemorrhoids
usually are not dangerous or life threatening. Rarely, a patient
can have bleeding so severe, that severe anemia or death may
occur. In some cases, hemorrhoidal symptoms simply go away
within a few days. But in most cases, hemorrhoidal symptoms
eventually return, often worse than they were before. Although
many people have hemorrhoids, not all experience symptoms.
The most common symptom of internal hemorrhoids is bright
red blood covering the stool, on toilet paper, or in the toilet
bowl. However, an internal hemorrhoid may protrude through
the anus outside the body, becoming irritated and painful.
This is known as a protruding hemorrhoid. Symptoms of external
hemorrhoids may include painful swelling or a hard lump around
the anus that results when a blood clot forms. This condition
is known as a thrombosed external hemorrhoid. In addition,
excessive straining, rubbing, or cleaning around the anus
may cause irritation with bleeding and/or itching, which may
produce a vicious cycle of symptoms. Draining mucus may also
cause itching.
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How
Common Are Hemorrhoids?
Hemorrhoids are very common in both men and women. About half
of the population have hemorrhoids by age 50. Hemorrhoids
are also common among pregnant women. The pressure of the
fetus in the abdomen, as well as hormonal changes, cause the
hemorrhoidal vessels to enlarge. These vessels are also placed
under severe pressure during childbirth. For most women, however,
hemorrhoids caused by pregnancy are a temporary problem.
How
Are Hemorrhoids Diagnosed?
A thorough evaluation and proper diagnosis by the doctor is
important any time bleeding from the rectum or blood in the
stool occurs. Bleeding may also be a symptom of other digestive
diseases, including colorectal cancer. The doctor will examine
the anus and rectum to look for swollen blood vessels that
indicate hemorrhoids and will also perform a digital rectal
exam with a gloved, lubricated finger to feel for abnormalities.
Closer evaluation of the rectum for hemorrhoids requires an
exam with an anoscope, a hollow, lighted tube useful for viewing
internal hemorrhoids, or a proctoscope, useful for more completely
examining the entire rectum. To rule out other causes of gastrointestinal
bleeding, the doctor may examine the rectum and lower colon
(sigmoid) with sigmoidoscopy or the entire colon with colonoscopy.
Sigmoidoscopy and colonoscopy are diagnostic procedures that
also involve the use of lighted, flexible tubes inserted through
the rectum.
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What
Is the Treatment?
Medical treatment of hemorrhoids is aimed initially at relieving
symptoms. Measures to reduce symptoms include · Warm tub baths
several times a day in plain, warm water for about 10 minutes.
· Application of a hemorrhoidal cream or suppository to the
affected area for a limited time. Preventing of the recurrence
of hemorrhoids will require relieving the pressure and straining
of constipation. Doctors will often recommend increasing fiber
and fluids in the diet. Eating the right amount of fiber and
drinking six to eight glasses of fluid (not alcohol) result
in softer, bulkier stools. A softer stool makes emptying the
bowels easier and lessens the pressure on hemorrhoids caused
by straining. Eliminating straining also helps prevent the
hemorrhoids from protruding. Good sources of fiber are fruits,
vegetables, and whole grains. In addition, doctors may suggest
a bulk stool softener or a fiber supplement such as psyllium
or methylcellulose. In some cases, hemorrhoids must be treated
endoscopically or surgically. These methods are used to shrink
and destroy the hemorrhoidal tissue. The doctor will perform
the procedure during an office or hospital visit. A number
of methods may be used to remove or reduce the size of hemorrhoids.
Painless non-surgical techniques,
lasers for hemorrhoids, harmonic
scalpel for hemorrhoids, and the use of hemorrhoid medications
are discussed further in this web site.
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How
Are Hemorrhoids Prevented?
The best way to prevent hemorrhoids is to keep stools soft
so they pass easily, thus decreasing pressure, and to empty
bowels without undue straining as soon as possible after the
urge occurs. Exercise, including walking, and eating a high
fiber diet, help reduce constipation and straining by
producing stools that are softer and easier to pass.
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Painless
Techniques for the Treatment of Hemorrhoids
Major surgery for hemorrhoids can generally be avoided in
favor of more sophisticated and often painless methods of
treatment. Non-surgical methods of treatment are available
to most patients as a viable alternative to a permanent hemorrhoid
cure.
Bipolar Coagulation
Bipolar electrotherapy is applied for a directed coagulation
effect of the mucous membrane near the hemorrhoid. Specialized
Bipolar Circumactive Probes (BICAP) are effective for the
treatment of bleeding internal hemorrhoids. Bipolar electrotherapy
is applied for a directed coagulation effect of the mucous
membrane near the hemorrhoid. Specialized probe designs are
effective for the treatment of bleeding internal hemorrhoids.
For more detailed information about how electric modalities
are used in the treatment of hemorrhoids, view the Electric
Treatment Of Hemorrhoids.
HAL
Hemorrhoidal Arterial Ligation (H.A.L.) is performed using
a modified proctoscope in conjunction with a Doppler ultrasound
flowmeter. A needle and thread is passed beneath the artery,
and a knot is externally tied, to stop the blood flow to the
hemorrhoid. For more informaion on the HAL-RAR Method visit www.hemorrhoid.net.
Hemorrhoidolysis
Therapeutic galvanic waves applied directly to the hemorrhoid,
produces a chemical reaction that shrinks and dissolves hemorrhoidal
tissue. This technique is most effective when it is used on
internal hemorrhoids. Therapeutic galvanic waves applied directly
to the hemorrhoid, produces a chemical reaction that shrinks
and dissolves hemorrhoidal tissue. This technique is most
effective when it is used on internal hemorrhoids. For more
detailed information about how electric modalities are used
in the treatment of hemorrhoids, view the Electric
Treatment Of Hemorrhoids.
Injection
To shrink the hemorrhoid and its blood vessels, medicine is
injected into the mucous membrane near the hemorrhoid. This
method is reserved for the smallest of hemorrhoids.
Photocoagulation
A device called a photocoagulator focuses infrared light into
a fine point at the end of a probe, which spotwelds the hemorrhoid
in place. This is used for hemorrhoids that are actively bleeding.
Rubber Banding
A special instrument fits a small rubber band over part of
the hemorrhoid. A tight rubber band stops the blood flow into
the pinched-off portion, which falls off in about a week.
This technique is widely used for hemorrhoids protruding into
the anal canal.
For patients with a lesser degree
of prolapse, Rubber Band Ligation is currently the most widely
used procedure in the United States for treatment of internal
hemorrhoids. In this procedure, the hemorrhoidal tissue is
pulled into a double sleeved cylinder to allow the placement
of latex/rubber bands around the tissue. (fig. 1) Overtime,
the tissue below the bands dies off and is eliminated during
a bowel movement. (fig. 2)
Rubber band ligation
can be performed in a doctor's office and requires little
preparation. Often, however, there is the need for more than
one procedure to resolve a patient's condition. Rubber band
ligation is most effective when combined with a sclerotherapy
injection for prolapse.
Super Freezing
A cryogenic device uses liquid nitrogen to super freeze the
hemorrhoid. This causes the affected tissue to slough off,
so that new healthy tissue can grow in its place. This technique
is most effective when it is used on external hemorrhoids.
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HAL-RAR Method Hemorrhoidectomy
A product of A.M.I. (Agency for Medical Innovations) is the (DG) HAL/RAR® System. It is the first system to utilize minimally invasive surgical techniques to treat the source of hemorrhoidal disease without surgical excision, stapling or banding. It is a single system that offers two procedure options, (DG) HAL (Doppler Guided Hemorrhoidal Artery Ligation) and (DG) RAR (Doppler Guided Recto Anal Repair Proctoplasty).
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How many patients have been treated and what are the results?
Available to patients since 2001, the procedures have been successfully performed on tens of thousands of patients worldwide. Physicians report an institutional success rate of 93-96% in treating patients with grades II to IV disease. Complication rates are very low, and any complications that do occur, such as minor bleeding, thrombosis, and defecation pain, are very manageable.
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How long does the procedure take, will I be hospitalized, and when can I go back to work?
The procedure can take as little as twenty minutes and patients usually leave the same day. Most patients experience only minor pain and discomfort, and return to work the next day.
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What kind of care will I need before, during, and after the procedure? What medications will the doctor prescribe?
Discuss this in-depth with your physician as your age, weight, and physical condition will influence how you are medicated and managed during and after the procedure. Your surgeon may opt to forgo general anesthesia for conscious sedation. Again, you should discuss these options with your doctor. Results are variable but post-procedural pain medications are usually minimal and for limited duration.
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Grade 1 Through 4 Hemorrhoid Prolapse
Grade 1 Prolapse
Hemorrhoid protrudes into the anal canal but does not prolapse outside the anus |
Grade 2 Prolapse
Hemorrhoid protrudes through the anus during straining or evacuation but returns spontaneously.
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Grade 3 Prolapse
Hemorrhoid protrudes through the anus during straining or evacuation but needs to be manually returned to position |
Grade 4 Prolapse
Hemorrhoid remains prolapsed outside the anus |
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A.M.I. (DG) HAL/RAR® System
The (DG) HAL/RAR® System is the first system to utilize minimally invasive surgical techniques to treat the source of hemorrhoidal disease without surgical excision, stapling or banding. It is a singlesystem that offers two procedure options, (Doppler Guided) Hemorrhoidal Artery Ligation and Recto Anal Repair (Proctoplasty).
Features and Benefits:
Good control
* Rapid identification of terminal branches of superior hemorrhoidal artery
* Precise, accurate ligation
* Immediate confirmation
Minimal discomfort
* Minimally invasive surgery
* Ligation sutures are placed 2-3 cm above dentate line
* General or MAC sedation
High success rate
* 90% or greater success rate
* No major complications reported
* Ratio of inflow to outflow drops significantly
HAL Doppler II System
Minimally-invasive treatment for lower grades of hemorrhoids.
 Features and Benefits:
- Displays identified artery depth.
- Displays blood flow velocity in identified arteries.
- New: A built in printer generates a protocol on the number, position and depth of ligated arteries.
- Recto Anal Repair (RAR®) Proctoplasty (Mucopexy)
A mucopexy can be performed through the window of the (DG) HAL proctoscope to treat grades III and IV hemorrhoids.
 Features and Benefits:
• No resection of mucosal tissue
• No severe complications reported
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A.M.I. HAL Method
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The HAL Method - Doppler Guided Hemorrhoidal Artery Ligation Procedure
1. The patient is positioned in Lateral Recumbent or in a Lithotomy Position.
2. Ultra Sound Gel is put on the A.M.I. HAL-Doppler Proctoscope before it is fully trans-anally inserted and slowly/gently turned until a typical Doppler sound of arterial blood flow can be heard.
3. The identified arteries are ligated in a distance 3 to 4 cm proximal to the Dentate Line through the ligation window of the A.M.I. HAL-Doppler Proctoscope, thus reducing the blood inflow to the inner hemorrhoidal plexus.
Good control
- Rapid identification of terminal branches of superior hemorrhoidal artery
- Precise, accurate ligation
- Immediate confirmation
- Minimum discomfort
- Minimally invasive surgery
- Ligation sutures are placed 2-3 cm above dentate line
- General or MAC (Monitored Anesthesia Care) sedation
- High success rate
- 90% or greater success rate
- No major complications reported
- Ratio of inflow to outflow drops significantly
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A.M.I. RAR Method
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The (DG) RAR Method – Doppler Guided Recto Anal Repair Proctoplasty (Mucopexy) Procedure
1. First, a running stitch is made from the top to the bottom. The device is so designed that only the prolapsing tissue is caught by the needle.
2. The ends of the thread are pulled together and knotted at the top. This has the effect of lifting up the hemorrhoids that are hanging down.
3. With this “lifting”, the hemorrhoids are back where they belong. The tissue scars over and integrates “seamlessly” back into the anal tissue. The stitches are placed not in the anus but in the lower rectum, where there are almost no pain nerves. Patients report little discomfort or pain associated with these procedures.
Patient Satisfaction
- “93.75% of patients would recommend treatment with (DG) HAL/RAR® to a friend because of the level of pain and effectiveness”
- “91% of patients would ask for HAL treatment if necessary”
- Recovery normally takes just one to three days
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Surgical
Classification of Hemorrhoids
Hemorrhoids (piles) arise from congestion
of internal and/or external venous plexuses around the anal
canal. They are classified, depending on severity, into four
degrees. First degree hemorrhoids bleed but do not prolapse
outside of the anal canal; second degree prolapse outside
of the anal canal, usually upon defecation, but retract spontaneously.
Third degree hemorrhoids require manual placement back inside
of the anal canal after prolapsing, and fourth degree hemorrhoids
consist of prolapsed tissue that cannot be manually replaced
and is usually strangulated or thrombosed. Symptoms associated
with hemorrhoids include pain, bleeding, puritus ani (itching)
and mucus discharge. In IV degree prolapse, the area where
the rectal mucous membrane meets the anal skin (the dentate
line) is positioned almost outside the anal canal, and the
rectal mucous membrane permanently occupies the muscular anal
canal.
For more detailed about information, about the concepts of
hemorrhoidal anatomy as applied to rectal surgery, view our
video on Overview:
Anatomy of Prolapse and Hemorrhoids > get Real
Player , an alternative approach to the surgical treatment
of hemorrhoids. In order to explain the rational of the surgical
procedure for prolapse and hemorrhoids it is helpful to take
a moment to review some concepts of anatomy.
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Traditional
Surgery
In many cases hemorrhoidal disease can be treated by dietary
modifications, topical medications and soaking in warm water,
which temporarily reduce symptoms of pain and swelling. Additionally,
painless non-surgical methods of treatment are available to
most of our patients as a viable alternative to a permanent
hemorrhoid cure.
In a certain percentage
of cases, however, surgical procedures are necessary to provide
satisfactory, long?term relief. In cases involving a greater
degree of prolapse, a variety of operative techniques are
employed to address the problem.
Milligan-Morgan Technique
Developed in the United Kingdom by Drs. Milligan and Morgan,
in 1937. The three major hemorrhoidal vessels are excised.
In order to avoid stenosis, three pear-shaped incisions are
left open, separated by bridges of skin and mucosa. This technique
is the most popular method, and is considered the gold standard
by which most other surgical hemorrhoidectomy techniques are
compared.
Ferguson Technique
Developed in the United States by Dr. Ferguson, in 1952. This
is a modification of the Milligan-Morgan technique (above),
whereby the incisions are totally or partially closed with
absorbable running suture.
A retractor is used to
expose the hemorrhoidal tissue, which is then removed surgically.
The remaining tissue is either sutured or is sealed through
the coagulation effects of a surgical device.
Due to the high rate
of suture breakage at bowel movement, the Ferguson technique
brings no advantages in terms of wound healing (5-6 weeks),
pain, or postoperative morbidity.
Conventional haemorrhoidectomy
can be performed as a day-case procedure. But due to poor
post-operative care in the community and high level of pain
experienced after the procedure, an in-patient stay is often
required (average of 3 days).
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Stapled
Hemorrhoidopexy (PPH Procedure)
Also known as Procedure for Prolapse & Hemorrhoids (PPH),
Stapled Hemorrhoidectomy, and Circumferential Mucosectomy.
PPH is a technique developed
in the early 90's that reduces the prolapse of hemorrhoidal
tissue by excising a band of the prolapsed anal mucosa membrane
with the use of a circular stapling device. In PPH, the prolapsed
tissue is pulled into a device that allows the excess tissue
to be removed while the remaining hemorrhoidal tissue
is stapled. This restores the hemorrhoidal tissue back to
its original anatomical position.
The introduction of the
Circular Anal Dilator causes the reduction of the prolapse
of the anal skin and parts of
the anal mucous membrane. After removing the obturator, the
prolapsed mucous membrane falls into the lumen of the dilator.
The Purse-String Suture
Anoscope is then introduced through the dilator.
This anoscope will push
the mucous prolapse back against the rectal wall along a 270°
circumference, while the mucous membrane that protrudes through
the anoscope window can be easily contained in a suture that
includes only the mucous membrane. By rotating the anoscope,
it will be possible to complete a purse-string suture around
the entire anal circumference.
The Hemorrhoidal Circular
Stapler is opened to its maximum position. Its head is introduced
and positioned proximal to the purse-string, which is
then tied with a closing knot.
The ends of the suture
are knotted externally. Then the entire casing of the stapling
device is introduced into the anal canal. During the introduction,
it is advisable to partially tighten the stapler.
With moderate traction
on the purse-string, a simple maneuver draws the prolapsed
mucous membrane into the casing of the circular stapling device.
The instrument is then tightened and fired to staple the prolapse.
Keeping the stapling device in the closed position for approximately
30 seconds before firing and approximately 20 seconds after
firing acts as a tamponade, which may help promote hemostasis.
Firing the stapler releases
a double staggered row of titanium staples through the tissue.
A circular knife excises the redundant tissue. A circumferential
column of mucosa is removed from the upper anal canal. Finally,
the staple line is examined using the anoscope. If bleeding
from the staple line occurs, additional absorbable sutures
may be placed.
What are the Benefits
of PPH over other Surgical Procedures?
1) Patients experience less pain as compared to conventional
techniques.
2) Patients experience a quicker return to normal activities
compared to those treated with conventional techniques.
3) Mean inpatient stay was lower compared to patients treated
with conventional techniques.
What are the Risks
of PPH?
Although rare, there are risks that accompany PPH:
4) If too much muscle tissue is drawn into the device, it
can result in damage to the rectal wall.
5) The internal muscles of the sphincter may stretch, resulting
in short-term or long-term dysfunction.
6) As with other surgical treatments for haemorrhoids, cases
of pelvic sepsis have been reported following stapled haemorrhoidectomy.
7) PPH may be unsuccessful in patients with large confluent
hemorrhoids. Gaining access to the anal canal can be difficult
and the tissue may by too bulky to be incorporated into the
housing of the stapling device.
8) Persistent pain and fecal urgency after stapled hemorrhoidectomy,
although rare, has been reported.
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The Harmonic Scalpel
uses ultrasonic technology, the unique energy form that allows
both cutting and coagulation of hemorrhoidal tissue at the
precise point of application, resulting in minimal lateral
thermal tissue damage. Because the Harmonic Scalpel uses ultrasound,
there is less smoke than is generated by both lasers and electrosurgical
instruments. The Harmonic Scalpel cuts and coagulates by using
lower temperatures than those used by electrosurgery or lasers.
Harmonic Scalpel technology
controls bleeding by coaptive coagulation at low temperatures
ranging from 50ºC to 100ºC: vessels are coapted
(tamponaded) and sealed by a protein coagulum. Coagulation
occurs by means of protein denaturation when the blade, vibrating
at 55,500 Hz, couples with protein, denaturing it to form
a coagulum that seals small coapted vessels. When the effect
is prolonged, secondary heat is produced that seals larger
vessels. Because ultrasound is the basis for
Harmonic Scalpel technology, no electrical energy
is conducted to the patient.
By contrast, electrosurgery
coagulates by burning (obliterative coagulation) at temperatures
higher than 150ºC. Blood and tissue are desiccated and
oxidized (charred), forming eschar that covers and seals the
bleeding area. The reduced postoperative pain after Harmonic
Scalpel hemorrhoidectomy compared with electrocautery controls,
likely results from the avoidance of lateral thermal injury.
Harmonic Scalpel
Applied to Tissue |
Harmonic Scalpel
Hemorrhoidectomy |
The protein coagulum
caused by the application of the Harmonic Scalpel is superior
at sealing off large bleeding vessels during surgery. It has
been my experience that this method is useful on large hemorrhoids
that may bleed during surgery, thus minimizing blood loss
and reducing the time needed for surgery.
For more detailed information,
view our video on Hemorrhoidectomy
Using Harmonic Scalpel > get Real
Player
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Laser
Surgery for Hemorrhoids
Skilled surgeons use laser light with pinpoint accuracy. The
unwanted hemorrhoid is simply vaporized or excised. The infinitely
small laser beam allows for unequaled precision and accuracy,
and usually rapid, unimpaired healing.
The result is less discomfort,
less medication, and faster healing. A hospital stay is generally
not required. The laser is inherently therapeutic, sealing
off nerves and tiny blood vessels with an invisible light.
By sealing superficial nerve endings patients have a minimum
of postoperative discomfort. With the closing of tiny blood
vessels, your proctologist is able to operate in a controlled
and bloodless environment.
Procedures can often
be completed more quickly and with less difficulty for both
patient and physician. Laser can be use alone or in combination
with other modalities. For more detailed information on combining
modalities in surgery, view our video on the performance of
both a Laser
& Harmonic Scalpel Hemorrhoidectomy. Get > Real
Player
A study of 750 patients
undergoing laser treatment for hemorrhoids reported successful
results of 98%. The patient satisfaction was 99%.
For more detailed information,
view our page on Published
Laser Research.
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Atomizing
Hemorrhoids
A new technique to remove hemorrhoids is called atomizing.
The Atomizer™ is a medical device that was developed
specifically to atomize tissue. The term "atomizing hemorrhoids"
was coined because the hemorrhoids are actually reduced to
minute particles into a fine mist or spray, which is immediately
vacuumed away. An innovative waveform of electrical current
and a specialized electrical probe, the Atomizer Wand™,
was created for this purpose (patent pending).
With a wave of the Atomizer Wand, the hemorrhoids are simply
excised or vaporized one or more cell layers at a time. The
hemorrhoids are essentially disintegrated into an aerosol
of carbon and water molecules. Using the Atomizer, the tissue
is sculpted into a desired shape and smoothness. As a
result, the surgeon operates with minimal bleeding, and gets
better homeostasis than with traditional electrosurgical techniques.
With the Atomizer, the patient gets better postoperative results,
and fewer anal tags than with traditional operative techniques.
In the United States, the Ferguson hemorrhoidectomy is considered
the gold standard by which most other surgical hemorrhoidectomy
techniques are compared. A clinical study at the Hemorrhoid
Care Medical Clinic, of thirty patients, compared the traditional
Ferguson hemorrhoidectomy with the CO2 laser hemorrhoidectomy,
and the Atomizer hemorrhoidectomy, and revealed the following:
Figure 1: Hemorrhoidectomy: Atomizing vs. the CO2 laser.
The results of atomizing hemorrhoids are similar to that
of lasering hemorrhoids, except that there is less bleeding
using the Atomizer, and the Atomizer cost less. In both procedures,
it is noted that there is less discomfort, less medication,
less constipation, less urinary retention, and a hospital
stay is generally not required. Complications using the Atomizer
are rare, and excellent results are typical.
Atomizing hemorrhoids is offered exclusively in Arizona.
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Complications
of Hemorrhoid Surgery
Early Complications
Include:
1) Severe postoperative pain, lasting 2-3 weeks. This
is mainly due to incisions of the anus, and ligation of the
vascular pedicles.
2) Wound infections are uncommon after hemorrhoid surgery.
Abscess occurs in less than 1% of cases. Severe necrotizing
infections are rare.
3) Postoperative bleeding.
4) Swelling of the skin bridges.
5) Major short-term incontinence.
6) Difficult urination. Possibly secondary to occult urinary
retention, urinary tract infection develops in approximately
5% of patients after anorectal surgery. Limiting postoperative
fluids may reduce the need for catheterization (from 15 to
less than 4 percent in one study).
Late Complications
Include:
1) Anal stenosis.
2) Formation of skin tags.
3) Recurrence.
4) Anal fissure.
5) Minor incontinence.
6) Fecal impaction after a hemorrhoidectomy is associated
with postoperative pain and narcotic use. Most surgeons recommend
stimulant laxatives, or stool softeners to prevent this problem.
Removal of the impaction under anesthesia may be required.
7) Delayed hemorrhage, probably due to sloughing of the vascular
pedicle, develops in 1 to 2 percent of patients. It usually
occurs 7 to 16 days postoperatively. No specific treatment
is effective for preventing this complication, which usually
requires a return to the operating room for one or more stitches.
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Knowing
What to Ask Your Surgeon
Before choosing the procedure you wish to have performed,
there are questions you should ask the surgeon:
1. What types of procedures have they performed?
2. How many of each procedure have they performed?
3. Why are they recommending one particular procedure over
another?
4. How long will the procedure take?
5. Will this procedure require a hospital stay and how long
do they anticipate your hospital stay will last?
6. How long do they expect the recovery process to take?
7. How soon will you be able to return to "normal" activity?
8. Will having the procedure mean having to change how I live,
work or eat?
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Allopathic
Medication
An allopathic remedy treats a condition through
antagonistic means, to stop the disease process.
Hydrocortisone cream and suppositories
are the cornerstone of conservative medical treatment in proctology.
By interfering with the body's natural immune response, this
medicine helps with the inflammation of hemorrhoids, but cannot
cure them.
Miscellaneous over the counter medications
are used with varying degrees of success. They contain, in
different proportions, an assortment of anesthetics, astringents,
anti-inflammatory agents, and emollients.
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Herbal
Medications
An herbal remedy is made from a medicinal plant or
plants and used to prevent and treat diseases and ailments
or to promote health and healing.
Barberry (Berberis Aristata) is a blood
purifier that has also been used for hemorrhoids or piles.
The unique qualities of berberine-rich plants lie in their
ability to promote healthy intestinal microbial balance and
normal liver and gallbladder function.
Butcher's Broom (Ruscus Aculeatus) is used
to treat varicose veins and hemorrhoids. The vein-narrowing
qualities of butcher's broom have been found to relieve discomfort
associated with varicose veins and other circulatory conditions.
Horse Chestnut (Aesculus Hippocastanum)
extract standardized for aescin or escin, seems to increase
the strength and tone of the veins in particular. It has astringent
and anti-inflammatory properties. It may be used internally
to aid the body in the treatment of phlebitis, varicose veins,
and hemorrhoids. Externally it may be used to treat the same
conditions as well as for leg ulcers.
Neem (Azadirachta Indica, Margosa) . In
the Ayurvedic tradition, neem is recommended for the treatment
of hemorrhoids. It has been shown to have anti-bacterial,
anti-inflammatory and pain-relieving properties. Neem helps
to prevent hemorrhoids by promoting the elimination of waste,
and avoiding constipation. Neem extract applied topically
to external hemorrhoids is soothing, and helps control bleeding
and itching.
Psyllium is a bulk laxative and demulcent
used for the short-term treatment of constipation. Constipation
can causes hemorrhoids and fissures to develop. It is also
used to treat people with irritable bowel syndrome, diverticular
disease, and hemorrhoids and to lower cholesterol in people
with high cholesterol.
Slippery Elm (Ulmus fulva) softens and
soothes internal or external inflamed bodily tissues, including
hemorrhoids.
White Oak Bark (Quercus Alba) . Popular
for its astringent qualities, White Oak Bark encourages tissue
proteins to tighten, thus strengthening vascular walls. The
oak tannin binds liquids, absorbs toxins, and soothes inflamed
hemorrhoidal tissues. The inhabitation of intestinal secretions
may also help to resolve diarrhea.
Witch Hazel (Hammamelis viriniana) is a
natural astringent used to reduce swelling and inflammation.
It is effective in stopping the flow of blood, and in reducing
secretions.
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Homeopathic
Medication
A homeopathic remedy is one that produces the same symptoms
that the patient is complaining of. A minimum dose is in used,
and relies on the body's regulation of self-healing to assist
nature. The homeopathic approach allows for the treatment
of conditions that are not treatable by traditional means.
Remedies are relatively inexpensive, without side effects,
and offer the possibility of a cure.
Aloe can help when your rectum is sore,
bleeding, and hot. Helps with the feeling of a constant bearing
down in the rectum.
Apis Mellifica is useful for external anal
skin, which is bright red, burning, and itching.
Calendula homeopathic ointment is a most
remarkable healing agent when applied locally. Useful for
open wounds, hemorrhoids that ruprure, parts that will not
heal, ulcers, etc. Promotes healthy granulations and rapid
healing by first intention.
Collinsonia Canadensis relieves pruritus
in pregnancy, itching of anus, hemorrhoids with a sensation
of sharp sticks in rectum, dry stools, and obstinate constipation.
Commonly called Stone Root.
Graphites helps to relieving constipation,
knotty stools united by mucus threads, burning hemorrhoids
with soreness, itching and anal fissures. A person who needs
Graphites is often overweight, has difficulty concentrating,
and tends toward developing skin eruptions. Commonly called
Black Lead.
Nitricum Acidum is indicated for constipation
with intense straining when there is with little or no bowel
evacuation, and for violent cutting pains after stool passage
which continues for hours. Also indicated for profusely bleeding
hemorrhoids. Commonly called Nitric Acid.
Nux Vomica can be used for itching, painful
hemorrhoids, a feeling of constriction in the rectum, and
chronic constipation with ineffectual urging. A person who
needs Nux vomica is usually impatient, tense, and irritable,
and often has a tendency toward heavy use of stimulants, strong
foods, and alcohol or drugs.
Paeonia Officinalis is suitable for relieving
anal itching, hemorrhoids, fissures, and ulceration's of anus
and perineum, and burning sensation in the anus after passage
of stool. Commonly called Peony.
Pulsatilla is indicated for hemorrhoids
that itch, with sharp sticking pains. The hemorrhoids typically
protrude, and improve after lying down. Warmth often aggravates
the symptoms. This is a very helpful remedy for hemorrhoids
that appear during pregnancy or around the menstrual period.
Sulphur is indicated for redness around
the anus with itching and burning, and for protruding hemorrhoids,
which are accompanied by a feeling of fullness and pressure
in the abdomen. A person who needs Sulphur typically may feel
worse from warmth and bathing, and may have flatulence with
a strong offensive odor. Commonly called Sublimed Sulphur.
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References
1. Endo-Surgery Inc, 2001, Ethicon Endosurgery, Procedure
for Prolapse and Hemorrhoids, 2001, http://www.jnjgateway.com/home.jhtml?page=viewContent
&contentId=09008b988004c944
2. The University of Birmingham, National Horizon Scanning
Centre, Stapled Haemorrhoidectomy, United Kingdom , 2001,
http://www.publichealth.bham.ac.uk/horizon/PDF_files/
Stapledhaemorrhoidectomy.PDF
3. Ethicon Endosurgery, Procedure
for Prolapse and Hemorrhoids Photo, 2001,
http://www.jnjgateway.com/home.jhtml?page=viewContent&contentId=09008b988004c944
4. Endo-Surgery Inc, 2001, Ethicon Endosurgery,
Procedure for Prolapse and Hemorrhoids, 2001, http://www.jnjgateway.com/home.jhtml?page=viewContent
&contentId=09008b988004c944
5. The University of Birmingham, National Horizon Scanning
Centre, Stapled Haemorrhoidectomy, United Kingdom, 2001, http://www.publichealth.bham.ac.uk/horizon/PDF_files/
Stapledhaemorrhoidectomy.PDF
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Video
References
1. Video: Overview:
Anatomy of Prolapse and Hemorrhoids 3 1/2 minutes, Ethicon
Endo-Surgery Inc. 2001, get > Real
Player
http://www.jnjgateway.com/home.jhtml?page=viewContent
&contentId=09008b988004c944
2. Video: View
Actual Hemorrhoid Surgery using the Harmonic Scalpel (8
minutes), Ethicon Endo-Surgery Inc. 2001,
http://www.jnjgateway.com/home.jhtml?loc=USENG&page=viewContent&
contentId=fc0de00100000325&parentId
3. Video: Harmonic
Scalpel & Laser Hemorrhoidectomy (5 minutes), Rick
Shacket, DO. 2002, get > Real
Player
4. Video: Hemorrhoid
Surgery Tutorial - The National Library of Medicine
http://www.nlm.nih.gov/medlineplus/tutorials/hemorrhoidsurgery/htm/index.htm
5. Video: General
Anesthesia Tutorial - The National Library of Medicine
http://www.nlm.nih.gov/medlineplus/tutorials/generalanesthesia/htm/index.htm
6. Video: Preparing
for Surgery Tutorial - The National Library of Medicine
http://www.nlm.nih.gov/medlineplus/tutorials/preparingforsurgery/htm/index.htm
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Links: Friends of Hemorrhoids.net
1) Gastric Banding Center
2) Top Rate Doctors
3) Proctology Associates
4) Arizona Genital Wart Center
5) Genital Warts Centers
6) Lap-Band San Diego
7) Office Colonoscopy Center
8) Missouri Genital Warts Center
Note: Hemorrhoids is a commonly misspelled word. Here are a few variations - hemorroids, hemorroid, hemmoroids, hemmoroid, hemroids, hemroid, hemeroids, hemeroid, hemmroids, hemmroid, hemmeroids, hemmeroid, haemorrhoids, haemorrhoid, hemoroids, hemoroid, hemmoroids, hemmoroid, hemrroids, hemrroid, hemorroides, hemorroide, hemorrhoid.
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