Hemorrhoid Treatment options vary considerably—from simple home remedies to invasive surgery, including a Hemorrhoidectomy.  The complexity of hemorrhoid treatment depends on the state of the hemorrhoid tissue. This article will cover several different types of treatment options for hemorrhoids. But first, let’s find out what a hemorrhoid is.

Before hemorrhoid treatment is discussed, just what are hemorrhoids?  They are simply dilated and congested veins at the lower end of the anal canal, and are very similar to varicose veins. They are highly vascular “cushions” or “pads” consisting of separate masses of thick sub mucosa containing blood vessels, smooth muscle, as well as elastic and connective tissues. These cushions in the anal canal are present in everyone but when they become enlarged and inflamed they become “hemorrhoids” with symptoms ranging from discomfort to substantial pain and need treatment.

To further understand the hemorrhoid treatment landscape, the rest of the environment needs clarification. The rectum is the 10-15 cm of the lower colon above the dentate line (a line dividing the upper 2/3s and lower 1/3 of the anal canal). In the rectal ampulla, in a space above the dentate line, there are three vascular hemorrhoidal cushions which help muscles maintain continence (preventing involuntary bowel movements). There are no pain fibers here. The dentate line separates the zone of internal hemorrhoids above from the zone of external hemorrhoids below.

The anal canal is the 3-4 cm between the dentate line and anal verge (a transitional zone between the skin of the anal canal and the perianal skin). The nerves here help maintain continence and discriminate between gas, fluid and solid waste, helping to avoid embarrassing solid and liquid discharges.  Anus or anal verge is the outlet covered by true skin rich in nerve endings.  Internal hemorrhoids are above the dentate line and covered with insensitive mucosa, while externals are below the dentate line and covered by sensitive skin-like cells.  The outer aspect of a hemorrhoid is covered with skin but the inner side is mucosa

By age 50, over half the population will have some occurrence of hemorrhoid symptoms requiring treatment, with the incidence peaking between 45 and 65. Men and women are affected equally, but men are more likely to seek treatment.  Ten to twenty million Americans have active hemorrhoids and as many as 5 million seek medical treatment each year. Consumers spend over 250 million dollars each year on over-the-counter hemorrhoid treatment products while 1.5 million use prescription medications for the treatment of hemorrhoids.  1.5 million patients undergo Colonoscopies annually as well as more than 120,000 surgical hemorrhoidectomies.  Most are unnecessary.

One of the main causes of developing hemorrhoids is not enough soluble fiber in your diet.  Other factors that cause hemorrhoids are insufficient hydration, straining, and sitting longer than 2 minutes on the toilet (also resulting in the prolapse of anal cushions). Tendencies for hemorrhoids may be inherited, if only through behavior lifestyle and diet habits passed along from parent to offspring. Other influences include increased abdominal pressure through pregnancy, obesity, pelvic tumors, spinal cord injuries, heavy lifting, prolonged sitting, smoking, coughing, constipation, diarrhea, anal intercourse, anal fissures and aging. Hemorrhoids can be exacerbated by excessive cleaning, rubbing, steroids and overuse of hemorrhoid creams. Further enlargement results from weakened supporting tissue that drags hemorrhoids downward, which most definitely requires treatment.  Dietary factors play an extremely important role as well, including erratic eating habits (mostly failure to eat breakfast), spicy foods, excessive consumption of fats and alcohol, inadequate hydration and any number of other dietary lifestyle issues. These are the most common factors that increase the need for treatment, especially among those between the ages of 30 to 65.

Hemorrhoid Grades for Treatment Options:

The severity is graded by the degree of prolapse

• Grade 1 hemorrhoid – no prolapse and painless bleeding.
• Grade 2 hemorrhoid – prolapse on defecation, but tissues return spontaneously. Seen on straining.
• Grade 3 hemorrhoid – prolapse requiring physical reinsertion resulting in bleeding and aching pain.
• Grade 4 hemorrhoid – unable to reinsert prolapsed hemorrhoid, leading to mucous discharge, bleeding, pain and necrosis.

Typical Hemorrhoid Symptoms Requiring Treatment:

• Chronic intermittent bright red bleeding with bowel movements, on tissue, in commode or streaked on stool surface.
• Feeling of fullness, swelling, extra tissue and incomplete bowel movement.
• Irritation or itching from seepage of mucus, fecal soiling or dermatitis from hemorrhoid creams causing rash.
• Pain may occur with prolapse, associated external hemorrhoids or anal fissure.
• Bulge of tissue on anal skin
• Blood on toilet tissue.
• Thrombosis of external hemorrhoids leading to a hard painful lump.
• Skin tags left over after dilated external hemorrhoids, hemorrhoidectomy, or resolved thrombosis (blood clot). Tags can trap stool, causing dermatitis and itching.

Diagnostics for the Treatment of Hemorrhoids:

• History and physical exam including peril-anal inspection and digital rectal exam, usually done in left lateral position with side viewing anoscopy. Significant pain suggests thrombosis, fissure, spasm, proctitis (inflammation) or abscess.
• Sigmoidoscopy to rule out tumors of lower colon
• A manometry/endorectal ultrasound-incontinence study
• Colonoscopy for persistent bleeding

Prevention Treatment of Hemorrhoids:

1. Eat foods high in fibers especially fresh fruits, leafy vegetables, and whole-grain breads and cereals. Take additional over-the-counter fiber supplements. Drink plenty of water and fluids—at least 6-8 glasses of water daily is a vital element in the prevention treatment cycle. Altering your eating and drinking habits help, especially consuming smaller portions more frequently to avoid constipation, enhancing the passage of stool.
2. Avoid sitting on the toilet for long periods of time. Use the toilet only whenever you feel the urge to have bowel movement. Prolonged sitting on the toilet as well as forcing out the stool exacerbates hemorrhoid development.
3. Observe proper anal hygiene. Keep the area clean and dry at all times. Avoid scrubbing, as this further aggravates hemorrhoids and irritates the anus. When wiping, use a gentle and slow motion.
4. Using water to clean the area is the best, but if this is not possible, use moist toilet paper or baby wipes.
5. Reduce your weight. Losing weight significantly decreases pressure on the lower part of your body, specifically the rectum. Maintain a healthy height to weight ratio to decrease hemorrhoids.
6. Avoid lifting heavy objects and other forms of activity resulting in excessive straining. Ask for help.
7. Refrain from prolonged sitting for extended periods of time. This limits pressure being exerted on your backside.
8. When work requires you to be seated most of the time, take a break every now and then and walk around for few minutes

Home Remedy Treatment of Hemorrhoids:

Apply an ice pack to the affected area. It provides a quick relief from the pain and swelling by shrinking the veins. Do not to insert ice directly into the rectum because it will burn your skin

Soak yourself in a warm tub or sitz bath several times a day for about 10 minutes. The warm water will ease swelling and alleviate the pain associated with hemorrhoids. Make sure to use clean water free of any bath products.

Anorectal preparations may temporarily help relieve anal itching or irritation, but will not cure rectal bleeding and prolapse. Patients prefer creams over suppositories.

Medical Treatment of Hemorrhoids:

Cauterizing methods can be effective for hemorrhoids through electrocautery, infrared radiation, laser, or cryosurgery.

Sclerotherapy hemorrhoid treatemnt involves the injecting of an agent, such as phenol, into the hemorrhoid, collapsing the vein walls causing the hemorrhoid to shrivel up. The success rate four years after treatment is 70%.

Doppler guided transanal hemorrhoidal dearterialization is minimally invasive, has fewer complications than the hemorrhoidectomy.  It utilizes ultrasound technology to locate arteries supplying blood to the hemorrhoid, which is then “tied off.”

Hemorrhoidectomy is the surgical removal of the hemorrhoid used only in severe cases with significant post operative pain, requiring 2–4 weeks for recovery.

In the stapled hemorrhoidectomy soft tissue is resectioned, disrupting the blood flow to the hemorrhoids. It is less painful than the hemorrhoidectomy and heals faster.

Non-Surgical Rubber Band Ligation Treatment of Hemorrhoids:

Rubber band ligation is an outpatient treatment for second-degree internal hemorrhoids.  In this procedure, a small band is applied at the base of the hemorrhoid, stopping blood supply to the hemorrhoidal mass, causing hemorrhoids to shrink and completely disappear within 2 to 7 days. The band then falls off during normal bowel movements.  Rubber band ligation is a viable alternative to a hemorrhoidectomy at this stage, as it involves less pain with a shorter recovery period. Its success rate is between 60 and 80%.  Some important RBL developments:

• 1999-Dr. Patrick O’Regan develops a disposable ligation system featuring gentle suction instead of metal grasper.
• 2006-2008 Centers for Colo Rectal Health opened in Chicago, Atlanta, Las Vegas, San Francisco, Los Angeles, Denver and New Orleans.
• Ligator has now been proven safe and reliable in over 15,000 applications.
• Banding normalized the size of hemorrhoidal cushions.
• Inflammation reattaches tissue to surrounding muscles.
• External disease improves but skin tags may be left behind.
• Banding may be done via side viewing anoscope. Band is placed 1.5 to 2 cm above dentate line to decrease pain. After band is applied it is digitally checked for position and comfort.

Post-RBL Treatment Protocol – Who Can Be Banded?

• Patients may resume normal activities after the banding but should avoid strenuous activities until the next day.
• There may be a feeling of heaviness or fullness for 1-2 days.
• Avoid constipation. Continue with fiber and fluids.
• Bleeding may occur which may be from associated fissures or other hemorrhoids. Lie down on side, drink fluids, apply ice to anal area and if condition persists call physician.
• Call physician for urinary retention, fever, myalgia, flu-like symptoms.
• The band will fall off and pass in 1-7 days.

Disadvantages to Banding Treatment:

• Anticoagulants such as Coumadin, Plavix, or aspirin are a relative contraindication to hemorrhoid treatment and if possible it is best to discontinue use for 5 days before and after banding.
• In portal hypertension the rectal varices are treated by treating the portal hypertension.
• In pregnancy try to stay away from rectal procedures to avoid the rare complication of pelvic sepsis or the liability of abortion. Anal fissures may be treated with Nitroglycerin.
• Not capable of tolerating office procedure.
• Large external hemorrhoid disease.
• Grade IV hemorrhoidal disease not responding to banding.

Other Hemorrhoid Treatment Modalities:

• Anti-inflammatory Cortisone preparation, to reduce itching and swelling.
• Over-the-counter products containing hydrocortisone are not FDA approved for internal anorectal use.
• Prolonged use can weaken tissue, promote infection, and cause allergic reaction

Options  to Surgical Treatment:

• Prevention is the best line of treatment
• Conservative treatment offers symptomatic relief but does not treat the cause.
• Rubber band ligation is a non-surgical, safe and painless, in-office treatment. This is the most recommended and effective first choice treatment.
• Surgical procedures are reserved for large external hemorrhoids and for internal hemorrhoids not responding to rubber band ligation.

Dr. Mando is the Medical Director of the Center for Colorectal Health in Louisiana.

Before discussing the five tips that will hopefully help our readers make a sound choice when deciding on a hemorrhoid treatment product, I would like to say this. Give me a minute to get up on my soapbox here and I’ll get started. We at H.I.C. find it utterly disgusting regarding the unethical tactics presently being demonstrated by some companies selling hemorrhoid treatment products on the Internet. Please know that H.I.C. has taken a beating, both financially and spiritually to keep the faith and uphold our mission, which is providing you, the reader, a safe haven to get honest, objective and accurate information. But it comes at a cost! It’s unfortunate that things have gotten to this point. I’ll never get used to it. Now here are the five tips……..drum roll please !

Five quick things to look out for when buying hemorrhoid treatment online.

♦Does the company’s website you’re thinking about buying hemorrhoid treatment from even have a phone number?

♦ Look out for false endorsement claims, such as, “as seen on”, or , “as advertised in”. If I’m paying for an ad, it’s quite different then an endorsement, which is the illusion their trying to create.

♦ Take a look at the user comment sections of some of these sites. If the comment times are all minutes apart, chances are they’re fake and the web site administrator or somebody in a similar capacity made them up.

♦Timed cure guarantees saying things like “24 hour” or “3 day cure” for most hemorrhoid conditions.

♦ Hemorrhoid treatment review sites that don’t tell you how they came to their conclusions. Ask them for proof about how they backup their claims, that’s if they have a phone number you can call. Most of these websites are full of……………..hey, have you read our article,  ”What is your stool telling you?”

Bonus Tip #1: Using the FDA’s logo, Badges or Widgets. The illusion, “We are ethical”

Bonus Tip #2: Hemorrhoid product review sites that have other health care  products they review (i.e.,acne, heartburn). Notice there isn’t a link however to buy these products. Once again, the illusion is that they are objective. It’s being used as a decoy so you think they just aren’t about hemorrhoids.

Over half a million people a year in the U.S. purchase some form of  home hemorrhoid treatment. I’m sure many of the creams, ointments,  ice packs, hemorrhoid toilet seats, hemorrhoid cookbooks, herbal remedies and whatever else is out there,  all work well on some individuals. One thing is for sure. There is plenty of business to go around for everybody.

On that note, good luck in your hunt for the right hemorrhoid treatment. I hope these tips will help you make an educated decision. Oh, and one last thing. Before you do any of this, see your doctor and get checked out. It’s better to be safe than sorry.

TEAM H.I.C.

© 2009   Hemorrhoid Information Center

FDA’s VIEWPOINT

Hemorrhoidolysis is a non-invasive procedure in which the hemorrhoid is shrunk using an electrical current that is manually applied to the actual site of inflammation, using a tool that is known as an electrode, or small probe.  The electrode transmits a low-grade electrical current onto the hemorrhoid itself, which in turn causes a chemical reaction in the tissue.  It is believed that the tissue at the inflamed site that undergoes this chemical reaction causes hemorrhoidal tissue to shrink, eventually alleviating both the hemorrhoids and its symptoms.  The procedure is also called Galvanic Electrotherapy, or the Ultroid method.

Hemorrhoidolysis is a relatively new modality of treatment for hemorrhoids that is most successful for resolving internal hemorrhoids.  Typically the procedure is painless and can be preformed without anesthesia in a very short period of time within a doctor’s office.  Since complications are virtually non-existent (there are rarely reported side effects such as bleeding or swelling), Hemorrhoidolysis is frequently performed on an outpatient basis, with the individual usually being be able to return to work or home the same day.

Hemorrhoidolysis is most commonly employed for the treatment of internal hemorrhoids.  The theory upon which electrotherapy is based has a long history of successful use by sports doctors and physical therapists for treating soft-tissue conditions such as muscle spasms or atrophy.  Typically the doctor is able to manually treat one hemorrhoid at a time, over what averages out to be three to four visits.  Because the procedure is non-invasive and produces so few complications, it is particularly popular amongst patients who wish to avoid the possible side-effects and recovery time associated with other remedies such as Rubber Band Ligation.  It should be noted that long-term resolution of one’s hemorrhoids and its symptoms also depends upon certain lifestyle changes that demand alterations to diet, exercise, and bowel habits.  Given the procedure’s rate of success treating milder cases of internal hemorrhoids, doctors and patients will likely continue turning to Hemorrhoidolysis.

David Gilbert received his BA from U.C.L.A. He is currently doing graduate work in psychology at California Graduate Institute, in Los Angeles, CA. Throughout his career in the mental health field he has worked clinically with several populations, and also contributed to academic works whose topics address both health and mental health issues.

© Hemorrhoid Information Center

Infrared Coagulation is a non-surgical procedure used to treat internal hemorrhoids. Infrared Coagulation is known as a fixative treatment, and is similar to other fixative treatments such as Rubber Band Ligation and Sclerotherapy, in that its objective is it reduce hemorrhoidal symptoms by eliminating hemorrhoids through obstruction of blood-flow to the infected region. Individuals can suffer from a variety of hemorrhoids, each case presenting its own symptoms and necessitating different courses of treatment. It is necessary to educate yourself and consult with your physician to decide on the proper intervention that will address your specific needs. This article will provide for you basic information specifically about Infrared Coagulation.

Infrared Coagulation is one of the most commonly prescribed procedures used to treat certain smaller, internal hemorrhoids. Like its sister fixative procedures, Infrared Coagulation is non-surgical and can be performed on a same-day basis in a doctor’s office. Because the side-effects, risks, and recovery time are so reduced, and because it boasts such a high success rate, it is favored amongst both doctors and patients.

Infrared Coagulation consists of inserting a small instrument into the anus that acts as a probe. Upon contact with the hemorrhoid, the probe emits a burst of infrared light directly onto the infected tissue for approximately 1 to 1.5 seconds. Exposing the hemorrhoid to the infrared light causes the hemorrhoidal vein to coagulate, or scar, which reduces blood flow to the hemorrhoid, eventually causing it shrivel, harden, and fall off. The scarring also acts as a prophylactic between the hemorrhoid and the anus and protects against further re-inflammation.

Infrared Coagulation does not cause discomfort, and unlike other fixative treatments such as Rubber Band Ligation or Sclerotherapy, does not typically require the use of anesthetics. Frequently, what the patient does experience during Infrared Coagulation is a momentary sensation of heat, which though frequently uncomfortable is rarely reported to actually be painful. The recovery time is relatively short, and typically patients can return to their regular activities the same day. As with most procedures performed to the rectal area, activities that require heavy lifting or straining should be avoided. Typically the procedure must be repeated approximately every 12 to 14 days, and only one hemorrhoid at a time may be treated per session.

Infrared Coagulation has an excellent success rate for small to medium internal hemorrhoids, and it is reported that with proper changes to diet, exercise, and bowel habits, symptoms do not return. It is not uncommon to experience slight bleeding from the anus for about 7 to 10 days, after which time the hemorrhoid falls off. Patients are often advised to use mild or over-the-counter pain relievers such as Tylenol to reduce discomfort; consult with your physician before using NSAID’s (non-steroidal anti-inflammatory drugs) or aspirin prior to, or just after, undergoing Infrared Coagulation, because of the risk of excessive bleeding clotting that can arise as a secondary complication, depending on your personal medical history. It is also common for doctors to prescribe stool softeners after Infrared Coagulation, to assist with easier bowel movement and thus ensure straining does not occur.

Infrared Coagulation’s success depends on both your doctor’s knowledge and skill, in addition to the necessary changes to your lifestyle that you are willing to make. Although Infrared Coagulation can be costly, it less costly than surgical procedures and less costly still than the certain consequences you will experience letting your hemorrhoidal condition go untreated. Whatever course of action you decide upon be sure to properly arm yourself with all of the information at your disposal, to ensure the correct intervention for yourself is in fact Infrared Coagulation.

written by David Gilbert

© 2009 Hemorrhoid Information Center

]]> http://www.hemorrhoidinformationcenter.com/infrared-coagulation-hemorrhoid-treatment/feed/ 4 http://www.hemorrhoidinformationcenter.com/hemorrhoid-surgery-less-invasive-procedures/ http://www.hemorrhoidinformationcenter.com/hemorrhoid-surgery-less-invasive-procedures/#comments Tue, 07 Jul 2009 23:00:54 +0000 Joy Seeman http://www.hemorrhoidinformationcenter.com/?p=729

Many medical techniques have been developed in recent years to alleviate the pain and suffering of patients with hemorrhoids. These methods are a vast improvement over the traditional hemorrhoidectomy surgery which required hospitalization and a lengthy recuperation period. Although the success rate is not as high with these treatments, they have many advantages over invasive surgeries. They are less expensive and have a quick recovery period for the patient. They can be done in the doctor’s office or on an outpatient basis; often patients can return to work the next day. Results of the minimally invasive procedures have been excellent for some patients to unsuccessful in others. Usually, only patients with severe hemorrhoids which have not responded to any other treatments submit to these procedures.

There are three main minimally invasive procedures performed:

· Coagulation is a technique where lasers or infrared lights are used on the hemorrhoid. The method causes the internal hemorrhoid to harden and dry-up. It has few side effects, but the hemorrhoids often return.

· Rubber band ligation has a better success rate than coagulation. In this method, the doctor ties off the hemorrhoid at the base with one or two rubber bands. Without a blood supply, the hemorrhoid falls off in a few days. The patient may experience discomfort and bleeding after the procedure, but complications are rare.

· Sclerotherapy is a hemorrhoid treatment where a chemical solution is injected into the hemorrhoid causing it to shrink. It is a painless technique, although it seems to be less successful than rubber band ligation and is usually only used on smaller hemorrhoids.

If your hemorrhoids have progressed to the point where they have curtailed your lifestyle, these are good options to consider. Consult your doctor is see if you are a candidate for these procedures. You may want to research doctors who specialize in these treatments since they would have the experience and expertise to give you the best care.

written by Joy Seeman

©2009 H.I.C. Digestive Health

Treating Hemorrhoids with a Squat Toilet my seem a little, well, left of center. However, truth be told, it’s anything but. It’s a known fact that our “western” style toilet  puts an unnecessary strain on the  body while in the process of  a bowel movement.The impact of the western toilet or porcelain throne, which was invented about 150 years ago, forced unsuspecting users to change from squatting to sitting on a toilet. This change has led to great distress, pain and suffering in some individuals. Two-thirds of the planet still uses the squat position, and for the most part, these people do not suffer with hemorrhoids as our “Western” culture does. Studies have shown that squatting, not the sitting posture, is the much more natural position to empty the bowels. This is the position in which the colon and body were designed to work. In the sitting position, it is physically impossible to evacuate waste matter completely. People who sit on toilets very often have a sensation that there is more to come, but it won’t come out without straining. The squatting position permits the straightening of the anorectal angle, which allows the anus to open freely for the smooth movement of the feces, and, thereby, it exerts the least amount of pressure to avoid straining.

In my estimation, squatting is another preventative to help cure hemorrhoids because it prevents continual aggravation and injury due to straining in the sitting position. When this problem is removed, natural healing will happen. However, we do not sell the squat platforms, but if you are interested, let us know by e-mail, and we will put you in touch with the company that does make them. You can also type Squat Toilets in Google and research the different manufactures that make them.