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The Treatment of Hemorrhoids Hemorrhoids are very commonly blamed for rectal bleeding and anal discomfort. Hemorrhoidal tissue is a normal part of the anal anatomy. Blood vessels interconnecting in a sponge-like tissue are even theorized to help maintain continence for the passage of air and liquid stool. "Hemorrhoids," the illness, happens when a variety of abnormalities occur. External hemorrhoidal thrombosis exists when a blood clot forms in the hemorrhoidal tissue lined by skin. It may be related to passage of a hard stool or vigorous physical activity such as heavy lifting or exercise. Truck and forklift drivers are frequently afflicted. Just as frequently, no cause can be identified. The major symptoms are severe anal pain, the presence of an anal lump and anal bleeding. The treatment in the first few days after occurrence, when there is severe pain, is to excise the hemorrhoid. When pain is on the wane, hot baths and bulk laxatives will calm the symptoms, and the mass will gradually shrink, usually leaving a small skin tag. Internal hemorrhoids are hemorrhoidal tissue covered by rectal lining cells which cause symptoms. They are classified by 4 levels of severity. Grade 1 Internal hemorrhoids bleed but do not protrude through the anal opening. Grade 2 hemorrhoids protrude but spontaneously return to their normal position. Grade 3 Internal hemorrhoids must be manually replaced. Grade 4 hemorrhoids cannot be replaced into the anal canal. Because rectal bleeding is a symptom common to tumors and hemorrhoids, visualization of the colon lining by colonoscopy is often recommended. The physician, on initial examination, will be able to diagnose if hemorrhoids are present. Many people come to the physician with anal pain and rectal bleeding thinking they have hemorrhoids, when actually their symptoms are due to an anal fissure or cut in the anal skin. The initial treatment of most hemorrhoidal disease is medical. It must be stressed that the diagnosis is clearly established as hemorrhoids, not a polyp or cancer, before any treatment is begun. A high fiber diet is begun with bran cereal and additional fresh fruits and vegetables. Water should be the predominant liquid in the diet with 1-2 glasses (8oz.) being taken with each meal. When constipation has been present a bulk laxative is prescribed. When symptoms persist with medical treatment, an operative procedure is indicated. The simplest, most useful, and effective treatment has been shown to be rubber banding of the hemorrhoids. There is little discomfort in most patients before and after the procedure, and the complication rate is quite low. This procedure works best for Grade 1 through Grade 3 hemorrhoids. When external skin tags or external hemorrhoids are also present and causing symptoms, rubber banding may be used to treat internal hemorrhoids but will not help external skin tag symptoms. Rubber banding causes little discomfort, because the area where they are applied usually has no pain nerve endings. The skin, of course, has many pain conducting nerves and so rubber bands cannot be used on skin-lined tissue. Infrared photocoagulation is comparable to banding and has few advantages. Surgical hemorrhoidectomy gives the best results for Grade 4 hemorrhoids and hemorrhoids associated with a large amount of anal skin involvement, with skin tags, or with external hemorrhoids. This procedure is performed with a local, spinal, or general anesthetic. After recovery, patient satisfaction is high. Laser hemorrhoidectomy has been shown to have prolonged wound healing and more complications than standard hemorrhoidectomy. The very common affliction of hemorrhoids, when properly diagnosed, can be treated with a high degree of patient satisfaction. Diet treatment, rubber banding, and surgical hemorrhoidectomy are the scientifically proven forms of treatment.
More Information The treatment of internal hemorrhoids which are causing symptoms of bleeding and protrusion is hemorrhoidal banding. Hemorrhoidal banding involves an instrument which places a rubber band precisely over the hemorrhoid. When individuals have a large skin component to their hemorrhoids, these are called external hemorrhoids. These patients are best treated with surgery. If the skin component is small, hemorrhoid banding can be performed, but often small skin tags will remain after treatment. Some people do find these troublesome and they are best removed surgically when they cause discomfort. A colon x-ray and sigmoidoscopy(a looking into the rec- tum and colon with an instrucment) is necessary before hemorrhoidal banding to insure there is not a reason, besides the hemorrhoids, for the symptoms, such as a colon polyp. Most people are comfortable treated with hemorrhoidal banding. They can often continue with their normal acti- vities after banding, but should avoid straining and heavy lifting. Metamucil or similar products, plenty of water, and a high fiber diet continued throughout the period of banding and for at least one year thereafter for the best results. Between 1 and 6 applications of bands are needed to control symptoms. Most people need three. When the symptoms of bleeding and protrusion stop, no further bands are applied. The bands are applied at three week intervals. This is an operation and as such it does have possible drawbacks and complications. There is a feeling of drawing or pulling in the rectum when the rubber band is applied. There is, in most individuals, only a mild, tolerable discomfort, and a feeling of a lump in the rectum after the rubber band is applied. About 10% of people have severe discomfort when the rubber band is applied. This happens because in these people the skin nerves have grown into the internal hemorrhoids. If you have severe pain after the band is applied, tell the doctor and he will remove it. Individuals in this situation are better off having a hemorrhoid operation under anesthesia. The rubber band takes an average of 3 days to fall off, but it may fall off with the hemorrhoid as early as one day or as late as 2 weeks after the band has been applied. Hemorrhoidal banding is always associated with some rectal bleeding. If the bleeding becomes heavy and clots pass, call the doctor. About one in 100 patients require hospitalization with bedrest for bleeding after rubber banding, and occasionally an operation is needed to stitch the site of bleeding. Severe pain occurs a few days after banding in a small percentage of patients. This may occur most commonly because a blood clot has formed in the skin. Infection, however, can occur quite rarely, When this is the case urination often becomes difficult. If severe pain occurs several days after banding or you have difficulty urinating, call the doctor. Please ask your doctor any further questions you might have.