Hemorrhoids are a very common problem. Hemorrhoids are nothing more than enlarged veins. When they occur in the lower legs, we call them varicose veins. When they occur in the rectum, they are called hemorrhoids or "piles." There are many ways to treat hemorrhoids.
In the past, people would simply tolerate most hemorrhoids until they became so bad that surgery was needed. Modern techniques have eliminated the need for surgical excision (cutting out) of hemorrhoids except in the most advanced cases. You may have heard of the Baron ligation technique, which involves putting a smaller rubber band around the hemorrhoids. This method has been used for many years. It is less painful than surgery and can be performed in the physician's office. Laser techniques have also been used. More advanced techniques using infared coagulation, radiofrequency, and low-dose electricity are available. They frequently provide excellent results with even less pain and less complications.
External hemorrhoids: Hemorrhoids that start below the pectinate line. These hemorrhoids are more difficult to treat because they start in an area that has pain fibers.
Mixed hemorrhoids: Hemorrhoids that are actually a combination of the previous two types. Thrombosed hemorrhoids: Hemorrhoids that have developed a blood clot inside the vein. These clots do not cause any major problems and are not dangerous. Rather, these small clots just cause severe pain. If you develop very severe discomfort, then you probably have a small clotted hemorrhoid. These are easily treated in the office by simply removing the clot.
Prolapsed hemorrhoids: Many times a hemorrhoid will protrude through the anus. Many people will call these external hemorrhoids but that is not technically correct. Hemorrhoids are classified as internal or external, based on where they start. Usually hemorrhoids that protrude out through the anus have their base above the pectinate line, so they actually are internal hemorrhoids. Sometimes these prolapsed hemorrhoids will come down and then go back up; and other times, they will stay down.
Skin tags: Oftentimes even after the hemorrhoid or vein is gone, the stretched skin that was over it will remain as a skin tag or an accumulation of loose, stretched out skin. Many people are bothered by skin tags, which are not painful, but make it difficult to keep the area clean.
Each different type of hemorrhoid problem requires a different type of approach. Depending on the problem that you have, a particular instrument will be used for the treatment.
is reserved for only the most advanced cases of hemorrhoids. Surgery
is often performed in the hospital operating room with the patient under
general anesthesia. Many hemorrhoid corrections can be done safely and
effectively in the office, using local anesthesia, and providing enormous
savings of time and money for the patient or insurer, with no sacrifice
of quality or comfort.
Trans-mucosal coagulation involves the application of a high-frequency electron burst to the base of the hemorrhoid which clots the hemorrhoid. There are usually three different areas inside the rectum where hemorrhoids occur, and they are referred to as complexes. One area, or complex, is treated at each office visit. Although the patient will occasionally feel a little warmth, there generally is minimal pain or discomfort. The patient may return to work the same day or the next day. Occasionally a little bleeding will occur between the fourth day and the tenth day after treatment. The patient returns in approximately I month for follow-up treatment.
Rediofrequency surgery involves the application of a very high-frequency current to remove external skin tags. The advantage of the technique is that it will often prevent the bleeding that is frequently associated with excision of these tags. It is similar to a laser procedure. Because skin is removed, tenderness in the area will be experienced for a longer period of time (1 to 3 weeks) until the wound is healed. A local anesthetic (to numb the area) is injected before the procedure to minimize pain.
You probably will not need to take time off from work: however, it might be best if you could take it easy for a couple of days after the procedure. Before coming in for the procedure, administer an enema (Fleet enemas are available without a prescription) approximately an hour before the planned surgery. Hold the enema for 5 to 10 minutes and then expel it. After the procedure, expect some weeping from the area and some soreness for up to several weeks. You should be able to do most normal activities within a few days. Often little or no pain medication is needed.
If you would like to play it safe, you may take three ibuprofen 200 mg tablets about an hour before coming to the office. You might want to schedule the procedure later in the day so that you do not have to go back to work. You may want to take a stool softener such as Colace, or a bulk laxative such as Metamucil or Citrucel, for a few days before the procedure. You just need enough to keep the stool soft. Also remember to drink plenty of water. You will probably want to continue this regimen for a week or so after the procedure.
After any hemorrhoid procedure, it is very important that you maintain a high bulk diet (a lot of fruits, vegetables, bran, etc.) so that your stool remains soft. Drink at least four to five glasses of water per day. You may use suppositories, if desired. Sitz baths are beneficial: simply sit in a hot bath for 20 to 30 minutes three or four times per day. It may help to apply an ointment such as Preparation H after bathing and to keep the areas from rubbing together. Your doctor may prescribe some Silvadene cream, benzocaine, or lidocaine ointment. Use them as directed. Ice bags may also help relieve the discomfort.
Complications include pain, bleeding, infection, return of the hemorrhoids, and failure of the treatment itself so that the hemorrhoids persist. None of these are expected, but all are possible.
After any of these procedures, if you have extreme pain, excessive bleeding, difficulty urinating, or if you develop fevers, chills, or sweats, call your physician immediately. You should make an appointment for a follow-up visit in 4 weeks.