Hemorrhoids, also called piles, are protrusions, folds, or irregularities of anal tissue, both inside the anus (internal), and outside (external). They are formed by the stress of bowel movements, straining and local irritation. They are comprised of epithelial lining (skin or mucus membrane), connective tissue and blood vessels, in varying proportions. The symptoms they produce include itching, bleeding, discharge, swelling, discomfort, and pain.
Hemorrhoids may suddenly become acutely swollen and painful. This occurs when blood clots within the hemorrhoidal veins. This condition is referred to as “thrombosed hemorrhoids.” Commonly a pea or marble sized painful lump will appear externally. Sometimes the entire anus swells, inside and out, producing severe pain.
Conservative treatments for hemorrhoids include creams and ointments, sitz baths, and measures to maintain soft bulky stools. Such stools are the least traumatic to anal tissue and are achieved by consuming a diet high in fiber with sufficient fluid intake. Fiber supplements and stool softeners may also be helpful.
Because hemorrhoids vary in structure and location, the methods to treat them also vary. In general, only hemorrhoids that produce symptoms are treated, although occasionally external hemorrhoids are removed for cosmetic reasons.
Small thrombosed external hemorrhoids usually resolve on their own within a couple of weeks. However, if seen early in their course, they may be surgically treated in order to hasten resolution and pain relief. The colon and rectal surgeon might excise the swelling containing the blood vessels and clots or “lance” the hemorrhoid to extrude a clot.
When non-thrombosed internal hemorrhoids cause symptoms, rubber band ligation is often the treatment of choice. Quick and effective, this is the most commonly performed procedure to eliminate internal hemorrhoids. Using a specially designed instrument, tiny elastic rings are applied to strangulate an internal hemorrhoid. This is usually done in the office, and no anesthesia is required. The hemorrhoid withers and disappears within days. The band is discharged, usually unnoticed, with a bowel movement.
When internal or external hemorrhoids are large, or cause symptoms that do not respond to conservative management, surgery may be considered. A well performed hemorrhoidectomy will usually provide permanent relief. An operation called Procedure for Prolapse and Hemorrhoids (PPH) may be a less painful and better option for selected patients. Dr. Leiboff was the first to perform PPH in Suffolk County and is highly experienced with this operation. Another approach, Transanal Hemorrhoidal Dearterialization (THD), controls symptoms by reducing the blood flow to the hemorrhoids. Dr. Leiboff has performed this procedure many times, but now considers THD to be inferior to other surgical techniques for treating hemorrhoids.
Dr. Leiboff makes all efforts to reduce the pain associated with hemorrhoid surgery and routinely uses Exparel®, a long acting local anesthetic, to make the patient comfortable for many hours after surgery. Exparel® is available at John T. Mather Memorial Hospital, but is not available everywhere.
Other methods exist to treat hemorrhoids. Infrared photocoagulation (IRC) can be helpful in treating low profile bleeding internal hemorrhoids. IRC is commonly confused with “laser” treatment. Injection sclerotherapy was a common technique employed in the last century and still is valuable in certain circumstances, such as to control bleeding in patients who are on blood thinners and cannot be safely taken off. Cryotherapy (freezing) and laser surgery, while once popular and heavily promoted, did not improve results, and are rarely used by colon and rectal surgeons today.
Dr. Leiboff is an expert in the treatment of hemorrhoids and is familiar with all the above techniques. He will help you select the treatment best for you.
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