Treatment for Hemorrhoids in Richmond and Mechanicsville, VA
WHAT ARE HEMORRHOIDS?
It is helpful to understand that hemorrhoidal tissue is actually a normal part of your anatomy. Hemorrhoids are blood vessels that reside in the anal canal just under the surface skin and anal lining. In some patients, hemorrhoids become enlarged, bulging blood vessels in and around the anus. The tissue that supports these vessels stretches and expands, causing the walls to thin and bleeding to occur. As the stretching and pressure progress, the weakened vessels protrude.
There are two types of hemorrhoids, external and internal. These are classified based on their location.
External (outside) hemorrhoids develop near the anus and are covered by sensitive skin. They are typically painless unless they become very swollen or a blood clot (thrombosis) forms.
Thrombosed external hemorrhoids are blood clots that form within these external hemorrhoids. Large clots can cause intense pain. A painful anal mass may appear abruptly and worsen within the first 48 hours. The pain typically diminishes over the following days. If the overlying skin opens, you may observe bleeding.
Internal (inside) hemorrhoids form inside the anal canal just below the anal lining. The most common symptoms are painless bleeding and protrusion during bowel movements. However, a completely prolapsed internal hemorrhoid can cause severe pain. This occurs when the internal hemorrhoid has come out of the anal opening and cannot be pushed back inside.
WHAT CAUSES HEMORRHOIDS?
Hemorrhoids can be caused by a variety of factors. The upright posture of humans places a large amount of pressure on rectal veins, which can potentially cause bulging. Other contributing factors include:
- Aging. The tissue that holds the hemorrhoids in place can weaken over time.
- Bowel Movements. Constipation, diarrhea or irregular bowel movements can exert pressure in these blood vessels
- Family history. Hemorrhoids can often be hereditary
- Poor Bowel Habits. Straining during bowel movements or spending long periods of time on the toilet (even without excessive straining) can cause pressure buildup in these blood vessel
- Pregnancy and childbirth. These can also cause added pressure in these vessels
WHAT ARE SYMPTOMS OF HEMORRHOIDS?
The following may be a sign of hemorrhoids:
- Bleeding with bowel movements which is usually bright red
- Protrusion of tissue during bowel movements
- Itchiness around the anal area
- Pain around the anal area
- Sensitive lump(s)
WHAT ARE OPTIONS FOR TREATING HEMORRHOIDS NON-SURGICALLY?
Before attempting self-treatments, it’s important to have your symptoms evaluated by a colon and rectal surgeon. A thorough examination will be performed, and treatment will be recommended.
Mild symptoms can often be relieved without surgery. Nonsurgical treatments typically relieve pain and swelling within two to seven days. The hemorrhoid should recede within four to six weeks.
Treatment includes:
- Consuming a high-fiber diet and taking over-the-counter fiber supplements (20-30 grams of fiber/day) can help in producing soft, formed, and bulky stools. Mixing 1 tablespoon of the psyllium (eg Metamucil) in an 8 oz. glass of water or juice every day can keep stool soft and promote regularity. Other types of fiber supplements include Benefiber, Citrucel, and store-brand supplements.
- Stool softeners such as MiraLAX and Milk of Magnesia can be taken daily if recommended by your doctor. These will hydrate your stool so that it passes easier.
- Drink at least 64 ounces/8 cups of non-caffeinated beverages each day. This will also help hydrate your stool.
- Avoid excessive straining during bowel movements. This will reduce the pressure on hemorrhoids, help prevent protrusion, and improve symptoms.
- Decrease the amount of time on the toilet to under 5 minutes to help prevent pressure buildup in those hemorrhoids.
- Take warm tub baths (sitz baths) for 10 to 20 minutes, a few times per day to help the healing process. This treatment is specific to painful or swollen hemorrhoids.
- Some patients find benefit in topical ointments or suppositories which may be prescribed or found over-the-counter
WHAT ARE OPTIONS TO TREAT HEMORRHOIDS SURGICALLY?
Thombectomy: Your physician may decide to remove the hemorrhoid and/or clot with a small incision if pain from a thrombosed hemorrhoid is severe. This procedure can be performed at your physician’s office or at the hospital under local anesthesia.
Rubber Band Ligation: This treatment is effective on internal hemorrhoids that protrude or bleed during bowel movements. It involves placing a small rubber band over the hemorrhoid, which cuts off its blood supply. The hemorrhoid and the band fall off within a few days. The wound typically heals in one to two weeks. This method will “tack up” the internal hemorrhoid tissue by creating a scar to prevent it from prolapsing out or bleeding. Mild discomfort and bleeding may occur after the procedure. Depending on the size or if the hemorrhoid returns, treatment may need to be repeated for complete treatment of the hemorrhoids. This option is only reserved for internal hemorrhoids and cannot be performed for external (outside) hemorrhoids.
Hemorrhoid stapling: Also called stapled hemorrhoidopexy or “PPH”, this method uses a specialized device to staple and remove tissue from internal hemorrhoids. This method can reduce the size of internal hemorrhoids but is not suitable for external hemorrhoids. This procedure is usually more painful than rubber band ligation but less painful than hemorrhoidectomy.
Transanal Hemorrhoidal Dearterialization (THD): This method employs an ultrasound machine to identify the hemorrhoid blood vessels. Sutures are then used to cut off the blood flow to these hemorrhoids and then secure the extra hemorrhoid tissue back into the rectum so it does not continue to protrude. Similar to hemorrhoid stapling, it can only be used for internal hemorrhoids and not external hemorrhoids.
Hemorrhoidectomy: This surgery will completely excise excess tissue that causes bleeding and protrusion. It is performed under anesthesia for both internal and external hemorrhoids. A several week recovery period is typically necessary. Discuss with your surgeon if hemorrhoid removal surgery is right for you.
DO HEMORRHOIDS LEAD TO COLORECTAL CANCER?
Hemorrhoids do not increase the risk of colorectal cancer nor will they cause colorectal cancer. At the same time, please be mindful that more serious conditions may present with similar symptoms. Your colon and rectal surgeon may recommend additional tests such as a colonoscopy. Although bleeding is most often caused by hemorrhoids, rectal bleeding may be due to a source above the hemorrhoids. A colonoscopy is the best way to fully evaluate the entire colon and rectum to determine the cause of rectal bleeding. Screening colonoscopy is recommended for average-risk individuals starting at age 45, but a colonoscopy may be recommended at a younger age to evaluate specific symptoms such as bleeding.
ABOUT COLON AND RECTAL SPECIALISTS
Colon and Rectal Specialists was founded in 1913. We are a group of dedicated fellowship-trained colorectal surgeons. We are experts in the surgical and non-surgical treatment of diseases of the colon, rectum, and anus. Our surgeons have all completed advanced surgical training in the treatment of these diseases in addition to full general surgical training. We are well-versed in the treatment of both benign and malignant diseases of the colon, rectum, and anus and are able to perform routine screening examinations and surgically treat conditions when indicated.
ABOUT C.A.R.E.S. CENTER
Colon and Rectal Endoscopy and Surgery (CARES) Center is our state-of-the-art Ambulatory Surgery Center. Our center has been accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) and has been given Medicare Deemed Status by CMS. We perform a variety of services including: screening colonoscopies, hemorrhoidectomy, abscess and fistula surgery, fissure surgery, pilonidal surgery, and surgery to treat fecal incontinence.
