Screening, Diagnosis and Treatment of Hemorrhoids
As a general rule, make an appointment with our office if your hemorrhoids are painful or bleed frequently or excessively. Most times, the longer you wait to address the issue the worse or more complicated the hemorrhoids or disease process becomes.
With earlier hemrorhoid treatments, many times the “cure” was as bad, or worse, than the disease. For this reason many hemorrhoid sufferers put off treatment until only surgery could correct the problem. Now with many non-surgical and office-based procedures, there is no reason to put off treatment – it is safe, effective and well tolerated by patients. The earlier treatment occurs with onset of hemorrhoids, generally, the easier it is to treat.
The most common sign of hemorrhoids is rectal bleeding, but because rectal bleeding can occur for other reasons, make an appointment so that our doctor can evaluate for more serious conditions or diseases. Other causes of bleeding in the lower gastrointestinal tract include:
- Proctitis, an inflammation of the inner lining of the rectum
- Colon or rectal growths (polyps)
- Anal fissure, a tear in the lining of your anus
- Anal fistula, an abnormal channel that develops between the anal canal and the skin around the opening to the anus
- Rectal prolapse, in which a portion of the rectal lining protrudes through the anus
- Diverticular disease, in which small sacs or pouches (diverticula) commonly form from the lining of the large intestine
If the onset of your hemorrhoids occurs along with a marked change in bowel habits or if you’re passing black, tarry or maroon stools, consult our office or your primary care physician without delay. These types of stools can signal more extensive bleeding elsewhere in your digestive tract. Seek emergency care if you notice large amounts of rectal bleeding, lightheadedness, weakness or a rapid heart rate of more than 100 beats a minute.
A doctor can determine if you have external hemorrhoids simply by looking. For internal hemorrhoids, a physician may want to conduct an examination with a rubber-gloved finger. But even this technique may be inconclusive because hemorrhoids are often too soft to detect and anoscopy is usually the only clear way to definitely diagnose them.
In this case, your doctor may want to examine the lower portion of your colon and rectum with an anoscope, proctoscope or sigmoidoscope. A more extensive examination could include a barium enema, which results in a better display of your colon and rectum on an X-ray, or colonoscopy — an examination of the entire colon using a flexible fiber-optic colonoscope. These tests can determine that the bleeding is not from higher in the colon, which typically indicates other conditions.
For some patients steps that can be taken on their own can lead to the prevention of hemorrhoids however, having exhausted these remedies medical treatment is likely necessary to return to a normal life without hemorrhoids.
For painful, persistent or problematic hemorrhoids, there are several medical procedures:
- Sclerotherapy: A chemical solution is injected around the blood vessel to shrink the hemorrhoid. Quite effective for internal hemorrhoids and one of the only methods available for hemorrhoids too small for surgery or RBL. This treatment is very fast and can start to lessen symptoms the very same day. It has multiple applications to both the hemorrhoids as well as perirectal tissue prolapse.
- Rubber Band Ligation/Banding (RBL): A doctor places one or two tiny rubber bands around the base of an internal hemorrhoid to cut off its circulation. You may experience a little pressure or fullness in the rectum after the procedure. Within 5 to 15 days, the hemorrhoid falls off and you may see a few drops of blood. This fairly simple procedure is very effective, fast, generally well tolerated and is done right here in our office. It is most effective for larger, prolapsing, internal hemorrhoids and is the savior treatment for many patients with large internals that were told they must get surgery.
- Infrared Coagulation: This new technology utilizes a short burst of infrared light to seal off small blood vessel circulation to the internal hemorrhoid. You may experience some warmth during the procedure and about one in three patients experience a little bleeding within a few days. It is a very fast, effective, and patient-friendly treatment. Most times the patients will start to notice positive changes within a few days.
- Laser therapy: In this procedure — called laser coagulation — a laser beam vaporizes hemorrhoidal tissue. True laser is not performed much anymore due to collateral damage and perforation of the bowel. We use the high tech alternative to laser, infrared coagulation (IRC) which is very similar and effective but lessens the risk to the patient and has less complication and a faster recovery.
- Freezing: This technique, cryosurgery, freezes the affected tissue, cutting off circulation and destroying the hemorrhoidal tissue.
- Bicap/Galvanic: Bursts of electric current shrink a hemorrhoid. This is a long procedure and not patient friendly due to small electrical pulses or shocks and many patients have anal spasm after the treatment.
- Surgery: If other procedures haven’t been successful or if you have a large hemorrhoid, your doctor can remove tissue in a procedure called hemorrhoidectomy. The more extensive the removal of tissue, the lesser the chance of recurrence but the greater the discomfort. Surgery may require up to a 1- or 2-day hospital stay — a significantly longer and more painful recovery period than other methods of hemorrhoid removal.
- Incision and Drainage: If a blood clot has formed within an external hemorrhoid, our physician can easily remove the clot with a simple incision, which provides prompt relief. The internal feeding hemorrhoid usually needs to be treated as well to fully disconnect the backwards blood flow source.