Improved Treatment for Hemorrhoids

Source: Times Newspapers Medical Advances
Story By: Julius P. Bonello, MD
Date: August 2005

No one likes to talk about hemorrhoids — it’s certainly not your typical conversation starter. Yet it’s something that should be talked about because many people suffer needlessly from pain, itching and discomfort. In fact, more than half a million patients are treated each year for symptomatic hemorrhoids while countless more suffer in silence.

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The latest treatment

Although some people dread the pain of a hemorrhoidectomy, the latest innovation in treating hemorrhoids is typically less painful. The Procedure for Prolapse and Hemorrhoids (PPH) has been found to be effective in treating severe hemorrhoids (third and fourth degree) or for those hemorrhoids that have not responded to non-surgical treatment. It is also effective for rectal mucosal prolapse, which is when part of the rectum lining (mucous membrane) slides out of place and protrudes out of the anus.

PPH uses a hemorrhoidal circular stapler device to remove hemorrhoidal tissues and close the wound. Once this is done, blood flow is reduced to the internal hemorrhoid(s) and they usually shrink within four to six weeks. Or, in the case of mucosal prolapse, the stapler device is used to lift up or reposition the mucosa to restore anal tissue to its original position.

The reason that PPH is less painful than traditional hemorrhoidectomy is because this procedure is done in a part of the anal canal which has fewer nerve endings than the area in which a conventional hemorroidectomy is performed.

Benefits of PPH

Several different clinical trials have compared the difference in results between patients that have undergone PPH with those who have had a traditional hemorrhoidectomy. These ongoing studies demonstrate that:

• PPH is a less painful procedure.
• PPH results in faster recovery times.
• PPH has fewer overall adverse effects.
• PPH patients have less “intense” post-op pain.
• PPH patients needed less post-op pain medication.

Although PPH is considered generally safe, all procedures carry potential risks. Possible complications include damage to the rectal wall or the internal muscles of the sphincter. Your physician can discuss the benefits and risks of various treatment options with you.

You’re not alone

The American Society of Colon and Rectal Surgeons reports that 50% of all Americans will have hemorrhoids at some point in their lifetime, typically in people over age 30 (yet they can occur in people of any age). Conditions that can increase your risk of hemorrhoids include obesity, pregnancy, family history of hemorrhoids, heart disease, liver disease or constipation. Straining during bowel movements, standing too long, lifting too much or sitting too long on the toilet can make hemorrhoids worse.

Hemorrhoids are the veins within the rectum and under the skin around the anus. When these veins swell as the result of the situations mentioned in the previous paragraph, patients may experience itching, bright red blood on the toilet tissue or in the toilet bowl, aching after a bowel movement or sensitive lumps. (Of course, if any of these symptoms are present, it’s important to be evaluated by your physician.)

Although many hemorrhoid sufferers can be treated with at-home measures, 10-20% of patients who see their physician about hemorrhoids require surgery. Traditional hemorrhoidectomy is done under general or spinal anesthesia. Incisions are made in the tissue surrounding the hemorrhoid and the swollen vein inside the hemorrhoid is tied off enabling the hemorrhoid to be removed.

For those patients who have smaller hemorrhoids, your physician may recommend at-home treatments including soaking in warm baths several times a day, gentle cleansing of the anal area, nutritional modifications or taking pain medications (such as Tylenol). In some cases, the non-surgical procedure known as rubber band ligation may be utilized. Ligation involves tying off the hemorrhoid to reduce blood supply, which causes the hemorrhoid to shrink away.

Don’t suffer in silence

With the advent of new procedures such as PPH, it is hoped that more people will come forward to treat their uncomfortable and painful hemorrhoids. Although some are embarrassed by their condition or fear that the treatment is worse than their current pain, this procedure gives new hope to hemorrhoid sufferers.

Dr. Bonello has more than 24 years of experience in Colon and Rectal Surgery. He also is a faculty member at the University of Illinois College of Medicine.