Degree of Prolapse and Treatment Options for Internal Hemorrhoids
1st degree Do not prolapse, may bleed, often asymptomatic Bowel management, IRC, ST
2nd degree Prolapse with BM and reduce spontaneously Bowel management, IRC, RBL
3rd degree Prolapse with BM or spontaneously & are manually reducible BM, RBL, occasionally hemorrhoidectomy
4th degree Chronically prolapsed, either are not reducible or do not stay reduced Operative hemorrhoidectomy
Abbreviations: BM = bowel movement; IRC = infrared coagulation; ST = sclerotherapy; RBL = rubber band ligation.
Most hemorrhoidectomies are now performed in an ambulatory setting. Pain is
significant for 1 to 2 weeks after hemorrhoidectomy but results are impressive, with
recurrence rates of only 2 to 5%. Rarely, internal hemorrhoids may prolapse and
become incarcerated and extensively thrombosed. These patients present with severe
pain and require emergent surgery.
(REF: NEJM 2/3/94; 330:337 Runyon BA)
Although this condition is benign and easily treated, patients may delay seeking medical advice because of embarrassment of hemorrhoids or fear of cancer. As a result, many people first see their physician when the problem is advanced, requiring extensive hemorrhoid treatment, and causing greater distress than if the condition had been adequately diagnosed and managed at an earlier stage.
Early Hemorrhoid Treatment Options
Often lifestyle and dietary changes, topical medications, and good hygiene may be all that are needed to reduce the symptoms of hemorrhoids. Most painful hemorrhoids stop hurting on their own in one to two weeks. If pain persists, talk to a physician about other hemorrhoids treatment options.
Advanced Hemorrhoid Treatment Options
Advanced Hemorrhoid options include:
· Rubber band ligation is widely used for the treatment of internal hemorrhoids where the hemorrhoidal tissue is pulled into a double-sleeved cylinder to allow the placement of latex/rubber bands around the tissue. Over time, the tissue below the bands dies-off and is eliminated during a bowel movement. Rubber band ligation can be performed in a doctor’s office and requires little preparation. Often, however, there is the need for more than one procedure to resolve the condition.
· A hemorrhoidectomy surgically removes the tissue that causes bleeding or protrusion. It is done under anesthesia and may require hospitalization and a period of inactivity.
Other methods of hemorrhoid treatment include Infrared Coagulation, BICAP Coagulation, Injection Sclerotherapy, Laser Hemorrhoidectomy, and Doppler Ultrasound Guided Hemorrhoidal Artery Ligation.
Innovative Hemorrhoid Treatment Options
For advanced hemorrhoids is called the Procedure for Prolapse and Hemorrhoids (PPH). This minimally invasive surgery technique was developed in the early 1990s to reduce the prolapse of hemorrhoidal tissue to allow a patient to experience less pain and recover faster than patients who undergo the conventional hemorrhoidectomy procedure.
Conventional hemorrhoidectomy procedures are painful because hemorrhoidal tissue is surgically removed, affecting many nerve endings. In comparison, PPH reduces the prolapse of hemorrhoidal tissue by utilizing a circular stapler to trim out a band of tissue above the dentate line, or the area where the patient would feel pain, within the anal canal. The PPH surgical procedure essentially "lifts up" or repositions the anal canal tissue and restores the hemorrhoidal tissue to its original anatomical position, without cutting sensitive nerve endings. The internal hemorrhoids then shrink within four to six weeks after the procedure.