E-Note for Adult Medicine
Stat | Lytes
| Drugs | ID | Heart | Lungs | Kidneys
| GI | Rheum | Heme-Onc | Endo
| Neuro | Derm | Misc. | Resource | Home |
|
Hemorrhoids Two types: Internal Hemorrhoids External Hemorrhoids Degree of Prolapse and Treatment Options for Internal Hemorrhoids Characteristics Treatment 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 |
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. REF: http://www.pphinfo.com/dtcf/ |