Treatments for hemorrhoids | Colon and Rectal Specialist

MANILA, Philippines - Hemorrhoids are actually present in all individuals whether healthy or not. They are the vascular cushions which surround the general area of the rectum and anus.

The term hemorrhoids is associated with the symptoms when this part of the body becomes enlarged, inflamed, thrombosed or prolapsed.

Many people have them without suffering from any symptoms, and therefore these may be safely left alone. Treatment is usually required for those whose hemorrhoidal symptoms such as excruciating throbbing pain affect quality of life and daily living. 

There are many traditional remedies and non-surgical treatments for hemorrhoids. However, if none of these work, surgical procedures may be required as a last resort.

 How do hemorrhoids look and feel?

Hemorrhoidal cushions are skin, vascular and soft tissues that line the anal canal, playing a small role in defecation and continence.  Everyone has them, although with our daily travails of straining and movement, they do change over time, becoming more lax or loose as we age. 

Hemorrhoidal disease occurs when these changes result in bothersome symptoms such as bleeding, prolapsed, or pain.  Almost everyone may develop symptoms at some point in their life, but these are not life-threatening, and may be safely observed. Treatment is usually required for those whose hemorrhoidal symptoms impact on quality of life and daily living.

What are the symptoms of hemorrhoids? 

Bleeding from hemorrhoids is usually bright red, often dripping into the toilet bowl, or noticed when wiping. The stools themselves are normal looking, indicating that the bleeding is originating only from the anorectal area.  Sludge of dark blood and stool mixed thoroughly together is usually from a source within the small and large intestines and not hemorrhoids. Hemorrhoidal bleeding is painless, and this differentiates it from anal fissures, which is also a very common anal condition that presents with similar bright red bleeding during defecation, but with anal pain.

Hemorrhoids only become painful when they thrombosed or incarcerated.  Thrombosed hemorrhoids occur when blood clots within the hemorrhoids, causing very obvious swelling and pain.  While surgery for this may be effective during the first 4 days of the attack, if left alone the swelling and pain gradually subside and disappear after 2 weeks.  Usually this occurs just once or twice in a person’s lifetime, and it is uncommon to have repeated episodes of thrombosis. 

Doctors often classify patients as to having either external or internal hemorrhoids.  External hemorrhoids are located just outside the anus, and hence are always visible on routine inspection.  Many people have them without suffering from any symptoms, and therefore these may be safely left alone.  Sometimes external hemorrhoids may make cleaning difficult, allowing sweat and anal discharge to hide between folds, resulting in anal itching.

Internal hemorrhoids arise from inside the anus and are therefore only visible when, because of excessive laxity, they protrude outside.  This condition is called prolapsed, and usually occurs during defecation.  When internal hemorrhoids prolapsed they may either slip back inside on their own, or require manipulation by the person for it goes back in.  When the prolapsed hemorrhoids cannot be returned, they become trapped outside, resulting in pain and swelling.  This scenario is called incarcerated hemorrhoids.

What are the forms of treatment for hemorrhoids– surgical and non-surgical?

Hemorrhoids only require treatment when there are symptoms.  And the type of treatment depends on the severity of symptoms.  Mild symptoms may be managed just by eating a lot of fiber and taking in bulk laxatives such as psyllium to improve the consistency of stools and ease bowel movement.  Some over-the-counter creams may provide symptomatic relief.

Non-surgical and almost painless treatments for hemorrhoids include injection sclerotherapy, infrared photocoagulation (often mislabeled as “laser treatment”), and rubber band ligation, any of which can be done safely in the clinic as an out-patient procedure.  In scientific studies comparing these methods, rubber band ligation was found to be the most effective and cheap, which is why it is the most common non-surgical procedure for hemorrhoids in the world today.

Non-surgical treatment is often ineffective for large, incarcerated or thrombosed hemorrhoids.  Surgery is usually recommended in these situations, and also when non-surgical treatment has failed to relieve symptoms.  Traditional surgery requires cutting out the hemorrhoid using a variety of instruments such as scissors, knives, cautery, and ultrasonic dissectors. Unfortunately, any wound created in the outer skin of the anus results in often Sever post-operative pain, which is responsible for the reputation of hemorrhoid surgery being one of the most painful of operations.

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Endorectal Ultrasound, also called transrectal ultrasound, is a special ultrasound technique in which the transducer is directly inserted through the anus and into the patient's rectum. The sound wave echoes detected by the transducer are converted by a computer into an image.

Transanal Hemorrhoidal Dearterialization (THD)

Using a doppler ultrasound, the blood vessel supplying the hemorrhoid is identified and ligated with stitches. Deprived of its blood supply, the hemorrhoid then shrinks and shrivels. There is no wound outside and is therefore almost painless.

Stapled Hemorrhoidopexy

Using a specially-designed, single-use stapler instrument, the hemorrhoids are excised and the anus repaired from the inside. The end result is that the surgical wound is inside, and no wound is visible outside the anus. Scientific studies have proven that this is less painful than traditional surgery. It is best recommended for hemorrhoids with prolapse.

Rubber Band Ligation (RBL)

A  procedure in which the hemorrhoid is tied off at its base with rubber bands, cutting off the blood flow. The hemorrhoid then shrinks, in about a week, and then falls off.

Diagnostic and Therapeutic Colonoscopy with Multi-band Intensity

Common Misconceptions about Treatments for Hemorrhoids

Hemorrhoids are actually present in all individuals whether healthy of not. They are the vascular cushions which surround the general area of the rectum and anus. The term we call hemorrhoids is associated with the symptoms when this part of the body becomes enlarged, inflamed, thrombosed or prolapsed. Many people have them without suffering from any symptoms, and therefore these may be safely left alone. Treatment is usually required for those whose hemorrhoidal symptoms such as excruciating throbbing pain impact on quality of life and daily living. There are many traditional remedies and non-surgical treatments for hemorrhoids. However, if none of these works, surgical procedures maybe required as a last resort. There are common misconceptions about hemorrhoids treatments that hinder sufferers to seek medical attention.

Misconception No.1- All surgical procedures for hemorrhoids are very painful. Due to this reputation of being a painful operation, advances in hemorrhoid surgery have focused on making it less painful.  One such operation is stapled hemorrhoidectomy. Using a specially-designed, single-use stapler instrument the hemorrhoids are excised and the anus repaired from the inside. The end result is that the surgical wound is inside, and no wound is visible outside the anus. Scientific studies have proven that this is less painful than traditional surgery.

Another advanced surgical technique is Transarterial Hemorrhoidal Dearterialization (THD).  Using a doppler ultrasound, the blood vessel supplying the hemorrhoid is identified and ligated with stitches.  Deprived of its blood supply, the hemorrhoid then shrinks and shrivels.  Again there is no wound outside and is therefore almost painless. 

Misconception No. 2 – Another more common misconception about surgery for hemorrhoids is that it can cause fecal incontinence, or the inability to control farting or defecation.  Again this is not true. Properly done hemorrhoid surgery, using any of the techniques discussed previously, does not entail cutting or injuring the anal muscles.  Therefore no complication such as incontinence should develop. 

All surgical procedures for hemorrhoids, however, whether traditional or innovative, may sometimes develop complications such as bleeding, infection and stricture. It is important therefore when seeking treatment, to see practitioners with real expertise in performing such procedures.

Colorectal Specialists provides comprehensive, advance and efficient care to wide range of colorectal conditions. Its expertise is in the surgical management of colorectal cancer, diverticulitis, inflammatory bowel diseases, and other benign disorders like hemorrhoids, fissures, fistulae, polyps, fecal incontinence, sexually transmitted diseases (STDs), and other colorectal problems. It always strives to provide comfort, privacy and total quality service to its clienteles.