Hemorrhoids and Fissures

What are hemorrhoids HEMORRHOIDS, what are they?

Hemorrhoids are blood vessels in the anal area serving as cushions during bowel movement. Internal hemorrhoids are located inside the anus while external hemorrhoids are located outside. 

What are the types of internal hemorrhoids?

First degree hemorrhoids.Hemorrhoids that bleed but do not come out during passage of bowel movement.

Second degree hemorrhoids. Hemorrhoids that occasionally bleed and come out during bowel movement but go back in.

Third degree hemorrhoids.Hemorrhoids that occasionally bleed and come out during bowel movement but can be pushed back in manually.

Fourth degree hemorrhoids. Hemorrhoids that are pushedoutside and can not be pushed back in manually anymore.

What does hemorrhoids a person with experience?

There is usually bleeding of bright red blood dripping into the toilet bowl during bowel movement. Often, a mass or fleshy tissue comes out during straining.

What are the different types of treatment for hemorrhoids?

Medical management: for first and second degree internal hemorrhoids.

Rubber band ligation: for bleeding first and second degree internal hemorrhoids. This involves application of an elastic band at the base of the internal hemorrhoid.

• A high fiber diet that includes fruits and leafy vegetables.

• Adequate fluid intake.

• Avoidance of straining in the bathroom

Surgery: for persistent symptoms of bleeding, fleshy mass coming out, and problems with hygiene; unresponsiveness to medical management; or third or fourth degree or mixed (internal and external component) hemorrhoids.

• Hemorrhoidectomy: for third and fourth degree internal hemorrhoids. This is the traditional method of removing hemorrhoids. It makes use of a knife, scissors and other devices such as ligasure or harmonic scalpel.

• Stapled hemorrhoidopexy makes use of a surgical stapler to remove hemorrhoids and is associated with minimal post operative pain.

• Transarterial hemorrhoidal dearterialization: for second and third degree internal hemorrhoids. This method makes use of  Doppler ultrasound to detect arteries which are then ligated. This method is also is associated with minimal post-operative pain.

Examination for Common Anorectal Conditions

Common anorectal conditions are usually examined using digital rectal exam. A doctor  inserts a lubricated, gloved finger into the rectum to feel for abnormal lumps or areas. Then, a lubricated instrument (anoscope) is placed a few inches into the rectum. This is to view the anus, anal canal, and lower rectum.

Sexually Transmitted Anorectal Disease Examination

Diagnosis for sexually transmitted anorectal diseases has become more difficult in recent years owing to the complexity of  pathogens. Diagnosis and treatment has become even more challenging in the HIV+ patient population. Some common sexually transmitted anorectal infections are gonorrhea, chlamydia, syphilis, herpes simplex virus, and cytomegalovirus.

The specialist usually begins with a thorough history of the patient. This is accompanied by a focused physical examination. Laboratory studies (serological, bacteriological or pathological with tissue biopsy and examination) confirm the diagnosis.

 Proctosigmoidoscopy / Flexible Sigmoidoscopy

A sigmoidoscopy is an examination that allows the doctor to look inside the rectum and lower (sigmoid) colon for polyps using a narrow, lighted tube called a sigmoidoscope. If any polyps are found during the exam, they can be removed in a procedure called a polypectomy. A sigmoidoscopy is recommended every three to five years.

Endorectal and Endoanal Ultrasonography (UTZ)

Endorectal Ultrasound is a special ultrasound technique in which a 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. It is one of the most useful diagnostic tools for diseases of the anal and rectal regions of the body, especially for cancer screening and staging.

Diagnostic and Therapeutic Colonoscopy with Multi-band Intensity

A colonoscopy is an internal examination of the colon (large intestine) and rectum, using a long, flexible, tubular instrument called a colonoscope.

The colonoscope has a small camera attached to a flexible tube.  Unlike sigmoidoscopy, which can only reach the lower third of the colon, colonoscopy examines the entire length of the colon.

The patient will lie on his left side with knees  drawn up toward the chest.  After administering a sedative and pain reliever, the colonoscope is inserted through the anus. It is gently moved into the beginning of the large bowel and sometimes into the lowest part of the small intestine. Air will be inserted through the scope to provide a better view. Suction may be used to remove fluid or stool. Tissue samples may be taken with tiny biopsy forceps inserted through the scope. Polyps may be removed with electrocautery snares, and photographs may be taken.

Fecal Occult Blood Examination using the latest immunological-based test.

This test should be performed every year to check for tiny amounts of blood in the stool. FOBT involves placing a small amount of stool on a test pack. New FOBT uses the latest immunological-based test which does not require fasting and diet preparations. In concert with an FOBT, a flexible sigmoidoscopy should be done every 3 years. A positive FOBT should warrant a complete colonoscopy.

6. Dr. Marc Paul J. Lopez

• Clinical Associate Professor of Surgery, UP-Philippine General Hospital

Subspecialty Training (Local)

• Fellowship in Colon and Rectal Surgery, UP-Philippine General Hospital

Subspecialty Training (International)

• Laparoscopic colorectal surgery, as well as advanced hemorrhoid and anal fistula surgery, Department of Colorectal Surgery, Chulalongkorn University, Thailand
• Laparoscopic colorectal surgery, University Medical Center, Ho Chi Minh, Vietnam
• Trained under Dr. Paul Sugarbaker at the Medstar Washington Hospital Center in Washington DC and Dr. Jesus Esquivel at the St. Agnes Hospital in Baltimore MD.  Dr. Lopez studied Peritoneal Surface Malignancy and the conduct of Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).
• Completed a one-year Research Fellowship at the Uniformed Services University of the Health Sciences (USUHS) and at the National Institutes of Health (NIH) in Bethesda MD.

Special Interests

• Colorectal surgery
• Laparoscopic colorectal surgery
• Advanced hemorrhoid and anal fistula surgery
• Peritoniectomy for carcinomatosis

Hospital Affiliations

• Asian Hospital and Medical Center
• Philippine General Hospital.
• The Medical City

5. Dr. Carlo C. Cajucom

• Training officer, Section of Colon and Rectal Surgery, Jose R Reyes Memorial Medical Center
• Training officer, Department of Surgery, Quirino Memorial Medical Center

Subspecialty Training (Local)

• Fellowship in Colon and Rectal Surgery, Jose R Reyes Memorial Medical Center

Subspecialty Training (International)

• Singapore General Hospital
• National University Hospital, Singapore
• Sydney, Australia

Special Interests

• Colorectal surgery
• Laparoscopic colorectal surgery
• Advanced hemorrhoid and anal fistula surgery

Hospital Affiliations

• The Medical City
• Chinese General Hospital 

4. Dr. Dione Parreño-Sacdalan

• Clinical Associate Professor of Surgery, UP-Philippine General Hospital

Subspecialty Training (Local)

• Fellowship in Colon and Rectal Surgery, UP-Philippine General Hospital

Subspecialty Training (International)

• Minimally invasive surgery and anorectal surgery, Department of Colorectal Surgery, Chulalongkorn University, Thailand
• Full Research Fellow at the Uniformed Services University of the Health Sciences (USUHS) at Bethesda, Maryland, USA
• Only Filipino awarded the International Guest Scholarship from the American Society of Colon and Rectal Surgeons, with rotations for anorectal physiology at the University of Minnesota, and colorectal cancer surgery at the Memorial Sloan Kettering Cancer Center, New York

Special Interests

• Colorectal surgery
• Laparoscopic colorectal surgery
• Advanced hemorrhoid and anal fistula surgery
• Anorectal Physiology

Hospital Affiliations

• The Medical City
• Philippine General Hospital
• Medical Center Manila