Office Treatment of Internal Hemorrhoids

Office Treatment of Internal Hemorrhoids

A hemorrhoid is a vascular cushion of tissue in the lining of the anal canal. Everyone has three internal hemorrhoids, they are part of your anatomy. When these hemorrhoids become enlarged, they may cause painless rectal bleeding. Swelling of the hemorrhoid may cause it to prolapse (slide out) during a bowel movement.  The prolapsed tissue may go in on its own, but if the hemorrhoids are very large, the patient may need to push them back in manually.  The swelling and prolapse can lead to leakage of mucus and fecal matter and cause anal discomfort, itching or burning.  Unless the hemorrhoids are thrombosed and massively swollen, they usually do not cause intense pain.  Severe, acute anal pain is more likely due to an anal fissure or abscess.

Evaluation

Many patients come or are sent to Fairfax Colon & Rectal Surgery because they are thought to be having hemorrhoid problems. Upon evaluation by our surgeons, approximately one third of them are found to have a diagnosis other than hemorrhoids as the root cause of their symptoms.  We frequently see patients who have been repeatedly treated by ‘hemorrhoid relief centers’ who on examination are found to have a different problem entirely. This is why it is imperative that each patient be thoroughly examined at the time of their initial evaluation. The skin around the anus and the opening of the anal canal are carefully inspected to be sure there is no other pathology such as a fissure or fistula which could account for the patient’s symptoms. A digital rectal exam will be performed to determine the presence or absence of tenderness or any palpable growth.  Next, an anoscope (a short instrument to allow the inside of the canal to be inspected) is inserted and the size, location and characteristics of the hemorrhoid tissue are determined. If the patient has been having rectal bleeding, a longer scope (a proctoscope) may be inserted to be sure there are no other lesions in the rectum that could be the underlying cause of the bleeding.

Treatments

After your examination the surgeon will discuss the findings with you and explain the treatment options.  Most patients with hemorrhoid problems benefit from increasing the amount of fiber in their diet.  Taking a fiber supplement such as Benefiber, Metamucil or Citrucil is an additional way to increase daily fiber intake.  For patients with very mild symptoms this may be all that is needed.  Sometimes a low dose steroid suppository or ointment is prescribed.  Often by the time many of the patients seek care from us the hemorrhoids are large enough that some additional procedure will be required to relieve the patient’s symptoms.  Fortunately, the overwhelming majority of patients can be treated with office based procedures that require neither surgery nor anesthetics.  Your physician will explain these to you.  The most commonly utilized treatments are:

• Barron ligatures (rubber bands)--A rubber band is put around the hemorrhoid, causing it to wither and fall off over a seven- to ten-day period.  Frequently this is a series of treatments during which a single hemorrhoid is treated at each session.
• Infra Red Coagulation--A light source is used to cause a small burn on the surface of the hemorrhoid, causing it to stop bleeding and shrink down to normal size. Although all the hemorrhoids can be treated at once, the procedure may need to be repeated once or twice for greater effect.
• Injection of hemorrhoids--A liquid is injected into the hemorrhoid, stopping the bleeding and preventing it from protruding.  This is a less frequently utilized modality than the first two options.  It may require repeat injections.

All of these options are available and are performed on a daily basis at Fairfax Colon & Rectal Surgery.  These treatments are only used for internal hemorrhoids. They would be extremely painful if used for external hemorrhoids.  These procedures are usually performed at your next office visit after you have had the opportunity to discuss the treatment options with the surgeon.  Because the manipulation is done inside the canal, where there are minimal pain nerve fibers, these are not painful procedures to go through.  The main discomfort is from the anoscope which is inserted to expose the tissue during the procedure.  Each procedure usually takes just a few minutes to accomplish.  Remember that bleeding and prolapse will probably persist until all the hemorrhoids and prolapsing tissue have been treated. There is no preparation or fasting needed for the procedure.  Patients can expect to be able to drive themselves home afterwards. 

After Treatment

Symptoms

You may feel mild to moderate pain, a dull ache, or essentially nothing for the first 36 to 48 hours. A sense of urgency to have a bowel movement is normal after these treatments. If discomfort is mild, take over-the-counter medications such as Tylenol® or Advil®. Do not take aspirin or products containing aspirin because they promote bleeding. If your pain is more severe, you will be given a prescription for pain medicine. Taking warm baths for 15 to 20 minutes will help relieve your discomfort.

Diet

After your treatment, it is important to keep your bowel movements soft and regular. Eat foods high in fiber and drink lots of water (6-8 glasses a day). Continue the fiber supplement recommended by your doctor. Caffeine contributes to constipation so limit your consumption of coffee, tea, colas, and chocolate.

Activity

You may continue your normal physical activities. You will be able to drive your car immediately, walk up stairs, and do normal daily activity.  Heavy lifting and exercise work outs should be avoided for 48 hours afterwards.  Discuss any particular limitations and concerns with your doctor.

Causes For Concern

Call the doctor if you have any of the following problems:

• Pain that does not gradually lessen in three days
• Increasing pain several days after treatment
• Tender swelling in the anal area
• Fever or chills
• Difficulty urinating
• Severe constipation (no bowel movement for three days)
• Diarrhea (more than three watery stools within 24 hours)
• Increased bleeding (more than one cupful)
• Three to four large bloody bowel movements within three hours
• Drainage of pus from the rectum

If your own doctor is unavailable, the doctor on call is available 24 hours a day, every day of the year. After hours, call any of our offices and the answering service will locate one of our doctors on call. In an emergency try to contact us for advice before you go to the hospital. A telephone call may save you a lot of time, discomfort and expense.