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ANORECTAL CONDITIONS

 

Hemorrhoids

 

What are Hemorrhoids?

Hemorrhoids are part of everyone’s normal anatomy. These blood vessels in and around the lower rectum and anus can occasionally become engorged or enlarged similar to varicose veins in ones legs.

External hemorrhoids are located outside the anal opening and are covered by sensitive skin. When they become engorged they can fill with blood, which may clot (thrombosis) leading to a painful hard lump with a blue hue.

Internal hemorrhoids are located inside the anal opening. When they engorge or fill with blood, they can cause painless bleeding or protrude during bowel movements. Most of the time internal hemorrhoids protrude and reduce back into the anal canal by themselves. In severe cases, hemorrhoids can become “prolapsed”, where they protrude from the anus but cannot be pushed back inside.

Factors which may predispose someone to hemorrhoids include prolonged sitting or standing, straining during bowel movements, constipation or diarrhea, overuse of laxatives or enemas, pregnancy, aging, heredity, or prolonged time on the toilet (reading).

What are the symptoms of hemorrhoids?

Some of the symptoms of hemorrhoids include bleeding during bowel movements, protrusion of a lump during bowel movements, painful anal lump, or anal itching.

 

What is the treatment of hemorrhoids?

Thrombosed external hemorrhoids can typically be managed with a diet rich in fiber and water, warm baths for 15 minutes at a time, 3 times a day, and creams to sooth the area and reduce swelling. In cases of severe pain associated with a thrombosed external hemorrhoid, your colorectal surgeon may use a small incision under local anesthesia as an office or outpatient procedure to remove the hemorrhoid containing the clot.

Internal hemorrhoids can generally be managed with conservative measures such as a diet high in fiber (25-30 grams/day) and water (8-10 glasses/day). Dr. Zaghiyan also offers office-based treatments in her office in Los Angeles to help shrink the hemorrhoids. If office-based treatments are unsuccessful or if hemorrhoids are more severe, surgery may be necessary.

Office-Procedures

Sclerotherapy – Performed in the office by Dr. Zaghiyan, sclerotherapy is a method to shrink hemorrhoids using a solution of 5% phenol and olive oil. The procedure causes minimal discomfort and patients may return to regular activity the same day.

Infrared coagulation (IRC) – This treatment uses heat to create scarring and shrinkage of the hemorrhoids. Similar to sclerotherapy, the procedure causes minimal discomfort and is performed in the office by Dr. Zaghiyan. Patients may return to regular activity the same day.

Rubber band ligation – Using an anoscope, Dr. Zaghiyan will place a small rubber band around the hemorrhoids, cutting off their blood supply. The hemorrhoids and the band fall off in a few days. Patients may experience mild discomfort or bleeding. Patients may return to mild activity the same day and regular activity in a week.

Outpatient Surgery

Transanal hemorrhoidal dearterialization (THD) – THD is a minimally invasive outpatient treatment for hemorrhoids performed by colorectal surgeons. Unlike traditional hemorrhoid surgery, THD causes less pain and discomfort. Dr. Zaghiyan will perform THD in the operating room under anesthesia. Using Doppler guidance, the branch vessels feeding the hemorrhoids will be identified and ligated (or tied off). In addition, a mucopexy will be performed whereby the hemorrhoidal tissue is restored back into the anal canal in its normal anatomical position.

Procedure for prolapsing hemorrhoids (PPH) or stapled hemorrhoidopexy – is performed in the operating room using a special surgical stapler to remove a circular sleeve of hemorrhoidal tissue and pull the remaining hemorrhoidal tissue back up into the anal canal.

Hemorrhoidectomy – is the standard surgical treatment of hemorrhoids. The procedure, performed in the operating room by Dr. Zaghiyan, includes removal of the internal and external hemorrhoids in their entirety. This procedure may be used for patients who have failed conservative office based treatments or in patients with severe symptoms that includes both internal and external hemorrhoids. The procedure usually requires some down time from work and strenuous activity, typically 1-2 weeks.

Make an appointment with Dr. Zaghiyan today in her office in Los Angeles for a comprehensive evaluation and tailored plan to treat your hemorrhoid symptoms.