The field of colorectal surgery provides diagnosis and treatment for a variety of lower digestive tract disorders, specifically the colon, rectal, and anal areas. Over 50% of adults will experience hemorrhoids during their life although many will be unaware of it because they can be asymptomatic. Hemorrhoids, a natural part of the anal canal, consisting of small bunches of blood vessels and fibrous tissue, help control the passage of stool.
Internal hemorrhoids develop when the veins, arteries, and surrounding tissue swell up, become enlarged, and extend into the anal canal. They rarely cause pain and the first symptom of a problem is bright red blood over the stool or when blood appears on toilet tissue. An internal hemorrhoid can become so large that it extends down through the anus. For some people, hemorrhoids slip through the anus only during bowel movements after which they recede. External hemorrhoids occur so close to the end of the anal canal that they swell outside of the anus causing painful lumps accompanied by itchy skin, and swelling. Similar to varicose veins, external hemorrhoids can develop blood clots and requires medical treatment.
The causes of hemorrhoids are believed to result from irregular bowel patterns, certain exercise activities, a low fiber diet, straining of the anal muscles or lower abdomen, pregnancy, a genetic predisposition, aging, obesity, and certain lifestyles.
For people who have developed hemorrhoids, a program of hemorrhoid management is recommended. It's important to keep stools soft by increasing dietary fiber, exercise, drinking water, taking sitz baths to soothe the area, and pain relievers (NSAIDs) and possibly stool softeners. To relieve itching, over the counter drugs such as Preparation H are helpful.
When the prescribed hemorrhoid treatment(s) are ineffective, or there is bleeding, or the hemorrhoids do not retreat back into the anal canal following a bowel movement, the physician may recommend further options. Rubber band ligation is a procedure in which the surgeon puts elastic bands around an internal hemorrhoid, cutting off the blood supply and causing the tissue to die. This is an outpatient procedure in which the surgeon inserts an endoscope, locates the tissue to be treated, holds it with a pliers-like appliance and places the band around it. Complications, such as, pain and/or bleeding, a band that slips or breaks, infections, and anal fissures, may occur following the procedure. Recovery from this kind of colorectal surgery can include some bleeding, and patients are advised to avoid straining and heavy lifting.
Sclerotherapy is another method to treat hemorrhoids in which the doctor injects a drug, causing the veins to the hemorrhoid to weaken and collapse, shrink up and fall off. In similar treatments, electrocautery, infrared radiation, dry ice, or lasers are used to eliminate the unwanted tissue and leave a scar behind. For small internal hemorrhoids or for people unable to withstand more involved procedures, the doctor may inject a chemical into a vein causing it to harden and form a scar reducing the movement of the hemorrhoid.
The complications of these hemorrhoid treatments include an allergic reaction to the drug, causing anal skin to burn, infection in the sphincter area, incontinence of bowel and/or bladder, prostate infection, and bleeding. Recovery from these procedures involves bleeding for seven to ten days especially when the hemorrhoid falls off. Over the counter pain medications, sitz baths, and stool softeners are recommended.
For the most extreme cases the best treatment for hemorrhoids is colorectal surgery. Hemorrhoid surgery, also known as a hemorrhoidectomy, is the excision of the hemorrhoid from the wall of the anal canal. A hemorrhoid dearterialization procedure, which uses a Doppler ultrasound machine to locate where the artery flows to the hemorrhoid, ties off the artery and stitches the hemorrhoid to its natural position. In a stapled Hectomy the hemorrhoid's blood flow is interrupted and it is reattached to the anal wall with staples.
The risks involved in surgery include urinary retention, bleeding, infection, and anal strictures. The dearterialization and staple procedures take less time to perform and post-op pain is not as significant as in a hemorrhoidectomy.
Call us at 703-942-8770 or go to www.crhcenter.com to learn more about our area of expertise. We cover almost every aspect of colorectal surgery including laproscopic colon resections for cancer and laproscopic resection of diverticular disease of the colon.
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