Cures

Hemorrhoids Made Easy

Hemorrhoids Made Easy
A step by step guide to getting rid of hemorrhoids permanently- Never to return- No More Pain Ever Again.
Hemorrhoids Made Easy

Banov L, Knoepp LF, Erdman LH, Alia RT (1985). “Management of hemorrhoidal disease”. J S C Med Assoc 81 (7): 398–401 Kaidar-Person et al, 2007 Nienhuijs SW, de Hingh IHJT. Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic Hemorrhoids. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD006761. DOI: 10.1002/14651858.CD006761.pub2. J. J. Tjandra*, J. J. Y. Tan*, J. F. Lim*, C. Murray-Green*, M. L. Kennedy† and D. Z. Lubowski† *Department of Colorectal Surgery, Epworth Colorectal Center and The Royal Melbourne Hospital, Melbourne and †Colorectal Unit, St George Hospital, Sydney, Australia - Rectogesic® (glyceryl trinitrate 0.2%) ointment relieves symptoms of haemorrhoids associated with high resting anal canal pressures

Guidelines are recommended by NICE the National Institute for Health and Clinical Excellence (NICE) Hiromi Iwagaki, Yasuhiko Higuchi, Sadanori Fuchimoto and Kunzo Orita First Department of Surgery, Okayama University Medical School, Okayama, Japan – laser treatment of hemorrhoids Information sheet – Summary of Product Characteristics last updated on the eMC: 12/12/2008

Oily Phenol Injection BP (UCB Pharma Ltd) Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids: a systematic review and economic evaluation. Burch J, Epstein D, Baba-Akbari A, Weatherly H, Fox D, Golder S, Jayne D, Drummond M, Woolacott N. Centre for Reviews and Dissemination, University of York, UK.

Surgical treatment of haemorrhoidal disease with CO₂ laser and Milligan–Morgan cold scalpel technique L. C. Pandini*, S. C. Nahas†, C. S. R. Nahas*, C. F. S. Marques†, C. W. Sobrado† and D. R. Kiss† Departments of *Digestive Surgery and †Coloproctology, University of Sao Paulo, Sao Paulo, Brazil

Novel Technique: Radiofrequency Coagulation — A Treatment Alternative for Early-Stage Hemorrhoids Pravin J. Gupta, MS [Gen. Surgery] Posted: 07/31/2002

Doppler-Guided Hemorrhoidal Artery Ligation: An Alternative to Hemorrhoidectomy George Felice¹, Antonio Privitera¹, Ernest Ellul¹ and Maria Klaumann¹ Department of General Surgery, St. Luke’s Hospital, Gwardamangia, Malta

Doppler-guided haemorrhoidal artery ligation: long-term outcome and patient satisfaction : Wilkerson, P. M.; Strbac, M.; Reece-Smith, H.; Middleton, S. B. : Colorectal Disease Volume 11, Number 4, May 2009 , pp. 394-400(7)

Anal Itching

This is one of the symptoms of hemorrhoids and yet is often made worse by the ointments and creams that are liberally put around the area to improve them! More is not always better.

Causes of Anal Itching

The area around your anus is very sensitive and the inflammation can be due to a variety of reasons such as not having cleaned the anus after passing a stool (faeces/poo).

Sometimes mucous from the anal canal can cause the irritation as the anal sphincter is not as effective and the leakage causes irritation on the skin surface.

It can also be made worse by constant washing with perfumed soaps, washing after having your bowels open is a good idea if you have hemorrhoids; but just be aware it may be the soap which is causing the irritation. If you would like another option baby wipes are very gently and do not contain any harsh cleansers so may well be gentler on your bottom.

The irritation may also be due to a fungal infection called Candida Albicans / thrush which can be easily treated with an anti fungal cream.

Your bottom may be sore and itchy due to excess perspiration; this can be due to the climate or your work environment. A doctor will be able to determine which is the cause of your discomfort and may well be able to offer a more appropriate form of treatment.

Hemorrhoid Banding

Banding / Baron Ligation Technique

This is a treatment which is very popular as it is 80% effective and the procedure can be performed without a general anaesthetic. It is more effective than any of the other hemorrhoid treatments.

The hemorrhoid banding procedure

The doctor who is performing the procedure will explain what they are going to do, and will ask for your permission to perform the procedure.
This procedure is performed on grade2-3 hemorrhoid
If you are happy that you understand both what procedure you are going to have done and have been told of the risks involved with the procedure then you can sign the relevant document.
You will be asked to take your clothes off and put on a gown and placed in the correct position for the procedure.
You will be positioned either on a couch with stirrups for your feet to go in or on you side on a couch with your knees drawn up to your chest it will depend on the location of the hemorrhoid. ( it will seem all a bit undignified but you will have either a sheet or blanket covering you until the procedure begins
An instrument called a proctoscope or anoscope will be gently placed in your anus so the doctor will be able to have a good view the hemorrhoid.
The doctor may use some local anaesthetic around the base of the hemorrhoid to numb the area.
The hemorrhoid will be grasped gently with a forceps and the hemorrhoid fed through a ringed instrument.
The small elastic band will then be released at the base of the hemorrhoid which will cut off its blood supply.
You will usually have only one or two hemorrhoids treated in this way at a time. Further treatment will be done at 4- weeks’ interval to allow for healing.

Post procedure pain after hemorrhoid banding

You may feel faint or sick after the procedure
You will usually experience pain for anything between 24- 48 hours after the procedure
You may feel as if you want to have your bowels open

Special precautions

Ensure you have adequate pain relief available to you.
Make sure you have someone available to help you should you need it for at least he next twelve hours
Make sure you are able to urinate easily after the procedure(go for a wee)
Do not use aspirin for pain relief post procedure as it may encourage bleeding
Drink plenty of fluids
Try and do some gentle exercise
Eat plenty of fibre rich foods so you do not become constipated
Do not do any heavy lifting for at least two weeks

Healing / recovery time after hemorrhoid banding

In one – two weeks the bands will fall off as the hemorrhoid has been strangled as there is no blood supply to it. The hemorrhoid withers and falls off and is expelled when you have a bowel movement. A scar will be left behind which should prevent a further hemorrhoid occurring.

Complications and risks of hemorrhoid banding

You may experience problems passing urine (going for a wee) after the procedure
You may experience pain during the procedure
There is a risk of infection
Your hemorrhoid may return
You may have severe bleeding

Thrombosed Hemorrhoid Treatment

An external thrombosed hemorrhoid looks like a bluish – purple lump hence all the bunch of grape jokes! They can vary in size and can be extremely painful.

The blood flow through the tissue of the hemorrhoid has become damaged therefore causing the blood to clot within a very confined space. The pressure increases until the bleeding stops, but you are then left with an excruciatingly painful lump full of clotted blood.

There are two ways of dealing with an external thrombosed hemorrhoid

Visit you doctor or A&E department where they will examine you and then give you the option of doing nothing or treating. If you have consulted the doctor within the first 72 hours of the onset it is like the doctor will suggest to drain it. If you choose to have the clot removed you will be asked to sign a consent form for the procedure
You will be positioned either in stirrups or face down on the operating trolley and you will be covered appropriately to maintain your dignity
They will treat by injecting local anaesthetic around the thrombosed clot and then making a small incision (cut) allowing the entire clot to be released.
This give you immediate pain relief as the pressure is now gone. The wound will be either packed with ribbon gauze, and gauze padding or dressed with an absorbent dressing. You will need to ensure you wash your bottom after you have had a bowel motion to make sure the area is clean and dry to optimise healing conditions.

Complications of external thrombosed hemorrhoid

can involve bleeding
infection
pain

Post operative care for external thrombosed hemorrhoid

will involve the removal of the packing gauze after 48 hours if has not already fallen out.
You may experience minor discomfort as the wound heals, but it can be relieved with something like regular paracetamol/ ibuprofen.
Diet should include plenty of fibre rich food
Possibly a stool softener
Drink plenty of fluids

The second option for ttreatment of external thrombosed hemorrhoid

Is to do nothing and just take regular pain relief. The pain will continue for probably about 7 days as the body begins to reabsorbs the clot, the whole process can take up to 4 weeks depending on the size of it. If you are still in pain after this time you will need to return to your doctor for further advice and treatment.

Sclerotherapy for Hemorrhoids

This is an old treatment of hemorrhoids and rarely used these days due to it not being as effective as banding, as people require repeated injections. People do not want to go through having a doctor rummaging around in their bottoms once let alone repeatedly.

It is a quick treatment involving the injection of Oily Phenol Injection BP 5%w/v into the base of the hemorrhoid causing the soft tissues to harden and scar, the hemorrhoid will then wither and fall off.

The Sclerotherapy Treatment Procedure

The doctor who is performing the procedure will explain what they are going to do, and will ask for your permission to perform the procedure.
This procedure is performed on grade1-2 hemorrhoids
If you are happy that you understand both what procedure you are going to have done and have been told of the risks involved with the procedure then you can sign the relevant document.
You will be asked to take your clothes off and put on a gown and placed in the correct position for the procedure/ or just to remove your lower garments
You will be positioned either on a couch with stirrups for your feet to go in or on you side on a couch with your knees drawn up to your chest it will depend on the location of the hemorrhoid. ( it will seem all a bit undignified but you will have either a sheet or blanket covering you until the procedure begins
An instrument called a proctoscope or anoscope will be gently placed in your anus so the doctor will be able to have a good view the hemorrhoid.
The doctor will then inject the base of the hemorrhoid with the oily phenol.

Post procedure pain

The procedure itself is usually not too uncomfortable and you may experience pain for the next 24 – 48 hours. Regular paracetamol should keep you comfortable.

Special precautions

Make sure you inform your doctor if you have any nut allergies as you will not be able to have this procedure
Ensure you inform you doctor prior to the procedure if you think you may be pregnant or are breast feeding
Ensure you have adequate pain relief available to you.
Make sure you have someone available to help you should you need it for at least the next twelve hours
Make sure you are able to urinate easily after the procedure(go for a wee)
Do not use aspirin for pain relief post procedure as it may encourage bleeding
Drink plenty of fluids
Try and do some gentle exercise
Eat plenty of fibre rich foods so you do not become constipated
Do not do any heavy lifting for at least two weeks

Healing / recovery time

In two weeks the scar will have blocked off the blood supply to the hemorrhoid and it will have withered and been passed with your stools

Complications and risks

Your Doctor can inject 2-3mls of oily phenol at one time and it can be injected at the base of different hemorrhoids around the anal canal but the total used must not exceed 10mls or else you may suffer from a toxic reaction.
Dizziness
You may have an allergic reaction to the almond carrier oil
Discomfort – the phenol is supposed to cause numbing of the nerves but it may not be effective causing pain.
The area treated may form an ulcer or abscess possibly leading to Necrotising fasciitus
Urinary incontinence
The phenol may be injected incorrectly and enter the blood stream causing Hepatitis
Prostatitis (a painful inflammation of the prostate in men) or Impotency due to the phenol
Bleeding after the procedure

Prolapsed Hemorrhoids Treatment

This type of hemorrhoid is one which has originated from above the dentate line in the anal canal this has no nerve therefore are often painless. Below the line which has nerves are called external Hemorrhoids. This is why it can be a bit of a shock when you feel a piece of tissue outside your body which should be inside. This piece of tissue will not feel painful unless it has become strangulated or thrombosed that is to say that the hemorrhoid has become stuck outside the anus and you cannot push it back inside. If the tissue has become strangulated it will become painful and inflamed and you will need to seek medical help urgently.

Treatment for Prolapsed Hemorrhoids

If you have suffered with prolapsed hemorrhoids this will mean that when you visit your Doctor you will referred to a Consultant at a hospital in your area. The surgeon will discuss your options with you when you go for your initial consultation and will usually suggest surgery of a Hemorrhoidectomy or Hemorrhoidopexy.

Bleeding Hemorrhoids Treatment

It is important to state that if you have blood coming from your rectum it is not necessarily hemorrhoids. Bleeding of unknown origin needs to be investigated by a qualified healthcare worker.

If you treat your bleeding hemorrhoids prior to diagnosis from your doctor you could be missing a more serious condition.

The anal veins supply the cushions of the anal canal and it is these cushions which have swollen and become hemorrhoids. Bleeding usually occurs when hard stools (faeces/poo) and straining have caused the thinned walls of the hemorrhoid to bleed. The bleeding can vary from just noticing red blood on the toilet paper after wiping your bottom, to blood dripping into the toilet from perhaps a prolapsed hemorrhoid. It is very alarming the first time this happens and can be the incentive you need to get you along to see the doctor.

If you have small amounts of blood on the toilet paper after you wipe you bottom this will stop fairly rapidly it may well be internal hemorrhoids which will stop bleeding quite quickly.

If you are bleeding from hemorrhoids near to the anus and they are itching as well as bleeding it is important to treat this with care, you will need to wash carefully after your bowel motion so your bottom is clean. Do not use perfumed soap as this will aggravate and sting. If you use baby wet wipes these are very gentle as well as cooling. If bleeding persists use a clean piece of toilet paper wet it with cold water and hold it against the bleeding area firmly for a couple of minutes it can take up to five. This can seem an awfully long time to put pressure on the hemorrhoid but if you keep dabbing at the wound it will continue to bleed. If you have been prescribed cream for use after you have had a bowel motion, wait until the bleeding has stopped prior to application.

What to ask the Doctor about Hemorrhoids

Before having any treatment for the removal of your hemorrhoids there are questions you should ask the doctor/surgeon:

Which is the best treatment to have?
What are the options?
Which options give the best long term results?
Can I try conservative treatments first?
If I have to have an operation how long will it take?
How long will I have to wait for the operation?
What type of anaesthetic will I have
Who is doing the operation?
How experienced is the surgeon with performing this procedure?
What are the post op complications of the procedure?
How long will it take you to recover?
How painful will the procedure be?
What pain relief medicine will I be given and how effective is it?
When will you be able to return to activities of normal daily living?

Hemorrhoid Artery Ligation Operation

Hemorrhoid artery Ligation Operation (HALO) Also known as Doppler-Guided Hemorrhoidal Artery Ligation (DGHAL or HAL)

This procedure seems to have the potential for revolutionising hemorrhoid treatments. It was devised by Japanese surgeon Dr Morinaga and reported on in 1995. This is an exciting development in the treatment of hemorrhoids’ and seems to be getting rave reviews regarding post op recovery time, pain and time spent in the hospital. The operation can be done as a day patient with the success rate being 95% effective two years on. The procedure itself takes 20 minutes it is also said to be very effective on bleeding hemorrhoids.

The Hemorrhoid artery Ligation operation (HALO) operation

The doctor who is performing the procedure will explain what they are going to do, and will ask for your written permission to perform the procedure. This procedure is performed on grade 2-4 hemorrhoids

If you are happy that you understand both what procedure you are going to have done and have been told of the risks involved with the procedure then you can sign the relevant consent form.
You will be asked to take your clothes off and put on a gown
If you are having a General or spinal anaesthetic then this will be performed by an anaesthetist you will have discussed this prior to the operation
If you are having local anaesthetic and sedation this will be done once you are on the operating table
You will be positioned either on the operating table with stirrups for your feet called the lithotomy position. Or on your front with your bottom raised it will depend on the location of the hemorrhoids. ( it will seem all a bit undignified but you will have either a sheet or blanket covering you until the procedure begins
You will have sterile drapes put over you to maintain a sterile field for the surgeon
An antiseptic/bacterial solution will be painted around the perineal area to eliminate germs from the skin surface
An instrument called a modified proctoscope will be gently placed in your anus so the doctor will be able to have a good view the hemorrhoids.
Local anaesthetic will be injected either before or after the operation depending on the type of anaesthetic you have been given.
The equipment houses a miniature Doppler transducer which is used to locate the blood vessels which are supplying the hemorrhoids.
The device has a small window which allows the surgeon to place a suture (stitch) around the artery cutting off the blood supply to the hemorrhoid
If there are protruding hemorrhoids these will be hoicked back inside the bowel and secured in place
An absorbent pad will be placed over the anus and a minor amount of bleeding may occur

Normal bowel habits should be resumed as soon as possible, and you will be encouraged to eat fibre rich foods and drink plenty of fluids. The first bowel movement is often dreaded due to pain however it is important that you open your bowels regularly to prevent constipation.

Post Operative pain

As there is no excision involved in this procedure therefore there are no wounds, general discomfort is the main problem but most people feel well enough to go home the same day.

Special Precautions

Ensure you have adequate pain relief available to you; if you are uncomfortable ask the nursing staff for additional pain relief.
Make sure you have someone available to help you when you are discharged form hospital
Make sure you are able to urinate easily after the procedure(go for a wee)
Maintain a good fluid intake
Try and do some gentle exercise, do not lie in bed or on the couch all the time
Take any stool softener or laxatives you have been prescribed
Eat plenty of fibre rich foods so you do not become constipated
Do not do any heavy lifting for at least two weeks
Maintain a good hygiene regime wash after each bowel movement

Healing / Recovery time

Research has shown that recovery time is staggeringly good with people returning to work after 48 hours. The hemorrhoids shrink as the blood supply has been cut off