Posts Tagged ‘Blood Supply’
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
Hemorrhoidopexy is also known a PPH
Hemorrhoidopexy is also known a PPH – Procedure for Prolapse and Hemorrhoids, Stapled Anopexy, Stapled Prolapsectomy and Stapled Mucosectomy.
The operation does not involve the removal of the hemorrhoids it involves removing a band of the tissue above the dentate line. This process reduces the blood supply to the hemorrhoids and trims the tissue available to prolapse. Studies have evaluated the two operations and in terms of effectiveness it appears that conventional surgery still has the upper hand. With statistics showing that rates of post operative prolapse being significantly more with Hemorrhoidopexy. However statements from patients commented that pain was less and return to normal activities of daily living was quicker with patients following Hemorrhoidopexy
The Hemorrhoidopexy 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 3-4 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 document.
- You will be asked to take your clothes off and put on a gown
- You will have discussed which anaesthetic is suitable for you and the anaesthetist will then either give you a general or spinal anaesthetic
- 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 Circular Anal Dilator will be gently placed in your anus so the doctor will be able to have a good view the hemorrhoids.
- The dilator will be above the level of the hemorrhoids as the idea of the equipment used is to remove a circular piece of the bowel tissue, donut shaped.
- A purse string suture is created around the circumference f the bowel tissue
- The top section of the stapling device is inserted above the purse string.
- The purse string suture is then tightened drawing the bowel inwards
- The two pieces of bowel are then stapled together. Thus having the effect of hoicking up the hemorrhoids inside the bowel.
- The circular piece of bowel tissue is removed with the stapling device
- The hemorrhoids have not been removed merely relocated further up the bowel where hopefully they will remain and not cause a problem
- Once the operation is completed non adhesive dressing will be placed on the wound site with dressing gauze and a large sanitary pad this will be taped in position
- You will be placed on your side after the procedure to cause your buttocks to press together helping with the pressure which reduces bleeding.
- When you are in recovery the wound site will be inspected frequently to check on bleeding a small amount is expected but larger quantities may require surgical opinion.
- 24 hours after the operation the dressings will be removed and you will be encouraged to take a bath.
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
The procedure is painful however in the immediate post operative period not as painful as hemorrhoidectomy; you will be given pain relief to take. This needs to be taken regularly to be effective. Pain can persist for up to two weeks postoperatively.
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
The healing time is similar to that of hemorrhoidectomy although research indicates return to activities of daily living is quicker with Hemorrhoidopexy. The pain is less as well although research indicates that reoccurrence rates are higher with the Hemorrhoidopexy. The initial healing takes approximately two weeks until you feel more comfortable. Most people will takes two weeks off work for recovery but may not be able to return to work for a month depending on the type of work you do. You may be able to discuss reduced hours with your employer so you are able to resume work gradually.
Complications and risks
- Pain – you may find that having your bowels open may continue to cause you pain and you may experience faecal urgency
- If too much muscle tissue is drawn into the stapling device damage to the rectal wall may occur
- Bleeding – a post operative bleed can sometimes take place unexpectedly days after the operation
- Infection – the internal stapled bowel surface may become infected, you will experience a foul smelling discharge with pus if this occurs, pelvic sepsis can occur
- Return of the hemorrhoids – the operation may not be effective
- Faecal (stool/ poo) incontinence – this can happen in the short term but usually sorts itself out if not you will need to see your doctor
- Inability to pass urine (wee) – this is something that might happen immediately post operatively and would be rectified at the hospital
- Anal Fistula / Fissure (a narrow track from inside the bowel to the skin surface)
- Narrowing of the lumen of the bowel (the internal scaring of the bowel has caused it to become smaller) causing dysfunction
Haemorrhoids Home Treatment
Conservative/ non invasive hemorrhoid treatments include
- Change of diet
- Plenty of fluids
- Creams with either local anaesthetics/ corticosteroids or both
- Controlled use of Laxatives
There are a great many home treatments for haemorrhoids which you can find on the internet some proven others not. If you are shy and have found it difficult to consult your doctor the internet and information can be a mine field for you. First and foremost I would urge you to visit your doctor to exclude any other type of condition. Secondly be reassured that often people who have had one incident of haemorrhoids don’t always go on to develop long term problems. There are positive steps you can take at home to help yourself.
Haemorrhoids and diet
- Foods which are rich in fibre such as vegetables, fruit and wholemeal products like bread and pasta, bran, brown rice. In consultation with your doctor you may be advised to take a bulk-forming laxative not a bowel stimulating one like senna but one with ispaghula husk or similar to help with your bowel movements and the affect it has on your haemorrhoids.
Hemorrhoids and Exercise
- 20-30 minutes exercise everyday will keep you fit and strong which helps to maintain a healthy digestive system. Always consult your doctor prior to embarking on a regular activity which you have not undertaken before, begin gently and work up to a regular routine.
Hemorrhoids and Weight loss
- If you are overweight the pressure you will be unnecessarily exerting on the blood supply around you anus will be increased, therefore by lowering you weight that pressure will decrease.
Hemorrhoids and Fluids
- One of the fundamental things to help yourself is to drink more fluids ideally that should be water, however if you drink milk or juice or Squash just by increasing those fluids will help with your digestive system. Your body needs fluids approximately two litres a day, and if it doesn’t have enough fluids it removes it from the food travelling through your intestines (gut) thus making your stools (faeces /poo) hard and lumpy. If you drink more your stools will be soft and more easily expelled more like toothpaste consistency.
- One cautionary word about alcohol and caffeine. These drinks are counterproductive they act as a diuretic making you urinate(wee) more often this causes your intestines to loose fluid and again the stools become hard and difficult to pass. If you drink lots of tea or coffee during the day try switching to decaffeinated.
Hemorrhoids and Personal Hygiene
- It is important to keep your bottom clean; this will help prevent rashes and irritation. You can carry small packets of baby wipes or moisten toilet paper to use after you have had a bowel motion. This will ensure no stool motion remains on the skin surface to cause irritation. Do not use perfumes soaps to wash with as these can irritate the skin and do not use talcum powder to dry the area or to prevent moisture build up it does not work and can make the itching worse. Pat your bottom dry with clean toilet paper. If you have a constant problem with leakage you will need to visit your doctor for advice but in the meantime you can use a small amount of nappy cream which will protect your skin and sanitary pad can be used effectively to absorb fluid.
Medicines and creams for Haemorrhoids
- There are a huge amount of products out there to help you with your problem some of which make outrageous cure claims. As stated before piles cannot be cured they CAN be relieved and treated but there is not sure way any one can tell you that if a haemorrhoid is reduced and not causing a problem that it won’t rear its ugly head again or that another won’t occur.
- Many creams will be wonderful and soothing and some will contain a local anaesthetic which will numb the affected area for a period of time. Other creams have corticosteroids in them which are used to reduce inflammation. There are precautions which you will need to be aware of prior to using any of these products so always read the information supplied with the medication. Make sure you are not allergic to any of the ingredients. Burning stinging and itching are some of the side-effects but these symptoms should pass. These products should notbe used for more that 7 days at a time due to further irritation from over use. If your problem continues after this you will need to consult your doctor. Always wash you hands after using any of these preparations
Pain relief for Haemorrhoids
- If you are in discomfort with your haemorrhoids you can take regular pain relief tablets which you can obtain from your local chemist or supermarket. Usually the pain is short lived just when you are passing stools (faeces /poo) and the creams with local anaesthetic can help with this. You should follow the instructions on the packaging when using creams but they usually say to be used after each bowel movement or morning and night
- If you have other ailments which are causing you pain please be aware that some pain relief medications can contain codeine i.e co-codamol. This is known to cause constipation and exacerbate your symptoms. Consult your doctor to perhaps look for alternative pain relief.
Hemorrhoids and Toilet Habits
- It is both unhygienic and ill advised to sit and read either the newspaper or books whilst sitting on the toilet. This is something which should be avoided as it increases the pressure exerted on the blood vessels supplying the anus causing them to engorge. You should aim at spending only a couple of minutes evacuating your bowels and always respond to your body when you feel you need to empty your bowels – do not wait until later as the stool will become dry making it more difficult to pass. If you are unable to open your bowels as soon as you sit on the toilet get up and walk around until the urge to go again happens then try again. Sitting straining will make mattes worse.
Hemorrhoids and Constipation
- If you are having problems with constipation you can improve your digestive system by combining the main elements of health. Eat fibre enriched food drink plenty of fluids and become more active. If you are still having problems after you have improved your life style it may be time to speak to your doctor regarding laxatives. It is very important that you have the correct one as products like senna cause contractions in the bowel which may give you further problems. Stools softeners, bulk forming laxatives or lactulose will be far better as they improve the stool making the passage through the bowel easier.
Hemorrhoids and Cold compresses
- If you want some cooling soothing relief from you haemorrhoids you can use cold compresses. I am concerned about the amount of advice that I have read especially on the web that says to use ice for this as there doesn’t seem to be any warning or acknowledgement that using ice straight onto the skin surface can itself cause damage. Cold water compresses are just as effective however, if you do use ice it should be wrapped up in a flannel and used for only short periods at a time. It can be counter productive due to the nature of the body wanting to warm the skin surface after it has been chilled to such an extreme.

