Posts Tagged ‘Skin Surface’
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 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
Complications and risks
- Pain – you may find that having your bowels open may continue to cause you pain
- Bleeding – a post operative bleed can sometimes take place 1-3weeks after the procedure
- Do not use aspirin for 3 weeks after the procedure as this is known to cause bleeding
- Return of the hemorrhoids – the operation may not be effective
- Inability to pass urine (wee)
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
Less used Hemorrhoid Treatments
Other less common hemorrhoid treatments include: Cryosurgery for hemorrhoids This is a procedure where hemorrhoid tissue is frozen and eventually sloughs off, it are not popular as a form of treatment due to pain and the watery discharge. The major disadvantage to cryosurgery is the post operative pain associated it seems to be not as effective as other treatments and people do not tend to want to have repeated treatments due to the pain. Diathermy – bi-polar for hemorrhoids This is used to cause coagulation (burning) of the tissue of the hemorrhoid causing the tissue to fall away. This leaves the tissue underneath fibrosed, like a scar which is hoped will keep the cushions of the anal canal from forming another hemorrhoid. One of the main draw backs of this is the burning sensation which local anaesthetic did not completely eliminate during the procedure and post operative pain. Post operative bleeding was another of the complications. Radiofrequency coagulation for hemorrhoids This is another form of coagulation (burning) which seals the skin surface causing scaring. Research showed that with early stage 1-2 hemorrhoid treatment this was effective and although patients still experienced pain immediately post operatively the majority of people returned to their activities of daily living quite rapidly. It should be noted that grade 1-2 hemorrhoids do not require the same level of intervention as 3-4 and to date more research is needed with regard to this. However the outlook is distinctly promising with reduced pain, complications and return to work.
Hemorrhoids Cream
(OTC) Over the counter preparations can be purchased from you local chemist. If you speak to the pharmacist they will usually be able to help you decide which preparation will help you with your specific problem. Like all things in life creams/ lotions should be applied in moderation. Most of these topical creams will contain some of the following attributes.
- Local anaesthetic
This causes a short term numbing effect and a good form of topical pain relief. It may cause allergic reactions and should not be used for longer than a week at time as it might make the condition worse - Hydrocortisone 1%
This is an anti inflammatory product used for reducing the local irritation of swelling, burning, and itching sensations which you experience with external hemorrhoids - Vasoconstrictors
Ephedrine is one of the most common constrictors – this act by shrinking the blood vessels thereby reducing pain and bleeding. - Astringents
These can dry the skin surface and should be used sparingly witch hazel is one of these and it can reduce itching and swelling. - Corticosteriods
These should be used with great caution. They reduce the inflamed area around the anus and relieve itching however they should not be used for more than two weeks continuously as they may cause permanent skin damage. - Barriers / Skin Protectors
The are called barrier creams as they act as a barrier to the leakage of faecal mucous and fluid from the anal canal. This fluid can lead to irritation and soreness around the anus the cream protects the skin.
