Hemorrhoid Bleed

Often lifestyle changes, topical medications, and good hygiene are all that is needed to reduce the symptoms of hemorrhoids. Most painful hemorrhoids stop hurting on their own in one to two weeks. If the pain persists, it is time to talk to a physician about other treatment options.

In a certain percentage of cases, surgical procedures are necessary to provide satisfactory, long-term relief. The newest procedure for advanced hemorrhoids is called the Procedure for Prolapse and Hemorrhoids (PPH). PPH is a technique developed in the early 90’s that reduces the prolapse (enlargement) of hemorrhoidal tissue. With the PPH procedure, patients experience less pain and recover faster than patients who undergo the conventional hemorrhoidectomy procedure.

PPH reduces the prolapse of hemorrhoidal tissue by cutting out a band of the prolapsed anal mucosal membrane with the use of a circular stapling device. The PPH procedure essentially “lifts up” or repositions the mucosal, or anal canal tissue, and restores the hemorrhoidal tissue back to its original anatomical position. This reduces blood flow to the internal hemorrhoids. These internal hemorrhoids, then, typically shrink within four to six weeks after the procedure. The PPH procedure results in less pain than traditional procedures because it is performed above the “pain” line, or dentate line, inside the anal canal. The advantage is this method affects few nerve endings, while traditional procedures are performed below the dentate line, affecting many sensitive nerve endings.

For patients with a lesser degree of prolapse (internal hemorrhoids that have fallen outside the anus), rubber band ligation is widely used for the treatment of internal hemorrhoids. In this procedure, the hemorrhoidal tissue is pulled into a double-sleeved cylinder to allow the placement of latex/rubber bands around the tissue. Over time, the tissue below the bands dies-off and is eliminated during a bowel movement. Rubber band ligation can be performed in a doctor’s office and requires little preparation. Often, however, there is the need for more than one procedure to resolve a patient’s condition.

In cases involving a greater degree of prolapse, a variety of operative techniques are employed to address the problem. In traditional hemorrhoidectomy, surgery is used to remove the hemorrhoids. A hemorrhoidectomy removes excessive tissue that causes the bleeding or protrusion. It is done under anesthesia and may require hospitalization and a period of inactivity. Laser hemorrhoidectomies do not offer any advantage over standard operative techniques. They also are quite expensive, and contrary to popular belief, are no less painful.

Other treatments include cryotherapy, BICAP coagulation, and direct current. Cryotherapy, popular 20 years ago, consists of freezing hemorrhoidal tissue. It is not recommended for hemorrhoids because it is very painful. BICAP, also known as bipolar diathermy coagulation, and direct current, which is low current electric stimulation, are techniques that shrink the hemorrhoids and cause the hemorrhoidal tissue to die. None of these treatments has gained widespread acceptance.

Although anorectal conditions are benign and easily treated, patients may delay seeking medical advice because of embarrassment of hemorrhoids or fear of cancer. As a result, many patients first see their physician when the problem is advanced, requiring extensive treatment, and causing greater patient distress than if the conditions had been adequately diagnosed and managed at an earlier stage.