How Do You Treat Hemorrhoids?
Hemorrhoids can cause bleeding, prolapse (protrusion), and pain. The treatment will depend on which of these symptoms is predominant.
Treating Hemorrhoid Pain
Hemorrhoids rarely cause pain. Most people who think they have hemorrhoids because they have anal pain are usually suffering from something else such as a fissure or a perianal hematoma. When hemorrhoids do cause pain it is very dramatic because it is caused by clotting within a hemorrhoid (thrombosis) and this results in tremendous swelling and disability. Most patients with a true internal hemorrhoid thrombosis cannot sleep for a couple of days and are unlikely to be able to work for at least a week. Treatment consists of ice packs, rest, muscle relaxant creams placed into the anal canal to reduce spasm, and pain relievers. Surgery is rarely appropriate except in cases where the hemorrhoids become so clotted that they turn gangrenous (rare).
Treating Hemorrhoid Prolapse (Sticking Out)
If hemorrhoids are prolapsing but go back inside on their own after a bowel movement or can be pushed in and will stay in, then elastic band ligation (see above) may be effective in reducing or eliminating the prolapse. If hemorrhoids are constantly prolapsed or come back out frequently after being pushed back in, surgery may be required.
Treating Hemorrhoid Bleeding
Bleeding from hemorrhoids is bright red fresh blood. It may be on the toilet paper, or drip into the toilet bowl or shoot into the toilet bowel like a water pistol. Sometimes the blood can be on the outside of the stool, but not mixed within it. Hemorrhoid bleeding is painless. Sometimes the blood will drip onto the floor when you stand up from the toilet. This suggests the hemorrhoid is prolapsing as well as bleeding. To stop hemorrhoid bleeding you should push any protruding tissue back up into the anal canal and get up off the toilet. Although bleeding into the toilet bowel always looks like a lot of blood even when it isn’t, hemorrhoid bleeding can actually be quite profuse and can lead to iron deficiency and anemia. In some cases, higher parts of the rectum and colon will need to be assessed prior to treatment in order to make sure the bleeding is not coming from a higher source. This higher assessment with flexible sigmoidoscopy at the Pezim Clinic is provided at no cost.
The ways to treat hemorrhoid bleeding include diet change and increased fiber, ointments, elastic band ligation, infrared photocoagulation, injection therapy, excision of a hemorrhoid under local anesthetic, and surgical hemorrhoidectomy in a hospital operating room.
Avoiding dietary anal irritants and adding fiber to the diet can be effective in reducing modest hemorrhoid bleeding. It may not make a big difference when the hemorrhoids are large and prolapsing.
Ointments that lower the squeezing pressure of the sphincter muscle can reduce bleeding by relaxing the anus thereby reducing damage to the hemorrhoids.
This common treatment involves placing a tight small rubber band around hemorrhoid tissue or just above it. The band cuts through the tissue in 2 to 4 days and the tissue falls off leaving an ulcer that heals in a matter of weeks. This gets rid of excess tissue and reduces bleeding by destroying the bleeding vessels. Anywhere from one to 4 bands may be needed to fix the problem, usually applied on separate visits spaced 6 weeks apart in order to allow healing between each banding session. The Pezim Clinic uses state-of-the-art hemorrhoid banding systems including Cook’s disposable Short Shot Saeed Hemorrhoidal Multiband Hemorrhoid Ligator and the CRH O’Regan System, a disposable single shot bander.
The downside of banding is that it can hurt for a few days, and about 1 in 500 patients will experience significant bleeding when the band cuts through in 2 to 4 days. The actual banding procedure just takes a minute and is painless. The amount of pain the patient feels within the first few days is very unpredictable. Some patients feel almost nothing, whereas others have quite a bit of discomfort. Beware of any practitioner who guarantees there will be no pain. Hemorrhoid banding is not magic. If the procedure is done properly, the patient will usually be aware of at lease some discomfort.
If the bleeding is not under good control after four bandings, it usually means that banding is not the right treatment and something more aggressive such as surgery is needed if the bleeding is still significant.
The infrared photocoagulator is a device that creates an intense focused infrared light beam that causes a very localized burn when placed up against body tissue. This can be very useful in cauterizing and destroying bleeding vessels in the anal canal. Just as with elastic band ligation, infrared photocoagulation treatment usually requires a series of sessions to get the bleeding under control. Infrared photocoagulation is a good method for treating hemorrhoids that are not prolapsing. Hemorrhoids large enough to prolapse are better treated with elastic banding since that results in the removal of tissue whereas infrared photocoagulation just cauterizes vessels in place. Like elastic band ligation, infrared photocoagulation treatment may cause some discomfort or pain for a few days. The Pezim Clinic uses the state-of-the-art Redfield Corporation IRC 2100 infrared photocoagulation system with disposable sheaths.
This consists of injecting irritating substances underneath the hemorrhoids in an attempt to cause the hemorrhoid vessels to clot or occlude. It is a very old technique that is used mostly in Europe and the UK and third world countries. It never really caught on in North America. There have been some significant complications including prostate damage from injections that were too deep.
In cases in which there is one major hemorrhoid that is prolapsing and responsible for bleeding, it may be possible to remove it (excise it) under local anesthetic at the Pezim Clinic. Whether or not this will be possible will depend on the anatomy of the patient, the size of the hemorrhoid and the patient’s preference and tolerance.
While hemorrhoid surgery is much less common than it used to be, it still has a role in those patients who have significant bleeding that cannot be controlled with the non-surgical measures listed above. Especially in those patients who have bled enough to become anemic or who have significant bleeding plus a large amount of prolapse, surgery is often the best treatment. Surgical hemorrhoidectomy usually requires a general anesthetic. If you need this procedure, staff at the Pezim Clinic will arrange to refer you to an excellent in-hospital surgeon.
What Makes Us Unique?
- We see patients FAST! Usually within a week or two or even the same day if the problem is urgent. We have saved thousands of years of patient waiting!
- The Pezim Clinic is fully accredited as a Non-Hospital Medical/Surgical Facility by the College of Physicians and Surgeons of British Columbia.
- Dr. Pezim is a specialist Colorectal (Mayo Clinic) and General Surgeon (UBC) and a Fellow of both the Royal College of Surgeons of Canada and the American College of Surgeons.
- The team at the Pezim Clinic provides customized individual care and aims for extreme quality.
- We have world-class low complication rates.
- The Pezim Clinic is not associated with or funded by any equipment or drug manufacturer so we are free to use whatever device or medication best fits your problem.
- We maintain a wide variety of special pediatric equipment to minimize discomfort during examinations and treatment.