Hemorrhoids often lead to itching, burning and pain, which limits activities and decreases the quality of life of those who suffer from them. Luckily, though, most people can manage their symptoms and reduce their hemorrhoids through lifestyle changes that include eating a proper diet and not straining during bowel movements. Of course, there are some severe cases that require further treatment.
How Are Hemorrhoids Initially Treated?
The first-line treatment prescribed for hemorrhoids is almost always changes to the diet and behavioral modifications. This often includes eating more high fiber foods and taking a fiber supplement. This will help you avoid having to strain to use the bathroom, and will prevent constipation. You will also be asked to minimize the time you spend sitting on the toilet because this leaves the anal area unsupported. Sitz baths, which require you to sit in a few inches of warm water several times a day and after bowel movements, may be recommended to ease symptoms. Your doctor may also recommend over-the-counter ointments for relieving hemorrhoid symptoms, although these should not be used for more than a few days at a time due to their steroid content.
Are There Less Invasive Treatments Than Surgery?
If the behavior and dietary modifications don’t reduce symptoms within a few weeks, your doctor may recommend a slightly more invasive procedure. In most cases, this will be a treatment that is done in the doctor’s office and does not require extensive aftercare. There are three common in-office treatments that colon and rectal specialists offer: rubber band ligation, sclerotherapy, and coagulation therapy.
Rubber band ligation, commonly referred to as banding or RBL, is the most common nonsurgical treatment used to remove hemorrhoids. This procedure is popular primarily because it is highly effective and has a low risk of complications. It can be be performed easily in your doctor’s office and is relatively quickly performed.
According to a study published in Techniques in Gastrointestinal Endoscopy, many people who receive treatment for hemorrhoids undergo RBL. Complications occur in only about one to three percent of patients, and typically include only minor pain and bleeding.
Hemorrhoidal Sclerotherapy is done by injecting medicinal compounds around the hemorrhoid or the area just below it. These specially selected compounds then cause hardening of the tissue, and lead to a lack of blood flow into the hemorrhoid. This works to pull the prolapsing hemorrhoid back into the underlying tissue. In general, sclerotherapy can be as effective as banding. Complications, while extremely rare, may include pain, abscess, urinary retention, or minor, temporary bleeding. Serious complications rarely occur, and this procedure is highly effective for some people.
Coagulation therapy utilizes a tool known as an anoscope to deliver a controlled amount of heat or energy to the area around the hemorrhoid. This can be done with an infrared probe, a heater probe, with direct current or during bipolar diathermy. This procedure causes tissue destruction in targeted areas, leading to scarring which fixates the tissue in a proper position. Your doctor will tell you if you are a good candidate for this procedure based on your individual symptoms and health history.
What If I Need A Hemorrhoidectomy?
While nonsurgical procedures work for between 80 and 99 percent of all people with hemorrhoids, invasive treatments may still be required if your condition does not respond to other treatments or if your hemorrhoids are large or prolapsed. Typically, an operation known as a hemorrhoidectomy is used in these cases.
A hemorrhoidectomy is performed in a hospital or surgical center, and is most commonly done under general anesthesia. If there are reasons why you are not a good candidate for general anesthesia or your doctor feels he or she can perform the procedure without it, a local anesthetic may be used in conjunction with a sedative during the surgery. The procedure itself calls for the surgical removal of the hemorrhoids using a scalpel or other instrument.
For most people, a hemorrhoidectomy is performed as a day surgery, and they are able to return home that night. Recovery usually includes a few days to a week off of work. Pain during bowel movements may continue for up to four weeks, although it gradually becomes less painful over time. Most people usually fully recovered in four to six weeks.
Are There Other Surgical Options?
There are other surgical procedures that may be used to treat hemorrhoids. Your doctor may recommend one of these treatments based on the severity and location of your hemorrhoids. These include:
- Stapled Hemorrhoidopexy: A stapled hemorrhoidopexy is also known as a stapled hemorrhoidectomy, circumferential mucosectomy, the Procedure for Prolapse and Hemorrhoids, and the PPH procedure. This surgery is used for hemorrhoids which have prolapsed and have not responded to other treatments. In use for about 15 years, this surgery utilizes a specially-designed circular stapling device. These staples affix the prolapsing tissue to the rectal wall, effectively resecting and repairing the hemorrhoid. Because this procedure is less invasive than a traditional hemorrhoidectomy, it often requires less post-operative recovery. There is usually less post-operative pain associated with PPH.
- Transanal Hemorrhoidal Dearterialization (THD): THD is used to treat internal hemorrhoids, and is considered a minimally invasive operation. Developed in 1995, this procedure uses Doppler testing to locate the arteries that feed the hemorrhoids. Stitches are then used to decrease the blood flow in these arteries, effectively reducing their ability to become enlarged and painful. The hemorrhoid is then sutured higher up into the rectum, thus reducing the prolapse.
As always, you should consult your colon and rectal surgeon (also known as a proctologist), to obtain answers for your questions or concerns.