Colon and Rectal Surgeons of Long Island, P.C.

Hemorrhoids

Hemorrhoids are protrusions, folds, or irregularities of anal tissue, both inside the anal verge (internal), and outside on the anal margin (external). They are formed by the stress produced by bowel movements, straining and local irritation. They are composed of epithelial lining (skin or mucus membrane), connective tissue and blood vessels in varying proportions. The symptoms they produce include itching, bleeding, discharge, discomfort, and pain.

Hemorrhoids may become acutely swollen and painful. This occurs when blood clots within the hemorrhoidal veins. This condition is referred to as "thrombosed hemorrhoids." Commonly a pea or marble sized painful lump will suddenly appear just outside the anal verge. Sometimes the entire anus swells, inside and out, producing severe pain which requires urgent treatment for relief.

Conservative treatments for hemorrhoids include creams and ointments, sitz baths, and measures to maintain soft bulky stools. Such stools are the least traumatic to anal tissue and they are achieved by consuming a diet high in fiber with sufficient fluid intake. Fiber supplements, such as Metamucil, and stool softeners, such as Colace, are also helpful.

Because hemorrhoids vary in their structure and location, the procedures to remove them must also vary. In general, only hemorrhoids which produce symptoms are treated, although occasionally hemorrhoids are removed for cosmetic reasons.

Small thrombosed external hemorrhoids usually resolve on their own within two weeks. However, if seen early in their course they may be surgically removed in order to hasten pain relief. The Colon and Rectal surgeon will, in the office, excise the swelling containing the blood clots and the veins which hold them. "Lancing" the hemorrhoid and squeezing out the clot, as performed by other doctors, does not produce reliable results. Not all clots can be removed in that manner and clots may form again within the veins either immediately or in the future.

When the source of symptoms are non-thrombosed internal hemorrhoids rubber band ligation is usually the treatment of choice. This procedure is simple and quick and is the most frequently performed to remove hemorrhoids. Using a specially designed ligator tiny elastic rings are applied to strangulate a hemorrhoid. This is an office procedure and no anesthesia is necessary. The hemorrhoid withers and disappears within five to ten days. The band is discharged with a bowel movement.

When internal or external hemorrhoids are large, or when both internal and external hemorrhoids are responsible for symptoms, and conservative management fails, surgery may be considered. A well performed surgical hemorrhoidectomy will usually provide permanent relief. A new operation called PPH, which is less painful, could be an even better treatment option.

Other methods exist to treat hemorrhoids. Infrared photocoagulation (IRC) can be helpful in treating low profile bleeding internal hemorrhoids. Injection sclerotherapy was a common technique employed in the last century, but is now used less frequently. Cryotherapy (freezing) and laser surgery, while once popular and heavily promoted, did not improve results, and are not techniques used by most Colon and Rectal Surgeons today.

The surgeons of Colon and Rectal Surgeons of Long Island, P.C. are experts in the treatment of hemorrhoids and are familiar with all the above techniques. We will help you select the treatment best for you.

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