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Colon and Rectal Surgeons of Long Island, PC

Hemorrhoids

Hemorrhoids are protrusions, folds, or irregularities of anal tissue, both inside the anus (internal), and outside (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 suddenly 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 appear just outside the anal verge. Sometimes the entire anus swells, inside and out, producing severe pain.

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 are achieved by consuming a diet high in fiber with sufficient fluid intake. Fiber supplements, such as Metamucil or Benefiber, and stool softeners, such as Colace, are also helpful.

Because hemorrhoids vary in their structure and location, the methods to treat them vary also. 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 is sometimes helpful, but does not always 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 non-thrombosed internal hemorrhoids cause symptoms, rubber band ligation is often the treatment of choice. Quick and simple, this is the most commonly performed procedure to eliminate hemorrhoids. Using a specially designed instrument, tiny elastic rings are applied to strangulate a hemorrhoid. This is usually done in the office, and no anesthesia is necessary. The hemorrhoid withers and disappears within five to ten days. The band is discharged, usually unnoticed, with a bowel movement.

When internal or external hemorrhoids are large, or cause symptoms that do not respond to conservative management, surgery may be considered. A well performed hemorrhoidectomy will usually provide permanent relief. A newer operation called PPH, which is less painful, could be an even better option for selected patients. An even newer approach, THD, which stands for Transanal Hemorrhoidal Dearterialization, controls symptoms by reducing the blood flow to the hemorrhoids, causing the tissue to shrink and the symptoms to disappear.   

Other methods exist to treat hemorrhoids. Infrared photocoagulation (IRC) can be helpful in treating low profile bleeding internal hemorrhoids. IRC is commonly confused with “laser” treatment. 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 rarely used by Colon and Rectal Surgeons today.

Dr. Leiboff is an expert in the treatment of hemorrhoids and is familiar with all the above techniques. He will help you select the treatment best for you.

For more information, click on hemorrhoids.

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