Hemorrhoids Treatment: Rubber Band Ligation
The principle of rubber band ligation is to encircle the base of the hemorrhoidal clump with a tight rubber band. The tissue cut off by the rubber band dies, and is replaced by an ulcer that heals with scarring.
A similar procedure was described in 460 BC by the Greek physician Hippocrates:
And hemorrhoids you may treat by transfixing them with a needle and tying them with very thick and woolen thread, for application, and do not foment until they drop off, and always leave one behind and when the patient recovers, let him be put on a course of Hellebore.
Rubber band ligation can be used with first-, second-, and third-degree hemorrhoids, and may be more effective than sclerotherapy. Symptoms frequently recur several years later, but usually can be treated with further ligation.
The most common complication of ligation is pain. However, bleeding one or two weeks after ligation or bacterial infection in the tissues surrounding the hemorrhoids may occur.
Severe Hemorrhoids Vs Mild Hemorrhoids: Stages
Many physicians use a grading system to categorize hemorrhoids along four stages:
- First-degree hemorrhoids: Hemorrhoids that bleed, but do not prolapse. These are slightly enlarged hemorrhoids, but they do not protrude outside the anus.
- Second-degree hemorrhoids: Hemorrhoids that prolapse and retract on their own . These may come out of the anus during certain activities like passing stool, and then return back inside the body.
- Third-degree hemorrhoids: Hemorrhoids that prolapse and must be pushed back in by a finger.
- Fourth-degree hemorrhoids: Hemorrhoids that prolapse and cannot be pushed back in the anal canal. Fourth-degree hemorrhoids also include hemorrhoids that are thrombosed or that pull much of the lining of the rectum through the anus.
Can Hemorrhoids Be Prevented Or Avoided
Just about everyone has hemorrhoids at some time. But some things may make you more likely to get them. People whose parents had hemorrhoids may be more likely to get them. Pregnant women often get hemorrhoids because of the strain from carrying the baby and from giving birth. Being very overweight or standing or lifting too much can make hemorrhoids worse.
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Treatments For Fissures And Hemorrhoids
Dr. Miller: When do you treat a fissure or hemorrhoids with a procedure?
Dr. Pickron: I’ll talk about the fissures first and probably maybe 10 or 20% of those are actually treated surgically. We have creams that we can use that generally take care of things. If that doesn’t work, Botox injection is an option. If those don’t work, then the last resort is certainly surgery.
Dr. Miller: So that’s treatment for fissures, how do you treat hemorrhoids?
Dr. Pickron: Again, most of these are treated non-operatively. There are procedures in the office we do. The most common thing we do is a procedure called rubber band ligation, where we put rubber bands around the hemorrhoids on the inside. That sounds pretty painful, but truthfully the internal hemorrhoids really have no sensation, so it’s a very easy procedure to do and very well tolerated. It’s usually just some mild pressure for about 24 hours and that’s it. The ones that do need to be treated surgically, like I said, are typically the external ones and those are, fortunately for patients, fairly rare.
Dr. Miller: It would seem to me to be rare, but are there times that the pain could be induced by something like a cancer?
Dr. Pickron: It is. That’s certainly one reason that these symptoms need to be evaluated very thoroughly.
Dr. Miller: So if they’re going on for weeks, that’s something that probably ought to be looked at?
Hemorrhoids: Signs Symptoms And Complications
Andy Miller, MD, is board-certified in internal medicine and infectious disease. He is an associate professor at Weill Cornell Medicine in New York City.
For most people, the signs and symptoms of hemorrhoidsitchiness, swelling, discomfortwill be mild and respond to home remedies. In a minority of cases, however, hemorrhoid signs and symptoms will be severe enough that they require treatment from a physician. Rarely, hemorrhoids that cause significant blood loss or a blood clot can be life-threatening. Its important to note that one of the chief calling cards of hemorrhoids, blood in or on the stool or on toilet paper, should never be considered normal. While the cause could indeed be hemorrhoids, a more serious condition could be afoot.
Hemorrhoids can come with external and/or internal symptoms, depending on how they form.
External Hemorrhoids
Hemorrhoids on the outside of the anus are known as external hemorrhoids. A hard lump might be felt in that area and can often be uncomfortable because it is irritated by bowel movements and by wiping with toilet paper. External hemorrhoids are painful because of the many nerve endings located on the skin around the anus.
If the hemorrhoid becomes inflamed and engorged with blood it may look bluish-purple and be painful, not only during a bowel movement but even when walking or sitting.
Internal Hemorrhoids
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Tips On Adding Fiber To Your Diet
- Add more fiber-rich foods such as fresh fruit, vegetables, and whole grains to your diet.
- Eat prunes, theyre a natural and mild laxative .
- Take a fiber supplement, such as psyllium husk. This adds bulk and softens bowel movements, so you dont have to strain.
- Add fiber to your daily diet slowly to help avoid gassiness.
- Staying hydrated is especially important if youre adding more fiber to your diet.
Bleeding From The Anus
A common sign of hemorrhoids is bleeding from the anus. Blood from hemorrhoids is likely to be a brighter red because it comes directly from arteries or veins. The blood can be found:
- On toilet paper after wiping
- In the toilet bowl
Anal bleeding is a symptom of several other conditions, including:
Anal fissure, anal abscess and anal fistula
Bright red blood can also be a sign of an anal fissure, anal abscess and/or anal fistula.
- An anal fissure is a small tear or sore in the skin of the anal canal
- An anal abscess is a pocket near the anus filled with pus
- An anal fistula is a tunnel that runs from the end of the bowel to the skin around the anus
Symptoms of these conditions that are not shared with hemorrhoids include:
- Anal fissure can cause sharp pain during and after passing a stool, while hemorrhoid pain is normally less severe
- An anal abscess can cause a firm, warm, tender, non-thrombosed lump around the anus. Abscesses may sometimes cause fever
- Anal fistula commonly forms after a previous abscess
Colorectal polyps
Polyps are another type of growth that can be found in similar parts of the body to hemorrhoids. A polyp in the colon or rectum can also cause bleeding. In the case of colorectal polyps, blood can sometimes be seen in the feces. If a person has polyps they may also experience:
- Abdominal pain
- Mucus from the anus
- A change in bowel habits
Colon cancer and rectal cancer
Anal cancer
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What Causes Colon Cancer And Hemorrhoids Do Hemorroids Lead To Colon Cancer
Colon Cancer Causes
Most colorectal cancers arise from adenomatous polyps. Such polyps are comprised of excess numbers of both normal and abnormal appearing cells in the glands covering the inner wall of the colon. Over time, these abnormal growths enlarge and ultimately degenerate to become adenocarcinomas.
People with certain genetic abnormalities develop what are known as familial adenomatous polyposis syndromes. Such people have a greater-than-normal risk of colorectal cancer. In these conditions, numerous adenomatous polyps develop in the colon, ultimately leading to colon cancer.
- There are specific genetic abnormalities found in the two main forms of familial adenomatous polyposis.
- The cancer usually occurs before age 40 years.
- Adenomatous polyposis syndromes tend to run in families. Such cases are referred to as familial adenomatous polyposis . Celecoxib has been FDA approved for FAP. After six months, celecoxib reduced the mean number of rectal and colon polyps by 28% compared to placebo 5%.
Another group of colon cancer syndromes, termed hereditary nonpolyposis colorectal cancer syndromes, also runs in families. In these syndromes, colon cancer develops without the precursor polyps.
HNPCC syndromes are sometimes linked to tumors in other parts of the body.
Other high risk factors for developing colon cancers include any one of the following:
- Ulcerative colitis or Crohn’s colitis
- Breast, uterine, or ovarian cancer now or in the past
- A family history of colon cancer
Causes And Risk Factors Of Hemorrhoids
You may be more likely to get hemorrhoids if other family members, like your parents, had them.
Pressure building up in your lower rectum can affect blood flow and make the veins there swell. That may happen from:
- Pushing during bowel movements
- Anal sex
People who stand or sit for long stretches of time are at greater risk, too.
You may get them when you have constipation or diarrhea that doesn’t clear up. Coughing, sneezing, and vomiting could make them worse.
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What Do External Hemorrhoids Look Like
Hemorrhoids, often referred to as piles, get their name from the Greek word haimorrhoides. If you do hear someone talking about piles, just know that piles and hemorrhoids refer to the same thing.
This means veins that are liable to discharge blood. Do external hemorrhoids go away? Yes, in most cases, they’ll go away in a few days and won’t require any medical treatment.
External hemorrhoids, unlike internal ones, are noticeable to the human eye. They are located underneath the skin that surrounds the anus.
When external hemorrhoids swell, they can be visible. When an external hemorrhoid becomes swollen, it will prolapse to the outside of the anus and can then be seen or felt.
External hemorrhoids appear as clumps of dilated blood vessels outside the opening of the anus.
When hemorrhoids swell, the veins enlarge, and their walls become stretched, causing the swollen bulges we see in external hemorrhoids.
External hemorrhoids appear in bunches as soft lumps. They are generally soft or squishy to touch and can range in size. Witch hazel is often used for external hemorrhoids.
External hemorrhoids can be as small as a pea and as large as a grape. There is a mucus covering on hemorrhoids that can become damaged during bowel movements.
This is when bleeding external hemorrhoids occur.
External hemorrhoids that become thrombosed may appear different as explained in the next section.
You may experience serious hemorrhoid pain with a thrombosis.
What Do Hemorrhoids Feel Like To Touch
Hemorrhoids usually feel wet to touch. This is because the veins are broken and damaged. Don’t touch your hemorrhoids with your bare hands.
The last thing you want to do is touch your hemorrhoids and pass germs on to them.
If a hemorrhoid gets infected, that can be a problem. If you have to touch your hemorrhoids make sure your hands are clean.
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The Most Common Symptom Of Internal Hemorrhoids Is Bleeding
Internal hemorrhoids form when blood vessels inside the rectum become swollen and engorged. Although they form in the lowest part of the rectum, internal hemorrhoids are still far enough inside you may not even know that theyre there. In fact, everyone actually has internal hemorrhoids, but we only notice them once they become a problem. Internal hemorrhoids can worsen over time, but since there are very few pain-sensing nerves in the lower rectal area, you are unlikely to feel any pain. In fact, the most common symptoms of mild internal hemorrhoids is bleeding. You can read more about hemorrhoid bleeding on our blog: here. However, when internal hemorrhoids become moderate to severe, you will likely begin to experience those hard-to-ignore hemorrhoid symptoms.
So You Think They Are No Big Deal Wrong Napoleon Bonaparte And His Fight With Hemorrhoids
It has been identified by Dr. Paul Wolf, 2001, that Napoleon Bonaparte could have won the Battle of Waterloo by attacking earlier in the day, but Napoleon Bonaparte delayed his attack because he suffered greatly from hemorrhoid pain that morning. By the time the afternoon came, the weather and troop disposition advantaged the British.
Napoleon Bonaparte suffered greatly from hemorrhoid pain during many of his battles, as the tension of battle apparently caused his sphincter muscles to tighten horrendously on them, thereby generating massive pain and discomfort for him.
Napoleon Bonaparte used bathing to help control the pain, but during the battle of Waterloo he was constipated which made his discomfort much worse. So he left the battlefield, left his army in the command of a subordinate, and sat in a bath to ease his miserable state, then went back to the battlefield later in the day, resumed his command. By that time, heâd lost the battle, and thus the war!
An interesting bit of history there, one I think many of us can understand and sympathize with, as well as be warned from!
I have also heard of another version, where the battle was lost because Napoleon was unable to survey the battlefield properly, as his hemorrhoids caused him too much distress at the time. Without this surveillance information, it is argued he lost the battle.
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Causes And Risk Factors
Increased pressure on the anal canal can cause hemorrhoids to become enlarged. Various factors might make this more likely. For example:
- Being overweight
- Regularly lifting heavy objects
- Pregnancy and giving birth
The risk of enlarged hemorrhoids increases with age probably because the tissue becomes weaker over time. And hemorrhoid problems are thought to run in families too.
What Should I Do If I Have Signs And Symptoms Of Colon Cancer Or Hemorrhoids
When to Call the Doctor for Colon Cancer Symptoms and Signs
If you have any of these symptoms call a doctor.
- Bright red blood on the toilet paper, in the toilet bowl, or in your stool when you have a bowel movement
- Change in the character or frequency of your bowel movements
- Sensation of incomplete evacuation after a bowel movement
- Unexplained or persistent abdominal pain or distension
- Unexplained weight loss
- Unexplained, persistent nausea or vomiting
If you have any of these symptoms, go to the nearest hospital Emergency Department.
- Large amounts of bleeding from your rectum, especially if associated with sudden weakness or dizziness
- Unexplained severe pain in your belly or pelvis
- Vomiting and inability to keep fluids down
When to Call the Doctor for Hemorrhoid Symptoms and Signs
Bleeding from the rectum or anus is never normal and although hemorrhoids are the most common reason to have blood in the stool. If you have rectal bleeding or blood in your stool, call a doctor. Other causes of rectal bleeding exist and can be serious. Inflammatory bowel disease and cancers of the colon can cause with rectal bleeding. Blood in the stool should never be ignored.
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An Important Symptom Of Hemorrhoids Is Their Color
External ones are often a brownish colour.
Internal ones that are sticking out are usually a reddish pink colour, and might be shiny on the surface like the inside of your bowel is.
Purplish blue or dark reddish colours on a haemorrhoid might mean the blood inside them has become clotted or thrombosed.
What Medications And Other Products Treat Hemorrhoids
Medications are used to control symptoms by softening the stool, decreasing the inflammation of the hemorrhoids, and treating the pain. Stool softeners work by increasing the water and fat content within the stool allowing it to be passed more easily. Docusate sodium is the most often recommended drug in this class .
Inflammation can be controlled with over-the-counter creams or suppositories. Some brand ingredients include low dose topical anesthetics to help with symptoms. Others contain astringents that help shrink the swollen tissues. Both may contain low dose steroids to decrease inflammation. People with diabetes should check with their pharmacist or health care professional before using OTC hemorrhoid treatments. If the medication contains a vasoconstrictor it may elevate blood sugar levels if absorbed in large amounts. Prescription-strength lidocaine or hydrocortisone may be offered by the health care professional.
Grade 2 and 3 hemorrhoids are initially treated the same way, using techniques to destroy hemorrhoids. These include injecting the hemorrhoid vein to make it sclerose or harden, using rubber bands to choke off the blood supply and make the hemorrhoidal tissue shrivel, or other procedures that cause the mucosa to shrivel and die.
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Does A Hemorrhoid Feel Like A Ball
A thrombosed hemorrhoid will appear as a lump at the anal verge, protruding from the anus, and will be dark bluish in color because of the blood clot contained inside the swollen blood vessel. Non-thrombosed hemorrhoids will appear as a rubbery lump. Often more than one swollen hemorrhoid appears at the same time.
When To Seek Medical Advice For Hemorrhoids
Lumps around the rectum and anus, and bleeding from the rectum and anus should be examined by a doctor to rule out more serious conditions.
If hemorrhoids become painful, or cause discomfort or distress, seek medical advice. Many people wait a long time before consulting a doctor, possibly due to embarrassment. Early intervention can ease discomfort. There are various ways to treat hemorrhoids, many of which are painless and/or more successful the earlier the treatment is started.
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When Do I Get My Hemorrhoids Checked
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