What If I Need A Hemorrhoidectomy
If rubber band ligation or another similar in-office procedure does not help or if you have large protruding hemorrhoids that make you a poor candidate for this type of treatment you may require a hemorrhoidectomy.
A traditional hemorrhoidectomy is an invasive surgery that takes a week or more of recovery before you can return to work and your regular activities. It also requires general anesthesia. Still, it is the most effective method of getting rid of problematic hemorrhoids.
The surgeon completes this procedure by making an incision around the inflamed tissue and removing the involved blood vessels. Hemorrhoidectomies are typically performed as day surgery, and patients return home the same day. Complications or reactions to anesthesia may call for overnight hospitalization.
While traditional hemorrhoidectomies are very effective and most patients are pleased despite the long recovery time, a newer alternative is being used by some doctors to treat prolapsed internal hemorrhoids. Known as a stapled hemorrhoidopexy or PPH, this procedure utilizes a special stapler to tack the inflamed tissue back into its natural position. Over the following days, the inflamed tissue returns to its original size, eliminating symptoms.
How Do Doctors Treat Hemorrhoids
Doctors treat hemorrhoids with procedures during an office visit or in an outpatient center or a hospital.
Office treatments include the following:
- Rubber band ligation. Rubber band ligation is a procedure that doctors use to treat bleeding or prolapsing internal hemorrhoids. A doctor places a special rubber band around the base of the hemorrhoid. The band cuts off the blood supply. The banded part of the hemorrhoid shrivels and falls off, most often within a week. Scar tissue forms in the remaining part of the hemorrhoid, often shrinking the hemorrhoid. Only a doctor should perform this procedureyou should never try this treatment yourself.
- Sclerotherapy. A doctor injects a solution into an internal hemorrhoid, which causes scar tissue to form. The scar tissue cuts off the blood supply, often shrinking the hemorrhoid.
- Infrared photocoagulation. A doctor uses a tool that directs infrared light at an internal hemorrhoid. Heat created by the infrared light causes scar tissue to form, which cuts off the blood supply, often shrinking the hemorrhoid.
- Electrocoagulation. A doctor uses a tool that sends an electric current into an internal hemorrhoid. The electric current causes scar tissue to form, which cuts off the blood supply, often shrinking the hemorrhoid.
Outpatient center or hospital treatments include the following:
Sometimes complications of hemorrhoids also require treatment.
Preparation H Maximum Strength Hemorrhoid Cream
Amazon
Why We Like It: This maximum-strength Preparation H cream relieves burning, itching, and pain within minutes.
Its Worth Noting: This cream is not suitable for internal use.
Preparation H is a well-known brand in hemorrhoid care, and their Maximum Strength Hemorrhoid Cream is an effective solution for relieving the symptoms of your hemorrhoids. The creams primary active ingredient is phenylephrine HCla topical vasoconstrictor that shrinks swollen tissues and helps reduce the discomfort associated with hemorrhoids.
The formula also contains a blend of glycerin, Pramoxine HCl, and white petrolatum to soothe the skin while encouraging tissue healing. It’s easy to apply and starts working immediately to offer relief from itching, burning, pain, swelling, and painful bowel movements.
While the application process is a bit messy, the relief is well worth it.
Price at time of publication: $7
Product Details:
- Active ingredients: Glycerin, Phenylephrine HCl, Pramoxine HCl, white petrolatum
- Dose: Apply up to four times daily
- Uses: External hemorrhoids
- Symptoms treated: Burning, itching, pain, swelling, painful bowel movements
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How We Selected The Best Hemorrhoid Creams And Treatments
We researched the top-rated and most popular hemorrhoid creams and treatments to find the best on the market. We also spoke with gastroenterologists to gain insights into the most effective ingredients. Our experts recommended products with anti-inflammatory and astringent properties, as well as those with numbing agents like lidocaine.
The experts we spoke to include:
- Sara Mesilhy, MD, board-certified gastroenterologist and medical reviewer at ProbioticReviewGirl.
- Srinivas Ramireddy, MD, board-certified gastroenterologist at UTHealth Houston and Memorial Hermann in Texas.
- Supriya Rao, MD, board-certified gastroenterologist and managing partner at Integrated Gastroenterology Consultants in Chelmsford, MA.
What Causes External Hemorrhoids
External hemorrhoids are typically preceded by internal hemorrhoids. If you are able to catch and treat internal hemorrhoids before they cause external flare ups, you may be able to prevent the associated pain and irritation that comes with external hemorrhoids.
In short, external hemorrhoids are caused by pressure. This pressure can result from constipation, diarrhea, pregnancy, exercise, and other factors, including age, dehydration, and diet.
Additionally, any other factors that cause changes to your digestive system mean you are at risk for external hemorrhoids. Factors such as age, obesity, and pregnancy.
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Why Is Laser Hemorrhoid Surgery Better Than Other Treatment Methods
Laser Hemorrhoid Surgery is effective and is an outpatient procedure that uses a narrow laser beam to shrink or remove the affected tissue without causing much damage to the nearby healthy tissue. This treatment option is preferred over conventional surgery because it carries the following benefits:
Recticare Anorectal Lidocaine 5% Cream
Amazon
Why We Like It: Contains a maximum-strength local anesthetic for immediate relief.
Its Worth Noting: Not suitable for use on broken skin.
“The most significant benefit of using hemorrhoid products that contain lidocaine is the numbing,” explains Supriya Rao, MD, board-certified gastroenterologist and managing partner at Integrated Gastroenterology Consultants in Chelmsford, MA. “Lidocaine acts as a pain relief, blocking the pain from the nerve endings wherever it’s applied.”
The cream is easy to apply. You can expect immediate relief from the deep-penetrating anesthetic. The cream is easy to apply. Plus, it can be used up to six times a day.
Price at time of publication: $20
Product Details:
- Dose: Apply a small amount up to six times daily
- Uses: External hemorrhoids
- Symptoms treated: Pain, itching, burning, swelling
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Clearing Up Confusion About Hemorrhoidal Disease
Hemorrhoidal disease is a topic many people will have to address at some point in their lives. Conservative management may be the most powerful tool to treat symptomatic internal hemorrhoids. Management includes keeping stools soft through fiber rich foods, a fiber supplement, avoiding straining while defecating, not sitting on the commode more than five minutes at a time, increasing physical activity, and drinking 64 oz of water per day or more .
After three months of conservative measures, if the patient is continuing to experience hemorrhoidal disease symptoms, it could be time to consider rubber band ligation or a hemorrhoidectomy.
If you have questions about hemorrhoidal disease or would like to speak with a colorectal specialist, please call or request and appointment online.
What Are The Treatment Methods Available
Hemorrhoids treatments are not strenuous, nor are they too complicated. Hemorrhoids usually disappear on their own without treatment. Bleeding and pain may persist for a week or longer.
Doctors treat hemorrhoids with procedures if signs dont improve after a week of at-home treatments. The treatments include the following:
- Rubber band ligation
- Infrared photocoagulation
- Electrocoagulation
In all the above methods of treating hemorrhoids, the treatment causes scar tissue to form, which cuts off the blood supply, often shrinking hemorrhoids.
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Types Of Hemorrhoid Surgery
Surgeries for hemorrhoids can be divided into simpler, outpatient, and less invasive procedures you can do without anesthesia and more complex, inpatient surgeries.
Depending on the severity of your symptoms, and whether you have complications, your doctor will determine whether you need surgery and the type of procedure best for you.
The severity of hemorrhoids is classified by grades as follows:
- Grade 1: no prolapse
- Grade 2: prolapse that goes away by itself
- Grade 3: prolapse that you have to push back in on your own
- Grade 4: prolapse that you cant push in on your own and causes you pain
Best For Internal Hemorrhoids
Why We Like It: These fast-acting suppositories are small and easy to insert.
Its Worth Noting: They may stain your underwear.
Internal hemorrhoids are located inside the rectum and can be incredibly uncomfortable. Anusol suppositories deliver targeted relief and help shrink troublesome veins. The suppositories contain a combination of active ingredients, including zinc oxide and bismuth subgallate, which reduce swelling and shrink veins to help ease pain, itching, and discomfort.
The suppositories are easy to use and offer fast-acting relief for internal hemorrhoids. The direct application of the suppositories offers comfort where its needed most. Simply insert one suppository into the rectum in the morning, evening, and after each bowel movement.
Price at time of publication: $15
Product Details:
- Active ingredients: Zinc oxide, bismuth subgallate, balsam peru, bismuth oxide
- Dose: Insert one suppository in the morning, evening, and after each bowel movement
- Uses: Internal hemorrhoids
- Symptoms treated: Discomfort, itching, swelling
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When Is More Invasive Treatment Necessary
Usually hemorrhoids can be managed with conservative treatment. In some case, however, more invasive treatment may be necessary. The most common reason internal hemorrhoids call for more invasive treatment is because symptoms persist despite conservative treatment.
Some patients also have severe enough symptoms to require medical intervention at the time of diagnosis. This includes patients with:
- Excessive bleeding, especially bleeding that leads to anemia
- Prolapsed hemorrhoids that cannot be manually reduced
- Strangulated hemorrhoids
- Signs of gangrene due to reduced or absent blood supply to the tissue
Treatment For Internal Or External Hemorrhoids
Whenever you feel you may be suffering from internal or external hemorrhoids, its always the best choice to consult with your doctor and get a diagnosis first before beginning any external hemorrhoids treatment.
An official diagnosis can help direct your treatment and make it more effective. Its essential to see your doctor if youre suffering from chronic flare-ups or your hemorrhoids are getting in the way of living everyday life. Internal hemorrhoids bleeding also causes for a doctors visit to prevent any severe side effects.
Internal hemorrhoids treatment and treatment for external hemorrhoids range from natural remedies and over-the-counter products to surgical options, which your doctor can arrange. These procedures can include:
These out of the home procedures are usually reserved for stubborn and recurring hemorrhoids. At-home options for treating hemorrhoids are plentiful and very effective in reducing the symptoms in most cases. These treatments are affordable and accessible just about anywhere medication is sold and are powerful in their ability to bring you relief. However, if you notice that your symptoms arent going away after a week or two of using the following treatments, please consult your doctor.
Lets take a look at your at-home treatment options:
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Less Time In The Bathroom
Johannsson et al6 reported that patients with hemorrhoids spent more time on the toilet and had to strain harder and more often than controls in the community and hospital.
Garg and Singh7 and Garg8 use the mnemonic TONE for appropriate defecation habits:
- Three minutes during defecation.
- No straining and no cell phone use during defecation.
How Are Internal Hemorrhoids Treated
Even if you require medical treatment for your symptomatic internal hemorrhoids, there are often other treatments to try before resorting to surgery. The most common of these methods is known as rubber band ligation.
Most colon and rectal specialists perform this procedure in the office, and it only take a few minutes. The doctor places a tiny band at the base of the hemorrhoid, reducing blood flow. This will shrink the inflamed tissue, stopping symptoms. Some patients require as many as four band placements to completely eliminate symptoms. This process causes only mild pain, requires no anesthesia, and you can return to work immediately.
Some doctors may prefer other procedures that work in a similar way, including sclerotherapy , infrared or laser coagulation and cryosurgery.
Recommended Reading: Over The Counter Creams For Hemorrhoids
How To Use Hemorrhoid Cream
Each product is different. Always read the instructions carefully before use. Make sure the area is clean and dry before applying the product. You should also wash your hands thoroughly with soap and warm water before and after each application.
To apply, squeeze a small amount of product onto your finger or a cotton swab and apply to the affected area. Most hemorrhoid creams are intended for external use, meaning you should only apply the cream directly to external hemorrhoids . Avoid using external products inside your rectum or on broken skin.
If the product is designed for internal use, use a lubricated finger or applicator to insert the cream into your rectum as directed. Be sure to follow all dosage instructions carefully. Never exceed the recommended amount of applications per day. Doing so can cause skin irritation and other adverse effects. If you experience any discomfort or irritation after using hemorrhoid cream, stop and speak with a healthcare professional.
Contact your healthcare provider if symptoms persist for longer than seven days or if there is an increase in rectal bleeding.
Surgery For External Hemorrhoids
When surgery is warranted, most external hemorrhoids are surgically cut out or excised. This is called a hemorrhoid excision.
Alternatively, an incisional hemorrhoidectomy may be performed for a thrombosed external hemorrhoid. With this type of surgery, a cut is made over the skin of the hemorrhoid. Just the clot is removed.
An incisional hemorrhoidectomy is less likely to be successful if a patient has been experiencing pain for more than 48 hours. In addition, if the incision is too small, blood can reaccumulate and form another clot inside the hemorrhoid.
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What Is The Best Way To Get Rid Of Hemorrhoids
For mild cases, lifestyle changes such as increasing fiber intake and drinking more water can help alleviate symptoms. Over-the-counter topical medications, ointments, creams, or suppositories may provide temporary relief. In more severe cases where other treatments don’t provide the necessary relief, hemorrhoid banding or a surgical hemorrhoidectomy may be needed.
Misconceptions About Hemorrhoidal Disease Treatments
1. Stool softeners and stimulants wont fix the problem.
Polyethylene glycol/Miralax, an osmotic bowel stimulant, is also a commonly used medication for constipation. It can cause diarrhea, which is one of the irritants and causes of symptomatic internal hemorrhoids. Miralax is best prescribed when the patient has attempted a fiber supplement and needs an additional bowel stimulant with it. It should be used primarily with colonic inertia .
2. Removing a hemorrhoid isnt always the best option.
3. A hemorrhoidal skin tag may not need to be removed.
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How Can I Treat My Hemorrhoids
You can most often treat your hemorrhoids at home by
- taking a stool softener or a fiber supplement such as psyllium or methylcellulose
- drinking water or other nonalcoholic liquids each day as recommended by your health care professional
- not straining during bowel movements
- not sitting on the toilet for long periods of time
- taking over-the-counter pain relievers such as acetaminophen, ibuprofen, naproxen, or aspirin
- sitting in a tub of warm water, called a sitz bath, several times a day to help relieve pain
Applying over-the-counter hemorrhoid creams or ointments or using suppositoriesa medicine you insert into your rectummay relieve mild pain, swelling, and itching of external hemorrhoids. Most often, doctors recommend using over-the-counter products for 1 week. You should follow up with your doctor if the products
- do not relieve your symptoms after 1 week
Most prolapsed internal hemorrhoids go away without at-home treatment. However, severely prolapsed or bleeding internal hemorrhoids may need medical treatment.
Pros Of Laser Hemorrhoid Surgery:
1. Non-invasive procedure
Laser Hemorrhoid Surgery is non-invasive and suitable for those nervous about surgery. In this procedure, laser beams are used to burn and destroy the blood vessels, causing piles to shrink and disappear.
2. Local anesthesia
The procedure is performed under local anesthesia, so there are no risks associated with general anesthesia used in conventional surgery. Thus, the procedure can be performed with minimal risk and discomfort to the patient.
3. Minimal blood loss
There is minimal blood loss associated with the procedure since no incision is involved. In contrast to the conventional procedure, which involves manual coagulation, the laser uses a laser to coagulate the blood vessels.
4. Minimal damage to the surrounding tissue
There is a high risk of damaging the surrounding tissues during conventional surgery. However, due to the laser beams precision and accuracy, there is no damage to the surrounding tissues.
5. Reduced pain and discomfort
The majority of patients are afraid of the pain they might feel after conventional surgery. After surgery, bowel movements may be excruciating. Compared to traditional surgery, laser surgery causes minimal tissue damage and is less painful, so it is a preferred option for patients.
6. Outpatient procedure
Since laser surgery does not require intensive postoperative monitoring, the patient does not need to be hospitalized and can return home the same day. It is usually performed as an outpatient procedure.
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How Long Does It Take For Hemorrhoids To Shrink Or Heal
The amount of time it takes for hemorrhoids to shrink or heal depends on the severity and location, according to Dr. Ramireddy and Dr. Rao. Most mild cases can be managed in two to six weeks with lifestyle modifications and treatment. Hemorrhoids as the result of pregnancy may resolve after birth, Dr. Rao adds.
Patients With Compounding Conditions
Pregnant patients often develop hemorrhoids as intra-abdominal pressure increases, particularly during the third trimester.36 Also, acute episodes of pain and bleeding are common in pregnant women with preexisting hemorrhoids.
Immunosuppressed patients and those on anticoagulant therapy are more prone to serious complications such as sepsis and profuse bleeding. Thus, conservative management should be used in these patients as well. Injection sclerotherapy may be beneficial, as it has been shown to decrease bleeding. Of note, patients on immunosuppressive agents should stop taking them and start taking an antibiotic, and patients on anticoagulant or antiplatelet medications should be instructed to stop them one week before any intervention.
Crohns disease. Some patients with Crohns disease may have hemorrhoids, though this is rare. Eglinton et al,37 in a series of 715 patients with Crohns disease, reported that 190 had symptomatic perianal disease. Of these, only 3 had hemorrhoids. Treatment is always conservative and directed at the Crohns disease rather than the hemorrhoids.
Patients with portal hypertension are prone to have anorectal varices that may resemble hemorrhoids. Anorectal varices can be treated with vascular ligation, whereas sclerotherapy is the preferred method for hemorrhoids in this group, in whom coagulopathy is common.
Read Also: How Do I Treat Bleeding Hemorrhoids