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.
What Are Internal Hemorrhoids
Hemorrhoids are vascular structures in your rectum.Specifically, the final portion of the large intestine that your body uses to store and pass stool. These veins are cushioned by muscle and connective tissue.
Everyone has internal hemorrhoids, but we only notice them once they become a problem.
When we refer to hemorrhoids or piles, we are typically referring to hemorrhoids that have become inflamed. About half of adults over 50 experience this issue.
Internal hemorrhoids form near the end of the rectum, but you likely wont see or feel anything unusual, even when a hemorrhoid swells, because they are still far inside the body.
You only see or feel an internal hemorrhoid if they prolapse. Internal hemorrhoids do not cause pain because they are located in an area without any nerve endings. If you are experiencing pain, it may be from a different condition, such as external hemorrhoids, anal fissures or spasms.
Why Are Internal Prolapsed Hemorrhoids At A Greater Risk Of Becoming Thrombosed
Whether internal or external, if your hemorrhoid is prolapsed it is at a greater risk of becoming thrombosed. When outside the anus the hemorrhoids blood supply can be cut off or limited by the anal sphincter limiting blood flow.
Since thrombosis occurs as a result of a lack of blood flow, these types of hemorrhoids are particularly susceptible to this painful condition.
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How To Diagnose Internal Hemorrhoids
If you have any above-mentioned history, signs, and symptoms, consult your doctor for an early diagnosis, your doctor may do a Per Rectal examination or digital rectal examination to confirm the diagnosis of hemorrhoids. Apart from DRE, proctoscopy can help in diagnosis.
In order to rule out other diseases, you might need other tests such as sigmoidoscopy & colonoscopy.
Symptoms Of Internal Hemorrhoids
Symptoms of internal hemorrhoids vary depending on their severity. Even as hemorrhoids worsen, you arent likely to experience pain due to the lack of nerve endings in the lower rectal area. Pain associated with hemorrhoids is typically caused by an associated condition, such as anal fissures or external hemorrhoids.
If you cant feel internal hemorrhoids, then how do you know theyre there?
In most cases, its because you begin to notice bleeding. You may see blood in your stool or notice it on the toilet paper when you wipe. Because this blood has a short path to travel outside the body, it should be bright red. You may not notice it right away if the bleeding is light.
While bleeding is the most common indicator of internal hemorrhoids, you may experience other symptoms if a hemorrhoid prolapses. This typically happens during a bowel movement, and in many cases, the tissue will go back in on its own. In other cases, you may have to push the tissue back in. In the case of Grade IV hemorrhoids, the tissue will remain prolapsed.
Its important to note that bleeding is also a common symptom of colorectal cancer, as well as internal hemorrhoids. Thats why we recommend you see a physician right away if you are experiencing any rectal bleeding, especially if it is accompanied by other suspect symptoms.
Only a qualified physician can accurately diagnose internal hemorrhoids.
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Whom Do Hemorrhoids Affect
Although most people think hemorrhoids are abnormal, almost everyone has them. Hemorrhoids help control bowel movements. Hemorrhoids cause problems and can be considered abnormal or a disease only when the hemorrhoidal clumps of vessels enlarge.
Hemorrhoids occur in almost everyone, and an estimated 75% of people will experience enlarged hemorrhoids at some point. However only about 4% will go to a doctor because of hemorrhoid problems. Hemorrhoids that cause problems are found equally in men and women, and their prevalence peaks between 45 and 65 years of age.
Avoid Making Hemorrhoids Worse
- Blot the anus gently with white toilet paper moistened with water or a cleansing agent after bowel movements. Baby wipes or other pre-moistened towels are also useful for this purpose.
- Avoid rubbing the anal area. You can rinse off in the shower or on a bidet instead of wiping yourself with toilet paper. After cleansing, gently pat the anal area dry with a soft, absorbent towel or cloth.
- Use soaps that contain no perfumes or dyes.
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What Are The Signs And Symptoms Of An External Or Thrombosed Hemorrhoid
Thrombosed external hemorrhoids are a painful condition. These occurs when a blood clot develops in a hemorrhoidal blood vessel causing swelling and inflammation.
- When a blood clot occurs in a hemorrhoid, the hemorrhoid will become even more swollen. This swelling leads to increased pain.
- The pain is usually worse with bowel movements and may increase with sitting.
A thrombosed external hemorrhoid may resolve on its own however, this condition often needs medical care. Bleeding with a bowel movement is never normal and should prompt a visit to a health-care professional. While hemorrhoids are the most common cause of bleeding with a bowel movement, there may be other reasons for bleeding including inflammatory bowel disease, infection, and tumors.
Hemorrhoids are not arteries or veins, but instead are normal blood vessels called sinusoids that are located in the walls that surround the rectum and anus. When the venous pressure within these blood vessels increases, the hemorrhoids swell and dilate, because it is more difficult for blood to empty from them. This leads to the most common symptoms of bleeding and swelling.
Common situations that increase pressure within the hemorrhoidal blood vessels and lead to abnormalities include the following.
- Straining to have a bowel movement. This may be due to constipation or diarrhea.
- Prolonged sitting, including on the toilet
- Lack of exercise
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.
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What To Do About My Uncomfortable Hemorrhoids
Two things are almost always true when it comes to hemorrhoids: Theyre uncomfortable and theyre embarrassing. But if you notice discomfort or itching, you shouldnt let embarrassment keep you from seeking treatment.
Hemorrhoid treatment can effectively relieve pain and discomfort. Plus, many methods dont require incisions. Elvira Klause, MD, FACS, specializes in hemorrhoid treatment at her office in San Clemente, California.
Symptoms Of Thrombosed External Hemorrhoids
External hemorrhoids can be felt as bulges at the anus, but they usually cause few of the symptoms that are typical of internal hemorrhoids.
External hemorrhoids can cause problems, however, when blood clots inside them. This is referred to as thrombosis. Thrombosis of such a hemorrhoid causes an anal lump that is
- very painful,
- tender, and
- often requires medical attention.
The thrombosed hemorrhoid may heal with scarring, and leave a tag of skin protruding in the anus. Occasionally, the tag is large, which can make anal hygiene difficult or irritate the anus. Even after such a hemorrhoid goes away, a residual skin tag may remain, and this may need to be surgically removed.
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Internal Thrombosed Hemorrhoids Treatment Suggestions
Internal thrombosed hemorrhoids treatment can go with or without surgery. Piles can be cured using home remedy and non-operative management if diagnosed in the early stages. If left without proper attention and care, they may be quite a problem as they become really large and painful. In such cases, they require urgent surgery treatment.
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.
Hemorrhoids: Diagnosis And Treatment Options
TIMOTHY MOTT, MD, Naval Hospital Pensacola, Pensacola, Florida
KELLY LATIMER, MD, MPH, U.S. Naval Hospital Sigonella, Catania, Italy
CHAD EDWARDS, MD, Hamilton Medical Center, Dalton, Georgia
Am Fam Physician. 2018 Feb 1 97:172-179.
Patient information: A handout on hemorrhoids is available.
Hemorrhoids develop when the venous drainage of the anus is altered, causing the venous plexus and connecting tissue to dilate, creating an outgrowth of anal mucosa from the rectal wall. However, the exact pathophysiology is unknown. Hemorrhoids occur above or below the dentate line where the proximal columnar transitions to the distal squamous epithelium . The anus is approximately 4 cm long in adults, with the dentate line located roughly at the midpoint.2 Hemorrhoids developing above the dentate line are internal. They are painless because they are viscerally innervated. External hemorrhoids develop below the dentate line and can become painful when swollen. The extent of prolapse of internal hemorrhoids can be graded on a scale from I to IV, which guides effective treatment . This grading system is incomplete, however, because it focuses exclusively on the extent of prolapse and does not consider other clinical factors, such as size and number of hemorrhoids, amount of pain and bleeding, and patient comorbidities and preferences.3
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Increasing fiber intake is an effective first-line, non-surgical treatment for hemorrhoids.
Questions To Ask Your Doctor
- Why do I have hemorrhoids?
- Are there any lifestyle changes I can do that can relieve or prevent hemorrhoids?
- I saw blood on toilet paper. Is this serious?
- Are having hemorrhoids a sign of another health condition?
- Will I always have hemorrhoids?
- Is there medicine I can take for hemorrhoids? Are there side effects?
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Can Natural Home Remedies Treat And Prevent Hemorrhoids
Regardless of the size or swelling of a hemorrhoid, no treatment is required if symptoms do not exist. Prevention is perhaps the most effective treatment. Diet and adequate hydration are very important to maintain normal bowel movements. Hemorrhoid symptoms can occur with the passage of hard stool and constipation, as well as diarrhea and frequent bowel movements. People with constipation may require a high-fiber diet, adequate hydration, and stool softeners. Those with too frequent bowel movements may require antidiarrheal medications and diet adjustments. These preventive measures decrease the amount of straining that is required to have a bowel movement, thus decreasing the pressure within the blood vessels to prevent swelling. The internal hemorrhoid always stays protruded or prolapsed and is at risk for thrombosis or strangulation should the anal muscles go into spasm.
Grade 1 hemorrhoids are treated symptomatically. There can be some spasm of the anal muscles. Warm sitz baths, sitting in a warm tub for 20 minutes, two or three times a day may be helpful. Avoiding spicy food may also prevent anal itching. Over-the-counter medications may be helpful.
The Four Stages Of Internal Hemorrhoids
Hemorrhoids are an uncomfortable medical condition that is quite common, with some studies indicating that up to 90% of the population will experience the condition in some form during their lifetime. Each particular sufferers case of hemroids is different, however, as the type and severity of hemroids can vary.
There are essentially two types of hemorrhoids: internal and external. Internal hemorrhoids are those hemroids which occur in the anal canal and rectum, while external hemroids occur outside the anal canal, near the anal opening.
Internal Hemorrhoids: The Four Stages
Internal hemroids can be classified by severity into four distinct stages. Effective treatment of internal hemroids will vary according to the severity or stage of the hemorrhoids.
With stage I internal hemorrhoids, the hemroids are still in the interior anal canal and protrusion or prolapse has not occurred. Itching may occur in this stage, and the internal hemroids may actually be mistaken for anal fissures.
When internal hemorrhoids reach stage III, they have all the symptoms of the earlier stages with one notable exception: the prolapsed internal hemroids no longer return to their original position on their own. They must be manipulated back into the anal canal manually. This stage of internal hemroids severity is very painful, and requires almost constant treatment for pain.
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Treating External Hemorrhoids At Home
There are many methods of alleviating external hemorrhoids symptoms at home, such as:
However, should symptoms persist, or if you are unsure if your symptoms result from external hemorrhoids, it is best to contact a physician for diagnosis and treatment. Although these remedies can provide relief, most at-home treatments merely mask the symptoms caused by hemorrhoids instead of getting rid of the underlying issue. For this reason, you will most likely need to see a professional for long-lasting pain relief.
Interestingly, although you may think your symptoms come from your external hemorrhoids, many times it is the internal hemorrhoid disease causing the problems.
How Are Hemorrhoids Diagnosed
Your healthcare provider diagnoses hemorrhoids based on symptoms and a physical exam. You may also have:
- Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum to feel for swollen veins.
- Anoscopy: Your provider uses an anoscope to view the lining of the anus and rectum.
- Sigmoidoscopy: Your provider uses a sigmoidoscope to view inside the lower part of the colon and rectum. Procedure types include flexible sigmoidoscopy and rigid sigmoidoscopy .
These tests may be uncomfortable but arent painful. They typically take place in a doctors office or outpatient center without anesthesia. You go home the same day.
Your provider may perform a colonoscopy to confirm findings from other tests or check for signs of colon cancer. This outpatient procedure requires anesthesia.
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When Do I Need To See A Health Care Provider For Hemorrhoids
You should see your health care provider if you
- Still have symptoms after 1 week of at-home treatment
- Have bleeding from your rectum. Hemorrhoids are a common cause of bleeding, but other conditions can also cause bleeding. They include Crohn’s disease, ulcerative colitis, colorectal cancer, and anal cancer. So it’s important to see your provider to find the cause of the bleeding.
Best Thrombosed Internal Hemorrhoid Home Remedy Alternatives
Beside surgery, there are some conservative methods of internal thrombosed hemorrhoid treatment. They involve home remedy options, painkillers, stool softeners and other medicaments like ointments, creams, and suppositories. They will help you strengthen blood vessels, stimulate blood clot resorption, and fight such symptoms as swelling, inflammation, and bleeding.
You should start with dietary and habitual changes and try to make them long-lasting in order to improve your condition. These helpful suggestions will also serve as prevention methods for your internal thrombosed piles:
- Eat food with a high fiber content, which will help you make your stool softer .
- Drink potato juice before your meal since it has anti-inflammatory effect.
- Exercise daily to help your body keep in tone, especially if you have a sedentary job.
- Dont put off a visit to a restroom if you feel you need to defecate in order to avoid straining.
Another effective treatment would be these home remedies for thrombosed internal hemorrhoid:
All these home remedy options can be used in combination with medical drugs if approved by your health provider.
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Symptoms Of Prolapsed Internal Hemorrhoids
Hemorrhoids prolapse when their blood vessels swell and extend from their location in the rectum through the anus. In the anal canal, the hemorrhoid is exposed to the trauma of passing stool, particularly hard stools associated with constipation. The trauma can cause bleeding and sometimes pain when stool passes.
The presence of
- inflammation, and
- constant moisture
can lead to anal itchiness , and occasionally the constant feeling of needing to have a bowel movement. The prolapsing hemorrhoid usually returns into the anal canal or rectum on its own or can be pushed back inside with a finger, but falls out again with the next bowel movement.