There are several types of surgical procedures that can reduce hemorrhoids. Most
surgical procedures in current use can be performed on an outpatient level or
office visit under local anesthesia. Rubber band ligation is a technique that
works well with internal hemorrhoids that protrude outward with bowel movements.
A small rubber band is tied over the hemorrhoid, which cuts off the blood
supply. The hemorrhoid and the rubber band will fall off within a few days and
the wound will usually heal in a period of one to two weeks.
The
procedure causes mild discomfort and bleeding. Another procedure, sclerotherapy,
utilizes a chemical solution that is injected around the blood vessel to shrink
the hemorrhoid. A third effective method is infrared coagulation, which uses a
special device to shrink hemorrhoidal tissue by heating. Both injection and
coagulation techniques can be effectively used to treat bleeding hemorrhoids
that do not protrude. Some surgeons use a combination of rubber band ligation,
sclerotherapy, and infrared coagulation; this combination has been reported to
have a success rate of 90.5%.
Surgical resection (removal) of hemorrhoids is reserved for patients who do
not respond to more conservative therapies and who have severe problems with
external hemorrhoids or skin tags. Hemorrhoidectomies done with a laser do not
appear to yield better results than those done with a scalpel. Both types of
surgical resection can be performed with the patient under local
anesthesia.
Diagnosis Most patients with hemorrhoids are diagnosed
because they notice blood on their toilet paper or in the toilet bowl after a
bowel movement and consult their doctor. It is important for patients to visit
the doctor whenever they notice bleeding from the rectum, because it may be a
symptom of colorectal cancer or other serious disease of the digestive tract. In
addition, such other symptoms in the anorectal region as itching, irritation,
and pain may be caused by abscesses, fissures in the skin, bacterial infections,
fistulae, and other disorders as well as hemorrhoids. The doctor will perform a
digital examination of the patients rectum in order to rule out these other
possible causes.
Following the digital examination, the doctor will use an anoscope or
sigmoidoscope in order to view the inside of the rectum and the lower part of
the large intestine to check for internal hemorrhoids. The patient may be given
a barium enema if the doctor suspects cancer of the colon; otherwise, imaging
studies are not routinely performed in diagnosing hemorrhoids. In some cases, a
laboratory test called a stool guaiac may be used to detect the presence of
blood in stools.
Preparation Patients who are scheduled for a surgical hemorrhoidectomy are
given a sedative intravenously beforethe procedure. They are also given
small-volume saline enemas to cleanse the rectal area and lower part of the
large intestine. This preparation provides the surgeon with a clean operating
field.
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