Hemorrhoids can be a painful and embarrassing condition, but many people suffer from it, especially as they get older. Luckily, the condition is easy to treat. Sergey Kantsevoy, director of the Center for Therapeutic Endoscopy at Mercy Medical Center, said one new treatment is simpler and quicker than the older options.
What are hemorrhoids and what causes them?
Hemorrhoids are the clumps or pillow-like clusters of veins and supporting tissue, including muscle and elastic fiber, that lie within the anal canal just beneath the mucous membranes. Everyone has these structures, located in the lowest part of the rectum and anus. We only refer to them as a pathological condition — when a patient will say, "I have hemorrhoids" — when there is swelling and enlargement of the tissue, like varicose veins in the legs.
Hemorrhoids are classified as either internal — occurring inside the lower rectum — or external, developing under the skin around the anus. The external variety rarely cause a problem, only when painful blood clots form inside the external hemorrhoids, which will usually dissolve, leaving a skin tag that can be sore, itchy or both.
Internal hemorrhoids aren't usually painful but can cause bleeding, which you may notice on toilet paper or in the toilet bowl. However, if you see blood, don't assume that the bleeding is hemorrhoids. See your physician or a gastroenterologist for a complete exam to rule out other conditions, such as colon polyps and cancer. Internal hemorrhoids can sometimes extend beyond the anus or "prolapse." This can cause pain, itching and irritation as mucus and stool particles ("pruritus ani") collect on the protruding hemorrhoid.
Hemorrhoids are very common and affect up to 5 percent of the general population, particularly people over the age of 50. Of the approximately 15 million Americans with this condition, only about 500,000 will need medical treatment. Most susceptible to development of hemorrhoids are pregnant women (the pressure of the fetus and hormonal changes can cause these vessels to expand) and those with weak rectal vein walls. People leading a sedentary lifestyle and who eat a diet low in fiber and have chronic constipation are especially prone to hemorrhoids.
How are hemorrhoids treated and what have been some of the problems with these treatments?
Treatment for external hemorrhoids is usually surgical and only required in the acute phase of thrombosis — to cut the skin above the hemorrhoids and to remove the blood clot.
Treatment of internal hemorrhoids should start with modifications of a patient's lifestyle and an increase in dietary fiber and fluid intake to liquidate constipation and to normalize bowel movements. Conservative treatment of internal hemorrhoids also includes stool softeners, sitz bath with warm water before each bowel movement and local ointment applications.
If conservative therapy fails, the patients are usually referred for non-surgical treatment of internal hemorrhoids. Traditional non-surgical modalities include rubber band ligation, infrared coagulation, laser therapy, etc. However, all these treatments can have significant drawbacks. For example, the application of rubber bands is an effective but very painful procedure. Rectal discomfort and pain after placement of the rubber bands can be so severe, that it may even necessitate the removal of the band. In addition, numerous serious and even life-threatening complications, such as infection and necrosis, have been reported after hemorrhoidal rubber banding. Other traditional non-surgical modalities (sclerotherapy, infrared coagulation, bipolar diathermy, laser photocoagulation) cause less post-procedural pain, but are also less effective compared to band ligation and usually require repeated therapeutic sessions, significantly increasing the treatment expenses.
What are the newer methods of treating hemorrhoids?
The new tissue ligation device, the HET Bipolar System, has recently been cleared by the FDA for the treatment of internal hemorrhoids. The device is a modified anoscope (a small tube used in the examination of the rectum and anus) with a built-in tissue atraumatic ligating bipolar forceps, a light source and tissue temperature monitoring mechanism. Bipolar electrical energy is used to ligate the blood vessels feeding the hemorrhoids, thus stopping the bleeding, eliminating prolapse and shrinking the hemorrhoids. In essence, the device uses heat to staunch the bleeding and other problems caused by internal hemorrhoids.
How do the newer methods improve treatment of hemorrhoids compared to older treatments?
The HET Bipolar System can be used by gastroenterologists during endoscopic procedures, like a colonoscopy, with patients under sedation, or as an outpatient procedure without any sedation. The technique is simple, fast (it takes less than one minute to treat all hemorrhoids in each patient), easy to perform in an outpatient setting, requires only one treatment session and is highly effective in stopping hemorrhoidal bleeding and prolapse.
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Who are good candidates for these newer methods of treatment?
Any patient with Grade I hemorrhoids, which are actively bleeding internal hemorrhoids without a prolapse, or Grade II hemorrhoids, which are internal hemorrhoids prolapsing out of the rectum and spontaneously moving back inside the rectum, with or without bleeding, is a good candidate for treatment with HET Bipolar system.
Will these newer methods eventually replace older methods?
The treatment of internal hemorrhoids with HET Bipolar System is essentially painless, highly effective and will probably eventually replace all other non-surgical modalities for treatment of internal hemorrhoids.