What you can do about your Internal Hemorrhoids
What are hemorrhoids? How did I get them?
Before we talk about treatment, first we have to define the problem. We all have a network of blood vessels in our rectums, and nerves around the anus. External Hemorrhoids are bumps or irritations in the anal area, and they tend to hurt or itch because of those underlying nerves. Internal Hemorrhoids are actually the blood vessels on the inside of the rectum, and when those vessels get swollen and irritated, internal hemorrhoids are born.
The general rule of thumb is that situations which increase pressure in the rectum will promote Internal Hemorrhoid formation. Constipation, straining, and pregnancy are some of the more common reasons. When they are small, the treatment goals are simple - try to avoid the cause of the increased pressure such as treating constipation (you can read a separate post regarding constipation here), and topical medications such as creams or suppositories. The problem becomes when the hemorrhoids outgrow this type of therapy.
What symptoms might I be experiencing?
There are a number of symptoms that can occur with Internal Hemorrhoids:
Incontinence or soiling
feeling of a fullness or growth in the anus
Sometimes rectal pain can be from Internal Hemorrhoids, but it is important to be evaluated by a doctor to make sure you are not really suffering from an Anal Fissure, which is a small tear or irritation in the anal canal and is treated differently.
How big are my hemorrhoids?
Hemorrhoids are graded on a scale of 4:
Grade 1 - These are the small ones. Just some prominent blood vessels
Grade 2 - Starting to get bigger. They may prolapse occasionally, but will reduce back on their own
Grade 3 - Large and prominent. Prolapsing - may feel like something is stuck in the anus. You will be able to manipulate them back inside with your finger
Grade 4 - Prolapsed out of the anus and staying there. You can't push them back in.
Unfortunately Grade 4 hemorrhoids still need to be treated surgically, but Grade 2 and Grade 3 hemorrhoids are where we can now offer alternatives to surgery such as Hemorrhoid Banding, Sclerotherapy (injection), and cautery (burning).
Which procedure should I have done?
In my practice, we offer the CRH O'Regan hemorrhoid banding system for treatment of Grade 2 and Grade 3 hemorrhoids. I have found that my patients are comfortable with the process of the procedure, and just as importantly are happy with the results. With this system you come to the office visit (by yourself without a designated driver if you like), have a hemorrhoid treated, and then you can return to your day because no anesthesia was needed.
How does the procedure work?
A rectal exam is performed to identify the hemorrhoid that will be treated. Typically one hemorrhoid is treated per session. A disposable scope may be used to identify the hemorrhoid. The applicator is placed over the hemorrhoid, and a plunger is pulled back. If you don't feel anything (and you shouldn't), a rubber band will be placed on the suctioned hemorrhoid. A repeat rectal exam is then done to feel the hemorrhoid and free up any trapped tissue. That's it! The procedure is typically painless, and the risks are minimal.
By binding the excess tissue, a scar is formed and the blood vessel is tightened. This decreases the size of the hemorrhoid and makes it less likely to be symptomatic. Once treated, good bowel hygiene and avoidance of the factors that increase bowel pressure that was discussed above go a long way towards helping the procedure remain durable.
Learn more about the CRH O'Regan system in the video below
If you are in the DFW area and would like to schedule a consultation to discuss your hemorrhoids, please do not hesitate to request an appointment by calling us at 972-265-3379 or clicking on the Appointments tab.