HEMORRHOIDS AND OTHER ANORECTAL PROBLEMS

Rectal Bleeding

Rectal bleeding is a particularly important symptom. Most often it is the result of hemorrhoids, anal fissure, or other minor problem. Unfortunately, a cancer in the rectum or lower colon can cause a similar pattern of bleeding. Concern over the possibility of cancer or other serious disease is often what brings the patient to the doctor. If a definite site of bleeding cannot be identified on examination of the rectum, more extensive testing such as barium enema or colonoscopy is necessary to ensure that a cancer is not the bleeding site. In patients over the age of 50, colonoscopy may be advisable even if a bleeding site is seen. If you experience rectal bleeding please contact our office. We will try to see you as soon as possible in order to identify the source and perform appropriate testing. Careful rectal examination and anoscopy (examination of the anal opening with a special light) is the most important part of the evaluation.

Hemorrhoids

Hemorrhoids are enlarged veins in the lower end of the rectum just inside the anus. Under certain conditions these veins may become swollen and can actually protrude or prolapse from the anus during a bowel movement. When this occurs the hemorrhoid may become irritated and painful and can bleed. The hemorrhoid is covered with the mucous membrane lining of the rectum. If it is protruding, it oozes mucous which can cause irritation, itching, and discomfort in the skin around the anus.

Constipation, pregnancy, heavy lifting, and sitting on the toilet for long periods may aggravate hemorrhoids. Correction of these problems are essential to successful conservative treatment of hemorrhoids. Various anesthetic ointments and suppositories are useful for short-term relief of hemorrhoidal discomfort. Prolonged use may cause a contact dermatitis and actually worsen the inflammation.

If conservative treatment does not relieve hemorrhoidal symptoms, then surgery or other treatment must be considered. We offer two types of treatment for hemorrhoids not responding to conservative measures. Both are performed in our office and do not require anesthesia or hospitalization. There is minimal discomfort involved and there are no restrictions on your activity after the procedure.

IRC (Infrared Coagulator)

While you are lying on your left side, an anoscope is inserted to carefully inspect the hemorrhoids. The IRC probe is used to cauterize several areas on the upper portion of the hemorrhoid. This causes scarring which helps shrink the hemorrhoid and anchor it in the rectum to reduce prolapse. The insertion of the anoscope is the only uncomfortable part of the procedure. Cauterization is performed inside the rectum above the level of the pain nerves of the anal canal. It takes about two weeks for the scarring to develop fully. It may take as long as two weeks for the scarring to occur a

Hemorrhoidal Banding

In this procedure, an instrument is passed through an anoscope into the rectum. The enlarged hemorrhoid is suctioned into the instrument and a tiny rubber band is applied. The rubber band causes the hemorrhoid to dry up and fall off within a few days. Banding is done inside the rectum, above the level of the pain nerves of the anal canal. There may be some discomfort which can be relieved by warm sitz baths. 

Both procedures are safe and reasonably effective. Patients whose hemorrhoids do not improve may require referral for surgical hemorrhoidectomy. Risks of these procedures are minimal and complications are uncommon. 

If you experience significant bleeding, severe rectal pain, fever or any other problem please contact our office immediately.

Other Conditions

Anal fissure is one of the most common causes of rectal bleeding. This is a split or tear in the lining of the anus. It is often painful but not always. Rectal bleeding usually occurs with a bowel movement.

Pruritus ani is chronic inflammation of the skin around the anus. It is commonly a result of moisture in the area and irritation from leakage of small amounts of mucous or stool. Mechanical irritation from overly vigorous cleansing and chemical irritation from creams and medications only worsen the problem. Treatment involves stopping all medications, cleansing frequently and gently with plain water, and protecting the skin with Vaseline or A&D ointment to create a moisture barrier. Occasionally a yeast or fungus infection may be present and must be treated.

Thrombosed hemorrhoid occurs when a clot forms inside a hemorrhoid. This creates a painful lump. Sometimes the clot will erode through the skin and burst with a small gush of blood. Most of these resolve spontaneously but some do require surgery.

Perirectal abscess forms as a result of inflammation and infection of small glands or crypts in the lower end of the rectum. The infection then spreads into the space around the rectum and forms an abscess. This condition requires urgent surgical drainage. If it is not treated, the infection can spread widely and burst through the skin. This results in a fistula or hole which will chronically drain blood, pus and sometimes stool. A fistula is likely to require more extensive surgical treatment.

Perianal Care:

Treatment of Anal Discomfort or Pain due to hemorrhoids, anal fissures, pruritus ani and other conditions:

1. Sitz Bath: Soak in warm water several times a day, especially after having a bowel movement, to keep the perianal area scrupulously clean. Pat dry afterward. If you cannot do sitz baths after a bowel movement, then gently clean yourself with a wet tissue, baby wipe, or washcloth. This is less irritating than dry toilet tissue. 

2. After cleansing, apply a thin film of Vaseline or A&D Ointment. This acts as a moisture barrier to protect skin and allows it to heal. An anesthetic cream or foam (Proctofoam, Preparation H, Anusol) may be used for a few days to alleviate the pain. Prolonged use may result in sensitivity and can cause worsening of irritation and itching. 

3. Avoid constipation. A high fiber diet is essential. The easiest way to increase your fiber intake is to consume a high fiber cereal every day. You can also take a fiber supplement such as Citrucel or Metamucil once or twice a day in eight ounces of water. Drink plenty of fluids. A stool softener such as Colace or Surfak may also be helpful taken once or twice a day if you have hard stools. 

4. If you are having problems with bleeding from hemorrhoids, you should avoid straining at the stool, and avoid sitting on the toilet for prolonged periods of time. Sitting for too long causes the hemorrhoids to pop out or prolapse, and will worsen pain and bleeding. Don't stay in the bathroom for more than about five minutes.