digestive disorders
Hemorrhoids
Treatment of Hemorrhoids
Stool softeners and sitz baths For external thrombosed hemorrhoids, removal of blood clot For internal hemorrhoids, injection sclerotherapy, rubber band ligation, or infrared photocoagulation Sometimes surgical removal Usually, hemorrhoids do not require treatment unless they cause symptoms. Taking stool softeners or bulking the stools with fiber supplements (such aspsyllium) may relieve straining with bowel movements. Hemorrhoid symptoms can sometimes be relieved by soaking the anus in warm water in what is known as a sitz bath. The soaking is accomplished by squatting or sitting for 10 to 15 minutes in a partially filled tub or using a container filled with warm (not hot) water placed on the toilet bowl or commode. especially those that cause severe pain, a doctor may inject a Local anesthesia and regional anesthesia to numb the area and cut out the blood clot or hemorrhoid, which sometimes relieves the pain more rapidly. Takingacetaminophenor a nonsteroidal anti-inflammatory drug (NSAID) can help alleviate the pain of a thrombosed hemorrhoid. Local anesthetic ointments or witch hazel compresses also may help. Pain and swelling usually diminish after a short while, and clots disappear over 4 to 6 weeks. Forbleeding internal hemorrhoids,a doctor can inject a substance that causes scar tissue to form and destroy the hemorrhoids. This procedure is called injection sclerotherapy. An alternative to injection sclerotherapy is infrared photocoagulation. During this procedure, an infrared light is used to treat bleeding hemorrhoids. Large internal hemorrhoids and those that do not respond to injection sclerotherapy can be tied off with rubber bands (a procedure called rubber band ligation). The band causes the hemorrhoid to wither and drop off painlessly. One hemorrhoid is treated about every 2 weeks. Some internal hemorrhoids are removed by tying them off with rubber bands in an outpatient procedure called rubber band ligation. The instrument used (ligator) consists of forceps surrounded by a cylinder with ¼-inch (½-centimeter) rubber bands placed on one end. The ligator is inserted into the anus through an anoscope (a short, rigid viewing tube), and the hemorrhoid is grasped with the forceps. The cylinder is slid upward over the forceps and the hemorrhoid, pushing the rubber bands off the cylinder and around the base of the hemorrhoid. The rubber bands cut off the hemorrhoid's blood supply, causing it to wither and drop off painlessly in a few days. One hemorrhoid is ligated about every 2 weeks. Several treatments may be required. Sometimes, multiple hemorrhoids can be ligated at a single visit. Surgeryto remove the hemorrhoids may be used if other treatments do not work. However, hemorrhoid surgery (called hemorrhoidectomy) may result in severe pain, as well as urine retention and constipation. Another technique is called circumferential stapled hemorrhoidopexy, in which a circular surgical stapler is used. This technique causes less pain after it is done, but it may result in a higher rate of complications than conventional surgical hemorrhoidectomy, and hemorrhoids may return. Other methodsto destroy internal hemorrhoids, such as Doppler-guided hemorrhoid artery ligation, are being tried. In this method, hemorrhoid arteries are identified using ultrasonography and tied off with a suture, thus reducing the blood supply to the hemorrhoids. Treatments using lasers, freezing probes, or an electrical current (electrocoagulation) are unproved. Rubber band ligation is still the standard treatment. 