As of Friday, September 27, 2013
DEAR DOCTOR K: I’ve suffered with bleeding hemorrhoids for many years and lifestyle changes haven’t helped. My doctor suggested surgery. Is this risky?
DEAR READER: Hemorrhoids are swollen veins in the anus. Many people have both internal and external hemorrhoids. Internal hemorrhoids are located inside the anus, but can sometimes push out through the opening of the anus. External hemorrhoids are located at the rim of the anus. Both types can cause bleeding, itching and discomfort.
The lifestyle changes you’ve probably tried include increasing your fiber intake, taking warm sitz baths, drinking plenty of water, and applying ice packs or petroleum jelly to your anal area. You’re also likely to have tried over-the-counter hemorrhoid creams, ointments and suppositories.
If none of these have worked, it might indeed be time to consider surgical repair. My Harvard Medical School colleague, Dr. William Kormos, recently talked about surgical treatments for hemorrhoids in the Harvard Men’s Health Watch. Here is what he discussed:
Some procedures can be done in a doctor’s office, but only on internal hemorrhoids. One such procedure is really “low tech”: rubber band ligation (RBL). In RBL, the doctor places a small band around an internal hemorrhoid to cut off its blood supply. Ligation can cause minor pain.
Another office-based technique is infrared photocoagulation (IPC). IPC uses infrared light to heat and scar the hemorrhoid. IPC causes less pain than RBL, but it may be less effective for severe hemorrhoids.
The final office-based treatment is sclerotherapy. The doctor injects an irritating chemical solution into the hemorrhoid or surrounding area. This solution triggers a reaction that causes the hemorrhoid to shrink. (I’ve put an illustration of these three office-based procedures on my website, AskDoctorK.com.)
When office-based treatments don’t work, hemorrhoids may have to be surgically removed in an operating room. This is called hemorrhoidectomy. The surgery is effective for both internal and external hemorrhoids. However, there often is pain following the surgery, which can be controlled by medication. Sometimes there is some bleeding following the operation, but this is usually a minor problem. On unusual occasions, the pain as the surgery heals can cause temporary difficulty in urinating.
A final surgical option is hemorrhoid stapling. In this procedure, a special device staples and removes hemorrhoid tissue. Used only for internal hemorrhoids, stapling is less painful than hemorrhoidectomy and appears to be almost as effective.
We don’t really know why hemorrhoids develop. The veins that turn into hemorrhoids are the blood vessels through which blood returns from the anus and nearby area to the heart. When the flow of blood is partially blocked, the veins swell up. Conditions that cause such blockage are numerous: pregnancy, tumors in the pelvis (such as large fibroid tumors of the uterus), chronic constipation or just prolonged sitting. That last is another good reason for people with desk jobs to get up several times an hour and walk around.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.