Hemorrhoid procedures,There are many treatments available for hemorrhoids. The main types are listed and described below.
Hemorrhoid Procedures Medical Treatment
Creams and ointments for Hemorrhoid Procedures
A range of creams are available, including steroid creams containing hydrocortisone such as Preparation H® to dampen down inflammation. Others include Germoloids® Haemorrhoid Cream containing the local anaesthetic lidocaine for pain relief and Tronolane® Anesthetic Hemorrhoid Cream, which contains an anti-itch medication called pramoxine.
A combined version known as Proctofoam-HC® (hydrocortisone) and pramoxine is also available and has been shown to be safe in pregnancy. However, you should only use steroid and anaesthetic creams for a week at a time, as they may have long-term side effects and can irritate the skin.
Other skin treatments include synthetic ointments containing calcium dobesilate, naftazone, aminaftone or chromocarbe, and natural creams such as iquinosa, flunarizine and sulfomucopoly-saccharide, in various preparations.
Laxatives, fiber and stool softeners
A Cochrane review of laxatives such as Dulcolax® (bisacodyl) to reduce constipation in 378 patients found that hemorrhoid symptoms were reduced by 50% over three months. Dietary fiber supplements such as Fybogel® (isphagula), Regularity Plus® (vegetable-based and wheat-free) or Metamucil® (psyllium) may also be useful. Stool softeners can help bowel movements to pass through more easily and include Colace® (docusate) and Surfak® (docusate). They can cause stomach cramps, nausea and throat irritation. Let your doctor know if any of these become severe.
Pain relief for Hemorrhoid Procedures
A variety of pain treatments are available, including non-steroidal anti-inflammatory drugs such as Fasprin® (aspirin) and Tylenol® (acetaminophen). Opiate-based medications such as Duramorph® (morphine) and codeine are less commonly used, as these can cause constipation.
This is one of the oldest and most well-tried techniques. There are several types including the Milligan-Morgan open procedure and the Ferguson closed procedure. Both have similar effectiveness and recovery times. It requires a local or light general anaesthetic and generally a hospital stay, although some younger patients can go home the same day. The main complications are early and late bleeding, narrowing of the canal, persistent pain and ulcers. Studies suggest it is generally safe in pregnancy.
Newer developments include the use of LigaSure® technology to fuse the blood vessels, which reduces bleeding during and after the operation. This has been shown to have similar effectiveness but superior pain relief. However, the long-term effects and risk of recurrence are unknown. Another is the Doppler ultrasound-guided technique, known as haemorrhoid arterial ligation (HAL), which identifies the blood vessels affected and ties them off.
One clinical trial looked at the use of different equipment in hemorrhoid surgery. The Harmonic Scalpel is a new scalpel that causes less heat damage than the traditional Bovie scalpel. Rather than cutting the skin, it rotates and vibrates, a bit like an egg whisk. The trial found the Harmonic Scalpel to be safer, with less blood loss during the operation and lower pain scores afterwards.
To find out more about hemorrhoids and hemorrhoidectomy procedures, please watch this YouTube video from Nucleus Medical Media:
Stapling is a less invasive procedure than hemorrhoidectomy, although the long-term results are less well-known and it is best for Grade 1 (first degree) hemorrhoids. The technique used for hemorrhoids is the procedure for prolapse and hemorrhoids (PPH). It requires a general anaesthetic but is shorter than hemorrhoidectomy.
Following stapling, you should be able to pass bowel movements normally and without pain. You may occasionally pass staples – this is normal. The most common complication is urinary retention, which usually resolves by itself. Another, less frequent complication is post PPH syndrome, where the rectum becomes inflamed. This is treated with anti-inflammatory suppositories.
One study looked at 863 patients treated with rubber band ligation, infrared photocoagulation or injection sclerotherapy. They found that people who had received banding had the lowest rates of recurrence, but also the highest pain scores after the operation. Infrared photocoagulation had fewer complications and these were less severe. These techniques are generally not suitable if you have Grade 4 hemorrhoids.
Sclerotherapy involves combinations such as aluminum potassium sulfate and tannic acid (ALTA) to shrink and harden external hemorrhoids.
Home treatments are a good option for early hemorrhoids. These include herbal remedies, which together with synthetic compounds are known as phlebotonics. These increase lymph drainage, improve the muscle strength of veins and stabilize small vessels called capillaries.
They include the H miracle guide developed by Holly Hayden, a hemorrhoid sufferer, Hemocyl® (containing the herbs Messua Ferea and Berberis Vulgaris) and traditional Chinese medical herbs (including Radix Sanguisorbae, Radix Rehmanniae, Fructus Sophorae, Radix Angelicae Sinensis and Radix Scutellariae).
Flavonoids such as Daflon® mixture, buckwheat and ginko biloba, and saponosides including horse chestnut seed extract have also been investigated, as have Ayurvedic medications Curculigo orchioides, Curculigo capitulata and Curculigo pilosa.