Hemorrhoid Treatment

Internal Hemorrhoids

Internal hemorrhoids are classified by their degree of prolapse, which helps determine management:

• Grade One: No prolapse
• Grade Two: Prolapse that goes back in on its own
• Grade Three: Prolapse that must be pushed back in by the patient
• Grade Four: Prolapse that cannot be pushed back in by the patient (often very painful)

Internal hemorrhoids have various causes: constipation, diarrhea, dehydration, lack of a high fiber diet, sitting for a long period time, pregnancy, heavy lifting (ie: weight lifting).

External Hemorrhoids

An External hemorrhoid is really just a bruise 3D. This is a large clot that has burst from an end vein. These are almost always caused due to increased straining and are largely avoidable.

Anal Skin Tags

Patients often complain of painless, soft tissue tag on the outside of the anus. These are usually due to old external hemorrhoids and can be difficult to clean or cosmetically displeasing.

How Do we Treat Hemorrhoids?

There are both surgical and non-surgical ways to treat hemorrhoids.

Dietary/Lifestyle Changes

Dr. Schultzel recommends the following to avoid and reduce the symptoms of hemorrhoids:

• Consume a High Fiber Diet: Plenty of fresh fruits and vegetables are always recommended
• Add a Fiber Supplement: Metamucil, Citrucel, Vitafusion Fiber Well gummies (Costco)
• Avoid sitting long periods on the toilet, this causes excessive Straining Limit time to no more than 5-10 minutes
• Try a Squatty Potty: This allows for a more normal positioning of your body to facilitate a bowel movement
• Take a Pro-biotic: Activa Yogurt is an excellent source, ask your doctor about prescriptions choices as well
• Drink plenty of Water Coffee, soda, and tea DO NOT assist in hydration, they actually do the opposite. I recommend 6-8 tall glasses of water per day (unless have contraindicating kindey issues)
• Be Positive A good outlook on life is associated with less bowel complaints

Office-Based Therapies for Internal Hemorrhoids

We provide various in-office treatments for hemorrhoids depending on the grade and severity of the condition.

Rubber Band Ligation

Rubber Band Ligation is a procedure where an anoscope is placed into the anal canal. Through the anoscope, Dr. Schultzel will evaluate and isolate your hemorrhoids. A rubber band with be placed around the base of the hemorrhoid. This will cause the blood supply to the hemorrhoid to be cut off. Over a brief period of 1-3 days the hemorrhoid will fall off. Patients on chronic anticoagulants may no be appropriate candidates for this procedure.

• Please do not eat a heavy meal prior to your in office procedure. Light liquids and something small such as toast is reasonable.
• Please stop all asprin/motrin 7 days before your procedure.
• After the procedure you will feel pressure in the anal canal, similar to the feeling of needing to have a bowel movement. This is normal and can last from 24 hours to 3 days.
• Bleeding is normal after the procedure and once the hemorrhoid falls off there will be some expected spotting.
• We recommend hot water baths (20 minutes at a time), with soapy water/salty water to soothe the anus.
• Please also use Tylenol for discomfort.
• Make sure you are drinking plenty of water and avoid straining during your bowel movements.
• A diet high in fiber is always recommended.

Office Treatment of External Hemorrhoids

Generally the treatment of external hemorrhoids is conservative. We typically recommend a high fiber diet, stool softeners, warm water baths (sitz baths), and the avoidance of straining. Patients with an acute thrombosis may be appropriate candidates for clot evacuation in the office. A numbing medication is injected into the hemorrhoid and the clot is removed. This provides some early relief for newly thrombosed hemorrhoids. External hemorrhoids can take up to 1 month to completely subside.

Operative Treatment of Hemorrhoids

Only a small fraction of patients with symptomatic hemorrhoids will require surgery (less than 10%). Hemorrhoidectomies are completed under anesthesia where the hemorrhoid is surgically excised from the anus. Dr. Schultzel employs an energy device used to seal the hemorrhoid at its base. This decreased post-operative pain, bleeding, and recurrence of hemorrhoids. Additionally, Dr. Schultzel performs a nerve block on the site which decreases post-operative pain.

Postoperative Instructions

You should expect to have pain following hemorrhoid surgery. The goal is to make it manageable. Most patient will require medications for their pain. Sitting in a bath (sitz bath) 2—3 times daily for >20 minutes per time in warm water up to your lower abdomen may make you more comfortable. Occasionally, patients will have difficulty urinating after anorectal surgery. If you are unable to void, try urinating in the tub during a sitz bath or while seated (men). If that does not work, proceed to an emergency department for placement of a catheter in your bladder. Moving your bowels after hemorrhoid surgery is always a concern for patients and can be painful. Most surgeons recommend having a BM within the first 48 hours after surgery. You should already be taking a diet high in fiber, a fiber supplement, a stool softener, and increased liquid intake. If this does not produce a BM, you may need to take laxatives to achieve this. Expect to have some bleeding with BMs for several weeks after surgery.