Wait. Everyone Has Hemorrhoids? (Yep, Even You)

This is great!! -- Dr. Dale

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Everyone Has Hemorrhoids (Yes, Even You)

http://gizmodo.com/everyone-has-hemorrhoids-yes-even-you-1563334066

Scott - TodayIFoundOut.com

Much like bathroom-humor at the dinner table, hemorrhoids can be a taboo subject. The truth is, everyone has them.

Their job is to protect your anal sphincter muscles (the ones that open and close your anus) and to help keep your anus closed when you have moments of increased abdominal pressure, like when you're coughing. They become a problem for us when they become inflamed. Once this happens they're known as piles. Popular culture has led to "hemorrhoids" and "piles" to be interchangeable in common vernacular. By the age of 50, about half of the US population will have dealt with these inflamed itchy protrusions from your anus. Because most people with piles get curious about why their butt itches, let's take a closer look at what they are, what causes them to become inflamed, and how we can prevent that from happening.

Your anus is controlled by one of the many sphincter muscles within the body. Sphincters are muscles that form like a doughnut around the many openings within the body, like the entrance and exit of your stomach. Those would be the lower esophageal sphincter and pylori sphincter respectively. When sphincters relax, they allow the entrance or release of liquids and solids. Normally sphincters are constricted which keeps those liquids and solids from leaving their respective positions within the body. No one likes the acid from your stomach coming back up and making your chest feel like it's on fire!

As mentioned before, your anal sphincter is cushioned by hemorrhoids. Hemorrhoids themselves are made up of what are known as modified squamous epithelium. These highly vascular cushions reside along the anal canal in three main areas- the left, right and back of the canal. They are made up of elastic connective tissue and smooth muscles. Many of them do not contain muscular walls like arteries and veins do. Because of this, they are technically known as sinusoids (a small blood vessel like a capillary) and can swell up due to blood not being able to leave.

When you're relaxed, they provide about 15-20% of the pressure keeping your anal canal closed. When you have an increase in abdominal pressure, like when sneezing, the blood going back to your heart through your inferior vena cava is reduced. This causes these vascular cushions to swell up with blood pushing on your sphincter, and thus, help prevent the infamous anal-leakage. It's also thought that hemorrhoids are responsible for helping us determine the exact content of what's coming out, like gas versus a solid bowel movement.

When your hemorrhoids begin to swell up chronically, they begin to cause problems. This is when they become known as piles. Once they are piles, they can cause symptoms like hard lumps that can be painful and itchy, the feeling like you still have to go to the bathroom after you've already gone, and mucous discharge or bright red blood while defecating.

Anything that causes an increase in your abdominal pressure can cause your hemorrhoids to become chronically inflamed. Thus, there risk factors for piles- things like being pregnant, chronic constipation, lifting heavy weights, straining when passing stool, being obese, and increasing age. Some studies have even suggested the tendency to develop piles is inherited.

You have two types of piles, internal and external. A line known as the dentate line is what differentiates them. Located below the dentate line is external piles. These are covered by a type of skin called Anoderm that contain nerve fibers, specifically fibers connected to the pudendal nerve. The cause of the itchy pain is revealed!

Internal hemorrhoids are broken down in to 4 classifications. 1^st degree protrude only into the anal canal. 2^nd degree protrude outside the canal but go back in spontaneously. 3^rd degree require you to push them back in manually, and 4^th degree don't go back in to your canal no matter what you do.

The treatment for your piles depends on severity. If only minor, your doctor may choose to simply treat the symptoms, administering things like corticosteroids to reduce inflammation, laxatives if constipated, pain medication and anti-itch creams, as well as advising you to attempt not to strain while on the toilet, and to use simple pads to help with irritation.

If your pile is more cumbersome, your doctor can choose to remove or reduce the pile. They can do this in a variety of ways. Banding involves placing an elastic band around the base, cutting off blood-flow to the pile. After a few days, it will die and simply fall off. They can inject medications into the pile causing it to shrink, known as sclerotherapy. Surgery is also an option. They can remove the pile (hemorrhoidectomy), or staple shut the blood-flow to the pile itself.

In the end (pun intended) we all have hemorrhoids. Scratch your bums with pride knowing that 50% of us will have theirs inflame by the time we're 50. Let's just hope it's only a minor inflammation, because no one wants a Doctor cutting anything off down there!

Does your anus itch?!

Have you been suffering with an anal itch for a long period of time?  Do you feel it inside your anus? It's most likely hemorrhoids!  BUT DON'T BE SCARED.  I'M AN EXPERT. 

There are many solutions to fix this but first let me explain what hemorrhoids are really quick.

A hemorrhoid is a collection of swollen tissue and blood vessels in the lower rectum or anus. With onset commonly occurring after the age of 30, hemorrhoids will affect more than half the population at some point in their lives. Common causes include constipation, pregnancy, childbirth, obesity, heavy lifting, sitting for long periods and diarrhea.

Home remedies such as a hemorrhoid cream, suppositories and warm baths may offer temporary relief from the symptoms of hemorrhoids. But for many people, hemorrhoids don’t go away.  Instead, they can get progressively worse over time, growing in both size and number. Some chronic sufferers develop hemorrhoids in as many as three locations.

Fortunately, you don’t have to put up with recurring hemorrhoid flare-ups and increasing pain.

What to Expect

The first appointment will typically consist of a consultation and physical exam. During the diagnosis you may receive a physical examination, anoscopy and/or proctoscopy which are visual examinations of the ano-rectal region.  There is no need for anesthesia, fasting or other preparation. If hemorrhoids are diagnosed, we may treat you with a cream along with lifestyle and dietary modification guidelines. If it is determined that the hemorrhoids need to be removed then we will discuss the use of The CRH O’Regan System to rubber band your hemorrhoids.  Please see my latest blog post to read about even further procedures.

This system may not be appropriate for all patients. You and your physician will determine an appropriate treatment for your diagnosis during your examination.

If your diagnosis includes hemorrhoids, treatment may start immediately.  In the event of multiple hemorrhoids, often the largest, most symptomatic hemorrhoid is banded first.  Additional appointments are then scheduled to treat the remaining hemorrhoids at two week intervals with a final check-up two or more weeks after the last remaining hemorrhoid is banded.

Sometimes patients have both an anal fissure and hemorrhoids. Our ligation system often allows us to begin concurrent treatment of both conditions allowing for a quicker recovery.

After Care Following hemorrhoid banding, we recommend normal activities as tolerated, except for heavy lifting, rigorous exercise or similar activities. You can resume full activity the next day.  You can have normal bowel movements during this time, but you may want to soak in a sitz bath (a warm tub with a tablespoon of table salt added) or use a bidet for a gentler cleansing of the anal opening.

Soon you’ll be feeling much better, but you’ll need to make some changes to prevent future problems.  Straining due to constipation should be diligently avoided, so be sure to drink seven or eight glasses of water a day and add 15 grams of fiber to your diet (two tablespoons of natural oat or wheat bran).  Metamucil, Benefiber, flax or other soluble fiber may be helpful as well.

We also recommend that you not sit longer than two minutes on the toilet.  If you can’t have a bowel movement in that time, come back later.  This two-minute rule can help keep you from straining during bowel movements without realizing it.  Finally, when traveling by air, stay hydrated, avoid alcohol, eat fiber and walk around when you can.

1. What are hemorrhoids? Hemorrhoids are cushions of tissue containing swollen blood vessels, located in the lower rectum or anus. There are two types of hemorrhoids: internal and external. Depending on the location, symptoms may include pain, inflammation, itching, and a feeling of fullness following a bowel movement. Additionally, there may be bright red blood covering the stool, on the toilet tissue or in the toilet bowl.

2. What causes hemorrhoids? Hemorrhoids result from an increase in pressure in the veins of the rectum This may be caused by constipation, pregnancy, childbirth, obesity, heavy lifting, long periods of sitting, or diarrhea. In Western countries, constipation is associated with diets low in fiber and high in fat.

3. Who gets hemorrhoids? Hemorrhoids affect both men and women. The incidence of hemorrhoids increases after age 30, and by age 50, about half of the population will have experienced the condition.

4. How does banding work? A tiny rubber band is placed around the tissue above the hemorrhoid. This cuts off blood supply to the hemorrhoid, causing it to shrink and fall off typically within one to five days. You probably won’t even notice when this happens or be able to spot the rubber band in the toilet.

5. Does banding hurt? No. Thanks to our improved instruments and technique, band placement is painless. You may experience a feeling of fullness or dull ache in the rectum for the first 24 hours, but this can generally be relieved by over-the-counter pain medication. Multiple studies of our banding technique show that 99.1% of patients experience no significant post-procedural pain.

6. How many bands are necessary? There are three sites where hemorrhoids form frequently, and it is not uncommon for all three sites to require treatment. We generally only band one hemorrhoid site at a time in separate visits, as multiple bandings have been found to increase complications. Also, some extremely large hemorrhoids may require additional banding sessions. Thus, multiple bands may be used in severe cases, but one to three is standard.

7. Can you treat external hemorrhoids? Yes. Most hemorrhoidal symptoms are from dilated internal hemorrhoids and or anal fissures. The banding of internal hemorrhoids usually shrinks the external hemorrhoids as well and is highly effective in relieving the symptoms of pain and bleeding. After banding is completed there may be an external component or skin tag that persists, but usually they do not cause much in the way of symptoms. An acute thrombosis of an external hemorrhoid can be very painful and may require drainage. Please note that not all offices offer skin tag removal or drainage of thrombosed hemorrhoids. Please consult with the office in which you would like to be seen prior to your appointment.

8. Will I have to miss work or other activities? Your first appointment with our office will probably be the longest, as it involves a consultation, obtaining a medical history, making a diagnosis of your problems and formulating a treatment plan. We suggest you allot up to an hour. Subsequent treatment sessions will be shorter, around 15-30 minutes total. After a hemorrhoid banding procedure, we recommend that you refrain from vigorous activities the rest of the day and resume full activity the next day. Most patients with office jobs find they can return to work immediately following their appointment.

9. Why aren’t creams and home remedies enough? Hemorrhoid creams and suppositories are designed to provide temporary relief for symptoms such as pain and itching. They cannot shrink the hemorrhoid, stop it from growing larger or make it go away. Ultimately, the only permanent cure for recurrent symptoms is the destruction or removal of the hemorrhoid itself.

10. How do I know if I have hemorrhoids or an anal fissure? Good question. Anal pain, itching and rectal bleeding are symptoms of both hemorrhoids and anal fissures. As a result, it’s possible for people to incorrectly self-diagnose themselves. Always consult a physician for a proper diagnosis. Because bleeding is also a symptom of colorectal cancer, it’s important to rule out other problems as well.

11. How much does banding cost? Please call the office where you would like to be treated for the most up-to-date pricing on the services you may require. Most major insurance plans including Medicare, cover hemorrhoid banding, anal fissure treatment and colorectal cancer screening.

12. Do hemorrhoids increase the risk of colorectal cancer? No. Hemorrhoids do not increase your risk of developing colorectal cancer. But since both conditions can produce rectal bleedingas a symptom, it’s important to determine whether cancer may also be present. Because of this fact, further diagnostic procedures, such as flexible sigmoidoscopy or colonoscopy may be recommended. Research shows that up to 2.3% of patients with bleeding hemorrhoids may also have colorectal cancer.

13. Will my insurance cover banding? Most major insurance plans including Medicare, cover hemorrhoid banding, anal fissure treatment and colorectal cancer screening. However, as insurance coverage varies, please call the office where you would like to be treated, for assistance with your specific policy.

14. How common is banding? Rubber band ligation is the most frequently used non-surgical treatment for hemorrhoids in the world. However, not all banding procedures are the same. Unlike traditional banding techniques that use a metal-toothed clamp to grasp the tissue, we use a gentle suction device, reducing the risk of pain and bleeding.

WHY ME??

As an award-winning Board Certified Internist and Gastroenterologist , I will diagnose and treat your hemorrhoid(s) with over 14 years of experience treating the most complex cases. I understand the need for thorough evaluation, aggressive treatment and close follow up. My state of the art facility has the latest equipment to most accurately diagnose and treat hemorrhoids to give you relief in no time.

I have received favorable reviews from patients and has been awarded the Patient’s Choice Award. I am also an Associate Clinical Professor of Medicine at the Geffen School of Medicine at UCLA. In addition to seeing patients at my private practice in Beverly Hills, I also see patients at Cedars-Sinai Medical Center.

I GOT YOU!

-- Dr. Dale

What?? A new way to treat HEMORRHOIDS?!

There are alternatives!  BUT WHAT ARE THEY?? Surgery isn't the only option:

• * creams
• * high fiber diet
• * if CREAMS and HIGH FIBER DIET don't work...
• * then we go to Banding (get's rid of 80% in office) (*COVERED UNDER INSURANCE)
• * if BANDING doesn't work...
• * then we go to THD, where the hemorrhoids are sewn, in office, with minimal discomfort, and back to full activity inside of 4 days (*COVERED UNDER INSURANCE)

THD is a proven solution to painful Hemorrhoids.

What's THD?  Transanal Hemorrhoidal Dearterialization

But what does that mean??

THD is indicated for symptomatic internal hemorrhoids that fail conservative management.

A Minimally Invasive Procedure

THD uses a doppler to locate the terminating branches of the hemorrhoidal arteries. Once the artery is located the surgeon uses an absorbable suture to ligate or “tie-off” the arterial blood flow. The venous “out flow” remains to “shrink” the cushion. This is done without excision of tissue. If necessary the surgeon will perform a hemorrhoidopexy to repair the prolapse. Again, this is done with suture and no excision of tissue. This repair restores and “lifts” the tissue back to its anatomical position.

The entire procedure is performed above the dentate line so that there is minimal discomfort. The procedure takes about 20 minutes and is offered as an out-patient surgery.

I'M HERE FOR YOU.

-- Dr. Dale