Hemorrhoid Treatments and Surgery

Hemorrhoids are swollen and inflamed veins in your anus and lower rectum. They may result from straining during bowel movements or from the increased pressure on these veins during pregnancy, among other causes. Hemorrhoids are either internal, external, or both. They can cause itching, irritation, bleeding, and pain.

Hemorrhoids can develop from increased pressure in the lower rectum due to a variety of different things. These can include – straining during bowel movements, sitting for long periods of time on the toilet, having chronic diarrhea or constipation, being obese, being pregnant, having anal intercourse, eating a low-fiber diet, and regular heavy lifting.

Rectal pain, rectal bleeding, rectal itching, pain with bowel movements, pain while sitting, feeling something come out during and after a bowel movement (prolapse), rectal discharge, swelling around the anus, feeling a lump or mass in and/or around the anus, constipation, and lower abdominal discomfort.

Hemorrhoid symptoms can improve with time but a change in diet, a bout of constipation, weight gain, or pregnancy can cause the symptoms to return. There is no “cure” for hemorrhoids, but there are treatments that can offer long-term relief.

Hemorrhoids are serious if they are causing you pain or discomfort. If the problems persist despite trying over-the-counter hemorrhoid creams or other remedies. If you’re passing stools that look maroon or tarry in color, it’s a sign of bleeding and you should seek treatment from a specialist.

Inflamed hemorrhoids are typically very painful, you find it difficult to sit, stand or even lay down. Inflamed hemorrhoids look like a large marble protruding through the rectum and around the anus. They can be singular or in clusters.

There is not a specific size of hemorrhoid that is too big. Thrombosed hemorrhoids can rupture and shrink on their own without surgical intervention, but this can take several days to weeks.

If hemorrhoids, big or small, are severely affecting your daily life, then hemorrhoid treatment is always recommended. Depending on the pain tolerance of a patient, hemorrhoids can become very large before finally seeking treatment.

Thrombosed hemorrhoids are swollen and very painful. They look like marbles protruding through the rectum around the anus. Thrombosed hemorrhoids make sitting, standing, and normal daily activities difficult.

There are four grades of hemorrhoids, and not all require immediate treatment. You should seek the care of a specialist for an evaluation to determine which treatment is the best option.

• Grade I hemorrhoids bleed but do not prolapse; on colonoscopy, they are seen as small bulges into the lumen.
• Grade II hemorrhoids prolapse outside the anal canal but reduce spontaneously.
• Grade III hemorrhoids protrude outside the anal canal and usually require manual reduction.
• Grade IV hemorrhoids are irreducible and constantly prolapsed. Acutely thrombosed hemorrhoids and those involving rectal mucosal prolapse are also considered grade IV.
• Anal Hemorrhoidal skin tags (non grade)

Not all rectal pain patients have a thrombosed hemorrhoid. An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements and have a streak of blood down the side of their stool.

Click here for more information on anal fissures.

Infrared photocoagulation (also called coagulation therapy or IRC) is a medical procedure used to treat small and medium-sized hemorrhoids. This treatment is only for internal hemorrhoids. During the procedure, the doctor uses a device that creates an intense beam of infrared light to shrink the hemorrhoids. Sometimes, multiple procedures are required.

Rubber band ligation is a procedure in which the hemorrhoid is tied off at its base with rubber bands, cutting off the blood flow to the hemorrhoid. This treatment is only for internal hemorrhoids. Rubber band ligation is a procedure that can be done at the Tahir Surgical Clinic offices.

Infrared coagulation or IRC (see above) is also a procedure used to treat Grade II hemorrhoids.

Stapled hemorrhoidectomy, a circular, hollow tube is inserted into the anal canal. Through this tube, a suture (a long thread) is placed, actually woven, circumferentially within the anal canal above the internal hemorrhoids. The ends of the suture are brought out of the anus through the hollow tube.

Stapled Hemorrhoidectomy procedures are done at an outpatient facility.

Grade IV hemorrhoids are often treated in different three ways: stapled Hemorrhoidectomy (outpatient), classic Hemorrhoidectomy (outpatient), or External Hemorrhoidectomy (in office).

Acutely tender, thrombosed external hemorrhoids can be surgically removed if encountered within the first 72 hours after onset. Hemorrhoidectomy is performed through an elliptic incision over the site of thrombosis, with the removal of the entire diseased hemorrhoidal plexus in one piece.

In many cases, hemorrhoidal disease can be treated by non–operative methods. These methods include dietary modifications, topical medications, and soaking in warm water, which temporarily reduces symptoms of pain and swelling. In some cases, these steps will be enough to eliminate the need for further treatment.

In a certain percentage of cases, however, surgical procedures are necessary to provide satisfactory, long-term relief. Examination by a board-certified surgeon like Dr. Tahir is necessary to decide the best course of treatment. Don’t hesitate to call or schedule an appointment.

Skin tags may be caused by blood vessels in the anal area swelling under the skin and then reducing in size again. When the swelling reduces, the skin may not reduce back down again to what it was before. The loose skin that results may become a skin tag.

Common and harmless—anal skin tags are small bumps on the anus that may feel itchy. Common causes include hemorrhoids, diarrhea, and inflammation. A doctor can remove the skin tags with a quick in-office procedure called electrodesiccation, in which an electrical current is applied to the skin and dries them out.

At Tahir Surgical Clinic, we’re transparent about pricing. If treatment is not covered under your insurance, we’ll get the best cash-pay rate available through our contracted facilities.

For insured patients, we’ll provide a breakdown of what’s covered under your health insurance. Including any out-of-pocket expenses so you know what to expect before proceeding with surgery.

Dr. Tahir is affiliated with several facilities, but he is a separate entity, in addition to the anesthesiologist. The facility fee is separate from the professional fee and they are not collected together.

If you have any further questions, don’t hesitate to call us.

Exparel is an injectable drug used to help with the discomfort and pain after an external hemorrhoidectomy. Exparel typically eases the most severe pain within those first 24-72 hours post-surgery. It also provides prolonged post-surgical analgesia for up to 72 hours with a single-dose local administration at the surgical site.

Exparel is not covered by insurance so we charge around $35.00 per CC and patients typically need around 6-8cc.

The following are instructions found on our post-opt instructions.

For PPH / Hemorrhoid / Rectal Surgery: Start a sitz baths 6 hours after surgery, always after a bowel movement, and several times daily. PPH (Staple Hemorrhoidectomy) patients are to remove the rectal packing with the first sitz bath. There will be a piece of the sponge packing hanging on the outside of the anus; pull gently on this to remove the packing. (It may come out of its own accord.)

Some patients with rectal surgeries will have absorbable packing in the rectum. It may come out of its own accord or with a bowel movement. This is nothing to be concerned about, it is normal.

Patients may experience rectal bleeding (spotting) for up to 8 weeks after surgery, this is normal.