Tag Archives: Banding

The Easy Hemorrhoid Care™ (EHC) | Minnesota

One Stop Medical Center invites you to experience an elevated level of care for your hemorrhoid treatments, with Minnesota’s first ever Easy Hemorrhoid Care™ Experience.

For nearly 20 years, Dr.Steven Shu has been providing exceptional hemorrhoid care utilizing the state-of-the-art medical techniques and technology available. Now he and his team offer Easy Hemorrhoid Care™ , a new care delivery system for hemorrhoid treatment with minimal invasive procedures, including Infrared Coagulation (IRC), rubber band ligation, and modified hemorrhoidectomy. It is an efficient system that requires only one trip. We provide patients a new experience in hemorrhoid care, from procedure through recovery. These advancements reduce discomfort, time, decrease the chance of complication and reduce the total recovery time.

For the first time in Minnesota, a personalized approach to meet your specific hemorrhoid care requirements is now available! The Easy Hemorrhoid Care™ Experience has been designed to take the stress and worry out of your hemorrhoid treatment. This package provides the most comfortable and seamless hemorrhoid care experience possible, with enhanced, customized hemorrhoid care, saving you precious time in your busy schedule.

Benefits of the Easy Hemorrhoid Care™ (EHC)
In the standard hemorrhoid care, the patients with hemorrhoids require multiple office visits with Infrared Coagulation and/or rubber banding ligation for their internal hemorrhoid treatments, followed by external hemorrhoidectomy and/or excision of anal hemorrhoids. It is a long process, but it is usually covered by your medical insurance.

The Easy Hemorrhoid Care™ (EHC) is a specially designed hemorrhoid care delivery system that aims to shorten the whole process of hemorrhoid treatment, to reduce discomfort, the chance of complications, and total recovery time. Patients are given Botox during the procedure to relax anal sphincter muscles, reducing post procedural pain. It is an efficient system that requires only one trip where you receive premium medical care, but it is not covered by your insurance.

To learn more about our Easy Hemorrhoid Care™ Experience in One Stop Medical Center, please contact us by calling at 952-922-2151 or email at info@shuMD.com.

Injections of Botulinum toxin for Anal Pain and Anal Fissure

Introduction
Botulinum toxin A, is a toxin protein produced by bacteria called clostridium botulinum. When injected into a muscle, it will temporarily blocking neural signals for muscle contractions, causing the muscle fibers at the injection area to relax. Botulinum toxin A has been successfully used for the treatment of a variety of medical conditions involving unwanted muscle spasms such as strabismus and cervical dystonia. It is also commonly used for removing unwanted wrinkles in cosmetic care.

The internal anal sphincter that controls the anus is always under tension. If this tension (also called resting pressure) is too high, it causes rectal pain. The common diseases associated with anal sphincter spasms are anal fissure and functional anal rectal pain. Spasm can make an anal fissure worse or prevent an existing one from healing.

Botulinum toxin A has also been used to treat anal fissure for several years. Injecting Botulinum toxin A into muscle around the anus will temporarily relax the internal anal sphincter. This reduces the spasm and pain and allows the fissure to heal.

Most patients have at least some pain relief in their pain after treatment with Botulinum toxin A. The success rate for an anal fissure healing after the injection is 70 out of 100 treatments. Sometimes the injection might need to be repeated, especially in the patients with functional anorectal pain.

What Happens During the Procedure?
There is no special preparation needed before the injection procedure. You don’t need to do any preparation, but you are encouraged to have bowel movement and please do carry out your usual hygiene routine (shower or bath) before you come in.

Dr. Shu will perform the injection procedure in the exam room or procedure room, and it takes a few minutes to perform. You will be awake throughout the procedure.

You will be asked to lie on your left side on the exam table. The area around your anus will be cleaned with an alcohol spray. Dr. Shu will then give 6-8 injections of Botulinum toxin A into your sphincter muscle with a hair thin needle. This will be uncomfortable during the injection, but it is an extremely quick procedure.

After the Procedure
You can drive home or return to work afterwards. Very occasionally, the patient develops vasovagal reaction (fainting) to the procedure, the you lie on the table for a few minutes to recover.

The Botulinum toxin A will start to work in a few days. The effects of Botulinum toxin A peaks in 1-2 weeks and usually lasts 3-6 months. During this time, anal fissures are allowed to heal.

Most people do not have any side effects. The potential side effects of botulinum injections may include the inability to control the passage of gas (gas incontinence), pain from the injections, bleeding, infection at the injection site, and rarely, fecal incontinence (we don’t have any case of fecal incontinence). If symptoms of incontinence occur following Botox® injection, they typically disappear completely after several months.

It is important to make sure that you continue to keep your stool soft following the treatment, to avoid straining. Continue anal care measures including Sitz bath, fibre in your diet, and drinking enough water.

Pregnancy and Hemorrhoids | Minnesota

Going to the doctor again for hemorrhoids is one of the last things a woman wants to deal with after pushing a child out of their body, but the only thing less appealing than that is actually having hemorrhoids. Pregnancy brings a lot of changes to a woman’s body, one of which is an increase in progesterone, a hormone that is responsible for regulating pregnancy. Aside from one of the greatest joys in life, progesterone also causes one of the greatest inconveniences: hemorrhoids. The combination of progesterone and intense pushing during labor makes hemorrhoid a common ailment among women.

One of the things that can affect the likelihood of developing hemorrhoids during pregnancy is whether the birth is vaginal or a C-section. A vaginal birth is much more likely to result in hemorrhoids, due to all the pushing and strain on the anorectal area. Straining that area of your body can cause hemorrhoids whether your pregnant or not (so don’t spend too much time reading the news on your phone in the bathroom), and anyone that has had experience with childbirth will know that women have to push very very hard, and that’s putting it lightly.

C-sections are less likely to result in hemorrhoids because the entire process of straining and pushing the baby through the birth canal is avoided. However, this all depends on how much straining the pregnant woman does before the procedure.

Usually, very conservative treatment is given to women with hemorrhoids, as additional stress from a procedure is usually not the best for a pregnant woman. Typically, fiber intake, topical ointments, and cold packs are enough to manage hemorrhoids. However, in more severe cases, a procedure may be required to deal with it. In this case, it is best to go with your doctor’s recommendation as to what is best for you and the baby.

Epidemiology on Hemorrhoids | Minnesota

Hemorrhoids are swollen blood vessels in the lower rectum and anus. They are among the most common causes of anorectal complaints, and only a small proportion of those people seek therapy. This blog will summarize the current epidemiology of hemorrhoids.

Prevalence
The prevalence of hemorrhoids is not well documented due to the lack of clinical research on this topic. There has been a scarcity of literature reporting on the epidemiology of hemorrhoids.
It is estimated that the overall prevalence of symptomatic hemorrhoids in the general population is about 4.4%, but the true prevalence of hemorrhoids, including asymptomatic hemorrhoids should be much higher than 4.4%.

According to a study done in a hemorrhoid center, estimates suggest that around half of Americans develop hemorrhoids by time they are 50. The number of people in the US suffering from symptomatic hemorrhoids is estimated to be around 10 million, with 1 million new cases occurring each year. Up to one third of those 10 million people with hemorrhoids seek medical treatment.

Trends
It is noticed that the number of people visiting hospitals for hemorrhoidectomies has fallen. A peak of 117 hemorrhoidectomies per 100,000 people was reached in 1974; this rate declined to 37 hemorrhoidectomies per 100,000 people in 1987, and the number should be much lower now. Office treatment of hemorrhoids with non-invasive methods account for some of this decline.

Gender
There is no known sex predilection, although men seem to be more likely to seek medical attention. However, the physiological changes that occur during pregnancy also increase the likelihood that hemorrhoids will become symptomatic and may increase the incidence of thrombosis in females.

Race
Caucasians are more frequently present with hemorrhoidal disease and seek treatment more often than other races.

Genetics
Some individuals are more genetically predisposed to hemorrhoids than others. But there are no indicative factors that can be used to identify this group of patients.

Age
The prevalence of hemorrhoids increases as people age. In most cases, hemorrhoids develop in individuals who are over 30 years old, with a peak in persons aged 45-65 years, although they can develop at any age. External hemorrhoids tend to occur more commonly in younger adults.

Socioeconomic Status
People who live in rural areas and those with a higher socioeconomic status appear to be more likely to develop hemorrhoids.

Normal Things that Can Give You Hemorrhoids | Minnesota

There are few things more annoying than suffering from hemorrhoids. Even with Grade I hemorrhoids, you will usually find out when there’s blood on their toilet paper or occasional itching and irritation around anus. God forbid it becomes Grade IV mixed hemorrhoid. It’s ghastly sight. Who wants to see that? You notice the blood and feel the itch, as well as mild anxiety- you look up the symptoms, and WebMD tells you that you probably have hemorrhoids. Then you have to pretend like you don’t have a itchy swollen bleeding vein in your rectum while you talk to your coworkers. And you’ll wonder: what did I do to deserve this?

Well, a lot of things. You’re probably doing one of them right now. Old habits die hard, or give you hemorrhoids. Here’s a list of everyday things that are actually giving hemorrhoids:

Straining too hard/long- Your colon and rectum can only take so much straining while you relieve yourself. This is usually because of constipation or diarrhea, or because you had eyes glued to your phone for 25 minutes. Eat your beans and keep trips to the bathroom short.

Weight/pregnancy- Putting on weight of any kind is going to put pressure on your rectum. And, for those who are overweight, diet and aerobic exercise will help keep you in shape and prevent hemorrhoids.

Lifting too hard/long- If your job often requires heavy lifting, or you never figured out how to deadlift correctly, the physical strain can injure your rectum and give you hemorrhoids.
Being born- Unfortunately, some people are just more genetically inclined to get hemorrhoids. For whatever reason, God decided you were gonna have weak easily-swollen veins that’ll start bleeding at 27.

Thankfully with modern medical technologies like IRC and old, but reliable rubber band ligation and surgical excision, and an ever growing understanding of hemorrhoids, even those destined to have an itchy rectum can still have a normal, nuisance-free existence.

The Combined Modalities Achieve the Best Result in the Treatment of Hemorrhoids | Minnesota

Hemorrhoids diseases begin internally, then external hemorrhoids develop when the internal hemorrhoids get worse over a period of time. Internal hemorrhoids are graded from I to IV based on the degree of prolapse. Because no single treatment modality can fix all hemorrhoids, a true hemorrhoid clinic will offer multiple treatment modalities and options to meet a patient’s needs and provide complete care.

If you are treated with a single modality for your hemorrhoids, regardless of the severity, type of hemorrhoids, and associated anorectal conditions, it leads to poor results because of poor quality care. Based on his hemorrhoid treatment experience for the past 20 years, Dr. Shu developed a practical and effective treatment strategy based on the severity of hemorrhoids.

For example, if you have to push the prolapsed hemorrhoids back with your finger after bowel movements, it suggests you may have grade three internal hemorrhoids. Dr. Shu will perform rubber band ligation one to three times to downgrade your hemorrhoids from grade three to grade one to two, then he will perform infrared coagulation to further treat the remaining hemorrhoids. The result of the combination treatments is much better than that of either single modality.

Rubber band ligation is widely used for the treatment of more advanced (more prolapsed) internal hemorrhoids where the prolapsed hemorrhoidal tissue is pulled into a double-sleeved cylinder to allow for the placement of rubber bands around the tissue. Over time, the ligated tissue dies off.

Infrared coagulation (IRC) is a non-surgical treatment that is fast, well tolerated, and remarkably complication-free. An infrared light quickly coagulates the vessels that provide the hemorrhoid with blood, causing the hemorrhoids to shrink and recede.

Dietary and lifestyle changes should also be part of the treatment plan for more advanced hemorrhoids.

If you have grade four internal hemorrhoids, large external hemorrhoids and/or persistent symptomatic external hemorrhoids, you may need surgery (external hemorrhoidectomy) to have them removed.

Kegel Exercises and How They Can Help to Prevent Hemorrhoids | Minneapolis & St Paul

Hemorrhoids, a disease that affects almost 75% of people at some point in their lives, can be a real nuisance for a busy adult. The itching, bleeding, and pain of hemorrhoids make them as annoying as they are unsightly, and getting rid of them may take a while or require going to a doctor’s office, which is why the best way to deal with hemorrhoids is preventing them from occurring in the first place!

Exercise may help to prevent hemorrhoids. Many people are under the impression that exercise can make hemorrhoids worse or even cause hemorrhoids, but this is only true for certain exercises such as weightlifting, typically due to bad form. Certain exercises are very good for hemorrhoid relief.

One method is kegel exercises. Kegel exercises, also known as pelvic exercises, involve contracting and relaxing the pubococcygeal, or PC, muscle in the pelvic floor in order to strengthen it. It’s the same muscle you contract and relax in order to go to the bathroom. They are commonly used to prevent urinary incontinence as well as other pelvic floor problems. Doing this exercise regularly may also reduce the chances of hemorrhoids, and can be done discreetly almost everywhere, either sitting, standing, or lying down, and requires no equipment, so it’s great to do it at work or at home!.

To perform a kegel exercise:
Squeeze the PC muscle for 3 seconds
Relax the PC muscle for 3 seconds
Perform steps 1. and 2. in succession for 10 reps
Take a 30 second break and perform the set of 10 reps two more times
3 sets of 10 reps should performed three times a day

This is by no means the only way to do kegels- feel free to modify as you see fit.

Comparison of Non-Surgical Methods of Treating Hemorrhoids | Minnesota

Hemorrhoids can be an embarrassing nuisance for a busy adult in Minnesota, and any would like to know what the best treatment is. While many people in Minneapolis and St Paul areas associate hemorrhoids with painful surgery, only a small percentage of patients actually require surgery. There are four non-surgical methods of treating hemorrhoids: sclerosing injection, electric desiccation, infrared coagulation, and rubber band ligation. This blog will go over the pros and cons of each one.

Sclerosing injection is a procedure used to reduce or remove abnormal veins, such as varicose veins. It can also be used for treating hemorrhoids. Essentially, the injection of sclerosing agents such as 5% phenol in almond oil (PAO) or Aluminum potassium sulfate and tannic acid (ALTA) induces inflammation in the area, and causes the walls of the vein to harden and thicken, reducing the flow of blood or completely eliminating it with a small enough vein. The procedure takes about 5-10 minutes, and it is tolerable with mild discomfort and pain. It takes about 6 weeks for the injections to take full effect. The treatment usually lasts up to about 6 months. Repeat treatments are usually necessary. The complications included pyrexia, low blood pressure, perineal pain, rectal ulcers and infection. However, this treatment is no longer often used in the US because it is only really effective for very small and early hemorrhoids and relatively high complication of infection. This treatment is not provided at Procedure Clinic in lieu of other, more effective methods.

Bipolar diathermy is the method of electric desiccation involves using high frequency electrical currents to dehydrate hemorrhoid tissue. The hemorrhoid subsequently dries, shrinks, and sloughs off. Larger hemorrhoids require more current. This method is not to be used in advanced cases, or if the patient has complications. The procedure itself also takes a considerable amount of time, which for many people is not convenient, especially when quicker methods are available. This procedure is not done at Procedure Clinic.

Infrared coagulation (IRC) is the most commonly used procedure of treating hemorrhoids in the US, so is our clinic. It is often used for small to medium sized internal hemorrhoids. In this procedure, an intense infrared light heats the hemorrhoid, creating scar tissue. The scar tissue blocks blood supply to the hemorrhoid, which shrinks and dies, leaving a scar that keep the veins from bulging into the anal canal. The procedure can be done every 10-14 days. This treatment works best for early-stage hemorrhoids, and has the advantage of being quick, from procedure to recovery time. Most people can go to work right away. The effectiveness of IRC is quite high. As we know, regardless of treatment methods, hemorrhoid is more prone to return if the patients don’t follow the instructions of prevention. The good news is that the IRC procedure can be repeated easily.

Rubber band ligation involves tying off the hemorrhoid tissue with a rubber band, mechanically cutting off blood supply to the tissue. It is best for more advanced hemorrhoids , such as grade 2 or 3 hemorrhoids- it is not appropriate for early or very late stage hemorrhoids (which is the may require surgery). The recovery time is longer compared to infrared coagulation, and patients report more pain after the procedure. However, ligation is generally more effective and hemorrhoids are less likely to return for this method. The procedure, like infrared coagulation, is usually limited to once every two weeks.

Procedure Clinic uses infrared coagulation and rubber band ligation to cover a wide range of hemorrhoids at different stages. Dr. Shu also performs the hemorrhoidectomy to treat the most advanced hemorrhoids. The best method will vary from person to person, and depends on various factors. By scheduling an appointment, you could find out which is the best method for you.

How to Prevent the Hemorrhoids | Minneapolis & St Paul

Hemorrhoids are a varicose vein disease. More than 10 million people in the United States suffer from hemorrhoids. Three out of four people will develop hemorrhoids at some time in their lives. Although they can be extremely unpleasant and painful sometimes, they can be easily treated with non-surgical therapy and they are preventable. Moreover, if patients don’t take preventive measures, it is possible to relapse after hemorrhoid care, especially in advanced hemorrhoids.

There are many ways to prevent hemorrhoids for patients in Minnesota.

1. One of the best things you can do to prevent hemorrhoids is to make important dietary changes to keep your stools soft and prevent constipation. Why is fiber so very important? People in Minnesota who do not get enough fiber in their diet tend to have constipation with hard stool and strain when going to the bathroom. In turn, this pressure constitutes one of the greatest risk factors to those who are vulnerable to developing hemorrhoids. Constipation with hard stool and straining often causes the rupture of hemorrhoidal veins and anal skin tearing.
Eating a diet that is high in fiber such as fruits, vegetables, beans, and whole grains is recommended. Taking a fiber supplement every day, such as Citrucel or Metamucil, can help keep bowel movements regular. Drinking enough fluids is equally as important so that these bulking agents work better (6-8 glasses of water daily).

Frequent diarrhea does not help, either. Straining related to diarrhea also can rapidly increase the pressure in the abdomen and hemorrhoid venous complex, too.

2. Daily exercise is also great to help the bowel move through your digestive system and prevent you from becoming constipated. Moderate activity of at least 30 minutes 3-4 times per week is recommended.

3. Obese patients are 2-4 times more likely to develop hemorrhoids than the average patient, so weight loss may help to reduce the recurrence.

4. Individuals who are prone to developing hemorrhoids should also avoid standing for extended periods of time and constant heavy lifting.

5. You should have a good toilet habit. The toilet time should not be too long; you should avoid the bad habit of reading newspapers or surfing on the Internet on the toilet. Scheduling time each day for a bowel movement and keeping it a daily routine may help. Take your time and do not strain when having a bowel movement, because it is the straining that causes hemorrhoids. Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum. Lastly, once you feel the urge, it is important to go because if you wait to pass a bowel movement, the urge goes away and your stool could become dry and harder to pass.

6. You may program your bowel movement in the way that you always try to have bowel movements right before your regular shower. For example, if you are a morning person, you go to the toilet first before you take a shower, so the anus is always clean without residual feces. Residual feces are irritable to the skin around anus. If you starting having recurrent symptoms, then a daily Sitz bath helps a lot to relieve the symptoms.

The Common Causes of Minor Rectal Bleeding | Minneapolis & St Paul

Minor rectal bleeding is one of the common symptoms that the Minnesotan patients seek for the medical care. It refers to the passage of small amount of bright red and fresh blood from the rectum and anus, which may appear on the surface of stool, on the toilet paper or in the toilet bowl.

This blog mainly discusses on the conditions with minor rectal bleeding that occurs intermittently. Rectal bleeding can be caused by various conditions, but even the slightest amount of bleeding should be taken seriously. Common causes of minor bleeding are internal hemorrhoids, ruptured thrombosed external hemorrhoids, fissures, fistula, diverticulosis, colon cancer, colitis, and polyps. Patients of older age or with significant family history of bowel disease or cancer should consider further examination. In addition, patients who were previously treated for rectal bleeding but continued to experience bleeding must be further examined.

The source of minor rectal bleeding is determined by history, physical examination and endoscopies. In the initial office visit, your doctor may inspect the anus visually to look for anal warts, anal fissures, cancer or external hemorrhoids, and followed by the digital examination with a gloved, lubricated finger and then anoscopy to look for abnormalities and sources of bleeding in the lower rectum and anal canal. If indicated, your doctor may also perform endoscopies, either sigmoidoscopy or colonoscopy.

Anoscopy is a rectal exam with a very short (3 to 4 inch) rigid metal tube to examine the lower rectum and anal canal, it is very useful when your doctor suspects hemorrhoids, anal fissures and other anorectal diseases.

A flexible sigmoidoscopy is to uses a short (24 inches) and flexible tube with a camera to examine the lower colon and rectum.

Colonoscopy is a test that examines the lining of the entire colon for abnormal growths, such as polyps or cancer. A long tube is passed into your bowel, and a light on the end allows the examiner to see the inside of the bowel. If anything abnormal is found, a small biopsy will be done, and polyps or growths can be removed.

The management of minor rectal bleeding mainly focuses on the treatments of the underlying diseases.

Why can’t Single Treatment Modality Fix All Hemorrhoids? | Minnesota

Hemorrhoids diseases include internal hemorrhoids, external hemorrhoids, anal tags, thrombosis of hemorrhoids and mixed hemorrhoids. Internal hemorrhoids are graded from I to IV based on the degree of prolapse. Besides causing anal itching, pain, bleeding and prolapse, hemorrhoids could cause other complications, such as thrombosis, anemia, and infection. Moreover, many hemorrhoid patients have a comorbidity of anal fissure, fistula, or anal warts. Because no single treatment modality can fix all hemorrhoids, a true hemorrhoid clinic will offer multiple treatment modalities and options to meet a patient’s needs and provide complete care.

If you are treated with single modality for your hemorrhoids, regardless of the severity, type of hemorrhoids, and associated anorectal conditions, it leads to poor results because of poor quality care.

No single treatment modality can fix all hemorrhoids or get rid of anorectal symptoms. Specialized hemorrhoid clinics should be able to offer multiple treatment modalities with cutting edge technologies to cure hemorrhoids and associated diseases.

Internal hemorrhoid Grade 1
Very early hemorrhoids can often be effectively dealt with by dietary and lifestyle changes. The lifestyle changes should also be part of the treatment plan for more advanced hemorrhoids.

Internal hemorrhoid Grade 1-2
Infrared coagulation (IRC) is a non-surgical treatment that is fast, well tolerated, and remarkably complication-free. The infrared light quickly coagulates the vessels that provide the hemorrhoid with blood, causing the hemorrhoids to shrink and recede.

Internal hemorrhoid Grade 3
Rubber band ligation is widely used for the treatment of more advanced (more prolapsed) internal hemorrhoids where the prolapsed hemorrhoidal tissue is pulled into a double-sleeved cylinder to allow the placement of rubber bands around the tissue. Over time, the ligated tissue dies off. Rubber band ligation downgrades the hemorrhoids to grade 1 or 2, so some patients may need to do Infra-Red Coagulation (IRC) treatments after Rubber band ligation.

Internal hemorrhoid Grade 4
A hemorrhoidectomy surgically removes the tissue that causes bleeding or protrusion. It is done in a doctor’s office, surgical center, or hospital under anesthesia and may require a period of inactivity.

External hemorrhoidal tags (anal tags)
Small and asymptomatic tags don’t need any treatment. If symptomatic, anal tags can easily be removed in the office using a local anesthetic and a radiofrequency device.

Thrombosed external hemorrhoids
These hemorrhoids are typically treated with either incision to remove the clot or with external hemorrhoidectomy. Simply draining the clot usually relieves the pain immediately, but it may not work well if multiple thromboses exist as it can also lead to recurrence, so it is better for patients with multiple thromboses to completely excise the thrombosed hemorrhoids.

External hemorrhoids
Small and asymptomatic external hemorrhoids don’t need any treatment, however most patients will have an intermittent flare up. Eventually patients may need surgery (external hemorrhoidectomy) if you have large external hemorrhoids and/or persistent symptomatic external hemorrhoids.

Rubber band ligation for the Treatments of Internal Hemorrhoids | Minnesota

Rubber band ligation is one of the most common outpatient treatments available for the Minnesotan patients with internal hemorrhoids. It is a better option for patients with prolapsed hemorrhoids. A number of prospective studies have found rubber band ligation to be a simple, safe, and effective method for treating symptomatic second- and third-degree internal hemorrhoids as an office procedure with significant improvement in quality of life. This procedure is almost never appropriate if there is insufficient tissue to be pulled inside the band ligator drum, such as grade 1 or mild grade 2 hemorrhoids, and it should not be done with the most severe (grade 4) hemorrhoids, either.

Rubber band ligation is an office procedure in which the prolapsed hemorrhoid tissue is tied off at its base with rubber bands, cutting off the blood flow to the hemorrhoidal mass. It is contraindicated in the patients using anticoagulants and other anorectal diseases, such as local infection, acute thrombosis and chronic anal fissure.

The process involves a doctor inserting an anoscope into the anus and identifying and grasping the prolapsed hemorrhoid with an instrument to place a rubber band around its base. With the rubber band in place, the hemorrhoid shrinks and recedes, dying off in a few days or a week. The reduced volume of venous tissue with the scar formation prevents hemorrhoid tissue from bulging into the anal canal. The procedure is usually done in a doctor’s office and only takes a couple of minutes. Treatment is limited to one to two hemorrhoids each office visit, and additional areas may be treated at two week intervals.

What to expect after the rubber band ligation treatment:

After the banding procedure, most patients don’t feel much discomfort; some may feel tightness and mild pain or feel as if you need to have bowel movement. People respond differently to this procedure. Most patients are able to return to regular activities (but avoid heavy lifting) almost immediately. Others may need a few hours or a day of rest. If you feel some pain after banding, you may use Tylenol or Ibuprofen as needed and take a lot of Sitz baths for 15-30 minutes at a time to relieve discomfort.

Some patients may have slight rectal bleeding after a week, when the rubber band falls off. The bleeding usually stops by itself; however, if you notice significant rectal bleeding, then you should call your doctor’s office. It is also very important to make sure that your stool is soft by taking stool softeners containing fiber and drink more fluids.

The Common Causes of Rectal Pain | Minneapolis

Rectal pain is a common sign of anorectal diseases in Minnesota. It can be caused by various conditions. Pain caused by an acute anal fissure may occur during intense, forced bowel movements that are often accompanied by rectal bleeding. Pain that begins gradually and becomes excruciating may indicate infection. In general, external hemorrhoids don’t cause significant rectal pain in Minneapolis and St Paul. They will cause pain, however, if the varicose vein complex ruptures, as blood clots occur and build up the pressure inside the lump. This condition, known as thrombosed external hemorrhoid, causes an extremely painful bluish anal lump. The somatic nerve in the anal canal (below the dentate line) can sense pain, this is why the patients feel significant pain with the immediate onset when they develop thrombosed external hemorrhoids.

Internal hemorrhoids, however, are not painful due to being located above the dentate line of the rectum that is supplied by the visceral nerve, like those found within the intestines, which sense pressure rather than pain. Similarly, rectal cancer typically does not cause pain unless the condition is advanced. The patients with chronic anal fissures usually have intermittent sharp rectal pain and bleeding with each bowel movement for a long time.

Proctalgia fugax (rectal pain) is a more serious anal pain condition that involves short spasms of intense pain. This condition may occur once each year or up to three or four times each week. The pain is typically accompanied by sweating and an urge to pass stool. There is currently no treatment for proctalgia fugax, but placing oneself in warm water may provide symptomatic relief.

The Common Causes of Rectal Bleeding Minneapolis

Rectal bleeding refers to the passage of red blood from the rectum and anus, often mixed with stool and/or blood clots. The severity of rectal bleeding varies widely in Minneapolis and St Paul. Most rectal bleeding is mild and intermittent in Minnesota, but it also may be moderate or severe.

Rectal bleeding can be caused by various conditions, but even the slightest amount of bleeding should be taken seriously. Common causes of bleeding are internal hemorrhoids, ruptured thrombosed external hemorrhoids, fissures, diverticulosis, colon cancer, colitis, polyps and angiodysplasias. Patients of older age or with significant family history of bowel disease or cancer should consider further examination. In addition, patients who were previously treated for rectal bleeding but continued to experience bleeding must be further examined.

The source of rectal bleeding is determined by history, physical examination and blood tests, assisted with anoscopy, sigmoidoscopy, colonoscopy, radionuclide scans, and angiograms.

Treatment of rectal bleeding includes correcting the low blood volume and anemia, determining the site and cause of the bleeding, and stopping the bleeding.

The Common Causes of Anal Itching | Minneapolis

Anal itching is a common symptom in the office visit in Minnesota. The initial relief of the itching does not necessarily mean the problem goes away. Continuous scratching or excessive cleaning of the anal area may further harm the sensitive tissues and worsen symptoms. In addition, the area can be highly sensitive to perfumes, soaps, fabrics, dietary intake and superficial trauma. When chronic itching occurs, the perianal area becomes white with fine fissures.

Possible causes of anal itching include:

Skin irritation: Moisture and friction can irritate the skin in the peri-anal area. Some products such as soap and toilet paper may also trigger irritation.
Hemorrhoids: Anal itching can be a symptom of hemorrhoids.
Digestive problems: Diarrhea or fecal leakage can cause anal irritation and itching.
Skin disease: Anal itching could be related to a specific skin disease, such as psoriasis or contact dermatitis.
Infections. STD, yeast infections, and the parasite may also involve the anus and can cause anal itching.
Anal tumors: Rarely, a cause of anal itching.

Treatments for anal itching include taking antihistamine as a sedative prior to sleeping to prevent the patient from unconsciously scratching, or using a topical corticosteroid to alleviate the itching. Underlying disorders such as hemorrhoids or infections must be considered and treated when diagnosing and treating anal itching.

Rubber Band Ligation | Minnesota

Rubber band ligation (RBL) is one of the common procedures to treat hemorrhoids in our clinic. RBL is an office procedure in which the prolapsed hemorrhoid tissue is tied off at its base with rubber bands. It works very well for prolapsed hemorrhoids, such as the advanced grade 2 and grade 3 hemorrhoids. It cannot be performed if there is not enough tissue to pull into the barrel in the banding device. This procedure is almost never appropriate for grade 1 or mild grade 2 hemorrhoids (treated with IRC), or most severe (grade 4) hemorrhoids (treated with surgery).

The process involves a doctor inserting an anoscope into the anus and grasping the prolapsed hemorrhoid with a long clamp to place a rubber band around its base. With the rubber band in place, the hemorrhoid dies off in a few days or a week. The procedure is done in a doctor’s office and only a couple of minutes. Treatment is usually limited to 1 hemorrhoid each office visit and additional areas may be treated at 2 week intervals.

After the procedure, some patients may feel tightness, mild pain or have the feeling of bowel movement. Most patients are able to return to regular activities (but avoid heavy lifting) almost immediately. If you feel some pain after banding, you may use Tylenol or Ibuprofen as needed and do a lot of sitz bath for 15-30 minutes at a time to relieve discomfort. Some patients may have slight rectal bleeding in a week. If you notice significant rectal bleeding, then you should call your doctor’s office.

Hemorrhoid Prevention for Minnesotans

There are many ways to prevent the hemorrhoids for the patients in Minnesota. One of the best ways to avoid hemorrhoids or a flare up is to avoid constipation by keeping your stools soft. Eating a diet that is high in fiber such as fruits, vegetables, beans, and whole grains are recommended. Taking a fiber supplement every day, such as Citrucel or Metamucil, can help keep bowel movements regular. Drinking enough fluids is equally as important so that your urine is light yellow or clear. Water is the best form of hydration. Daily exercise is also great to help the bowel move through your digestive system and prevent you from becoming constipated. Moderate activity of at least 30 minutes 3-4 times per week is recommended. Scheduling time each day for a bowel movement and keeping it a daily routine may help. Take your time and do not strain when having a bowel movement, because it is the straining that causes hemorrhoids. Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum. Lastly, once you feel the urge, it is important to go because if you wait to pass a bowel movement, the urge goes away and your stool could become dry and be harder to pass.

Hemorrhoid Treatment on the Road | Minneapolis & St Paul

I have an interesting story that happened while I visited China a few years ago. I was invited to give a lecture on office procedures as a guest professor in Zhejiang University, China. After the academic exchange, I had a few days to myself, so I went to visit an old friend of mine (let’s call him Dave). We decided to go visit a new resort town a few hours away from the city. As we were talking in the hotel, he was looking a bit shifty on the couch, as if he was very uncomfortable. After spending an unbelievable amount of time in the bathroom, I asked him if he was having a problem, and he said he had a lot of pain going to the bathroom because of his hemorrhoids. Thankfully, this being an area of my specialty, I was able to diagnose him with having a thrombosed hemorrhoid that needed immediate treatment. I told him that a thrombosed external hemorrhoid is the common complication of hemorrhoids. If the blood clots, the hemorrhoid develops localized bulging and becomes extremely painful, especially when going to the bathroom.

Dave said he would go to the hospital, but he hesitated to go because of inconvenient medical care in China. He didn’t trust the doctors in the local small hospital, and he was indecisive in choosing a larger hospital. I told him that I had fixed countless thrombosed hemorrhoids, and that if I had the tools I needed, I could fix it for him in a flash. I went to a local hospital in the town and identified myself, the medical staff believed that I was a general surgeon at Shanghai Medical University twenty years ago and that currently I practice in the US. I asked if I could get the necessary gear to do the procedure. Amazingly, the staff in the local hospital were very helpful and generous, and I managed to return with latex gloves, a scalpel, syringes, a pack of gauze, and a bottle of Lidocaine. I got him down on the bed and we did the procedure right there in the hotel.

The procedure took only a few minutes. I gave 0.5 cc Lidociaine to numb the top of the thrombosed hemorrhoid, then sliced open the hemorrhoid with a scalpel and removed the clotted blood with a cotton-tipped applicator. Once the clot was gone, I cleaned up the area by packing large amounts of gauze. The relief was immediate and other than a little bleeding for a day or so, the problem was gone. I told Dave if he had the chance to visit Minneapolis, I can do IRC treatments to treat the root cause of problem – internal hemorrhoids.

Infrared Coagulation (IRC) for Hemorrhoid Treatment | Minneapolis and St Paul

Since its introduction 20 years ago, infrared coagulation has become the world’s leading office treatment for hemorrhoids. This non-surgical treatment is fast, well tolerated and remarkably complication-free. A small probe is placed on the hemorrhoid and a few short bursts of infrared light are applied. The infrared light quickly coagulates the vessels that provide the hemorrhoid with blood, causing the hemorrhoid to shrink and recede. Shrinkage of the hemorrhoidal tissue may take a few weeks.

There may be a quick sensation of pain during the short burst of infrared light but overall the IRC treatments are very tolerable and painless. There are no post-treatment effects in 99% of patients. Usually approx 4 treatments are required. The IRC technology is very effective in treating grade 1 and grade 2 hemorrhoids, and the general treated hemorrhoids do not reoccur. Patients return to a normal lifestyle right after the treatment on the same day. There may be slight spot bleeding a few days later and up to 2 weeks. Heavy straining or lifting should be avoided and aspirin should not be taken for a few days. A sensible diet, moderate exercise and proper bowel habits will help so no further hemorrhoids will form.

Hemorrhoid History | Minneapolis & St Paul

As early as 2250 BC hemorrhoids have been recorded in literature to some extent. It would probably be safe to say that it is one of the oldest ailments known to people. The Egyptians were the first people who medically recorded the remedies for hemorrhoids. They used a poultice of dried acacia leaves with a linen bandage to heal protrusions and inflammations of venous material. A Greek physician named Hippocrates also wrote about hemorrhoids describing it as bile or phlegm which is determined to be the veins in the rectum. He treated the anal protusions very crudely avocating pulling the tissue off with the finger tips, or pulling the veins upward, while someone puts a hot iron to the hemorrhoid and burns it off. The first recorded endoscopy (use of speculum to inspect the rectum)can also be credited to Hippocrates. Even the bible has records of hemorrhoids in the earliest times from the Old Testament Book of Samuel 5:9 Philistines, “punished with emerods” and Samuel 5:12, “People who moved the Ark to Ekron were punished with emerods”.

One of the earliest known hemorrhoid treatments was with the aloe vera plant. Dioscorides, a Roman physician started using that to treat inflamed hemorrhoids. Then approximately 130-200 AD a Roman physician named Emperor Marcus Aurelius (Galen) prescribed ointment, laxatives, and leeches for hemorrhoids treatment. During the same time period in India, the use of clamp and cautery was used to get rid of hemorrhoids and control bleeding.

Between the 5th and 10th Century, Byzantine physicians used thread to ligate the base of the hemorrhoid and then followed by its amputation. Using the modern era of endoscopy, Philip Bozzini , an Italian-German physician, used an aluminum tube to see the genitourinary tract. He then earned the title “The father of endoscopy”. In 1935, Doctors E.T.C. Milligan and C. Naughton Morgan further studied the excision and ligation methods, which later became the gold standard in hemorrhoidectomy. In the 1960s, banding of larger hemorrhoids was introduced with rubber band ligation. In the 1970s, cryotheraphy, diathermy, and laser cauteries were developed for treatment. In the 1990s, Stapled Hemorrhoidopexy, also known as Procedure for Prolapse & Hemorrhoids (PPH) was first described by an Italian surgeon – Dr. Antonio Longo, and since then has been widely adopted to treat the grade 3 and 4 hemorrhoids. Moreover, Another non surgical procedure, called Infra-red coagulation (IRC) was developed to treat the early stage of hemorrhoids.

Anal Tags | Minneapolis & St Paul

Have you been using too much toilet paper because of pesky anal tags? Rest assured that these anal tags are harmless and very common. They are very similar to skin tags found in your armpit, neck, eyelids and sometimes groin. Anal tags are not contagious and cannot be passed from person to person.

Anal skin tags are flaps of skin or flesh found around the anus. The tags are usually flesh colored and hang in the opening of the anus by a stalk or stem that supplies the blood to the tag.

Anal skin tags are not caused by anal intercourse or sexually transmitted diseases. However, you need to be aware that anal skin tags are usually associated with other anorectal problems and may come about as a result of an injury, a hemorrhoid or an anal fissure.

Causes of anal tags include:

Hemorrhoids
Anal fissures. An anal fissure is a small tear in the anus usually as a result of a hard stool. Or extreme stretching of the anus.
Previous rectal surgery If you have previously had rectal surgery, those swollen skin edges may also develop into anal skin tags.
Anal infection or injury
Blocked anal gland
Tight fitting clothing

Anal tags can easily be removed in our office using local anesthetic and a radiofrequency device. The procedure only takes less than 10 minutes and you are able to drive yourself home afterwards.

Symptoms of Hemorrhoids | Minneapolis & St Paul

Severe pain is not a common symptom of internal hemorrhoids, because internal hemorrhoid happens in the area above the dentate line that is supplied by the visceral nerve, like those found within the intestines, which sense pressure rather than pain.

As the venous complex of an internal hemorrhoid becomes varicose and continues to enlarge, it bulges into the anal canal and loses its normal anchoring, becoming a prolapsing internal hemorrhoid. The prolapsing hemorrhoid usually returns into the anal canal or rectum on its own, or can be pushed back inside using one’s finger, but usually prolapses again after the next bowel movement. In the anal canal, a hemorrhoid is exposed to movement caused by passing stool, particularly hard stools that can cause bleeding and pain. The painless rectal bleeding with bright red blood is a common symptom of internal hemorrhoids. The rectal mucosal lining that has been pulled down secretes mucus and moistens the anus and its surrounding skin, while the stool itself can also leak onto the anal skin. Itchiness often occurs as a result of this dual presence of stool and moisture.

In general, symptoms of external hemorrhoids are different than those of internal hemorrhoids. External hemorrhoids can be felt as bulges at the anus, but rarely display any of the same symptoms seen with internal hemorrhoids. They will cause problems, however, if the varicose vein complex ruptures, as blood clots occur and build up the pressure inside the lump. This condition, known as thrombosed external hemorrhoid, causes an extremely painful bluish anal lump and often requires medical attention. The somatic nerve in the anal canal (below the dentate line) can sense pain, this is why the patients feel significant pain when they develop thrombosed external hemorrhoids. Thrombosed hemorrhoids may heal with scarring and leave a tag of skin protruding from the anus. Occasionally, the tag turns out to be quite large, which can make anal hygiene (cleaning) difficult or irritate the anus.

Hemorrhoids | Minneapolis & St Paul

Believe it or not, everyone has had a normal hemorrhoidal tissue in their rectum and anus. It’s only when your hemorrhoidal veins enlarge and become varicose veins that they’re considered abnormal or diseased.

There are three types of hemorrhoids – internal, external, and mixed hemorrhoids that consist of both internal and external. External hemorrhoids are those that occur outside the anal verge and affect bowel cleansing after one’s bowel movement, causing skin irritation and itching. A thrombosed external hemorrhoid is usually very painful due to rupture of one’s varicose veins, which causes blood clots and is often accompanied with swelling and irritation. These external hemorrhoids are typically treated with either an incision or removal of the clot, or with an external hemorrhoidectomy performed under local anesthesia.

Internal hemorrhoids are graded from I to IV based on the degree of prolapse. Grade I hemorrhoids bulge with defecation; grade II lesions also bulge with defecation, but then recede spontaneously. Grade III hemorrhoids require digital replacement after prolapsing, while grade IV hemorrhoids cannot be replaced once prolapsed. There are many treatment options for internal hemorrhoids that vary based on the severity of each case.

Colonoscopys at the Procedure Clinic | Minneapolis & St Paul

Your colon’s main function is to help your body eliminate waste, toxins and more from your blood, intestines and lymphatic system. Without your colon’s healthy function in your body, you can become seriously ill. A colonoscopy is among the most common types of exams performed on the colon. This is an invasive exam that allows a medical practitioner to view the inside of your colon through the use of a special scope. The procedure is most commonly recommended by a medical practitioner when a patient complains of symptoms such as bloody stools or blood in the toilet bowel, pain during bowel movements, abdominal pain when not having a bowel movement or any other abnormal or unexplained changes in bowel function. A family history of certain conditions may warranty the regular use of colonoscopy procedures as an early diagnostic step.

The procedure involves probing a long tube through the anus and into the colon. A light and camera are mounted to the end of this tube to provide the medical practitioner with the ability to visibly examine the colon. The procedure is most commonly performed on a patient under conscious sedation. In order to enjoy the best diagnostic results from your colonoscopy, you do need to have a clean colon. The colon is most commonly cleaned through the patient’s use of an enema and fasting.

Through the use of a colonoscopy, a medical practitioner can more accurately diagnose a number of colon and gastrointestinal conditions. These include colorectal polyps, colon cancer, inflammatory bowel disease, colitis and more. In certain instances, a medical practitioner may be able to take a biopsy of suspicious areas found during the colonoscopy, and some polyps or suspicious areas can be removed during this procedure. Polyps are abnormal growths and some may be cancerous in nature. Because of this, they are most commonly removed and biopsied when found during a colonoscopy. Early diagnosis of many of these colon and gastrointestinal conditions can provide a patient with the best outcome possible. Because of this, you should schedule a colonoscopy procedure immediately upon receiving the recommendation from your doctor.

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