Tag Archives: Hemorrhoid Treatment

Surgical Options for the Advanced Hemorrhoids | Minneapolis & St Paul

While nonsurgical procedures work for the majority of hemorrhoid people in Minnesota with , surgical treatments may still be needed if you have advanced hemorrhoids with more prolapsed tissue, or if your hemorrhoid condition does not respond to other treatments. Hemorrhoidectomies may be used in these advanced cases.

A hemorrhoidectomy can be performed in a surgical center or in a well-equipped office, and it is most commonly done under local anesthesia in conjunction with a sedative during the surgery or traditional general anesthesia.

During this procedure, the prolapsed tissue is surgically removed with a radiofrequency device. After the hemorrhoid is removed, the incision is sewn or cauterized shut. Medicated gauze is then placed over the remaining wound.

Recovery usually includes a few days to a week off of work. Pain during bowel movements is expected in the first two weeks, although it gradually becomes less painful over time. The complete healing time is generally about four weeks. During this time, you must increase fiber intake, drink plenty of fluids, and take stool softeners to keep your stool soft.

Are There Other Surgical Options?
There are other surgical procedures that may be used to treat hemorrhoids although our clinic does not offer these treatments. These include:

A stapled hemorrhoidopexy, also known as a stapled hemorrhoidectomy, is the Procedure for Prolapse and Hemorrhoids (PPH). This procedure utilizes a specially-designed circular stapling device. These staples affix the prolapsing tissue to the rectal wall, effectively resecting the hemorrhoid. Because this procedure is less invasive than a traditional hemorrhoidectomy, it often requires less post-operative recovery. The recurrent rate is slightly higher than traditional hemorrhoidectomy.

Transanal Hemorrhoidal Dearterialization (THD) is considered a minimally invasive operation used to treat internal hemorrhoids. It does not remove any hemorrhoid tissue. The procedure starts with Doppler testing to locate the arteries that feed the hemorrhoids. Stitches are then used to close these arteries, which decrease the blood flow from these arteries to hemorrhoid complex. The hemorrhoid is then sutured higher up into the rectum, thus reducing the prolapse.

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.

Google Searches for Hemorrhoids Information Skyrocketed Since 2008 | Minneapolis & St Paul

A few years ago, I read an interesting article on hemorrhoids written By Bahar Gholipour on LiveScience. It reported that the number of Americans searching online for hemorrhoids and how to treat them has skyrocketed since 2008. Information gathered from Google searches suggests that searches have doubled from 2008 to 2013. The term “hemorrhoids” was searched about 40,000 times weekly between 2004 and 2008, but this number started to rise during mid-2008, crept up to about 80,000 weekly searches in 2010, and reached nearly 120,000 during some weeks in 2013. I believe that the number could have tripled by now.

There could be two reasons why more people go online to search for hemorrhoid information. First, more people are becoming more comfortable with the Internet. More often than before, I’ve heard even from the elderly patients that they found our hemorrhoid clinic through Internet. Second, diseases such as hemorrhoids may be among the most searched-for online because people could be embarrassed to talk about them with a doctor. Many patients don’t realize that hemorrhoids are a common medical condition that affects many Americans. “Nobody has it but me” is one of the misconceptions about hemorrhoids.

If you search for “hemorrhoids” on Google, it shows about 8,220,000 results. Not all webpages are informative and useful. We have built an informative hemorrhoids website, hemorrhoidheal.com, that provides essential information about hemorrhoid care.

Laser Hemorrhoids Treatment Doctor Minnesota | MN Procedure Clinic

No longer will you have to fear hemorrhoid treatment — Infrared coagulation (IRC) of hemorrhoids is a fast and effective non-surgical solution.

A hemorrhoid is a common illness that numerous Minnesotans suffer from. It is estimated that more than 10 million people in the United States suffer from hemorrhoids. Approximately three out of four people will develop hemorrhoids at some time in their lives. Dr. Steven Shu, an office proceduralist, commonly treats hemorrhoids and can quickly alleviate your pain.

While many people associate hemorrhoids with painful surgery, only a small percentage of patients actually require surgery. A fast and simple office procedure has taken the fear out of hemorrhoid treatment. The majority of hemorrhoids patients are good candidates for non-surgical treatment, or Infrared coagulation (IRC).

What is Infrared Coagulation (IRC) of Hemorrhoids?
Infrared Coagulation (IRC) is a safe, fast, and effective solution for hemorrhoids. It is approved by the FDA for the treatment of hemorrhoids. This office-based procedure takes just a few minutes and uses infrared light to treat symptomatic internal hemorrhoids. Therefore, IRC has quickly become the most widely used office procedure for hemorrhoids and is preferred over other methods because it is fast, effective, well-tolerated by patients, and rarely has complications.

A small light probe contacts the area above the hemorrhoid complex under direct view, exposing the tissue to a burst of infrared light for about one second. This coagulates the veins above the hemorrhoid, causing it to shrink.

Since the hemorrhoids are located in an area that is full of sensitive somatic nerve endings (same as the nerves in skin), it is too painful to coagulate the hemorrhoids directly because they are too close to the opening of the anus. Fortunately, many small veins that feed the hemorrhoids lie in an area that is supplied with sympathetic nerve endings, which is not as sensitive as the somatic nerves in skin.

With IRC, your doctor can effectively coagulate the insensitive area right above the hemorrhoids and destroy these small veins. In this way, the sensitive and painful area is avoided, and IRC becomes a very tolerable treatment.

By destroying these small veins with IRC, it stops the flow of blood to the varicose veins of hemorrhoids, just like blocking many small rivers will dry up a large lake.

IRC offers major advantages to patients over previous hemorrhoid treatment methods:
• Fast, simple, and safe solution
• No anesthesia required
• No special preparation needed
• No recovery time after treatment
• Clinically proven results
• Covered by all major insurance companies

Who are the Best Candidates for Infrared Coagulation (IRC)?
Infrared coagulation can be used to treat the early stages of hemorrhoids, and it is most effective in grade 1-2 hemorrhoids. If you’re suffering from irritating internal hemorrhoids that continue to cause itching, discomfort, pain, bleeding and other symptoms, and it does not respond to conservative self-management, IRC treatments might be a good solution.

How is Infrared Coagulation Procedure Performed?
Before IRC procedure is performed, Dr. Shu gently inserts the anoscope (a very short, 3-4 inch rigid metal tube), then uses a handheld device that creates an intense beam of infrared light to touch the mucosa above the hemorrhoids, exposing the hemorrhoid tissue to a quick pulse of infrared light. The heat from the infrared light burns 4-5 spots in the targeted area, coagulating the vein above the hemorrhoids.
The resulting scar tissue cuts off the blood supply to the hemorrhoid venous complex. This causes the hemorrhoid complex to shrink and die. It may take a few weeks for all the hemorrhoids to shrink completely. Moreover, the scar tissue acts to hold nearby hemorrhoid veins in place so they don’t bulge into the anal canal easily and become hemorrhoids as you age.

Each IRC treatment only takes a couple of minutes. You may need as many as four separate treatment sessions every two weeks to cover all the areas where hemorrhoids appear, but this depends on each individual case and how extensive your hemorrhoids are.

What is the Recovery Time of Infrared Coagulation Procedure?
After the IRC procedure, you may feel mild discomfort in the anus and the urge to have a bowel movement sometimes. You are able to resume normal everyday activities immediately afterward. Typically, there are no post-treatment effects. However, there may be slight spot bleeding a few days later, but heavy rectal bleeding is extremely rare. Avoid heavy straining, lifting, and aspirin. If you notice significant rectal bleeding, you should call your doctor’s office.

You may use Tylenol as needed and take a warm sitz bath daily to relieve discomfort. A stool softener, fiber, and water will help ease your bowel movement while you heal.

Dr. Shu has had extensive experience in treating hemorrhoids with non-surgical IRC treatments in the past two decades, and he has successfully treated about two thousand hemorrhoids patients with almost ten thousand IRC treatments. Please call 952-922-2151 if you need help to treat your symptomatic hemorrhoids.

Hemorrhoid Disease and its Anatomy | Minnesota

Hemorrhoids are swollen clumps of vessels, smooth muscle and connective tissue in the anus and lower rectum. They are similar to varicose veins, but they are not considered the same. Hemorrhoids are quite common; about 75% of adults will have hemorrhoids in their life. Sometimes they are very benign; other times they may cause significant symptoms, such as itching, pain, prolapse and rectal bleeding.

Hemorrhoid cushions are a normal part of the body and only pose an issue when become engorged, prolapsed and inflamed. In their normal state, they have an important role in continence, and make up 15-20% of anal pressure at rest. When bearing down, the cushions expand to maintain anal closure as intra-abdominal pressure grows. Increased sphincter pressure may result due to hemorrhoid inflammation because of this effect.

Hemorrhoids are classified into internal and external hemorrhoids. Internal hemorrhoids develop deeper in the rectum, above the dentate line, from the embryonic endoderm and are covered by columnar epithelium. There are few somatic sensory nerves in this area, and as a result are not painful. Patients often only notice the blood after a bowel movement as a result of internal bleeding. External hemorrhoids are located around the anus, below the dentate line, derived from the ectoderm and covered in squamous epithelium. There are many sensory nerves here, so external hemorrhoids can be quite painful when the complication of thrombosis happens.

Hemorrhoid inflammation is often caused by excess pressure in the region. This can be exacerbated by straining when defecating, constipation/diarrhea, low-fiber content in diet, lack of fluid, sitting too long, weight, and lack of exercise. Proper rectal function and physical fitness are essential in preventing hemorrhoid formation.

Daily Activities Risk Factors for Causing Your Hemorrhoids | Minnesota

A hemorrhoid is a common disease that numerous Minnesotans suffer from. Many patients know treatment options such as infrared coagulation (IRC), banding, and surgeries, however far fewer people understand the causes of hemorrhoids and the risk factors contributing to it.

The normal hemorrhoids structure is clusters of vascular tissue, smooth muscle, and connective tissue lined by the normal epithelium of the anal canal. Most symptoms arise from enlarged internal hemorrhoids. The engorged anal hemorrhoidal mucosa is easily traumatized, leading to rectal bleeding. The prolapse of hemorrhoid tissue leads to soiling, mucus discharge, and trigger pruritus.

Many people in Minnesota don’t realize that they’re exposing themselves to the causes of hemorrhoids every day. Those activities actually become the risk factors of hemorrhoids. Whether you are currently suffering from hemorrhoids or are looking to avoid them, knowing the hemorrhoid risk factors related to your everyday activities is important. Therefore, you can work to prevent them from developing, worsening, and recurring.

Some of the most common hemorrhoid risk factors related to your everyday activities are:

Compromised Bowel Movements
You should have good bowel habits and maintain smooth stool. Constipation with hard stool and straining can increase abdominal pressure rapidly, as well as expansion of venous plexus, often causing rupture of hemorrhoidal vessels and even anal skin tearing. If you develop chronic constipation, you should treat it aggressively by having a high fiber diet, increasing water intake, walking daily, and taking bulking agents and laxatives. However, frequent diarrhea does not help, either. Straining related to diarrhea also can rapidly increase the pressure in the abdomen and hemorrhoid vessel complex, too. The toilet time should not be too long, and you should avoid the bad habit of reading newspapers or surfing the Internet on the toilet.

Sitting and Standing
Most people’s jobs in Minnesota involve either extended hours sitting or standing. But doing either for too long can result in increased pressure in the lower rectum, leading to develop hemorrhoids. Individuals who are prone to developing hemorrhoids should avoid sitting and standing for extended periods of time.

Heavy lifting
Heavy lifting can put pressure on the abdomen and lower rectum rapidly, increasing venous engorgement of the internal hemorrhoids which causes them to swell and enlarge, and also causes the rupture of hemorrhoidal vessels and even thrombosed external hemorrhoids, a common complication of hemorrhoids.

Weight and Pregnancy
Being overweight can also put pressure on the abdomen and lower rectum due to carrying too much weight for what body organs can normally withstand. The same goes for pregnancy, as the uterus increases venous pressure.
Unfortunately, hemorrhoids do run in some families. Although hemorrhoids are a very common disease, it is not a disease that everyone develops. Those who inherit certain genes are more likely to suffer from the condition.

Solution to Your Hemorrhoids
You may find that you are exposed to several of these common risk factors after reading this blog, but by knowing what these risk factors are, you can work to minimize their impact on your body.

Functional Anorectal Pain

Functional anorectal pain is a relatively common symptom that occurs in the absence of any clinical abnormality although some patients may also have other anorectal diseases, such as hemorrhoids. It is not sure if the local inflammation caused by hemorrhoids contributes to the development of anorectal pain syndromes in those patients. Despite their benign nature of functional anorectal pain, they can cause debilitating to the sufferer.

There are two functional anorectal pain syndromes.
• Proctalgia fugax (PF) (fugax = fugitive/fleeting in Latin)
• Levator ani syndrome (LAS)

Proctalgia Fugax is an anorectal pain syndrome that occurs as a result of cramping of the levator ani muscle. It occurs in episodes lasting seconds or minutes, typically in the middle of the night, though it is very possible to experience it during the day as well. Patients may feel spasm-like, sharp pain in the anus that is often mistaken for a sign that they must defecate. This may also be accompanied by an involuntary erection in men. Attacks, and typically start at the age of 45. An estimated 8-18% of people in the developed world are affected by proctalgia fugax, but true figures are not clear because many people do not seek professional diagnosis. It is estimated that only 20-30% of people with this condition seek out professional diagnosis.

The condition is recurrent, and while not curable, treatments are available.

Traditional ways to manage pain include warm baths, warn/hot enemas, relaxation techniques. Applying ice or some similar cold pack to the afflicted area can help pain as well. Severe attacks can be mitigated a bit using salbutamol. For most cases, reassurance, and topical calcium-channel blockers, salbutamol inhalers, and sublingual nitroglycerine are used for treatment. Botulinum toxin A injection is a new way to effectively reduce the tone of anal sphincters and reduce anorectal pain. Co-existent psychological issues should be addressed with behavioral and/or pharmacological therapies. Increased fiber intake and withdrawing gut-affecting medication can also help with pain. High-voltage pulsed galvanic stimulation has been shown to reduce short-term frequency of the attacks.

Levator ani syndrome presents the symptoms with vague, aching or pressure feeling high in the rectum. It could be worsened by sitting and relieved by walking. The pain tends to be constant and lasts from hours to days. It recurs regularly.

The diagnostic criteria of levator ani syndrome is that the symptoms must be present for three months with symptom onset at least six months prior to diagnosis, and other causes of similar anorectal pain must have been excluded.

Management of levator ani syndrome is similar to that of proctalgia fugax, including biofeedback treatment, Inhaled salbutamol, Botulinum toxin A, electrogalvanic stimulation and nerve stimulation.

Self Management in Relieving the Symptoms of Hemorrhoids | Minneapolis & St Paul

Studies suggest that an estimated more than 50% of Americans will develop a hemorrhoid condition by the age of 50- yet, only a small percentage of people seek treatment until it is impossible to ignore. While not a replacement for professional treatment, conservative treatments are available that can manage the symptoms and prevent recurrence.

For grade I internal and nonthrombosed external hemorrhoids, warm baths, a high-fiber diet, high fluid intake, stool softeners, topical analgesics, topical steroids, and proper hygiene can improve hemorrhoids. Warm baths increases blood flow and relaxes the sphincter, easing perianal pain caused by a hemorrhoid. Ice can be used in cases of acute thrombosis. The key to conservative management of hemorrhoids is reducing constipation and hard stool. This, in turn, reduces pressure in the lower rectum. Increasing dietary fiber increases fluid retained in the stool, which, combined with increased water intake, can greatly relieve pressure on hemorrhoids. Good sources of fiber include beans, fruit, veggies, and whole grains. Fiber supplements, such as psyllium husk powder, are effective and can make fiber intake more convenient. Another important consideration is time spent on the toilet- with so many ways to distractions available it is easy to linger in the bathroom, but one should only stay on the toilet long enough to evacuate the bowels.

Topical agents are available, but only a few are marginally effective. Topical hydrocortisone can relieve the rectal irritation and itching and decrease internal hemorrhoidal bleeding. However, it should not be used longer than two weeks due to mucosal atrophy.

Hemorrhoids can be a hassle, but luckily there are ways to manage it independently. Conservative treatment aims to reduce constipation and stool hardness, by adjusting diet or through supplements, reduce strain by changing toilet habits, and medicate in some circumstances with topical medication. However, if bleeding is persistent or if pain is present or if the irritation with itching affects your quality of life, it is best to see a medical professional.

How Accurate does a Physician Make a Diagnosis of Hemorrhoids? | Minneapolis & St Paul

Hemorrhoids are a condition in which swollen varicose veins are found in the lower rectum and anus. It is estimated that three out of four people will develop hemorrhoids at some time in their lives. Because of rich vascular and nerve supply, as well as tendency to prolapse in the anorectal area, hemorrhoids are among the most common reasons for anorectal complaints in office visits.

Although not all rectal symptoms are caused by hemorrhoids, hemorrhoids subsequently are blamed for almost all rectal complaints by patients and doctors alike. How accurate does a physician make a diagnosis of Hemorrhoids? Actually, the accuracy of a diagnosis is not very high. Studies show that the correct rate of hemorrhoid diagnosis is lowest in seven common anorectal conditions. There was no correlation between diagnostic accuracy and years of physician experience. The investigators in the studies found the average diagnostic accuracy among the physicians to be 53.5%, with the accuracy for colorectal and general surgeons being 70.4% and that for the rest of the doctors being less than 50%.

Hemorrhoids are a common and benign disease; many patients in Minnesota are too embarrassed to ever seek medical attention. It is important to rule out other rectal conditions, such as cancer and other causes of rectal bleeding, anal fissure and fistula, and anal warts. It is relatively common to see that the patients have two benign conditions at the same time. Occasionally, the patients have both hemorrhoids and rectal or colon cancers. Early medical consultation is important to confirm diagnosis and start early treatments, which not only improve the quality of life, but also save lives.

What Kind of Hemorrhoid Patients in Minnesota Need the Banding Treatments?

No single treatment modality can fix all hemorrhoids or get rid of anorectal symptoms. Early hemorrhoids can often be effectively treated with by Infra-red Coagulation (IRC) and dietary and lifestyle changes, but more advanced hemorrhoids may need Rubber band ligation (RBL) or hemorrhoidectomy.

RBL is one of the common procedures to treat hemorrhoids in in Minnesota. 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. Cutting off the blood flow to the hemorrhoid causing it to shrink and dies off within a week. The reduced volume of venous tissue with the scar formation prevents hemorrhoid tissue bulging into the anal canal. 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. Most patients require two to four treatments. Rubber band ligation downgrades the hemorrhoids to grade 1 or 2, some patients may need to do IRC to treat the remaining hemorrhoids after Rubber band ligation.

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.

Treatment of External Thrombosed hemorrhoids | Minneapolis

External hemorrhoids occur outside the anal verge. Thrombosed external hemorrhoids occur if varicose veins rupture and blood clots develop. It is often accompanied by swelling with a bluish-purplish discoloration and severe incapacitating pain.

The symptoms may improve in some patients with conservative nonsurgical treatment – the anal care I coined includes stool softeners, increased dietary fiber, increased fluid intake, warm Sitz baths, and analgesia. For most patients, surgical excision is often more effective and efficient in treating thrombosed external hemorrhoids. Surgical excision is an office-based procedure performed under local anesthesia. This safe office procedure offers low complication and recurrence rates and high levels of patient satisfaction.

After cleaning the anal area with an antiseptic, lidocaine with epinephrine is locally injected in the surgical area. The thrombosed hemorrhoid is unroofed by making an elliptical incision in the hemorrhoid, then the blood clots are removed, and the procedure is finished for a simple case. 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. The external hemorrhoidectomy may be performed, then the hemorrhoidal tissue with blood clots is removed together, and the bleeding in the wound is stopped with a cautery. The wound in the anal area is covered with sterile gauze.

Postoperative Care
The patient will be instructed to do anal care measures, including warm Sitz baths three times a day for 15-30 minutes at a time. Acetaminophen or ibuprofen should be used for pain control. The patient should remain well hydrated and take a stool softener to keep stool soft.

Common complications of thrombosed external hemorrhoid excision include pain, bleeding, infection and delayed healing. A perianal skin tag could develop in some patients. Stricture and incontinence are extremely rare complications.

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.

Infrared Coagulation (IRC) for Internal Hemorrhoids | Minnesota

Infrared coagulation (IRC) is a medical procedure used to mainly treat grade 1 to grade 2 internal hemorrhoids. This treatment is also used as an adjunctive treatment in conjunction with banding therapy or surgery for more severe hemorrhoids such as grade 3 and 4. During the procedure, the doctor uses an IRC device that creates an intense beam of infrared light. Heat created by the infrared light destroys vein complex and causes scar tissue, which cuts off blood supply to the hemorrhoid. Over the several weeks following the IRC treatments, the hemorrhoid shrinks and a scar formed in the lining of the anal canal, which holds nearby veins in place to prevent their prolapse.

Only one area of internal hemorrhoids can be treated at a time. Hemorrhoids patients typically get four IRC treatments at two week intervals.

Infrared coagulation is usually done in a doctor’s office in Minnesota. You may briefly feel heat and some stinging pain during the procedure, which lasts only 1-2 seconds in each touching.

What To Expect After Treatment:

Intermittent rectal bleeding could occur at any time within 14 days after the IRC procedure. Bleeding is usually minimal and mild, and resolves by itself after the treated areas heal.

  • You may use mild pain relievers such as Tylenol and sit in a shallow tub of warm water (sitz bath) for 15 to 30 minutes at a time to relieve discomfort.
  • To reduce the risk of bleeding, avoid taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) for a week both before and after the infrared coagulation.
  • You take stool softeners that contain fiber to ensure smooth bowel movements and avoid strain.
  • One Stop Medical Center in Minnesota offers comprehensive hemorrhoid care, please call 952-922-2151 if you need a consultation.

    What Can I Expect After Hemorrhoidectomy? | Minnesota

    Most cases of hemorrhoids can be managed through non-surgical anal care measures or minimal invasive office procedures. Some cases with more advanced grade, though, cause more severe symptoms and must be dealt with in a more invasive manner.

    Banding and Infra-red coagulation are common office procedures that are used to treat mild or moderate internal hemorrhoids. These minimal invasive procedures require little or no aftercare.

    In most cases that require surgical intervention, however, a hemorrhoidectomy is necessary. This procedure is usually performed under local anesthesia with or without sedation in a surgical center. During this surgery, your doctor will remove the prolapsed hemorrhoids by cutting them out and coagulating the varicose veins with the radiofrequency (RF) device. You are able to go home after a short observation.

    How Will I Manage The Pain After Surgery?

    Most people report that they have more pain with bowel movements in the first few days, but they usually feel better with each passing day after a hemorrhoid surgery. They should expect to have some pain for at least one week and maybe as long as two weeks. We usually offer prescription pain medicine for most patients following an extensive surgery. In the most time, we prefers not to give you a narcotic prescription to avoid constipation, but you are encouraged to use Tylenol and/or Ibuprofen to manage the pain after surgery.

    Even after the initial pain fades, many people have mild pain, irritation or itching during or after bowel movements for a few weeks after surgery. Following the anal care instructions with sitz bath, stool softener, and OTC topical creams, may help relieve these symptoms.

    What Else Do I Need To Know About Aftercare?

    In addition to pain medication, you are required to do regular sitz bath that helps not only heal and prevent infection, but also relieve the pain and other symptoms associated with hemorrhoid surgery. This consists of sitting in warm water for up to thirty minutes three times a day. The warm water will help to clean the anal area, as well as relax the muscles to ease pain.

    One of the keys to quick healing is to avoid straining while having a bowel movement. We usually suggest stool softener and fiber supplement. You should also drink water throughout the day. If you have constipation before surgery or you develop constipation after surgery, then you may need a laxative.

    After a bowel movement, you may have light bleeding. You can lessen this by using wet wipes instead of toilet paper during this time.

    As with any surgery, there is a risk of infection after hemorrhoid removal. Infection after hemorrhoidectomy is rare. It is important to call your doctor if you have severe swelling, redness or increased pain, a fever or any unusual draining from the surgical sites.

    How to Prevent the Hemorrhoids in Minnesota

    Now that you feel much better after hemorrhoid care and you are very happy that your quality of life is back, you are ready to enjoy the beautiful spring season in Minnesota next month. However, you may raise the question, do hemorrhoids come back? If so, how do I prevent them? Hemorrhoids are a varicose vein disease. It is possible to relapse after hemorrhoid care, especially in the advanced hemorrhoids, but recurrence rate is much lower in the mild hemorrhoids.

    Hemorrhoids are one of the most persistent chronic medical conditions in the Minneapolis and St. Paul areas, leading to many people becoming frustrated at the recurrent symptoms. Luckily, there are numerous different measures available to prevent them to come back.

    One of the best things you can do to prevent hemorrhoids is to make important dietary changes. Follow a high fiber diet. Why is fiber so very important? People in Minneapolis 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. In order to prevent the onset or return of hemorrhoids, you should strive to eat a diet rich in fruits, vegetables, and fibers.

    For those who have a history of hemorrhoids in the Minneapolis and St. Paul areas, it is recommended that these patients should integrate bulking agents into their daily diets, such as Metamucil The use of bulking agents is an important step in preventing the onset of hemorrhoids. These bulking agents work better if you drink plenty of water every day (6-8 glasses of water daily).

    You should have good bowel habits and maintain smooth stool. Constipation with hard stool and straining can increase abdominal pressure rapidly, as well as expansion of venous plexus, often causing rupture of hemorrhoidal veins and anal skin tearing. If you develop chronic constipation, you should treat it aggressively by having a high fiber diet, increasing water intake, walking daily, and taking bulking agents and laxatives. However, frequent diarrhea does not help, either. Straining related to diarrhea also can rapidly increase the pressure in the abdomen and hemorrhoid venous complex, too. The toilet time should not be too long; you should avoid the bad habit of reading newspapers in the toilet.

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

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

    People with other medical problems, such as liver cirrhosis with portal hypertension, cardiovascular diseases, and abdominal tumors are more likely to develop hemorrhoids. The treatment of these underlying medical diseases is important to prevent hemorrhoids.

    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 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.

    Finally, once the hemorrhoids come back, you should immediately request an experienced practitioner in Minnesota to treat it. One Stop Medical Center serves the entire Twin Cities and offers the comprehensive hemorrhoid treatment in both Edina and Shoreview offices.

    How to Manage the Hemorrhoids During Pregnancy in the Minnesotan Women

    Although the women in Minnesota are prone to develop hemorrhoids when pregnant, they’re not inevitable. There are several ways to avoid or improve hemorrhoids.

    Soak in warm water in the tub or sitz bath 2-3 times a day.
    Try witch hazel or ice packs to soothe the sting of hemorrhoids; a warm bath might reduce discomfort, too. If you’re really uncomfortable when sitting, use a doughnut-shaped pillow to make sitting on your bum a little less painful.
    Apply ice packs or cold compresses to your anus several times a day to help relieve swelling.
    Keep your anal area clean. Pre-moistened wipes may be more comfortable than dry toilet paper. Choose brands that don’t contain perfumes or alcohol — or use medicated wipes made specifically for people who have hemorrhoids.
    Try an over-the-counter hemorrhoid remedy. You may use Preparation cream for a few days or ask your health care provider to recommend a hemorrhoid cream that’s safe to use during pregnancy. Remember, hemorrhoid creams don’t cure the underlying condition — they simply soothe the pain of existing hemorrhoids. You should not use it continuously for a long term.
    Avoid constipation: Eat a high-fiber diet, drink plenty of water, and get regular exercise daily. When you’re constipated, you may take a fiber supplement or stool softener, drink 6-8 glasses of water. If your constipation doesn’t resolve, ask your practitioner about it. You may program your bowel movement, if you are morning person or evening person, you may train yourself to have the bowel movement regularly every morning before shower. Don’t wait when you have the urge to have a bowel movement, try not to strain when you’re moving your bowels, and don’t linger on the toilet, because it puts pressure on the area.
    Perform kegel exercises daily. Although no study shows Kegels decreases the chance of hemorrhoids, it increases the circulation which may help to avoid hemorrhoids. It also strengthens the muscles around the anus, the vagina and urethra, which can help your body recover after you give birth.
    Avoid sitting or standing for long stretches of time. Try lying on your side or standing up. If you must sit, get up and move around for a few minutes every hour or so. At home, lie on your left side when sleeping, reading, or watching TV to take the pressure off your rectal veins and help increase blood return from the lower half of your body.

    If these suggestions don’t help or your hemorrhoids get worse, consult with the hemorrhoid care expert Dr. Shu in Edina and Shoreview, MN. He provides one stop hemorrhoid care with multiple treatment modalities.

    Hemorrhoids During Pregnancy In the Minnesota Women

    Hemorrhoids are very common complaints during pregnancy. It afflicts 20 to 50 percent of all pregnant women in Minnesota. The hemorrhoids are actually varicose veins in the anorectal area, and although it is usually not dangerous, it can be very annoying. Four cardinal symptoms of hemorrhoids are itching, pain, bleeding and bulging out.

    Some women get them in the first pregnant, others get recurrent hemorrhoids. Hemorrhoids usually get worse in the third trimester, right after labor pushing or if you develop constipation. The good news is that hemorrhoids will begin to improve soon after giving birth.

    Why does pregnancy make women in Minneapolis and St Paul areas more prone to hemorrhoids? There are several reasons on it. First, hemorrhoids are a type of venous disease similar to varicose veins. Second, the enlarging uterus plus increased blood flow put pressure on the pelvic veins and other large veins that increases the pressure on the veins and causes them to become more dilated. Third, constipation is another common problem during pregnancy, which can also aggravate hemorrhoids due to the straining. Fourth, an increase in progesterone hormone during pregnancy causes the walls of hemorrhoidal veins to relax, allowing them to swell more easily. Moreover, progesterone slows down women’s digestive tract and contributes to constipation.

    Interesting Story about Hemorrhoids | Minneosta

    More than 10 million people in the United States suffer from hemorrhoids. Three out of four people in Minnesota will develop hemorrhoids at some time in their lives. In fact, the disease is so common that hemorrhoid sufferers have their own patron Saint, St. Fiacre.

    Patron Saint of Hemorrhoid Sufferers

    During the middle ages, an integral part of the therapy for certain ailments included prayer to “patron” saints for possible divine intervention. Through legends surrounding his life, St. Fiacre, a 7th century Irish monk, became the patron saint for hemorrhoid sufferers (and gardeners). During medieval times, hemorrhoids were known as St. Fiacre’s curse. St. Fiacre is also known as the patron saint of gardeners because he could farm all the land and manage to cultivate in a single day. As the legend goes, the saint was given a rather small shovel by his bishop and spent very long days spading his garden and developed a severe case of prolapsed hemorrhoids. Seeking a solution, he sat on a stone and prayed for help. The legend states he enjoyed a miraculous cure from the stone.

    Napoleon Bonaparte’s Hemorrhoids

    Napoleon Bonaparte had long suffered from hemorrhoids. On last day of the battle of Waterloo he was unable to mount his horse, and his doctors accidentally overdosed him with laudanum. Researchers believe that it’s possible that’s what caused the fatal delay starting the battle. It is pretty well known that if Napoleon had begun the battle earlier, the Duke of Wellington would not have been able to join forces with Blucher and the battle most likely would have been lost.

    Complications of Hemorrhoids in Minnesota

    Not everyone in Minnesota knows that hemorrhoids are actually part of the normal anatomy and that every human body has them, so hemorrhoids should not be embarrassing. When people in Minnesota complain about “hemorrhoids”, they are often referring to symptoms in the perianal and rectal areas. Hemorrhoid symptoms are the most common ailments affecting humans, almost everyone in Minneapolis and St Paul areas will develop symptoms at some time in their life, and significant percentage will develop chronic symptoms. Although hemorrhoids are usually not life threatening, they can certainly interfere with one’s quality of life.

    Complications of hemorrhoids in Minnesota include:

    Anal Itching

    Anal itching, or pruritis, is one of the most common symptoms related to hemorrhoid disease in Minnesota. Anal itching is instigated by the anal skin inflammation triggered by the hemorrhoids. Excessive wiping and scratching further damage the perianal skin and causes chronic dermatitis. Over use of OTC hemorrhoid cream containing steroid can cause the damage in the perianal skin. The patients may develop the true complication called Pruritic Ani with persistent cyclic anal itching.

    Thrombosed External hemorrhoid

    Thrombosed external hemorrhoid occurs when the enlarged hemorrhoidal venous complex ruptures, a blood clot can then form in the hemorrhoid. Thrombosed hemorrhoids are usually quite painful, and it requires immediate surgical intervention to remove the blood clot.


    Chronic blood loss from hemorrhoids may cause anemia, resulting in fatigue and weakness. We had a few cases in Minnesota in the past few years that developed severe iron deficiency anemia due to hemorrhoidal bleeding, and their Hemoglobin dropped to as low as 5 or 6.

    Strangulated hemorrhoid

    When the hemorrhoids are so severe that they prolapse, it leads to the anal sphincter spasm due to pain and irritation. Persistent sphincter spasm can cut off blood supply to an internal hemorrhoid which causes more swelling of hemorrhoid tissue, it turns into a vicious cycle. Eventually, the hemorrhoid may be “strangulated,” which can cause extreme pain and lead to tissue death.


    The local inflammation triggered by the bulging hemorrhoids causes the swelling and erosion of anorectal mucosa, which may increase the chance of infection. Opportunistic bacteria and microorganisms established on feces and the surrounding might attack and flourish in the damaged tissue.

    The Common Causes of Rectal Lumps | Minnesota

    A rectal lump is one of the common symptoms in the anorectal diseases in Minneapolis and St Paul areas. A rectal lump is a growth in the anal canal or rectal area. Rectal lumps vary in size and the degree to which they produce symptoms. Depending on the underlying cause, a rectal lump may or may not cause any pain.

    Should you be worried about that bump you just discovered back there? A palpable mass in the anal area may or may not indicate cancer or hemorrhoids. Lumps can be caused by a variety of conditions including anal warts, hemorrhoids, polyps, fissures, or cancer.

    • Hemorrhoids are probably the most common reason for having a rectal lump in Minnesota. It can be caused by internal hemorrhoids, but more commonly by external hemorrhoids. If a rectal lump is related to internal hemorrhoids, it usually gets bigger and more prolapsed right after the bowel movement; it could be spontaneously reduced in the early stage of internal hemorrhoids. But it could be non-reducible in the late stage of hemorrhoids. It may be associated with other symptoms such as bleeding, itch or pain. The thrombosed external hemorrhoids are usually very painful if the varicose veins rupture and the blood clots develop.
    • Anal warts are caused by human papilloma virus (HPV). HPV infection is considered to be sexually transmitted diseases. Left untreated, anal warts can spread and increase the risk of cancer in the rectal and anal region.
    • Anal Fissure is a small cut or split in the anal lining often caused by a painful, hard bowel movement. Fissures are typically located anterior or posterior to the anus. Anal fissure is often associated with a lump called sentinel pile, accompanied by pain and bleeding.
    • Rectal Cancer. The rectum is the last six inches of the body’s digestive system, exiting through the anus. One cause of a rectal lump is rectal cancer. Symptoms that require doctor’s attention include blood in the stool, change in bowel habits, tired feeling, abdominal discomfort, change in appetite, or unexplained weight loss.
    • Anal cancer occurs in the anal canal, it is account for 2% of cancer in the gastrointestinal tract. An external or internal mass may be palpable. Anal or rectal cancer generally do not produce any pain; Some lesions are so soft that they are missed on palpation. Anal cancer can take several forms including ulcers, polyps or verrucous growths.

    If you feel a lump in the anal or rectal area, contact our hemorrhoid clinics in Edina or Shoreview to determine the cause and get treatment. You should seek immediate medical care if the associated symptoms are serious such as high fever, drainage of pus from a rectal lump, severe pain, or bloody stool.

    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:

    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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