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    Suggest treatment for internal hemorrhoids

Posted on Fri, 21 Jul 2017 in Digestion and Bowels
Question: I am 66 in good general health. I have large internal hemeroids and bleed once a week. I take magnesium, miralax and colace so there is albost no straining. What should I do. There is no itching as of now. If I do not do anything will that make things worse. My blood readings are ok.
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Initially can try conservative approach for 3 months

Detailed Answer:
Thank you for choosing HealthcareMagic for your query.
I've gone through your details.
I am a Gastroenterologist and would be addressing your concerns.

As per your queries answers are-
Initial suggestion is that you should go for surgical management of hemorrhoid as sooner or later you have to go for it(as hemorrhoid is already large and there is minor bleed also).

However from your question it appears that you don't want to go for surgical procedure so conservative management can be tried for 3 months-

Continue taking laxatives and magnesium.

-Secondly start using PreprationH a combination containing contains Calcium Dobesilate, Hydrocortisone, Lignocaine, and Zinc.Apply it once daily before going to bed.
-Thirdly, request your gastroenterologist to prescribe you with oral Calcium Dobesilate-Doxium therapy for 3 months. Initially twice daily for 21 days followed by once daily for 10 weeks. Trials have shown that 3-month therapy can cause shrinkage of Hemorrhoids in almost 60% cases.

However, if not relieved even after 3 months of aggressive therapy proceed for Rubber bands ligation- inexpensive and are easy to deploy. It's a daycare procedure usually done under local anesthesia. The success rate varies from about 70-80%.

Some frequently used treatments in case of hemorrhoid are-

1)Rubber band ligation is a procedure in which the hemorrhoid is tied off at its base with rubber bands, cutting off the blood flow to the hemorrhoid. Bery effective with high success rate.

2sclerotherapy -In this procedure, a chemical solution is injected into the hemorrhoid tissue to shrink it may be less effective than rubber band ligation.

Surgical procedures-
Hemorrhoidectmy it removes excessive tissue.
Hemorrhoidectomy is the most effective and complete way to treat hemorrhoids.

Hemorrhoid stapling. This procedure, called stapled hemorrhoidectomy or stapled hemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. It is typically used only for internal hemorrhoids.

Strict lifestyle modification should be followed along with medications-

Take simple organic and vegetarian home cooked low-fat food for few days.
Avoid alcohol, smoking aerated beverages, junk food like pizza burger etc.

Take lots of probiotic rich food like yogurt.
Increase your fiber intake take oats, wheat, barley, vegetable and fruit like Pear, apple, and oranges.

No aerated beverages.
Take fiber containing easily digestible food.
Avoid red meat.
Drink a glass of lukewarm water before going to the washroom in morning.
Take Sitz bath.

Hope I provided you with the information you want.
Feel free to follow up.
Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. Ramesh Kumar 43 hours later
Thank you for your response. You mentioned a number of life style modifications - I suppose they are meant for conservative approach without surgery. I understand there is laser treatment - how does that compare to stapling? What are the chances of pain remaining with stapling? Thanks.
Answered by Dr. Ramesh Kumar 15 hours later
Brief Answer:
Laser is an excellent non invasive procedure.

Detailed Answer:

Infrared photocoagulation (also called coagulation therapy) is a medical procedure used to treat small- and medium-sized hemorrhoids. Pain can be there 24-48 hours post laser therapy.However it can be controlled very well by using mild analgesics like Tylenol.
Laser therapy is procedure of choice and is highly effective.
Stapling is a old school procedure(cost effective) more painful then laser.
Pain can be there for 2-5 days post stapling also.

Above answer was peer-reviewed by : Dr. Kampana
Follow up: Dr. Ramesh Kumar 15 hours later
Thanks for your response. I found that there are other methods also like CRYO surgery and electrical currents. What are your thoughts about these and how do they compare with laser and stapling. Also are there any latest techniques in USA where I am living. Thanks.
Answered by Dr. Ramesh Kumar 8 hours later
Brief Answer:
Laser therapy is latest and best.

Detailed Answer:
Hi again,
Electrical currents are very painful and old school procedure.So no one will perform it now.
Cryotherapy: Cryotherapy ablates the hemorrhoidal tissue with a freezing cryoprobe. It has been claimed to cause less pain because sensory nerve endings are destroyed at very low temperature.
Frankly speaking laser therapy is far superior to cryo etc and is very successful also.
"Hemorrhoid laser procedure is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by means of Doppler-guided laser coagulation.Despite higher cost, the hemorrhoid laser procedure technique was more effective than rubber band ligation in reducing postoperative pain, resolving symptoms, and improving quality of life in patients".

As per books Rubber band ligation can be adopted as the choice of treatment for moderate hemorrhoids butt with advent of latest technology you could go for laser surgery its the latest and best(if cost is not a issue).
please let me know in case you need more details.
Above answer was peer-reviewed by : Dr. Kampana
Follow up: Dr. Ramesh Kumar 2 days later
Thanks for your response. Cost is not an issue. Within laser therapy, are there any alternatives? What exact medical name should I use for the laser therapy?

This is in addition to the question I asked 1 hr back. I just found a method called HET system for hemeroid treatment. It looks very good. Please advise your thoughts on this also. Thanks.
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Follow up.

Detailed Answer:
Hi again,
Its termed as Infrared coagulation.
Best one is NYC laser.

HET can treat only grade 1 and grade 2 hemorrhoid.
Whether its meant for you or not depend on grade of your hemorrhoid.
Please specify is there in prolapse of hemorrhoid if yes then if it resolves spontaneously or it requires manual reduction?Any further suggestion about HET can be given after grading your hemorrhoid.

waiting for answer.

Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. Ramesh Kumar 45 minutes later
Thanks for your quick response. You wrote best one is NYC laser. Does NYC stand for New York city? Is NYC laser name of practice in New York?
Sometimes there is prolapse of hemorrhoid. I apply proctozone 2.5 percent and it is not prolapsed. Last few days there is no prolapse. There is no itching or pain. Thanks.
Answered by Dr. Ramesh Kumar 11 hours later
Brief Answer:
Follow up.

Detailed Answer:
Hi again,
NYC is basically a XXXXXXX name.
Medically it's termed as Nd:YAG (neodymium-doped yttrium aluminium garnet.It is a crystal that is used as a lasing medium for solid-state lasers. You can all it YAG laser.
I think in Newyork most likely they call it Nd Yag.

Internal hemorrhoids are classified as-
First degree: The state of venous engorgement during the bowel movement that does not protrude out of the anus but may bleed sometimes.
Second degree: hemorrhoid that prolapses out of the anus during the bowel movement but goes back inside spontaneously into the anal canal after defecation.
Third degree: Hemorrhoidal tissue protrudes external anal canal and requires manual reduction.: Third-degree hemorrhoids can be divided into third grade A and third degree B.
-Third level A: Hemorrhoid prolapses on defecation only and is reduced with manual reduction.
–Third Grade B: Prolapse of hemorrhoid occurs not only during the bowel movement but also on usual time, which must be pushed back in manually.

So as per your description most likely its Grade 2 hemorrhoid.

Yes you are a good candidate for HET.
Advantage over laser therapy-
HET can be used to treat multiple hemorrhoids in a single therapy session.
Practically no pain and discomfort.
Success rate is almost equal to laser therapy(its a latyest treatment not very frequently used so large trials and long term outcomes are still not known.)
Different colorectal surgeons have their different favourite's.HET is among the latest procedures so if you want to go for it first do a background search that you surgeon is well versed with this procedure or not.

Thanks you.
Above answer was peer-reviewed by : Dr. Remy Koshy
Follow up: Dr. Ramesh Kumar 13 hours later
Thank you very much for your detailed reply and guidance. I have set up appointments and will meet two different HET doctors in August and then make a final decision. I will contact you again as needed. Thanks again.
Answered by Dr. Ramesh Kumar 13 hours later
Brief Answer:
Good luck!

Detailed Answer:
hey again,
Wish you great luck!

Above answer was peer-reviewed by : Dr. Vaishalee Punj
Answered by
Dr. Ramesh Kumar


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