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Dr. Andrew Rynne

Family Physician

Exp 50 years

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TWIMC, I recently submitted a question regarding a swelling. I

Answered by
Dr. Ramesh Kumar


Practicing since :1986

Answered : 2040 Questions

Posted on Sat, 2 Feb 2019 in Digestion and Bowels
Question: TWIMC, I recently submitted a question regarding a swelling. I was unable to attach a photo from that device, so I am doing it from this one.

Thank you, XXXXXXX
Answered by Dr. Ramesh Kumar 9 hours later
Brief Answer:
What is TWIMC?
Detailed Answer:
Hello there,
Welcome to 'Ask A Doctor' service.
I've gone through your query in details and have seen the photo attached.
I can understand your concerns.
Cause of your problem is Hemorrhoids. Hemorrhoids are swollen veins in the lowest part of your rectum and anus. Sometimes the walls of these blood vessels stretch so thin that the veins bulge and get irritated.
According to standard texts Hemorrhoids are classified as-
Grade 1:hemorrhoid bulges into the canal but does not prolapse or fall completely into it. These may bleed.
Grade 2: hemorrhoid protrudes past the anal verge with straining for a bowel movement or passage of flatus, but spontaneously return to their original internal position once the straining has subsided.
Grade 3: the hemorrhoid may protrude past the anal verge without any straining and requires the patient to push them inside manually.
Grade 4: the hemorrhoid protrude past the anal verge without any straining and would not go inside inside even manually.
Your case is grade 3 or 4 hemorrhoid.

First you can go for non invasive therapy-
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.
In case if this is not successful then we have invasive surgical procedures like-
1)Hemorrhoidectomy: Excisional hemorrhoidectomy is the most effective treatment for hemorrhoids with the lowest rate of recurrence compared to other modalities.Success rate is more then 90%.

2)Stapled hemorrhoidopexy-A circular stapling device is used to excise a ring of redundant rectal mucosa proximal to hemorrhoids and resuspend the hemorrhoids back within the anal canal. Apart from lifting the prolapsing hemorrhoids, blood supply to hemorrhoidal tissue is also interrupted.
Initially go for digital and proctoscopic examination by a colo-rectal surgeon and see what he says.
Hope I provided you with the information you wanted.
In case you need further advice feel free to ask.


Above answer was peer-reviewed by : Dr. Nagamani Ng

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