co l o n o s co p y a n d t h e n co n t i n u e t h e m e ve r y 1 0 ye a r s.”
COLORECTAL SPECIALIST LEIGH H. NADLER, M.D.
ASK THE DOCTOR Q: What can I do about my bothersome and
(protruding) internal
bleeding hemorrhoids?
hemorrhoids. Both IRC
A:
and RBL might need
Many people ask me about hemorrhoids and rectal
to be repeated until all
bleeding. Hemorrhoid symptoms include rectal bleeding,
hemorrhoidal columns
burning, itching, protrusion, and swelling. Straining,
are treated. If bleeding and
constipation, and heavy lifting can cause swelling and hemorrhoid symptoms. Although most rectal bleeding or
other symptoms
spotting is hemorrhoidal in origin, other more serious
persist despite office
conditions can cause bleeding. Rectal or colonic polyps, tumors, colitis, anal fissures, and other conditions may be
LEIGH H. NADLER, M.D., F.A.C.S., F.A.S.C.R.S.
treatment, there are minimally invasive
the source of rectal bleeding, even in individuals with large
outpatient procedures that can be offered. Two excellent
hemorrhoids. Therefore, it is important to inform your
procedures are stapled hemorrhoidopexy (PPH-Procedure for
primary care physician if you see any blood in your stool.
Prolapsed Hemorrhoids) and THD (Transanal Hemorrhoidal Dearterialization). Both procedures are usually associated with
You may be of age for a screening colonoscopy. Currently,
minimal post-op pain. Each procedure takes about 30 minutes
it is recommended that individuals age 50 or older undergo
and is performed under light anesthesia. Excisional
colonoscopy every 10 years. African-Americans should begin
hemorrhoidectomy (removing the hemorrhoids) might be
screening at age 45, and individuals with a family history of
necessary if the external component is very swollen or inflamed.
colorectal cancer or polyps should begin screening at age 40
Analgesic catheters can be placed at the time of surgery to
and in some cases sooner if there is a young family member
minimize the post-op pain.
with colon cancer or certain hereditary syndromes. Treatment of hemorrhoids begins with adding fiber to the diet,
Although most bleeding is hemorrhoidal in origin, it is imperative to inform your primary care physician about these
drinking plenty of fluids, and using a fiber supplement daily to
symptoms and undergo evaluation to be sure there are no other
avoid straining and constipation. Over-the-counter creams,
more serious conditions.
suppositories, and sitz baths may provide some relief. Prescription suppositories and creams would be the next step in treatment. For individuals who do not respond to prescription medication, office treatment with infrared coagulation (IRC) or rubber band ligation (RBL) might be helpful. These procedures only take a few minutes to perform in the office setting and require no anesthesia. IRC uses infrared light above the inflamed
LEIGH H. NADLER, M.D., F.A.C.S., F.A.S.C.R.S. earned his medical degree at the University of Health Sciences/Chicago Medical School. The board-certified surgeon completed a residency and internship at Beth Israel Medical Center Mount Sinai School of Medicine, New York, N.Y. He completed a fellowship in colon and rectal surgery at the University of Illinois Carle Foundation Hospital, Urbana, Ill. He practices with the Colorectal Surgical Associates, a division of St. Clair Medical Services.
hemorrhoidal column to decrease blood flow and “shrink” the hemorrhoid. Band ligation is more useful for larger prolapsing
To contact Dr. Nadler, please call 412.572.6192.
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