Gastrointestinal Disease: Hemorrhoids
Guest: Dr. Kerry Hammond – Surgery
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am talking today with Dr. Kerry Hammond who is Assistant Professor of Surgery in the Digestive Disease Center here at the Medical University of South Carolina. Dr. Hammond, let’s talk about a very common problem, hemorrhoids. What exactly is a hemorrhoid?
Dr. Kerry Hammond: Hemorrhoids actually are part of the normal human anatomy which is something most people are not aware of. Everyone has hemorrhoidal tissue in their anal canal. What hemorrhoids do is they are vascular cushions that add to the support of the anal canal and they actually contribute to the ability to have normal continence of stool. We begin to consider hemorrhoids to be a surgical problem when the blood vessels in that region become dilated, such as what happens with constant straining for bowel movements. This can cause bleeding, blood clotting, and can cause patients to have discomfort.
Dr. Linda Austin: Can you offer some guidelines for what is, I think, a very typical kind of problem? Let’s say somebody has been very constipated, they have strained and when they go to wipe themselves, there is some blood on the tissue. At what point should a person be concerned enough about that to talk to their doctor?
Dr. Kerry Hammond: Any blood coming from the rectum should be investigated by a physician, particularly in patients who are over the age of 50 and are at increased risk for colon cancer. Blood is certainly something that we do not discount as a symptom. If the problem does turn out to be primarily constipation-related, what I recommend to all patients is to start increasing the fiber in their diet. This can be done very simply by increasing whole grain foods, vegetables that are high in fiber and, most importantly, a fiber supplement.
Dr. Linda Austin: Is there any particular fiber supplement you recommend?
Dr. Kerry Hammond: There are many different preparations that are available commercially. These vary from psyllium fiber, which is what is found in Metamucil, to some more synthetic types of fiber. I usually tell patients to find a product that they are willing to stick with and willing to take on a daily basis. That is the best type of fiber for them.
Dr. Linda Austin: How about the famous remedy, Preparation H? That has been advertised on television ever since I was a child, I think.
Dr. Kerry Hammond: Preparation H is a fine topical preparation. It does not cure the hemorrhoids. What it does is just give some symptomatic relief. It can relieve the itching and discomfort associated with hemorrhoids. Another thing that is quite popular is the moist Tucks Pads and those also are a fine thing to use for symptomatic hemorrhoids. There are some prescription medications that contain hydrocortisone as well as some topical numbing medicines that sometimes give better relief than Preparation H.
Dr. Linda Austin: So, then, given that this is a pretty common problem, at what point, then, do you recommend surgery?
Dr. Kerry Hammond: Usually when I see patients that are complaining of hemorrhoids, I would want to do a thorough examination and make sure that the problem is, in fact, prolapse of hemorrhoids and not some other problem in the anal region that can act the same as hemorrhoids, such as a fissure or certainly we need to rule out neoplastic, or cancer, lesions. My approach usually is to start patients on conservative management which is a very directed regimen to increase fiber in the diet and, therefore, reduce straining and constipation. I also instruct people to reduce the time they sit on the toilet when they are having their bowel movements because any prolonged period of sitting, such as if you are reading a book or newspaper, is putting pressure on that tissue and making the hemorrhoids worse. Other things I recommend are warm soaks in a tub, or a sitz bath, and then the topical creams for relief of discomfort.
Dr. Linda Austin: Tell us a little bit about the surgery that has to happen sometimes?
Dr. Kerry Hammond: Well, there are some procedures that we are available to do in the clinical setting that are quite effective for most grades of hemorrhoids. These procedures include rubber band ligation of the hemorrhoids, another procedure is infrared coagulation, which is kind of similar to a laser procedure. Both of those procedures are very well tolerated by patients and do not require anesthesia. That is usually my next step if patients fail to have significant improvement after a reasonable trial of conservative management with fiber and the things we talked about before.
Dr. Linda Austin: Those do sound, I mean, just on the face of them, like fairly simple procedures.
Dr. Kerry Hammond: They are fairly simple. Like every procedure, there are associated risks which are not a high percentage, but I do want patients to know that there is a risk of infection and a risk of bleeding after both of those procedures. For patients that have very large prolapsed hemorrhoids, those are usually best treated by surgery for hemorrhoids. The surgical resection is done as an outpatient procedure; you would go home the same day. There is quite a bit more discomfort associated with that after surgery just because the area that we operate in, on the anal region, is a very sensitive area. Of course, we give pain medications and stool softeners to try to reduce the postoperative discomfort.
Dr. Linda Austin: I would imagine that recurrence is reasonably common since you describe this as kind of a network of blood vessels that are there all the time. Am I right about that?
Dr. Kerry Hammond: Recurrence is common and is best prevented by preventing constipation.
Dr. Linda Austin: Dr. Hammond, thanks so much for talking with us today.
Dr. Kerry Hammond: Thank you.
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