Category Archives: Anorectal Care

Why does Pregnancy Make Minnesota Women More Prone to Hemorrhoids?

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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. The good news is that hemorrhoids will begin to improve soon after giving birth.

Some women in Minnesota get them in the first pregnant, others get recurrent hemorrhoids. hemorrhoidsusually get worse in the third trimester, right after labor pushing or if you develop constipation. The worst scenario of hemorrhoids in the pregnant women is the sudden onset of thrombosed external hemorrhoids. The patients develop the painful bulging out in the anus which needs the urgent intervention to relieve pain.

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 Stories about Hemorrhoids | Minneosta – Patron Saint & Napoleon’s Hemorrhoids

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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 Related to Hemorrhoids in Minnesota

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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. The rectal symptoms caused by hemorrhoids 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 external hemorrhoids are usually quite painful, and it requires immediate surgical intervention to remove the blood clot. We often receive the urgent calls from the patients in the Minneapolis and St Paul areas because of painful anal bulging out due to thrombosed external hemorrhoid.

Anemia
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. Strangulated hemorrhoid is a very rare complication.

Infection
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.

Causes of Rectal Lumps in Minnesota

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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, piles of fissures, or cancer.

1. 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. Hemorrhoidal tags are redundant skin without varicose veins, either due to the stimulation from local inflammation or after the resolution of thrombosed external hemorrhoids.

2. 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.

3. 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.

4. 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.

5. 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 One Stop Medical Center 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.

Causes of Rectal Pain | Minneapolis

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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 hemorrhoid 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 Botox may reduce the rectal pain by relaxing the sphincter, and placing oneself in warm water may provide symptomatic relief.

Causes of rectal bleeding in Minnesota

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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. Most rectal bleeding is mild and intermittent, 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 hemorrhoid, 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.

Many patients in the Minneapolis and St Paul areas think rectal bleeding is always caused by hemorrhoids. When these patients come to the doctor’s office because of rectal bleeding, they tend to say they have hemorrhoids. The notion that rectal bleeding is the same as hemorrhoids is dangerous, as this may lead to a delayed diagnosis and treatment. The truth is that rectal bleeding in some patients could be caused by colon cancer with or without hemorrhoids.

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

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Anal itching is one of four common anorectal cardinal symptoms in the office visit in Minnesota, other symptoms are rectal pain, bleeding and bulging out. Anal itching may resolve spontaneously or with topical medications, but 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. The peri-anal dermatitis with or without yeast infection can complicate the problem. 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 or mucus discharge 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.

Mild anal itching can be easily relieved with Sitz bath and topical OTC hemorrhoid cream. If Pruritic Ani with chronic itching occurs, cyclic urge to scratch must be broken. Treatments for intensive and cyclic anal itching include wearing mitten and 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.

Hemorrhoid Banding in Minneapolis/St. Paul

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Rubber band ligation (RBL) is one of the common procedures to treat hemorrhoids in Minnesota. Hemorrhoid banding 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. Hemorrhoid banding treatment 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 in the Minneapolis and St Paul areas 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 in Minneapolis/St. Paul

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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. Water is the best form of hydration (6-8 glasses daily). 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. Long time of sitting or standing should be avoided. Scheduling time each day for a bowel movement and keeping it a daily routine may help. The best time for a bowel movement is right before taking a shower, washing helps to reduce anal skin irritation after bowel movement. Another convenient option for people in the Minneapolis and St. Paul areas is to use IntelliSeat. Take your time and do not strain when having a bowel movement, because straining can aggravate 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.

Thrombosed External Hemorrhoid in Minnesota

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Thrombosed external hemorrhoid is a common problem in Minnesota. It is usually a complication from the underlying disease – internal hemorrhoids. It occurs outside the anal verge when one or more varicose hemorrhoidal veins rupture and blood clots develop. Typical symptoms of thrombosed external hemorrhoid are sudden onset with severe rectal pain and tender bluish swelling in the anus. These hemorrhoids are typically treated with either incision to remove the clot or with external hemorrhoidectomy. 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.

I have an interesting story that happened while I visited China a few years ago. My friend Dave developed the thrombosed external hemorrhoid in the hotel while he accompanied me to visit a new resort town after an academic exchange in China. 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. Surprisingly, the staff in the local hospital was 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 Dave down on the bed and we did an incision and draining procedure right there in the hotel. The relief was immediate and other than a little bleeding for a day or so, the problem was solved.

If anyone in the Minneapolis and St Paul areas develops the sudden onset of severe rectal pain, please call us immediately. We will accommodate to your urgent medical needs and offer the same day care.