Category Archives: anorectal disease

The Common Causes of Minor Rectal Bleeding | Minneapolis & St Paul

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Minor rectal bleeding is one of the common symptoms that the Minnesotan patients seek for the medical care. It refers to the passage of small amount of bright red and fresh blood from the rectum and anus, which may appear on the surface of stool, on the toilet paper or in the toilet bowl.

This blog mainly discusses on the conditions with minor rectal bleeding that occurs intermittently. Rectal bleeding can be caused by various conditions, but even the slightest amount of bleeding should be taken seriously. Common causes of minor bleeding are internal hemorrhoids, ruptured thrombosed external hemorrhoids, fissures, fistula, diverticulosis, colon cancer, colitis, and polyps. 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.

The source of minor rectal bleeding is determined by history, physical examination and endoscopies. In the initial office visit, your doctor may inspect the anus visually to look for anal warts, anal fissures, cancer or external hemorrhoids, and followed by the digital examination with a gloved, lubricated finger and then anoscopy to look for abnormalities and sources of bleeding in the lower rectum and anal canal. If indicated, your doctor may also perform endoscopies, either sigmoidoscopy or colonoscopy.

Anoscopy is a rectal exam with a very short (3 to 4 inch) rigid metal tube to examine the lower rectum and anal canal, it is very useful when your doctor suspects hemorrhoids, anal fissures and other anorectal diseases.

A flexible sigmoidoscopy is to uses a short (24 inches) and flexible tube with a camera to examine the lower colon and rectum.

Colonoscopy is a test that examines the lining of the entire colon for abnormal growths, such as polyps or cancer. A long tube is passed into your bowel, and a light on the end allows the examiner to see the inside of the bowel. If anything abnormal is found, a small biopsy will be done, and polyps or growths can be removed.

The management of minor rectal bleeding mainly focuses on the treatments of the underlying diseases.

Treatment of External Thrombosed hemorrhoids | Minneapolis & St Paul

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External hemorrhoids occur outside the anal verge. Thrombosed external hemorrhoids occur if varicose veins rupture and blood clots develop. It is often accompanied by swelling with a bluish-purplish discoloration and severe incapacitating pain.

The symptoms may improve in some patients with conservative nonsurgical treatment – the anal care I coined includes stool softeners, increased dietary fiber, increased fluid intake, warm Sitz baths, and analgesia. For most patients, surgical excision is often more effective and efficient in treating thrombosed external hemorrhoids. Surgical excision is an office-based procedure performed under local anesthesia. This safe office procedure offers low complication and recurrence rates and high levels of patient satisfaction.

Procedure
After cleaning the anal area with an antiseptic, lidocaine with epinephrine is locally injected in the surgical area. The thrombosed hemorrhoid is unroofed by making an elliptical incision in the hemorrhoid, then the blood clots are removed, and the procedure is finished for a simple case. 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. The external hemorrhoidectomy may be performed, then the hemorrhoidal tissue with blood clots is removed together, and the bleeding in the wound is stopped with a cautery. The wound in the anal area is covered with sterile gauze.

Postoperative Care
The patient will be instructed to do anal care measures, including warm Sitz baths three times a day for 15-30 minutes at a time. Acetaminophen or ibuprofen should be used for pain control. The patient should remain well hydrated and take a stool softener to keep stool soft.

Complications
Common complications of thrombosed external hemorrhoid excision include pain, bleeding, infection and delayed healing. A perianal skin tag could develop in some patients. Stricture and incontinence are extremely rare complications.

Why can’t Single Treatment Modality Fix All Hemorrhoids? | Minnesota

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Hemorrhoids diseases include internal hemorrhoids, external hemorrhoids, anal tags, thrombosis of hemorrhoids and mixed hemorrhoids. Internal hemorrhoids are graded from I to IV based on the degree of prolapse. Besides causing anal itching, pain, bleeding and prolapse, hemorrhoids could cause other complications, such as thrombosis, anemia, and infection. Moreover, many hemorrhoid patients have a comorbidity of anal fissure, fistula, or anal warts. Because no single treatment modality can fix all hemorrhoids, a true hemorrhoid clinic will offer multiple treatment modalities and options to meet a patient’s needs and provide complete care.

If you are treated with single modality for your hemorrhoids, regardless of the severity, type of hemorrhoids, and associated anorectal conditions, it leads to poor results because of poor quality care.

No single treatment modality can fix all hemorrhoids or get rid of anorectal symptoms. Specialized hemorrhoid clinics should be able to offer multiple treatment modalities with cutting edge technologies to cure hemorrhoids and associated diseases.

Internal hemorrhoid Grade 1
Very early hemorrhoids can often be effectively dealt with by dietary and lifestyle changes. The lifestyle changes should also be part of the treatment plan for more advanced hemorrhoids.

Internal hemorrhoid Grade 1-2
Infrared coagulation (IRC) is a non-surgical treatment that is fast, well tolerated, and remarkably complication-free. The infrared light quickly coagulates the vessels that provide the hemorrhoid with blood, causing the hemorrhoids to shrink and recede.

Internal hemorrhoid Grade 3
Rubber band ligation is widely used for the treatment of more advanced (more prolapsed) internal hemorrhoids where the prolapsed hemorrhoidal tissue is pulled into a double-sleeved cylinder to allow the placement of rubber bands around the tissue. Over time, the ligated tissue dies off. Rubber band ligation downgrades the hemorrhoids to grade 1 or 2, so some patients may need to do Infra-Red Coagulation (IRC) treatments after Rubber band ligation.

Internal hemorrhoid Grade 4
A hemorrhoidectomy surgically removes the tissue that causes bleeding or protrusion. It is done in a doctor’s office, surgical center, or hospital under anesthesia and may require a period of inactivity.

External hemorrhoidal tags (anal tags)
Small and asymptomatic tags don’t need any treatment. If symptomatic, anal tags can easily be removed in the office using a local anesthetic and a radiofrequency device.

Thrombosed external hemorrhoids
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.

External hemorrhoids
Small and asymptomatic external hemorrhoids don’t need any treatment, however most patients will have an intermittent flare up. Eventually patients may need surgery (external hemorrhoidectomy) if you have large external hemorrhoids and/or persistent symptomatic external hemorrhoids.

Rubber band ligation for the Treatments of Internal Hemorrhoids | Minnesota

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Rubber band ligation is one of the most common outpatient treatments available for the Minnesotan patients with internal hemorrhoids. It is a better option for patients with prolapsed hemorrhoids. A number of prospective studies have found rubber band ligation to be a simple, safe, and effective method for treating symptomatic second- and third-degree internal hemorrhoids as an office procedure with significant improvement in quality of life. This procedure is almost never appropriate if there is insufficient tissue to be pulled inside the band ligator drum, such as grade 1 or mild grade 2 hemorrhoids, and it should not be done with the most severe (grade 4) hemorrhoids, either.

Rubber band ligation is an office procedure in which the prolapsed hemorrhoid tissue is tied off at its base with rubber bands, cutting off the blood flow to the hemorrhoidal mass. It is contraindicated in the patients using anticoagulants and other anorectal diseases, such as local infection, acute thrombosis and chronic anal fissure.

The process involves a doctor inserting an anoscope into the anus and identifying and grasping the prolapsed hemorrhoid with an instrument to place a rubber band around its base. With the rubber band in place, the hemorrhoid shrinks and recedes, dying off in a few days or a week. The reduced volume of venous tissue with the scar formation prevents hemorrhoid tissue from bulging into the anal canal. The procedure is usually done in a doctor’s office and only takes a couple of minutes. Treatment is limited to one to two hemorrhoids each office visit, and additional areas may be treated at two week intervals.

What to expect after the rubber band ligation treatment:

After the banding procedure, most patients don’t feel much discomfort; some may feel tightness and mild pain or feel as if you need to have bowel movement. People respond differently to this procedure. Most patients are able to return to regular activities (but avoid heavy lifting) almost immediately. Others may need a few hours or a day of rest. If you feel some pain after banding, you may use Tylenol or Ibuprofen as needed and take a lot of Sitz baths for 15-30 minutes at a time to relieve discomfort.

Some patients may have slight rectal bleeding after a week, when the rubber band falls off. The bleeding usually stops by itself; however, if you notice significant rectal bleeding, then you should call your doctor’s office. It is also very important to make sure that your stool is soft by taking stool softeners containing fiber and drink more fluids.

Manangement of Anal Skin Tags | Minnesota

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Have you been using too much toilet paper because of pesky anal tags? Hemorrhoidal skin tags are flaps of skin or flesh found around the anus. They often form as a result of an existing hemorrhoid. Hemorrhoids occur when veins in the anorectal areas become swollen and inflamed.

Anal skin tags often occur if an individual heals the thrombosed external hemorrhoids at home without surgery, the thrombosed hemorrhoids may leave behind skin tags. Anal skin tags may also form because of non-hemorrhoid causes, such as anal fissure, surgery, or infection, etc. Despite the fact that people often confuse them with cancerous growths, skin tags are benign and present no serious health concerns.

Hemorrhoidal skin tags often don’t cause significant rectal symptoms, but they often affect the cleansing after bowel movement. If feces become trapped beneath the skin tags, it can cause irritation and lead to itching and further inflammation. Skin tags can also cause pain when it flairs up or if there’s another underlying rectal problem.

Patients suffering discomfort or itching due to hemorrhoidal skin tags can treat the condition with the following:

  • Thorough cleaning of the affected area after bowel movement. May use gentle cleansers, such as witch hazel or aloe vera extract.
  • Do a Sitz bath with warm water.
  • May use OTC hemorrhoid cream to reduce irritation and swelling.
  • If the skin tags frequently cause symptoms, individuals may consider having them removed surgically.
  • Most patients who have anal tags often have hemorrhoids, too, they should consider complete care by treating internal hemorrhoids before removal of anal tags or at the same time.

Excision of anal tags:
Anal tags can easily be removed in the office using local anesthetic. The procedure takes less than 10 minutes and patients are safe to drive immediately afterwards. There may be mild postoperative pain and discomfort with bowel movement in the first week. The patients are typically able to go back to work next day although the whole healing process may take a few weeks.

Why Single Treatment Modality can’t Fix All Hemorrhoids

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There are three types of hemorrhoids – internal, external, and mixed hemorrhoids that consist of both internal and external. Internal hemorrhoids are graded from I to IV based on the degree of prolapse. Because no single treatment modality can fix all hemorrhoids, a true hemorrhoid clinic will offer multiple treatment modalities and options to meet a patient’s needs.

Years ago, an IRC-only hemorrhoid clinic at France Avenue closed its business because a family physician treated every hemorrhoid patient with the single modality – Infra-red coagulation (IRC), regardless of the severity, type of hemorrhoids, and associated anorectal conditions. Poor quality care leads to poor results.

Many patients with more advanced hemorrhoids need banding, and even the surgical excision of anal tags and external hemorrhoids. Many hemorrhoid patients have a comorbidity of anal fissure, fistula or anal warts, and need further management with special expertise for these associated medical problems.

Most hemorrhoid patients have the symptom of rectal bleeding; a high quality hemorrhoid clinic should offer colonoscopy to rule out colon cancer and other colon diseases.

No single treatment modality can fix all hemorrhoids or get rid of anorectal symptoms. Specialized hemorrhoid clinic should be able to offer multiple treatment modalities with cutting edge technologies to cure hemorrhoids and associated diseases.

One Stop Medical center provides premier one stop hemorrhoid care. Regardless of how severe your hemorrhoids are, what kind hemorrhoids, or any associated anorectal diseases, we are able to find a solution for you. Supported by an outstanding medical team and equipped with cutting edge technology, our state-of-the-art accredited surgical center sets the standard for patient safety and high quality medical care.

Management of Thrombosed External Hemorrhoid in Minnesota

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It is not uncommon for patients in the Minneapolis and St. Paul areas to call our clinic and ask for immediate help because they have painful bulging in the rectum. Through phone triages, we know they develop the thromobosed external hemorrhoid. We accommodate their visits and help to relieve their pain the same day.

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 hemorrhoids are sudden onset with severe rectal pain and tender bluish swelling in the anus.

The differential diagnosis of rectal pain includes anorectal abscess, anal fissure, and rectal pain due to spasm of anal sphincters.

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.

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.

Severity of Hemorrhoids | Minnesota

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Initial symptoms of hemorrhoids are insidious and mild with occasional rectal itching, irritating or bleeding. Most people in the Minnesota don’t actively seek medical care in this stage. Treatment for hemorrhoids with mild discomfort involves steps that you can take on your own, such as lifestyle modifications and over-the counter (OTC) hemorrhoid creams; these OTC products contain ingredients, such as witch hazel or hydrocortisone that can relieve mild pain and itching, at least temporarily. Make sure you don’t use an OTC cream or other product for more than a few days, you should stop using it once the symptoms improve. These products can cause side effects, such as skin rash, inflammation and skin thinning.

With the worsening of hemorrhoids, symptoms occur more frequently, and then medical interventions and even surgical procedures are necessary. hemorrhoid treatments in the Minneapolis and St. Paul areas depend on the severity of hemorrhoids. If hemorrhoids are treated early, more invasive surgical procedures can be avoided later.

The severity of hemorrhoids is classified based on the prolapse.
Grade 1: the hemorrhoids remain completely inside rectum, although symptoms may continue.
Grade 2: the hemorrhoids prolapse during defecation and they spontaneously return inside rectum on their own.
Grade 3: the hemorrhoids prolapse during defecation. They return inside rectum only by manually pushing them in.
Grade 4: the hemorrhoids are permanently prolapsed and stay outside rectum and cannot be manually pushed back inside.

Hemorrhoid Prevention Guide (Part 2) | Minnesota

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There are many ways to prevent hemorrhoids or slow down the progression of hemorrhoids in Minnesota. One of the best ways to prevent hemorrhoids is to keep your stools soft, so they pass easily.

To prevent hemorrhoids and reduce symptoms of hemorrhoids, follow this guide (part 2):

  • Weight Reduction Obese patients in Minneapolis are 2-4 times more likely to develop hemorrhoids than the average patients, so weight loss may help to reduce the recurrence.
  • Treat the Underlying Diseases: People with other medical problems, such as liver cirrhosis with portal hypertension, cardiovascular diseases, and abdominal tumors are more likely to develop hemorrhoids. The treatment of these underlying medical diseases is important to prevent hemorrhoids.
  • Shower after Bowel Movement: You may program your bowel movement in the way that you always try to have bowel movements right before your regular shower. For example, if you are a morning person, you go to toilet first before you take a shower, so the anus is always clean without residual feces. Residual feces are irritable to the skin around anus. If you starting having recurrent symptoms, then a daily Sitz bath helps a lot to relieve the symptoms.
  • Early Treatment: Finally, once the hemorrhoids come back, you should immediately request an experienced practitioner in Minnesota to treat it. The earlier treated, the better the result. One Stop Medical Center serves the entire Twin Cities and offers the comprehensive hemorrhoids treatment in both Edina and Shoreview offices.

Hemorrhoids Prevention Guide in Minnesota (Part 1)

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The hemorrhoid patients in Minnesota often ask, do hemorrhoids come back? If so, how do I prevent them? hemorrhoids are a varicose vein disease. It is possible to relapse after hemorrhoid care, especially in the advanced hemorrhoids.

hemorrhoids are one of the most persistent chronic medical conditions in the Minneapolis and St. Paul areas, leading to many people becoming frustrated at the recurrent symptoms. Luckily, there are numerous different measures available to prevent them to come back.

  • Dietary Changes: One of the best things you can do to prevent hemorrhoids is to make important dietary changes. Follow a high fiber diet. Why is fiber so very important? People in Minneapolis who do not get enough fiber in their diet tend to have constipation with hard stool and strain when going to the bathroom. In turn, this pressure constitutes one of the greatest risk factors to those who are vulnerable to developing hemorrhoids. In order to prevent the onset or return of hemorrhoids, you should strive to eat a diet rich in fruits, vegetables, and fibers.
  • Increase Fluid Intake: For those who have a history of hemorrhoids in the Minneapolis and St. Paul areas, it is recommended that these patients should drink plenty of water every day (6-8 glasses of water daily). The bulking agents (stool softener and fiber) work better with water.
  • Avoid Straining:You should have good bowel habits and maintain smooth stool. Constipation with hard stool and straining can increase abdominal pressure rapidly, as well as expansion of venous plexus, often causing rupture of hemorrhoidal veins and anal skin tearing. If you develop chronic constipation, you should treat it aggressively by having a high fiber diet, increasing water intake, walking daily, and taking bulking agents and laxatives. However, frequent diarrhea does not help, either. Straining related to diarrhea also can rapidly increase the pressure in the abdomen and hemorrhoid venous complex, too. The toilet time should not be too long; you should avoid the bad habit of reading newspapers in the toilet.
  • Avoid Long Standing and Heavy Lifting: Individuals who are prone to developing hemorrhoids should also avoid standing for extended periods of time and constant heavy lifting.