Rectal Pain: What are the Common Causes? | Minnesota

Rectal pain is one of common symptoms in the minnesotan patients with anorectal diseases. It can be caused by various anorectal conditions.

Acute anal fissure usually causes sharp pain during intense, forced bowel movements, and it is often accompanied by rectal bleeding with bright red blood. The patients with chronic anal fissures usually have intermittent sharp rectal pain due to sphincter muscle spasm and bleeding with each bowel movement for a long time.

Pain that begins gradually and becomes excruciating may indicate infection that leads to anorectal abscess, and pain improves if the absecess ruptures, and pressure inside abscess reduces.

In general, external hemorrhoids often cause itching and discomfort due to the difficulty in cleasing after bowel movement, but it usually don’t cause significant rectal pain. 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.

Proctalgia fugax (rectal pain) is an anorectal pain syndrome that occurs in episodes lasting seconds or minutes, typically in the middle of the night, though it is very possible to experience it during the day as well. Patients may feel spasm-like, sharp pain in the anus that is often mistaken for a sign that they must defecate. Levator ani syndrome presents the symptoms with vague, aching or pressure feeling high in the rectum. It could be worsened by sitting and relieved by walking. The pain tends to be constant and lasts from hours to days. It recurs regularly. Both conditions are recurrent, and while not curable, treatments are available.

What is Rubber Band Ligation (Banding) in Hemorrhoid Treatments? | Minnesota

Rubber band ligation (RBL) is one of the common procedures to treat internal hemorrhoids in Minnesota. RBL, also called banding, is an office procedure in which the prolapsed hemorrhoid tissue is tied off at its base with rubber bands under anoscopy. 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. Therefore, this procedure 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 of banding 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 banding 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 banding procedure, some patients may feel tightness, mild pain or have the feeling of bowel movement. Most patients 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 few days or a week. If you notice significant rectal bleeding, then you should call your doctor’s office.

Some patients may need the combination of treatments with banding and infrared coagulation (IRC). They are treated with the banding first to downgrade their hemorrhoids, then IRC is used to treat the mild ones.

Hemorrhoids 101 | Minnesota

Believe it or not, everyone has had a normal hemorrhoidal tissue in their rectum and anus. It’s only when your hemorrhoidal veins enlarge and become varicose veins that they’re considered abnormal or diseased.

There are three types of hemorrhoids – internal, external, and mixed hemorrhoids that consist of both internal and external. External hemorrhoids are those that occur outside the anal verge and affect bowel cleansing after one’s bowel movement, causing skin irritation and itching. A thrombosed external hemorrhoid is usually very painful due to rupture of one’s varicose veins, which causes blood clots and is often accompanied with swelling and pain. These external hemorrhoids are typically treated with either an incision or removal of the clot, or with an external hemorrhoidectomy performed under local anesthesia.

Internal hemorrhoids are graded from I to IV based on the degree of prolapse. Grade I hemorrhoids bulge with defecation; grade II lesions also bulge with defecation, but then recede spontaneously. Grade III hemorrhoids require digital replacement after prolapsing, while grade IV hemorrhoids cannot be replaced once prolapsed. There are many treatment options for internal hemorrhoids that vary based on the severity of each case, including infrared coagulation, rubber band ligation and hemorrhoidectomy.

The Easy Hemorrhoid Care™ (EHC) – a New and Elevated level of Care Delivery System for Hemorrhoid Treatment | Minnesota

One Stop Medical Center invites you to experience an elevated level of care for your hemorrhoid treatments, with Minnesota’s first ever Easy Hemorrhoid Care™ Experience.

For nearly 20 years, Dr.Steven Shu has been providing exceptional hemorrhoid care utilizing the state-of-the-art medical techniques and technology available. Now he and his team offer Easy Hemorrhoid Care™ , a new care delivery system for hemorrhoid treatment with minimal invasive procedures, including Infrared Coagulation (IRC), rubber band ligation, and modified hemorrhoidectomy. It is an efficient system that requires only one trip. We provide patients a new experience in hemorrhoid care, from procedure through recovery. These advancements reduce discomfort, time, decrease the chance of complication and reduce the total recovery time.

For the first time in Minnesota, a personalized approach to meet your specific hemorrhoid care requirements is now available! The Easy Hemorrhoid Care™ Experience has been designed to take the stress and worry out of your hemorrhoid treatment. This package provides the most comfortable and seamless hemorrhoid care experience possible, with enhanced, customized hemorrhoid care, saving you precious time in your busy schedule.

Benefits of the Easy Hemorrhoid Care™ (EHC)
In the standard hemorrhoid care, the patients with hemorrhoids require multiple office visits with Infrared Coagulation and/or rubber banding ligation for their internal hemorrhoid treatments, followed by external hemorrhoidectomy and/or excision of anal hemorrhoids. It is a long process, but it is usually covered by your medical insurance.

The Easy Hemorrhoid Care™ (EHC) is a specially designed hemorrhoid care delivery system that aims to shorten the whole process of hemorrhoid treatment, to reduce discomfort, the chance of complications, and total recovery time. Patients are given Botox during the procedure to relax anal sphincter muscles, reducing post procedural pain. It is an efficient system that requires only one trip where you receive premium medical care, but it is not covered by your insurance.

To learn more about our Easy Hemorrhoid Care™ Experience in One Stop Medical Center, please contact us by calling at 952-922-2151 or email at info@shuMD.com.

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

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

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

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

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.

Why Single Treatment Modality can’t Fix All Hemorrhoids

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.

Severity of Hemorrhoids | Minnesota

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.

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