Category Archives: Hemorrhoids

The Common Causes of Rectal Lumps | Minneapolis & St Paul

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A rectal lump is one of the common symptoms in the anorectal diseases in Minnesota. 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, fissures, or cancer.

  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Anorectal abscesses are the result of infection of anal glands in the lining of the anal canal near the opening of the anus. The patient usually has the painful swollen lump if it is superficial abscess. The presence of an abscess warrants surgical incision and drainage as soon as possible. Just antibiotics would be ineffective at this stage in the infection.

If you feel a lump in the anal or rectal area, contact our hemorrhoid clinics in Edina 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.

Rectal Pain: What are the Common Causes? | Minnesota

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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 are the Common Causes of Minor Rectal Bleeding | Minnesota

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Minor rectal bleeding is one of the common symptoms that the Minnesotans seek for the medical attention in the primary care clinics. It refers to the passage of small amount of bright red and fresh blood from the rectum, 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 medical conditions, but even the slightest amount of bleeding should be taken seriously. The common causes of minor rectal bleeding are internal hemorrhoids, local tissue trauma, ruptured thrombosed external hemorrhoids, fissures, fistula, diverticulosis, colon cancer, colitis, and polyps. The patients of older age than 40 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 polps, anal fissures or fistula openings, 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.

The Common Causes of Anal Itching | Minneapolis & St Paul

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Anal itching, also called anal pruritus is a common symptom in the office visit in Minnesota. The symptom often fluctuates over time. 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. 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 and thick with fine fissures.

Possible causes of anal itching include:

Hemorrhoids: Anal itching can be an initial symptom of hemorrhoids. Hemorrhoids usually cause local inflammation. The skin folds, anal tags and external hemorrhoids make cleansing difficult.

Skin irritation: The local inflammation caused by hemorrhoids and anal leakage cause moisture around anus, and moisture and friction can irritate the skin in the peri-anal area. Some products such as soap and toilet paper may also trigger irritation.

Digestive problems: Diarrhea or fecal leakage 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.

Treatments for anal itching include:
1. Keep the peri-anal area dry and clean
2. Avoid scratching skin
3. Taking antihistamine as a sedative prior to sleeping to prevent the patient from unconsciously scratching
4. Using a topical cream such as Preparation H cream or corticosteroid cream to alleviate the itching.
5. Treat the underlying disorders such as hemorrhoids after thorough evaluation.

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

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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.

Hemorrhoid Prevention Measures | 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 so that your urine is light yellow or clear. Water is the best form of hydration.

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.

Scheduling time each day for a bowel movement and keeping it a daily routine may help. Take your time and do not strain when having a bowel movement, because it is the straining that makes hemorrhoids worse or cause the rupture of varicose veins and thrombosis. Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum.

Avoid frequent heavy lifting and obesity may reduce the chance of hemorrhoid development.

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.

Treatment of the Thrombosed Hemorrhoid on the Road | 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 under skin. It is often accompanied by swelling with a bluish-purplish discoloration and severe incapacitating pain.

I have an interesting story that happened while I visited China many years ago. I was invited to give a lecture on office procedures as a guest professor in Zhejiang University, China. After the academic exchange, I had a few days to myself, so I went to visit an old friend of mine (let’s call him Dave). We decided to go visit a new resort town a few hours away from the city. As we were talking in the hotel, he was looking a bit shifty on the couch, as if he was very uncomfortable. I asked him if he was having a problem, and he said he had a lot of pain because of his hemorrhoids. Thankfully, this being an area of my specialty, I was able to diagnose him with having a thrombosed hemorrhoid that needed immediate treatment. I told him that a thrombosed external hemorrhoid is the common complication of hemorrhoids.

Dave said he would go to the hospital, but he hesitated to go because of inconvenient medical care in China. He didn’t trust the doctors in the local small hospital, and he was indecisive in choosing a larger hospital. I told him that I had fixed countless thrombosed hemorrhoids, and that if I had the tools I needed, I could fix it for him in a flash. 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 thirty years ago and that currently I practice in the US. I asked if I could get the necessary gear to do the procedure. Amazingly, the staff in the local hospital were 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 him down on the bed and we did the procedure right there in the hotel.

The procedure took only a few minutes. I gave 0.5 cc Lidocaine to numb the top of the thrombosed hemorrhoid, then sliced open the hemorrhoid with a scalpel and removed the clotted blood with a cotton-tipped applicator. Once the clot was gone, I cleaned up the area by packing large amounts of gauze. The relief was immediate and other than a little bleeding for a day or so, the problem was gone. He was asked to do the Sitz bath three times a day and keep his stool soft.

I told Dave if he had the chance to visit Minneapolis, I can do IRC treatments to treat the root cause of problem – internal hemorrhoids.

Non-surgical Infrared Coagulation (IRC) for Hemorrhoid Treatment | Minneapolis and St Paul

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Since its introduction more than 20 years ago, infrared coagulation (IRC) has become the world’s leading office treatment for hemorrhoids. This non-surgical treatment is fast, well tolerated and remarkably complication-free. A small probe is placed on the hemorrhoid and a few short bursts of infrared light are applied. The infrared light quickly coagulates the vessels that provide the hemorrhoid with blood, causing the hemorrhoid to shrink and recede. Shrinkage of the hemorrhoidal tissue may take a few weeks. There may be a quick sensation of pain during the short burst of infrared light but overall the IRC treatments are very tolerable and painless. There are no post-treatment effects in 99% of patients. The IRC technology is very effective in treating grade 1 and grade 2 hemorrhoids. Patients return to a normal lifestyle right after the treatment on the same day. There may be slight spot bleeding a few days later and up to 2 weeks. Heavy straining or lifting should be avoided and aspirin should not be taken for a few days. A sensible diet, moderate exercise and proper bowel habits will help so no further hemorrhoids will form.

3 KEY BENEFITS OF INFRARED COAGULATION THERAPY FOR INTERNAL HEMORRHOIDS

Infrared coagulation is quick and near painless
Infrared coagulation can reduce or eliminate the hemorrhoid with a series of a few quick and near painless treatments using short bursts of hot light.

The primary benefits of infrared coagulation are the quick and near painless treatments. While a series of 3 or 4 treatments is normally required over a 2 month period to reduce hemorrhoid, the individual treatments only take a few minutes, and require no recovery time. This is a big perk compared to taking several days off for surgery and recovery, which can be required in the most severe cases.

Infrared coagulation is nonsurgical

While many people associate hemorrhoids with painful surgery, only a small percentage of patients actually require surgery. Hemorrhoidectomy is a surgical procedure to remove most severe hemorrhoids. Instead, infrared coagulation, or other nonsurgical treatments, can reduce or eliminate the source of a hemorrhoi. The treatment is performed right in the office with no anesthesia, incisions, or stitches.

Infrared coagulation is effective
Nonsurgical treatments are simple, quick and convenient, but they must also offer a certain level of effectiveness. To that end, infrared coagulation is up to 95% effective.
If you’d like to see how infrared coagulation can help you, give Procedure Clinic a call today at (952) 922-2151 to schedule a consultation. You can enjoy lasting relief from hemorrhoid pain!

History of Hemorrhoid | Minneapolis & St Paul

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As early as 2250 BC hemorrhoids have been recorded in literature to some extent. It would probably be safe to say that it is one of the oldest ailments known to people. The Egyptians were the first people who medically recorded the remedies for hemorrhoids. They used a poultice of dried acacia leaves with a linen bandage to heal protrusions and inflammations of venous material. A Greek physician named Hippocrates also wrote about hemorrhoids describing it as bile or phlegm which is determined to be the veins in the rectum. He treated the anal protusions very crudely avocating pulling the tissue off with the finger tips, or pulling the veins upward, while someone puts a hot iron to the hemorrhoid and burns it off. The first recorded endoscopy (use of speculum to inspect the rectum)can also be credited to Hippocrates. Even the bible has records of hemorrhoids in the earliest times from the Old Testament Book of Samuel 5:9 Philistines, “punished with emerods” and Samuel 5:12, “People who moved the Ark to Ekron were punished with emerods”.

One of the earliest known hemorrhoid treatments was with the aloe vera plant. Dioscorides, a Roman physician started using that to treat inflamed hemorrhoids. Then approximately 130-200 AD a Roman physician named Emperor Marcus Aurelius (Galen) prescribed ointment, laxatives, and leeches for hemorrhoids treatment. During the same time period in India, the use of clamp and cautery was used to get rid of hemorrhoids and control bleeding.

Between the 5th and 10th Century, Byzantine physicians used thread to ligate the base of the hemorrhoid and then followed by its amputation.

In 1935, Doctors E.T.C. Milligan and C. Naughton Morgan further studied the excision and ligation methods, which later became the gold standard in hemorrhoidectomy.

In the 1960s, banding of larger hemorrhoids was introduced with rubber band ligation.

In the 1970s, cryotheraphy, diathermy, and laser cauteries were developed for treatment.

In the 1990s, Stapled Hemorrhoidopexy, also known as Procedure for Prolapse & Hemorrhoids (PPH) was first described by an Italian surgeon – Dr. Antonio Longo, and since then has been widely adopted to treat the grade 3 and 4 hemorrhoids. Moreover, Another non surgical procedure, called Infra-red coagulation (IRC) was developed to treat the early stage of hemorrhoids.

Common Symptoms of Hemorrhoids | Minneapolis & St Paul

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Severe pain is not a common symptom of internal hemorrhoids, because internal hemorrhoid happens in the area above the dentate line that is supplied by the visceral nerve, like those found within the intestines, which sense pressure rather than pain. Many patients feel the irritating pain and pressure pain when their hemorrhoids flair up. Small percentage of hemorrhoid patients may develop spasmodic pain (proctalgia fugax) caused by spasms of anal sphincter muscles.

As the venous complex of an internal hemorrhoid becomes varicose and continues to enlarge, it bulges into the anal canal and loses its normal anchoring, becoming a prolapsing internal hemorrhoid. The prolapsing hemorrhoid usually returns into the anal canal or rectum on its own, or can be pushed back inside using one’s finger, but usually prolapses again after the next bowel movement. In the anal canal, a hemorrhoid is exposed to movement caused by passing stool, particularly hard stools that can cause bleeding and pain. The painless rectal bleeding with bright red blood is a common symptom of internal hemorrhoids. The rectal mucosal lining that has been pulled down secretes mucus and moistens the anus and its surrounding skin, while the stool itself can also leak onto the anal skin. Itchiness often occurs as a result of this dual presence of stool and moisture.

In general, symptoms of external hemorrhoids are different than those of internal hemorrhoids. External hemorrhoids can be felt as bulges at the anus, but rarely display any of the same symptoms seen with internal hemorrhoids. The patients with external hemorrhoids or anal tags often have the difficulty in cleansing after bowel movements because feces left in the folds of external hemorrhoids or tags causes irritation and itching. Some patients may develop severe and cyclic rectal itching (Pruritic Ani).

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 and often requires medical attention. The somatic nerve in the anal canal (below the dentate line) can sense pain, this is why the patients feel significant pain when they develop thrombosed external hemorrhoids. Thrombosed hemorrhoids may heal with scarring and leave a tag of skin protruding from the anus. Occasionally, the tag turns out to be quite large, which can make anal hygiene (cleaning) difficult or irritate the anus.