History of Hemorrhoid | Minneapolis & St Paul

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.

The Management of Anal Tags | Minneapolis & St Paul

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.

Anal tags are the shapeless lumps and flaps of skin and tissue found at the anal verge. They’re quite common and usually come with other anorectal problems, such as hemorrhoids.

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 sentinel 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. A radiofrequency device is used to get rid of skin tabs and resurface the anal area to acquire a good cosmetic result. 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. If the patient needs a hemorrhoidectomy, anal tags can be removed together as part of hemorrhoidectomy. If the anal tag is extensive, two stages of surgery may be necessary to avoid anal stenosis.

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.

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