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.

The Management of Anal Tags | Minneapolis & St Paul

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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.

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.

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.

Hemorrhoids 101 | Minnesota

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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.

Infrared coagulation (IRC) is a fast and effective non-surgical solution for hemorrhoid treatment!

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A hemorrhoid is a common illness that numerous Minnesotans suffer from. Approximately three out of four people will develop hemorrhoids at some time in their lives. While many people associate hemorrhoid treatments with painful surgery, only a small percentage of hemorrhoid patients actually require hemorrhoidectomy. A fast and simple non-surgical office procedure has taken the fear out of hemorrhoid treatments. The majority of hemorrhoid patients are good candidates for non-surgical Infrared coagulation (IRC) treatments.

What is Infrared Coagulation (IRC)?
IRC is a FDA approved office procedure that uses infrared light to treat symptomatic internal hemorrhoids, and it takes just a couple of minutes for each treatment. IRC is a safe, fast, and effective solution for hemorrhoids. Therefore, IRC has quickly become the most widely used office procedure for hemorrhoid clinics and is preferred over other methods because it is fast, effective, well-tolerated by patients, and rarely has complications.

A small light probe contacts the area above the hemorrhoid complex under direct view, exposing the tissue to a burst of infrared light for about 1.5 second. This coagulates the veins above the hemorrhoid, causing it to shrink.
With IRC, hemorrhoid doctor can effectively coagulate the insensitive area right above the hemorrhoids and destroy these small veins. In this way, the sensitive and painful area is avoided, and IRC becomes a very tolerable treatment.

IRC offers major advantages to patients over previous hemorrhoid treatment methods:

• Fast, simple, and safe solution
• No anesthesia required
• No special preparation needed
• No recovery time after treatment
• Clinically proven results
• Covered by all major insurance companies

Who are the Best Candidates for Infrared Coagulation (IRC)?
Infrared coagulation can be used to treat the early stages of hemorrhoids, and it is most effective in grade 1-2 hemorrhoids.

How is Infrared Coagulation Procedure Performed?
Before IRC procedure is performed, Dr. Shu gently inserts the anoscope (a very short, 3-4 inch rigid metal tube), then uses a handheld device that creates an intense beam of infrared light to touch the mucosa above the hemorrhoids, exposing the hemorrhoid tissue to a quick pulse of infrared light. The heat from the infrared light burns 4-5 spots in the targeted area, coagulating the vein above the hemorrhoids.

The resulting scar tissue cuts off the blood supply to the hemorrhoid venous complex. This causes the hemorrhoid complex to shrink and die. It may take a few weeks for all the hemorrhoids to shrink completely. Moreover, the scar tissue acts to hold nearby hemorrhoid veins in place so they don’t bulge into the anal canal easily and become hemorrhoids as you age.

Each IRC treatment only takes a couple of minutes. You may need as many as four separate treatment sessions every two weeks to cover all the areas where hemorrhoids appear, but this depends on each individual case and how extensive your hemorrhoids are.

What is the Recovery Time of Infrared Coagulation Procedure?
After the IRC procedure, you may feel mild discomfort in the anus and the urge to have a bowel movement sometimes. You are able to resume normal everyday activities immediately afterward. Typically, there are no post-treatment effects. However, there may be slight spot bleeding a few days later, but heavy rectal bleeding is extremely rare. Avoid heavy straining, lifting, and aspirin. If you notice significant rectal bleeding, you should call your doctor’s office.

You may use Tylenol as needed and take a warm sitz bath daily to relieve discomfort. A stool softener, fiber, and water will help ease your bowel movement while you heal.