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Hemorrhoids. Almost 3 out of every 4 of us will have to deal with them at least once in our lives. Much like varicose veins, hemorrhoids are bulging blood vessels that swell up in the rectum or on the anus. They can cause itching, discomfort or pain, and perhaps bright blood in the stool. And while the cause of hemorrhoids is sometimes a mystery, most can be treated at home simply by avoiding straining through eating a high fiber diet to prevent constipation. Your doctor can also write you a prescription for a topical cream that can be applied internally or externally.
“By the time patients reaches us, they have already seen their doctor and tried medical therapy,” says Allen Chudzinski, MD, FACS, FASCRS, colon and rectal surgeon at the Digestive Institute Tampa (DI). Dr. Chudzinski and his colleague, Haane Massarotti, MD, FACS, also a colon and rectal surgeon at DI, see and treat patients who have invasive hemorrhoids or high-grade, non-invasive ones causing them debilitating pain. They may even be missing work because of symptoms, which tend to be worse if the hemorrhoid contains a blood clot.
Dr. Chudzinski says that there are many different ways to treat hemorrhoids and that he and Dr. Massarotti consider the lifestyle factors of each of the patients they treat.
“Each patient is truly unique, and I give them personalized care,” Dr. Chudzinski says. “The approach I use is always customized and tailored to the patient.”
For example, if someone has a protruding hemorrhoid, the surgeon can treat it by performing a hemorrhoidopexy – that is, sewing it into the inside of the anorectal wall. Then, another procedure called a ligation is offered to deprive the hemorrhoid of blood. After these procedures, the hemorrhoid scars over and is absorbed into the wall of healthy tissue.
Ligation to Cut Off Blood Supply to the Hemorrhoid and Resolve Symptoms
For non-invasive hemorrhoids, a common treatment is rubber band ligation. This is a minor procedure – it can be done right in the clinic – in which a tiny rubber band is wrapped around the base of the hemorrhoid to tie off its blood supply. The hemorrhoid then shrinks, dies and falls off. Some patients find the treatment painful, but the results are lasting – very rarely do hemorrhoids treated in this fashion come back.
Another ligation approach associated with little to no pain is ultrasound-guided ligation, formally called “hemorrhoid artery ligation.” With this treatment, ultrasonic imaging gives the surgeon a view of the hemorrhoid’s blood supply. He or then is able to sew over the blood vessels leading to the hemorrhoid. Deprived of blood flow, the hemorrhoid shrinks and symptoms go away.
Dr. Chudzinski says that people often come in for an ultrasound-guided ligation procedure on Friday and go back to work on Monday. While ligation can be a very easy, minimally invasive treatment for patients – after a two to three days of a feeling of pressure, symptoms disappear – it leaves the hemorrhoid tissue.
“Some people don’t like the way that looks,” he says.
Formal Hemorrhoidectomy – A More Invasive Approach Preferred by Some Patients
While most patients opt for a simple treatment that takes care of their symptoms quickly, for people who want to be free of all hemorrhoidal tissue after their treatment, Dr. Chudzinski and Dr. Massarotti perform a formal hemorrhoidectomy. This approach removes all problem tissue completely and involves seven to 10 days of what Dr. Chudzinski calls “pain and discomfort,” but it leaves people with their desired results.
“We have very good outcomes,” he says, noting that he can provide anal reconstructive surgery when patients truly have debilitating hemorrhoids and want a good cosmetic result after treatment.
Digestive Institute Tampa Colon & Rectal Surgeons Handle Challenging Hemorrhoid Cases
Of course, if patients have not only hemorrhoids but also a more complex issues with their anal or rectal tissues – such as a fistula, pelvic floor issues such as rectocele or diverticulitis – the DI colon and rectal surgeons will need to use a much different surgical approach to take care of the larger issue. This is when they must tailor the procedure even more precisely to the patient, and they have many tools in their toolbox to do just that.
“For our more complex procedures, we often use robotic surgery,” says Dr. Chudzinski, noting that this transanal approach is especially beneficial for elders who might be too frail for an operation that involves larger incisions.
Putting an End to Symptoms
Finally, although certain symptoms are clearly caused by a hemorrhoid, if you experience rectal bleeding of any kind, you should see your doctor. Although the bleeding could be related to the hemorrhoid, it is also a symptom of other anal and rectal conditions, including cancer. It makes sense to have it checked out – and get the hemorrhoid treatment you need.
If you have hemorrhoids causing symptoms that don’t improve with medical treatment, learn how a colon and rectal surgeons at the AdventHealth Digestive Institute Tampa can help. Call us at
Call813-615-7557 for an appointment.