|Discussion in 'All Categories' started by Glory Nelson - Dec 10th, 2011 3:40 pm.|
|i have hemorroid for over one year now, i have tried most drugs and medication as prescribe by my pharmacist but the pains is still strong. please what more can i do?|
re: hemorroid by Dr M.K. Gupta - Dec 10th, 2011 11:58 pm
Dr M.K. Gupta
|Dear Glory Nelson
If medical treatment of hemorrhoid is failed you should go for surgery.
Every person comes into the world with hemorrhoidal vascular plexuses, but they are clinically known as "hemorrhoids" only when they become enlarged and symptomatic. Hemorrhoids are symptomatic in approximately 4% of the general population as well as in 50% of Americans over the age of 50 years. Predisposing or associated conditions include heredity factors, constipation, and increased intra-abdominal pressure due to pregnancy, ascites, coughing, vomiting, or strenuous physical activity.
Hemorrhoids are generally categorized as internal (covered with mucosa) and external (covered with squamous epithelium). Internal hemorrhoids bleed and prolapse to give full of effect, and patients will observe that hemorrhoids may protrude with bowel motions. Internal hemorrhoids are staged according to the amount of prolapse.
Stage I: Bleeding only, no prolapse
Stage II: Prolapse that reduces spontaneously, without or with bleeding
Stage III: Prolapse that needs manual reduction, without or with bleeding
Stage IV: Irreducible prolapsed hemorrhoidal tissue
Symptoms and Diagnosis
Hemorrhoids may present with symptoms usual for many pathologic anal conditions, including bleeding, pain, discharge, or perhaps a mass. Symptoms of hemorrhoids include local protrusion and swelling, discomfort related to protruding or swollen masses, and bleeding which may be significant enough to result in anemia. These symptoms are nonspecific, and also the presence of hemorrhoids shouldn't be presumed since more severe conditions for example inflammatory bowel disease and cancer can mimic hemorrhoidal symptoms. Patients with severe pain or incarcerated protrusions should be seen promptly.
External hemorrhoids generally do not bleed, but could thrombose and cause acute pain. Although external hemorrhoids can become necrotic and drain, most thrombosed hemorrhoids resolve spontaneously. Redundant "skin tags" may remain and may cause pruritis when the area can't be properly cleansed.
Acute complications can happen with either prolapse of internal hemorrhoids or thrombosis of the external hemorrhoids. Acute pain is usually constant and related to an obvious mass. Pain occurring following a bowel movement is rarely due to a hemorrhoid complication, but is more likely due to an anal fissure or ulcerating anal mass. Chronic anal pain and pruritus tend to be more commonly the results of non hemorrhoidal processes including anal fissure, mucosal prolapse, anal mass, or anal fistula.
Diagnosis is made with direct visualization by anoscopy or proctoscopy. All patients with rectal bleeding should have their colon examined to eliminate proximal causes of bleeding, even just in the existence of enlarged hemorrhoids. Because most causes of bright red bleeding are inside the reach of the flexible sigmoidoscope, patients should undergo flexible sigmoidoscopy in addition to anoscopy to eliminate other causes of bleeding. Intermittent protrusion or occasional bleeding does not require urgent consultation. However, patients with acute bleeding, pain or incarcerated protrusions should be seen promptly.
Initial therapy for chronic the signs of hemorrhoidal disease should be conservative, including stool bulking and topical therapy with ointments or suppositories. Outpatient surgical treatment is appropriate if conservative treatment fails and also the patient desires relief of symptoms. Operative treatment methods are restricted to symptomatic patients with Stage III or IV hemorrhoids. If the patient has proof of anemia, full colonic examination is indicated and much more aggressive treatment methods are necessary.
In patients with Stage I, II, or III internal hemorrhoids, local treatment could be appropriate as infrared coagulation, local injection, or rubber banding. Stage I and II diseases are effectively treated by these modalities, with resolution of symptoms in a minimum of 90% of patients. Cryotherapy ought to be avoided because of excessive post-treatment symptoms. Stage III disease is probably best treated by hemorrhoidal banding to get rid of redundant tissue, but long-term resolution of symptoms is likely in only 70% of these patients. Surgical intervention with operative excision is required in Stage lV disease. This is related to long-term resolution of symptoms in 95% of patients. Surgical excision may also be suggested for earlier stage ailment that is primarily made up of external hemorrhoids. Circular stapled hemorrhoidopexy is assigned to less postoperative pain but a greater long-term risk of recurrence. The word "laser hemorrhoidectomy" describes excision of hemorrhoidal tissues using a laser rather than standard surgical instruments, but is really a surgical procedure nonetheless.
Symptoms may also arise from residual hemorrhoidal tissue after an episode of acute thrombosis of external hemorrhoids. These external anal tags may prevent proper cleansing and can be excised with a local anesthetic if symptoms warrant.
The risks of hemorrhoidal disease are protracted symptoms, anemia-producing bleeding, and thrombosed hemorrhoids that undergo necrosis. Risks of treatment include bleeding and infection. The chance of bleeding after local therapy is about 1%. The chance of infection after local treatment methods are unknown, but is certainly under 1%. Local transient pain is probably from the dilation and pressure results of the treatments. Notable pain after banding or injection of internal hemorrhoids requires medical assistance. The pain sensation might be because of sphincter spasm, and may render urination difficult. Urinary retention is an occasional symptom of occult sepsis.
Bleeding and infection are greater risks after open hemorrhoidectomy, but occur under 5% of the time. Pain after open hemorrhoidectomy generally requires narcotics for relief. The fear of a bowel movement causing pain may lead to fecal impaction in some patients. Co-morbid conditions such as diabetes, AIDS and cardiovascular disease boost the perils of local treatment, but don't affect the kind of complications. There may be subtle changes in continence of gas or liquid stool following local treatment or surgery, but they're rarely socially significant. Anal sphincter injury leading to incontinence is a recognized risk, but is extremely rare in experienced hands.
Following local treatment, symptoms of local protrusion and bleeding ought to be eradicated. The chance of recurrent symptoms following such treatment varies using the extent of the disease, with a 10% recurrence rate for Stage I and II disease, and 30% for Stage III disease. Hemorrhoidectomy has a 5% risk of recurrent symptoms.
Most initial phase hemorrhoidal disease may be treatable in the office. Simple surgical hemorrhoidectomies can generally be completed under local anesthesia with intravenous sedation. More complicated excisions for advanced disease typically need a general anesthetic. A short stay in a healthcare facility may be necessary for pain control, with respect to the patient's pain threshold. Activity levels after the described interventions ought to be advanced according to the patient
re: hemorroid by Santi - Feb 9th, 2012 9:38 pm
|I rtenecly had. It’s not readily available at all drug stores, as they generally just carry the top name brands, but this product does the healing it’s supposed to do faster and better than anything I’ve ever used before.|
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