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Overview of Hemorrhoids
Hemorrhoids are one of the most common ailments for men and women alike — affecting more than half the population at some point in their lives. Onset commonly occurs after the age of 30, but hemorrhoids are reported in people of all ages. More than 525,000 patients in the United States are treated annually for symptomatic hemorrhoids. 6 Of these, approximately 10–20 percent will require surgical treatment for their condition.
What is a Hemorrhoid?
Each of us has veins within the anus that tend to stretch under pressure, somewhat like varicose veins in the legs. It is believed these veins exist to protect and cushion the anal canal. When these veins swell, they are called "hemorrhoids." One set of veins is inside the rectum (internal hemorrhoids), and another is under the skin around the anus (external hemorrhoids).
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Types of Hemorrhoids
Internal Hemorrhoids
Internal hemorrhoids usually are not painful, but may bleed. Sometimes, an internal hemorrhoid may stretch until it bulges outside the anus. This is called a prolapsed hemorrhoid. A prolapsed hemorrhoid may shrink back inside the rectum on its own over time, or it may be gently pushed back inside. If the prolapsed hemorrhoid cannot be pushed back inside, several hemorrhoid treatment options are available, including hemorrhoid surgery.
External Hemorrhoids
External hemorrhoids involve the veins around the anus. They can be itchy or painful and can sometimes crack and bleed. If a blood clot forms, one may feel a tender lump on the edge of the anus, and see bright red blood on toilet paper or in the toilet after a bowel movement.
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Hemorrhoid Classification Chart
| Classification |
Treatment Options |
1stDegree - No rectal prolapse |
- Diet
- Local & general drugs
- Sclerotherapy
- Infrared coagulation
|
2ndDegree - Rectal prolapse is spontaneously reducible |
- Sclerotherapy
- Infrared coagulation
- Banding [recurring banding may require Procedure for Prolapse and Hemorrhoids (PPH)]
|
3rdDegree - Rectal prolapse is manually reducible |
- Banding
- Hemorrhoidectomy
- Procedure for Prolapse and Hemorrhoids (PPH)
|
4thDegree - Rectal prolapse irreducible |
- Hemorrhoidectomy
- Procedure for Prolapse and Hemorrhoids (PPH)
|
Hemorrhoids Prevalence and Diagnosis
Hemorrhoids can affect men and women alike; however, an individual may be more likely to get hemorrhoids as they age or if their parents had them. Pregnant women often get hemorrhoids because of the strain from carrying the baby and from giving birth. For most women, such hemorrhoids are a temporary problem. Obesity, straining during bowel movements, sitting too long on the toilet, or standing or lifting too much can make hemorrhoids worse. Constipation is often the main cause of hemorrhoids.
If an individual is struggling with anorectal issues, it is important to visit a physician to correctly identify the problem. The physical evaluation should include observation, palpation, and anoscopic examination
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PPH In-Depth
PPH Procedure for Advanced Hemorrhoids Involves Less Pain and a Quicker Recovery.
In clinical trials the Procedure for Prolapse and Hemorrhoids (PPH) has been shown to be a less painful procedure for removal of advanced hemorrhoids when compared to conventional hemorrhoidectomy.
PPH is a technique that reduces the prolapse (enlargement) of hemorrhoidal tissue. With the PPH procedure, patients experience less pain and recover faster than patients who undergo conventional hemorrhoidectomy procedures.
Since the PPH procedure was first introduced in Italy in 1997, it has become a common procedure around the world for the surgical treatment of hemorrhoids. The procedure was first introduced in the United States in October 2001.
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How PPH Works
Using a hemorrhoidal circular stapler device, the procedure for prolapse and hemorrhoids procedure essentially "lifts up," or repositions the mucosa, or anal canal tissue, and reduces blood flow to the internal hemorrhoids. These internal hemorrhoids then typically shrink within four to six weeks after the procedure. The PPH procedure results in less pain than traditional hemorrhoidectomy procedures because it is performed above the "pain" line, or dentate line inside the anal canal. The advantage is that this hemorrhoid treatment method affects few nerve endings, while traditional hemorrhoidectomy procedures are performed below the dentate line, affecting many sensitive nerve endings.
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PPH Indications
PPH is indicated for patients with
PPH Illustration
Before and After PPH & Rectal Prolapse Repair
The Procedure for Prolapse and Hemorrhoids (PPH) procedure reduces the prolapsed mucosa and restores anal tissue to its original anatomical position. This hemorrhoid operation results in less pain than traditional procedures because it is performed above the dentate, or “pain” line inside the anal canal. Traditional procedures are performed below the dentate line, affecting many sensitive nerve endings. PPH surgery patients have been shown to experience less pain and a faster recovery (i.e. return to normal activities, such as work) than patients who undergo a traditional repair operation.
Risks of Surgery
Risks and Complications of the Procedure for Prolapse and Hemorrhoids
PPH Hemorrhoid Surgery Patient Indication
The Procedure for Prolapse and Hemorrhoids is indicated for patients with:
- Second degree hemorrhoids after failure of multiple rubber band ligation
- Third and fourth degree hemorrhoids
- Rectal mucosal prolapse
Important Consideration
The Procedure for Prolapse and Hemorrhoids should be considered when non-operative methods of hemorrhoid treatment do not provide satisfactory, long-term relief of hemorrhoidal disease and your physician recommends hemorrhoid surgery treatment.
PPH Hemorrhoid Surgery Risks and Complications
As with any surgical procedure, there are risks that accompany PPH:
- If too much muscle tissue is drawn into the device, it can result in damage to the rectal wall resulting in inflammation or infection.
- The internal muscles of the sphincter may be damaged, resulting in short-term or long-term dysfunction, such as severe pain or incontinence.
Questions to Ask Your Doctor
Before choosing a surgical procedure for the treatment of hemorrhoids, there are questions you should ask your surgeon:
What types of hemorrhoid procedures have they performed?
How many of each procedure have they performed?
Why are they recommending one particular hemorrhoid procedure over another?
How long will the procedure take?
Will this procedure require a hospital stay and, if so, for how long?
How long will the recovery process take?
How soon can “normal” diet and activity be resumed?
Will having the procedure require any long-term changes in work, diet, and activity?
What are the potential risks and complications of conventional hemorrhoidectomy?
What are the potential risks and complications of PPH hemorrhoid surgery?
FAQs - Hemorrhoids
Our Frequently Asked Questions section refers to United States-based generally standard and accepted practices. As always, please check with your healthcare provider to determine their practices, guidelines, and what they recommend for you.
What is a hemorrhoid?
Each of us has veins, or hemorrhoids, within the anus that tend to stretch under pressure, somewhat like varicose veins in the legs. It is believed these veins exist to protect and cushion the anal canal. When these veins swell and descend into the anal canal, they are considered “prolapsed.” One set of veins is inside the rectum (internal hemorrhoids) and another is under the skin around the anus (external hemorrhoids).
Why does hemorrhoidal tissue prolapse?
A number of factors contribute to hemorrhoidal issues — constipation with prolonged straining and pregnancy are two of the most common causes. With aging, the muscles and other anatomic structures that support the tissue weaken and help contribute to the prolapse of the hemorrhoid.
What are the types of hemorrhoids?
There are two types of hemorrhoids — internal and external.
Internal hemorrhoids usually are not painful, but may bleed. Sometimes, an internal hemorrhoid may stretch until it bulges outside the anus. This is called a prolapsed hemorrhoid. A prolapsed hemorrhoid can go back inside the rectum on its own over time, or it can be gently pushed back inside. If the prolapsed hemorrhoid cannot be pushed back inside, consultation with a physician about surgical treatment options is necessary.
External hemorrhoids involve the veins around the anus. They can be itchy or painful and can sometimes crack and bleed. If a blood clot forms, one may feel a tender lump on the edge of the anus, and see bright red blood on toilet paper or in the toilet after a bowel movement.
What are the symptoms of hemorrhoids?
Symptoms of hemorrhoids, both external and internal, include:
- Aching after a bowel movement
- Anal or rectal itching
- Bright red blood on toilet tissue or in toilet bowl
- Appearance of anal tissue pads or sensitive lumps
Consult your physician if you experience any of these hemorrhoid symptoms.
Who gets hemorrhoids?
Hemorrhoids are one of the most common ailments for men and women alike — affecting more than half the population at some point in their lives. Onset commonly occurs after the age of 30, but hemorrhoids are reported in people of all ages. More than 525,000 patients in the United States are treated annually for symptomatic hemorrhoids6. Of these, approximately 10–20 percent will require surgical treatment for the condition.
What are the chances that I will have hemorrhoids?
Hemorrhoids can affect men and women alike; however an individual may be more likely to get hemorrhoids as they age or if their parents had them. Pregnant women often get hemorrhoids because of the strain from carrying the baby and from giving birth. For most women, such hemorrhoids are a temporary problem. Obesity, straining during bowel movements, sitting too long on the toilet, or standing or lifting too much can make hemorrhoids worse. Constipation is oftentimes the main cause of hemorrhoids.
How can I prevent getting swollen or prolapsed hemorrhoids?
The following are tips for hemorrhoid prevention:
- Include more fiber in your diet. Fresh fruits, leafy vegetables, and whole-grain breads and cereals are good sources of fiber.
- Drink plenty of fluids (except alcohol). Eight glasses of water each day is ideal.
- Do not read on the toilet. Sitting and straining too long encourages swelling.
- Exercise regularly.
- Avoid laxatives, except bulk-forming laxatives, such as Fiberall®, Metamucil®, etc. Other types of laxatives can lead to diarrhea, which can worsen hemorrhoids.
- When you feel the need to have a bowel movement, don’t wait for long periods before using the bathroom.
How can I reduce my hemorrhoidal pain?
- Take warm soaks three or four times a day.
- Clean your anus after each bowel movement by patting gently with moist toilet paper or moistened pads, such as baby wipes.
- Use ice packs to relieve swelling.
- Use acetaminophen (Tylenol®), ibuprofen (Motrin®), or aspirin to help relieve pain.
- Apply a cream that contains witch hazel to the area or use a numbing ointment. Creams that contain hydrocortisone can be used for itching or pain.
What do I do if I think I have hemorrhoids?
If you find you are struggling with hemorrhoid symptoms, it is important to visit your physician to correctly identify the problem. The physical evaluation to confirm a diagnosis of hemorrhoids should include observation, palpation, and anoscopic examination.
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