Hemorrhoids are rarely a matter of life or death, but they can make some peoples lives seem unbearable due to possible symptomatic pain, itching, swelling, bleeding and protrusions. Symptomatic hemorrhoids are one of the most common complaints a physician evaluates. The problem is undiscriminating; it can occur in both men and women of any age. Often, hemorrhoids enlarge and become increasingly bothersome with age. Reports estimate that at least 50% of individuals over the age of 50 have some form of symptomatic hemorrhoids.
Many patients try to doctor their own hemorrhoids; they spend over $100 million a year on nonprescription remedies. Many are able to control their problem by increasing the fiber content of their diets, maintaining normal weight, and avoiding straining during bowel movements. Patients who have hemorrhoids that don’t respond to self-care measures should consult a physician. Not all rectal growths are hemorrhoids. And although rectal bleeding is not necessarily a sign of colon cancer it should be evaluated to rule out the possibility.
“I understand that issues like hemorrhoids and other problems in the rectal area can be quite embarrassing to most people,” assures Craig E. Amshel, MD, of Absolute Surgical Specialists. “Patients shouldn’t be embarrassed, however, because these problems are much more common than people realize. Hemorrhoids, for example, happen frequently to women, especially while they’re pregnant or after they have just given birth. People whose jobs require frequent standing or sitting are also commonly affected.”
Hemorrhoids may be a sensitive subject for most people, but it no longer has to be a painful one. Now new techniques can be performed in the privacy of a physician’s office that can cure the condition quickly and safely.
Non-surgical treatment
“Hemorrhoids, also known as piles, are masses of dilated veins in the anus or in the mucus membrane of the rectum,” explains Dr. Amshel. “Among factors contributing to this condition are heredity, nutrition, occupation, pregnancy, exercise, coughing and constipation. Hemorrhoids are rated in severity by four degrees and are classified as external or internal by their location. The extent of the disorder determines the treatment.”
Dr Amshel notes that the non-surgical treatment of hemorrhoids is best, and he always looks to provide a conservative solution before considering surgery.
“There are many procedures out there, but I like to get a full assessment of each patient’s bowel and dietary habits before considering surgery. How often does the person need to have a bowel movement, what is the consistency of their stool, and especially, how is their diet?”
“I take a conservative approach, avoiding surgery initially and putting the treatment in the patient’s hands. Fiber supplements are an inexpensive way to treat the problem and can make the patient feel so much better. Along with that, we also recommend that they drink an overly sufficient amount of fluids, such as water and unsweetened juice.”
“Dietary fiber supplements come in pill forms, wafers, crackers, and powders. I have the patient try a regimen of fiber and extra fluids for at least a month, and then I perform
a reassessment. Everyone has some improvement: Almost all the patients come in
with less pain, better bowel movements, and less bloating.”
Lesser hemorrhoids may require no treatment, but more extensive ones may need surgery.
In cases which very large internal and external hemorrhoids exist, a hemorrhoidectomy, or procedure for prolapse and hemorrhoids (PPH), may be the best option. A physician experienced in all treatment methods can serve as a knowing guide in making these decisions.
“Some people are just not completely satisfied after a month of the fiber regimen, and then we talk about different surgical options,” educates Dr. Amshel. “There are multiple options, from surgical excision to banding. This just goes to show that there has not been a true gold standard in terms of hemorrhoid removal. There are other procedures that claim to be "painless" by either coagulating or cauterizing the hemorrhoidal tissue or blood vessels. Some claim they use a laser procedure too, however, my opinion is that it’s expensive and doesn’t seem to give much relief and requires multiple visits to the physician who is administering the device. This physician may not even be trained in surgical care of anorectal disease. There is also a stapling technique, which seems to be less painful than a surgical incision.”
“Long-term results of hemorrhoids are generally favorable, but it’s also important to continue the initial regimen of fiber and fluids,” Dr Amshel reminds. “That is a lifetime commitment of at least a one-a-day supplement and fluid. Surgery always involves risks, so for that reason I think it’s important that patients and referring physicians seek out a surgeon with colorectal surgical experience.”
Concierge care
Dr. Amshel offers his patients concierge care – something new to a number of practices but standard for years at Absolute Surgical Specialists (813-633-0081).
“My philosophy is that every patient's time is just as valuable as mine,” he assures. “There is no wait longer than 10 days for an elective consultation. It’s typically a two-month wait just to see a doctor to get a colonoscopy, but in my practice patients are seen within about a week and have a colonoscopy within a week Once a patient arrives, their time is treated as important in the office as well. There is minimal waiting time in our office,” says Dr. Amshel. “If we’re fully booked, and a patient needs to be seen, we will make room for them that day. My staff and I speak Spanish fluently,” he adds, “and I keep my pager with me at all times, so I’m always available to patients. There is no single treatment for all hemorrhoids; the physician must evaluate each patient individually,” concludes Dr Amshel. “The good news is that with the advances in modern medicine we can offer more comfortable, less invasive treatments for a variety of hemorrhoid conditions. An office visit to your physician may produce a simple non surgical answer to a very old and common problem.”