Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Thomas P. Sokol, MD received his medical degree from the University of Health Sciences/The Chicago Medical School in 1980. He went on to his general surgical residency at Harbor/UCLA Medical Center and then to the Carle Clinic/ University of Illinois for Fellowship Training in Colon and Rectal Surgery.
A precise definition of hemorrhoids does not exist, but they
can be described as masses or clumps ("cushions") of tissue within the anal
canal that contain blood vessels and the surrounding, supporting tissue made
up of muscle and elastic
fibers. The anal canal is the last four centimeters through which stool passes
as it goes from the rectum to the outside world. The anus is the opening of the
anal canal to the outside world.
Although most people think hemorrhoids are abnormal, they
are present in everyone. It is only when the hemorrhoidal cushions enlarge that
hemorrhoids can cause problems and be considered abnormal or a disease.
Prevalence of hemorrhoids
Although hemorrhoids occur in everyone, they become large and cause problems in
only 4% of the general population. Hemorrhoids that cause problems are
found equally in men and women, and their prevalence peaks between 45 and 65
years of age.
What is stapled hemorrhoidectomy?
Stapled hemorrhoidectomy is the newest surgical technique for treating
hemorrhoids, and it has rapidly become the treatment of choice for third-degree
hemorrhoids. Stapled hemorrhoidectomy is a misnomer since the surgery does not
remove the hemorrhoids but, rather, the abnormally lax and expanded hemorrhoidal
supporting tissue that has allowed the hemorrhoids to prolapse downward.
For stapled hemorrhoidectomy, a circular, hollow tube is inserted into the anal
canal. Through this tube, a suture (a long thread) is placed,
actually woven, circumferentially within the anal canal above the internal
hemorrhoids. The ends of the suture are brought out of the anus through the
hollow tube. The stapler (a disposable instrument with a circular stapling
device at the end) is placed through the first hollow tube and the ends of the
suture are pulled. Pulling the suture pulls the expanded hemorrhoidal supporting
tissue into the jaws of the stapler. The hemorrhoidal cushions are pulled back
up into their normal position within the anal canal. The stapler then is fired.
When it fires, the stapler cuts off the circumferential ring of expanded hemorrhoidal tissue trapped within
the stapler and at the same time staples together the upper and lower edges of
the cut tissue.
Who is a candidate for stapled hemorrhoidectomy?
Stapled hemorrhoidectomy, although it can be used to treat second degree hemorrhoids, usually is reserved for higher grades of hemorrhoids - third and fourth degree. If in addition to internal hemorrhoids there are small external hemorrhoids that are causing a problem, the external hemorrhoids may become less problematic after the stapled hemorrhoidectomy. Another alternative is to do a stapled hemorrhoidectomy and a simple excision of the external hemorrhoids. If the external hemorrhoids are large, a standard surgical hemorrhoidectomy may need to be done to remove both the internal and external hemorrhoids.
Rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Rectal bleeding may be moderate to severe and most bleeding comes from the colon, rectum, or anus. Common causes include anal fissures, hemorrhoids, diverticulitis, and more.
Hemorrhoid is an enlarged vein in the walls of the anus and sometimes around the
rectum, usually caused by untreated constipation, but occasionally associated
with chronic diarrhea. If untreated, hemorrhoids can
worsen, protruding from the anus. Also known as piles.
Anal itching is the irritation of the skin at the exit of the rectum, known as the anus, accompanied by the desire to scratch. Causes include everything from irritating foods we eat, to certain disease and infections. Treatment options include local anesthetics, vasoconstrictors, protectants, astringents, antiseptics, keratolytics, analgesics, and corticosteroids. If condition persists, a doctor examination may be needed to identify an underlying cause.
An anal fissure is a small tear or cut in the skin lining of the anus. Pain and/or rectal bleeding during bowel movements are common symptoms of anal fissures. Treatment involves increasing liquid intake, using stool softeners and avoiding foods that may not be well-digested.
Anal itching is the irritation of the skin at the exit of the rectum, known as the anus, accompanied by the desire to scratch. Although
itching may be a reaction to chemicals in the stool, it often implies that there is inflammation of the anal area. The intensity of anal itching and the amount of inflammation increases from the direct trauma of scratching and the presence of moisture. At its most intense, anal itching causes intolerable discomfort that often is described as burning and soreness.
What causes anal itching?
Anal itching can be caused by irritating chemicals in the foods we eat, such as are found in spices, hot sauces, and peppers.
Anal itching also can be caused by the irritation of continuous moisture in the anus caused by frequent liquid stools,
diarrhea, or escape of small amounts of stool (incontinence). Moisture increases the possibility of infections of the a...
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