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Rectal problems present themselves by symptoms such as pain, burning, itching and/or some form of growth or protrusion. The cause of these symptoms can be hemorrhoids, skin tabs, abscesses, fissures, polyps, colorectal cancer, or numerous other disorders. By far the most common cause of these symptoms is hemorrhoids.
For many years it was believed that hemorrhoids were varicose veins located in the anal region. Today it is believed that hemorrhoids are made up of vascular cushion tissue that serves a useful function until prolonged downward pressure creates a loss of support for these tissues which then prolapse (hang down toward the anus), become congested, enlarged and bleed. The causes of the breakdown of the support for this tissue is attributed to one or more of the following factors: improper diet, constipation, frequent bowel movements associated with diarrhea, pregnancy and childbirth, heavy lifting and straining, and sitting or standing for prolonged periods of time.
Hemorrhoids are divided into two major types: internal and external. Internal hemorrhoids are covered by mucosa and reside inside the anal opening, while external hemorrhoids are covered by skin and reside outside the anal opening. Internal hemorrhoids are classified depending on the degree of prolapse (extension from the wall of the rectum) on a scale of one (least) to four (maximum). Generally, patient symptoms of bleeding, burning, itching, discomfort, and pain increase from a grade one to a grade four hemorrhoid. Proper treatment also varies with the degree of prolapse.
The development of hemorrhoids and their related symptoms increases with age. It is uncommon to find symptoms in people under 20 years of age. It is estimated that at least 50% of adults in the United States turning 50 years of age have hemorrhoids. Treatment of hemorrhoids ranges from ointments and suppositories (which provide only temporary relief from hemorrhoidal discomfort) to various forms of outpatient and inpatient treatment. The more common forms of treatment are described below.
Inpatient - Outpatient Treatment: Alternatives also exist that offer more than just temporary relief. These alternatives vary from simple outpatient procedures to a surgical procedure which requires a hospital stay. These procedures vary in cost, effectiveness, and the level of pain and complications the patient endures after the treatment. The following is a description of the alternatives.
Ointments and Suppositories: Numerous temporary relief ointments and suppositories are currently available for hemorrhoid sufferers. The market for these products, many available over-the-counter, exceeds $150 million annually.
Ultroid (DC current therapy): Application of a precise, low level DC electrical current to cause scarring and shrinkage of the hemorrhoid.
Bicap: Bipolar electrical current applied to the hemorrhoid to cause scarring and shrinkage. Disadvantage is more costly treatment because treatment probes must be disposable and are relatively expensive.
Rubber Band Ligation: Consists of placing rubber bands around the base of the hemorrhoid causing strangulated tissue to fall off within four to seven days. This procedure is most effective for grades one, two, and some grade three hemorrhoids, and is relatively inexpensive.
Infrared Coagulation: Destroys hemorrhoidal tissue with a burst of light. This procedure, done on an outpatient basis, is effective for grade one, two, and some grade three hemorrhoids.
Sclerotherapy: Consists of injecting a sclerosing agent to create scar tissue to hold the hemorrhoid in place. This procedure is relatively inexpensive, can be done on an outpatient basis and requires few visits to the physician.
Cryosurgery: This procedure consists of freezing the hemorrhoids with nitrous oxide or carbon dioxide. This procedure may be done on an outpatient basis, is relatively expensive, does not have consistent results and often results in foul discharge, pain and loss of work time. This procedure is not frequently used.
Laser Hemorrhoidectomy: Consists of the use of either a Yag laser or CO2 laser to excise or vaporize hemorrhoid tissue. This procedure may be done on an outpatient basis, but is usually done in the hospital. It is expensive, effective for all grades of hemorrhoids, is painful, requires recuperation time, and has no advantage over surgical hemorrhoidectomy.
Surgical Hemorrhoidectomy: This consists of surgically removing the hemorrhoids. This procedure is effective for grade three and four, is expensive, requires hospital stay, is painful, and normally requires recuperation time. The procedure may be necessary for the most severe hemorrhoid problems.