Hemorrhoid Band Ligation

What are hemorrhoids?

Men and women alike have hemorrhoids, they occur naturally in the body.
Hemorrhoids or "anal cushions" are a complex of blood vessels in the
anal canal. These cushions are part of the normal anatomy and are
thought to aid in defecation and assist in closing the anal canal.
Hemorrhoids are custom cushions where blood flows in and out to swell or
shrink the tissue to provide continence. 

Over time these cushions can enlarge with straining or extended time
spent on the toilet which thins the overlying mucosa and produces
bleeding with bowel movements. As they continue to enlarge they can
prolapse or protrude from the anus. 

CONSERVATIVE TREATMENTS:

Conservative treatment of hemorrhoids consists of educating patients on
the main causes of enlarged hemorrhoids and correcting them. Simple
treatments such as fiber therapy, taking all of the reading material out
of the bathroom, not straining to have a bowel movement and weight loss
can make a difference and allow patients to avoid surgery for their
hemorrhoids. 

HEMORRHOID CAUSES:

* Increased straining during bowel movements
* Sitting too long during bowel movements
* Pregnancy - increased straining, hypertension, delivery
* Constipation and diarrhea
* Obesity 

HEMORRHOID TYPES AND SYMPTOMS:

There are two types of hemorrhoids, internal hemorrhoids [3] and
external hemorrhoids [4]: 

INTERNAL HEMORRHOIDS are inside the anal canal and generally do not
cause pain. The most common symptom of internal hemorrhoids is bright
red blood - in the stool, on toilet paper, or in the toilet bowl.
Additionally, an internal hemorrhoid may form and prolapse outside the
anus and become irritated and painful. This is referred to as
"prolapsing" hemorrhoids. 

PROLAPSED HEMORRHOIDS: These are internal hemorrhoids that are so
distended that they are pushed outside the anus. They may spontaneously
reduce or be manually reduced. If the prolapsed hemorrhoid cannot be
gently reduced, consult with a doctor to discuss the treatments. 

GRADING OF INTERNAL HEMORRHOIDS: 

     * 1ST DEGREE: The hemorrhoids do not prolapse.
     * 2ND DEGREE: The hemorrhoids prolapse upon defecation but
spontaneously reduce.
     * 3RD DEGREE: The hemorrhoids prolapse upon defecation, but must be
manually reduced.
     * 4TH DEGREE: The hemorrhoids are prolapsed and cannot be manually
reduced.

THD is indicated for symptomatic internal hemorrhoids, degree 2nd, 3rd
and 4th. 

EXTERNAL HEMORRHOIDS are found outside the anus. Some form blood clots,
bright red blood is seen on toilet paper or in the toilet after a bowel
movement and often a lump on the anus presents outside the body. With
external hemorrhoids, you may experience itching, bleeding and painful
swelling. 

In most cases, hemorrhoids go away on their own. It is important to
discuss all anorectal issues with a physician so they can diagnose the
problem correctly. 

HEMORRHOID TREATMENT OPTIONS

CONSERVATIVE TREATMENT OPTIONS:

The level of treatment is based on the degree of the hemorrhoid [5]. THD
is indicated for symptomatic internal hemorrhoids, 2nd, 3rd and 4th
degrees.Consult a physician [6] to discuss the various treatment
options. 

     * 1ST DEGREE: Because most hemorrhoids "shrink" or heal on their own,
conservative therapy will often reduce the symptoms. Lifestyle
alterations, dietary changes, topical ointments and mediations may be
needed. Additionally, sclerotherapy or infrared coagulation may be a
benefit.
     * 2ND DEGREE: Lifestyle alterations, dietary changes, topical
ointments and mediations may be needed. Sclerotherapy, infrared
coagulation, as well as, banding may be a benefit. Problematic II Degree
hemorrhoids may require hemorrhoidectomy or THD( tm ).
     * 3RD DEGREE: Lifestyle alterations, dietary changes, topical
ointments and mediations may be needed. Additionally, they may require
hemorrhoidectomy, stapled hemorrhoidopexy or THD( tm ).

    * 4TH DEGREE: Lifestyle alterations, dietary changes, topical ointments
and mediations may be needed. Additionally, they may require
hemorrhoidectomy, stapled hemorrhoidopexy or THD( tm ).

THD™ - THE MINIMALLY INVASIVE TREATMENT OPTION:

THD™ – TRANSANAL HEMORRHOIDAL DEARTERIALIZATION
THD( tm ) uses a Doppler to locate the terminating branches of the
hemorrhoidal arteries. Once the artery is located the surgeon uses an
absorbable suture to ligate or "tie-off" the arterial blood flow. The
venous " out flow " remains to "shrink" the cushion. This is done without
excision of tissue. If necessary the surgeon will perform a
hemorrhoidopexy to repair the prolapse. Again, this is done with suture
and no excision of tissue. This repair restores and "lifts" the tissue
back to its anatomical position. 

The entire procedure is performed above the dentate line so that there
is minimal discomfort. The procedure takes about 20 minutes and is
offered as an out-patient surgery.