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How to Cure and Remove HEMORRHOIDS

rexmadrigal · 70 · 109395

rexmadrigal

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Do you know that 90% of hemorrhoids can be treated as an office procedure?

Hemorrhoids are treated depending on the grading system.
Grade I hemorrhoids are those that are bleeding but with no protruding mass
Grade II hemorrhoids are those that comes out on straining but spontaneously reduce
Grade III hemorrhoids are those that needs to be manually reduced
Grade IV hemorrhoids are those that can't be reduced

Majority  of cases are Grades I-III. These cases can in most circumstances can be treated with an office procedure called rubber band ligation.

Don't be afraid this is not a painful procedure. It uses a rubber band ligator to apply the rubber band and consequently leading to the elimination of hemorrhoids.

I personally operate only on Grades III and IV.

This is your colorectal surgeon speaking.
Posted on: Feb 12, 2010, 08:11 PM


This is one of the worst cases of hemorrhoids which is a Grade IV. Normally, surgery is the only option but due to advance age and medical co morbid factors, rubber band ligation was applied.



The first rubber band was applied using a rubber band applicator on the selected hemorrhoidal pile.



Several bands applied on other piles.After 1 week, the results are dramatic.
I'll see if I can post the results.



brownie

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Wow sir, nakakatakot naman to tingnan.... tanong lang,
ano ba yung kadalasan cause ng hemorrhoids at paano to maiwasan?
Thanks 4 the info!


rexmadrigal

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Brownie,

Thanks for the interest.

I posted those pictures not to scare anyone but rather to educate our members regarding hemorrhoids which if not properly cared of, might lead to serious cases like the one I posted.

Hemorrhoids are actually normal cushions for individual's adoptation to passage of stools.

Anything that can make you constipated will lead to symptomatic hemorrhoids.

Lack of fiber intake leading to constipation would be the main culprit.

Presence of anything that can delay passage of stools leading to constipation.

Tumors in the distal rectum.

Pregnancy especially during the later stages.

HOW TO PREVENT IT?

PERHAPS YOU WANT TO  ASK!


Shaun

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yes, doc how can we prevent this to happen?...one more thing doc, can a senior citizen still undergo this kind of surgery?  :thankyou:
« Last Edit: Oct 20, 2010, 01:47 AM by FutureGizmo »


rexmadrigal

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Shaun,

First, how do we prevent this.

The key here is a high fiber diet. Remember, anything that comes out from down there has something to do with what came in.

To prevent hemorrhoids is to prevent constipation as what I posted on the topic on colorectal cancer.

When we say high fiber diet, it means a daily dose of green and leafy vegetables. The nice ones are malunggay, pechay, talbos na kamote, kangkong, etc. Together with your usual daily meal, add these.

You can have fruits also instead of vegetables. Fruit that are rich in fiber like the ponkan, oranges, etc. Siempre the usual papaya that we all know.

ADD TO THESE is the water intake. It's not just 8 glasses of water. It depends on the humidity, temperature, and the activity that you have. I always tell my patients to buy a 2 liter bottle of mineral water so they can monitor their intake. Make sure you finish it from 7am in the morning to before 7am the following day.

Activity has something to do with constipation also. Regular exercise will definitely improve bowel movement.

If you follow these three important rules, then you have a great chance of not being constipated.

A nice stool is like a jumbo hotdog, soft, formed stools that comes out after a little push that will not last 5 minutes. I mean when you feel it, it goes out right away in one batch.

A NICE DAILY ROUTINE LIKE THESE will most likely prevent hemorrhoids which is caused by anything that makes you constipated.

FOR ELDERLY, yes it can be done and the picture posted was that of an elderly patient. Operating on elderly patients require added preparations before the procedure and definitely, yes, it is being done.

There are by the way a lot of fiber substitutes in the market  if you can't eat vegetables and fruits on a daily basis. Senna concentrates and psyliium fibers are the best. Most so called cleansers are actually just liquid solutions of Senna concentrates and psyllium. Don't waste your money on buying these. Just take two senokot tablets before bedtime or stuff like fibermate, etc.
« Last Edit: Oct 20, 2010, 01:47 AM by FutureGizmo »


brownie

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Doc,

Marami, maraming salamat!   God knows, you have helped many people w/ this info.
« Last Edit: Oct 20, 2010, 01:47 AM by FutureGizmo »


ferrariEverest

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Doc rex,
thanks for educating other people about this. im very sure many are unaware of many points u've raised/mentioned. sana sundin nila yung mga sinabi mo:
high fiber (fruits & veggies)
water,
exercise.  :rakenrol:
for most people, mahirap kasi sundin kahit isa jan  :watchuthink:
ako takot ako magkasakit, so super health conscious ako.  :hihi:


Quote
A nice stool is like a jumbo hotdog, soft, formed stools that comes out after a little push that will not last 5 minutes...

thanks for mentioning this.
from what i know, 'healthy stool' nga yung stool na 'isang buo parang hotdog' pag lumabas. yung stool na parang 'stool' ng kambing, totoo po ba talaga na 'unhealthy' yun?
also, is there such thing as a 'healthy stool color'? brown stool, perhaps? kasi may naririnig ako dati na iba ibang kulay na stool, like green, blue, red, yellowish, etc
do u know what each color indicates?

anong libro po ba ang nagdidiscuss nito? any books that u can recommend? (note:  i have no problem with medical jargons)
Thanks Doc!


rexmadrigal

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Ferrarieverest,

You are right, it seems that the three guidelines are quite hard but looking at it, a little exercise, 2 liters of water, and a high fiber diet( this can be substituted with fiber supplements like senokot  daily), is not hard as it look.

There no such thing as a healthy colored stool which can either be yellowish, greenish or brownish.

Ash colored is no no which means blockage of bile which connotes biliary obstruction.

Reddish, bright red that is(hematochezia), means bleeding somewhere down the rectum which most often are hemorrhoidal in origin or worst, distal rectal cancers.

Black the so called alkitran(the one for asphalt) is what we call melena. This means the blood was mixed with bile resulting to degradation of red cells. This can either be upper GI bleeding or a tumor or lesion arising at the right side of the colon

Posted on: Feb 28, 2010, 12:54 PM


As I promised, this is the result of rubber band ligation for 4th degree hemorrhoids on an elderly patients with heart problems.

This is one week post ligation and as you can see, much of the edema had sibsided and it do look better that before treatment.

Posted on: Feb 28, 2010, 01:42 PM


A circumferentially prolapsed 4th degree hemorhoids that can only be treated with a so called "Whitehead operation"


Hemorroidal pile being dissected from the dentate line with removal of all hemorrhoidal plexuses.





Flap sutured back at dentate line after removal of all piles.

This is a technique used for advanced cases of hemorrhoids specifically 4th degree circumferentially prolapsed. It is a little bit harder than the usual hemorrhoidectomy but if done properly, it offers an immediate relief of symptoms.

Rarely is there a need for such operation. In fact I only do it once or twice a year but with good results.
« Last Edit: Oct 20, 2010, 01:49 AM by FutureGizmo »


ferrariEverest

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Ferrarieverest,
You are right, it seems that the three guidelines are quite hard....

Thanks sa infos doc

1 of my Q's was about stool 'shape'.
Quote
from what i know, 'healthy stool' nga yung stool na 'isang buo parang hotdog' pag lumabas. yung stool na parang 'stool' ng kambing, totoo po ba talaga na 'unhealthy' yun?


also, naituro ba sa inyo kung totoo yung idea na ang lumulutang na stool ay 'healthy' while yung lumulubog na stool ay 'unhealthy'?

Thanks!


rexmadrigal

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Ferrarieverest,

First the shape of the stools. What we need to achieve is a well formed soft stools. For that we need a base for the stools to form, to become bulky and that's what we call bulk formers. We get these from vegetables and fruits. Why do we need bulky stools that are well formed but soft? So you can have that nice jumbo hotdog. When you fell the urge, if you have a "jumbo hotdog" then it can come out fast and with just a little straining.

Goat like stools are danger signs. It is mostly associated with colorectal cancer. It forms that way because once you have an intraluminal mass causing obstruction especially circumferential, then the stools take that shape and since it's causing obstruction, then it stays longer on the vault before you can push it out.

Champorado like stools can also be a bad sign especially if you see those blood admix with the stools.

For later stages of tumor obstruction you can have watery stools. Only this type can come out from the obstructing tumor.

Now for the floating stuff. To be honest, stools that float mean there's a lot of fat content. That's what we call steathoreic stools. When you eat fishes like gindara, or had a fatty meal like litson, you'll notice there would be a floating casino there in the bowl.

Again, thanks for your interesting question and hope to hear more from you.




bizzy

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hi doc, i just noticed in my company's healthcare benefits that they include these two:

Scalpel Hemorrhoidectomy
Conventional Hemorroidectomy

what's the difference of the two?

And also, totoo po ba na kapag mahilig daw sa maanghang nakakacause ng hemorrhoid??


rexmadrigal

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I am not really sure what it is. But when you say scalpel that means surgical knife which is the conventional way of doing hemorrhoidectomy. Meaning you cut out the tissues using a knife.

There are several ways of doing it. Some Uses cautery, some uses a stapler which is what we call stapler hemorrhoidectomy. The bottom line is how to remove these piles.


artsky

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doc yung red juice maganda sa bowel movement. mahal nga lang  :D


bizzy

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Ang naging remedy ko lang when  I was on my last term of pregnancy was pineapple juice (lots of it) and Senokot, recommended by my OB.  :D


rexmadrigal

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Yup you're right red juice, senokot. Any fiber supplement will do. Prune juice, etc.

As long as you have that jumbo hotdog, gone will be the hemorrhoids.


rexmadrigal

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A lot of pregnant women experience hemorrhoids during the course of their pregnancy. Fortunately, most of these subsides easily. There are however unlucky ones who experience severe pain and big bulge.

The reason for developing or aggravating a hemorrhoidal problem is pregnant women experience constipation especially when reaching full term because of the external compression brought about by a growing baby inside.

Make sure you drink plenty of water and have fiber in your diet to avoid this painful experience.



artsky

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nung una hindi ko matignan mga pics dito pero nasanay na din ako  :D


rexmadrigal

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What is a normal bowel movement?

A member ask me if it's normal that he/she goes to the bathroom after each meal.

The normal bowel movement is actually 3x a day to once every 3 days. These conditions are absolute as long as you don't have any other symptoms like hard, bloody painful defecation.

Bowel movement after each meal is what we call GASTROCOLIC REFLEX  which is a response to incoming food deposit. The brain sends signals for the colon to dispose it's contents to prepare for an incoming residue.
« Last Edit: Oct 20, 2010, 01:45 AM by FutureGizmo »


rexmadrigal

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When a patient complains of anything in the anus, the immediate reaction is  "I have a Hemorrhoid". When a physician evaluates cases like this, he thinks also of hemorrhoids as the culprit.

But do you know that the most common cause of painful defecation with blood is still a fissure?

Yup, a fissure which is essentially a cut in your anal skin due to over exertion during defecation.

Patients usually describes an episode of forceful evacuation and they felt something gave way. FISSURE IN ANO is an entirely different entity and is treated differently from hemorrhoids.


rexmadrigal

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A member asked about medical treatment for hemorrhoids and if suppositories really help.

Medical treatment for hemorrhoids is actually based on relieving constipation. Constipation can either be hard stools, painful difficult bowel movement or decrease in the frequency in a week. The normal bowel movement is 3x a day to every 3 days.

How to achieve that SUPER JUMBO HOTDOG STOOLS? Drink atleast 1.5 liters of water per day, eat green leafy vegetables like malunggay, pechay, talbos ng kamote, kangkong, etc. Or eat fruits like ponkan, oranges, papaya etc. Regular exercise.

Senna concentrate 2-3 tabs at bedtime or psyllium based drinks are recommended.

The truth about so called suppositories is they don't actually cure your hemorrhoids. They just lessen the inflammation but the hemorrhoids is still there.

Rubber band ligation is good for first to 3rd degree hemorrhoids.

Surgery for 3rd and 4th degree hemorrhoids.


rexmadrigal

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We might be surprised if I say that all of us have hemorrhoids.

Hemorrhoids are actually normal cushions that serves as a room for expansion in passing out large bulky stools.

However, complications arises that warrants treatment like thrombosis, bleeding, prolapse and severe pain.


rexmadrigal

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Congrats to PMT nice job on the new look.

Hemorrhoids though suffers the same old fate of being ugly and painful. Recently recruits from PNPA came to me for rubber band ligation having failed in their P.E. due to hemorrhoids. Glad my ligator was nicely fixed and was able to do several sessions.


rexmadrigal

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Which comes first, the chicken or the egg.

Sometimes a hemorrhoid is the presenting symptom of a patient with rectal cancer. Remember anything that will make you constipated will exacerbate a hemorrhoid so if you have this mass blocking the rectal outlet, hemoprrhoids may be the first symptom that will present.

BUT, A HEMORRHOID IS NOT PRECANCEROUS, MEANING IT WILL NOT DEGENERATE INTO A MALIGNANCY.


rexmadrigal

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To avoid constipation means eating 3 servings of vegetables in a day and not just any vegetables, it should be the green leafy ones


nel

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Doc, yun bang biguerlie pwede inumin ng taong may hemorrhoids? Wala ba side effects yun?


rexmadrigal

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As I said before, most slimming teas are there for profit.

are they really slimming tea? Well that's the greatest hoax among profit earners.

Biguerlai is just pure laxative containing senna concentrate. How much a tea cost? I have no idea but you take 2 senokots at bedtime gives the same effect.


nel

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^every night po ba iinum nung senokot? or kung constipated lang?


rexmadrigal

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The best ways to avoid constipation are the following, have vegetables the green leafy ones together with your regular meals like malunggay, pechay, talbos ng kamote, kangkong, etc, drink not less than 1500 ml of water a day, exercise.

You can also have fruits like papaya, ponkan, oranges,

If you cant have a regular fiber diet, then you take senokot 2-3 tabs at night daily because fiber is a requirement for good bowel movement.


nel

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rexmadrigal

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A patient recently underwent hemorrhoidectomy as a requirement for pre-employment. Nowadays, a mere presence of a second to 3rd degree hemorrhoids is an outright rejection of application. These are the cases that I recommend an office procedure rubber band ligation. It is cost effective and if can be done, has the same results as surgery.


nel

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^masakit po ba yan? wala po anesthesia pag rubber band ligation?


rexmadrigal

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Internal hemorrhoids are located in an area where there aresuppose to be less sensitive to pain.

Rubber band ligation is done on outpatient basis with far less pain but a little feeling of discomfort which is very much tolerable.


nel

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^eh pag external hemorrhoids po, kelangan ng surgery? pano pag both my internal at external hemorrhoids, pano po treatment nun?


rexmadrigal

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External hemorrhoids causes problems specially thrombosis. For employment purposes, d makakalusot even if external. However, normally you can not just have purely external hemorrhoids. Purely internal yes. Mixed hemorrhoids are treated practically the same. If the external component is big, then excisional hemorrhoidectomy is the best.


mlangseth

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Tinitingnan pala puwet ngayon bago magtrabaho???

External hemorrhoids causes problems specially thrombosis. For employment purposes, d makakalusot even if external. However, normally you can not just have purely external hemorrhoids. Purely internal yes. Mixed hemorrhoids are treated practically the same. If the external component is big, then excisional hemorrhoidectomy is the best.


rexmadrigal

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Privileged to hear you on a medical topic. Yes here in PHL (philippines), they now are so strict about these borthering to OA. Those hit by this are seamen, PNP and even domestic helpers.

The employers reason is simple,  it is a cause of wasted manpower hours in case those hemorrhoids develops complications like bleeding, thrombosis and prolapse.


mlangseth

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Wow...that is an eye-opener for me..mabuti na lang naka-abroad na....
Nakakahiya yata..tutuwad just to get a pre-employment clearance.
Well, if it's necessary, then what can the potential employees do??
Not much.
Thanks for the advise...


rexmadrigal

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I really don't know when it started, this ridiculous thing about pre-employment medical clearance. But in a way it has some sense since a lot of job hours will be lost in case a patient suffer thrombosis or complications during work.

On the other hand, I believe it is more of employers not wanting to shoulder hospitalization for this common stuff since they can assume it can be work related-especially for those lifting heavy objects. any form of straining will aggravate a hemorrhoidal pile.


rexmadrigal

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Some patients come back after 2 years complaining of recurrence of hemorrhoids after having undergone the procedure before. Primary hemorrhoids are the ones being removed most of the time, but there is such a thing as secondary hemorrhoids in between the piles that were previously removed. When a patient remains constipated, these piles come out.
« Last Edit: Dec 12, 2010, 08:52 AM by rexmadrigal »


puberer

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^ doc bakit hindi nalang pati yung secondary hemorrhoid ay tanggaling?  para wala nang recurrence. 



rexmadrigal

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That's an excellent question.

Why do surgeons remove the primary hemorrhoids only. Well you have to leave intervening mucosa so as not to develop strictures later on. Ordinary hemorrhoidectomy procedures entails excising the piles at the 3,7,11 o'clock postions. If a patient follows the regimen on stool softeners, secondary hemorrhoids should not come out.

I have operated on atleast 5 cases of strictures on patients who had surgery done by over enthusiastic surgeons from the US who did missions here in the Philippines. An advancements flap is needed to bring back the previous size of the anal opening.

In case of circumferential hemorrhoids which might be your concern, I do a special procedure which we call "Whitehead hwemorrhoidectomy". All the piles were removed using a flap technique which I have mastered through the years. This procedure if not done properly leads to worse complications.

So far I have done 12 cases of these in a span of 8 years for severe cases of hemorrhoids.
« Last Edit: Dec 12, 2010, 11:18 AM by rexmadrigal »


rexmadrigal

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Im back from the holidays and I miss you guys.

Anyway in some institutions, Stapled hemorrhoidectomy is available. If our reader's have time, you can see videos from you tube about this procedure popularized by Longno.

A newer procedure which claims to have  better pain control and less complications is TRANSANAL HEMORRHOIDAL DEARTERIALIZATION. This procedure uses an ultrasound to detect the offending vessel and with it the subsequent ligation of the said artery that leads to the elimination of the hemorrhoidal piles.

The drawback - COST.

« Last Edit: Jan 09, 2011, 08:01 AM by rexmadrigal »


rexmadrigal

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Unwanted stuff for your hemorrhoids,

SPICY FOODS, those with sili, alcoholic beverages, lifting weights, all meat diet, gindara fish(this gives you a very oily stools the following day).

GOOD FOR YOUR HEMORRHOIDS-green leafy veggies, oatmeals, wheat breads, fruits like oranges, ponkan, papaya, psyllium fibre, senna concentrates


puberer

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^ yan din pagkakaalam ko since nagkaron ng hemorrhoid yung friend ko.  iwas sa spicy foods and eat fiber rich foods.




rexmadrigal

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As I emphasized, minimum of 1.5 liters a day of liquids is needed and maybe more when it's hot.


rexmadrigal

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Easy remedy when that hemorrhoids is painful- have a sitz bath. Have that warm water and dip that buttocks. This will cause some relief of pain and also lessens the swelling.


cherrydog76

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My father has hemorrhoids and his doctor wants to remove them using laser surgery.  He is a little hesitant because he has had surgery in the past that hasn't went as planned.  He ended up getting a staph infection when he has knee surgery and wanted me to ask if there was a chance of infection from hemorrhoid surgery.


rexmadrigal

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Normally hemorrhoidal surgery does not require antibiotics except for elderly, immunocompromised, with diabetes, etc. I have done quite a number of these with no infection even without antibiotics. One of the easy outpatient remedy is a rubber band ligation which is done at the office.


vince07

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Based on testimonials helped cure from this kind
only ganozhi toothpaste with 1 week of application, marami na ang natulungan nito hindi lang sa pinas also abroad about 156 countries worldwide, trust me kung meron ka or may kakilala ka, ipadala mo tong mensahe ko, hindi mo kailangan gumastos ng malaki


rexmadrigal

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Not everyone is aware that all of us have hemorrhoids. Once it become symptomatic, treatment is required whether medical or surgical. Definitely a grade 1 or 2 hemorrhoids can be managed medically, but once it becomes grade 3, it will never resolve unless excised much so if it is 4th degree.


rexmadrigal

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I am having trouble with my photobucket I would have shared a picture of a rectal mucosal prolapse. A rectal mucosal prolapse is a complication of a third degree hemorrhoids where the rectal mucosa goes out and is misplaced. This condition requires not only a hemorrhoidectomy but an additional reconfiguration of that prolapse mucosa to return back to its opriginal place.


rexmadrigal

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A new way of removing hemorrhoids is thru Hemorrhoidal artery ligation which is very accurate and effective.


samvoy

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Doc Rex - have an ext hem and have been taking daflon 500. the hem is smaller now but I discontinued taking the daflon because of head ache, nausea and face allergies. I still have the hem and have not taken the daflon for about 1 week, though I still am using the faktu suppository.

I want to get rid totally of my hem. Can I go back again with daflon? or will i just use a faktu. It seems that the faktu cannot be used in prolonged time. I got a 5.38 potassium lately and i fear this is also one side effect of the drugs I am using. Please advise me doc. Thanks.

In the future i am thinking for a surgery for hem, How much is needed for hemorrhoidectomy?> Thanks again.


rexmadrigal

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any form of excisional surgery is the best option. Medications will temporize but eventually will require surgery. I do rubber band ligation of these piles at the clinic.

By the way we moved to the new Medical Arts building of UST. I am at suite 530


GoodSteward

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Doc Rex, how much is the  rubber band ligation? TIA!


rexmadrigal

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These are the options available for hemorrhoidal disease:
1. Dietary modification
2. Bulk formers/fibers/stool softeners
3. Rubber band ligation
4. Excisional surgery
5. stapler hemorrhoidectomy
6. Transanal hemorrhoidal dearterialization
7. any form of removal thru cauterization, cryosurgery etc
7.


rexmadrigal

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Mark my word, any patient who has a 3rd degree to 4th degree hemorrhoids will some point in their life have a procedure done for their condition.

Once a patient has hemorrhoids, temporizing solutions will later lead to surgery.


rexmadrigal

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The latest in as far as treatment of hemorrhoids is concerned is transhemorrhoidal arterial dearterialization.

In this procedure, ultrasound is used to detect the hemorrhoidal vessel and once identified is sutured.

Quite fast, reliable and less pain.


keso003

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HI doc i just want to ask how much mag pag rubber band ligation or excisional surgery


rexmadrigal

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You read a lot nowadays on different types of treatment for hemorhhoids. If amenable, i would still say that rubber band ligation is still economical than the rest


faz3418

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doc rexmadrigal,mga magkano po ang aabutin kapag nag pa opera ng hemorrhoids,may pag asa po ba maging normaal ang external hemorrhoids using natural remedy,


Shei80

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Doc Rex,magkano po mgpa rubberband ligation for hemorrhoid?Tia


Patast

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Hemorrhoids is a very dangerous and painful disease. I have seen a lot of people suffer because of it. I don't who what is the proper treatement for it. The world is so prone to diseases that we should do complete body chech-ups atleast once a year. There is no alternative to better health.


dmarco25

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Hi ,

Good day!

I have Hemorrhoids and after 2 weeks medication, I still feel the pain and whenever I touch my anus I feel like their is a part that is outside and I am really nervous about this. Does this lead to surgery? though It's not bleeding. How much would it cost for surgery?

Thank you!


dmarco25

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Hi Gud day! 

I hope someone can help.  :(

it really bothers me.
Doc please help.
« Last Edit: Feb 17, 2019, 09:50 PM by dmarco25 »


rexmadrigal

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Hi dmarco sorry i had a hard time trying to recover my login data but finally im back.
You seem to be suffering from severe pain most likely from a fissure in ano, chronic type. I do love to discuss your treatment options if you have time at my UST clinic suite 530. Im there tom and wed and saturday. Surgery gives you the best chance for curr


rexmadrigal

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Sorry guys i was not able to reply to your querries for i was iut of the loop for sometime.
Anyway the most common mistake is to think that hemorrhoids is synonomous to anal pain. Definitelynot not. On the otherhand, chronic anal fissure is asaociated with severe pain


dmarco25

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Hi doc,

Thank you for giving attention.

UST school po ba?  How much po kaya surgery?
I'm afraid I don't have enough money for surgery.

Lately I noticed medyo nagsubside na po ang pain pero meron pa rin and meron na parang laman na lumalabas everytime magpoops ako.

Thank you in advance po.


dlf

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Dok Ano po yung araw at time  office or clinic mo po  sa NAGA?At anong hospital din po.Thanks


kuray08

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Doc, may ka kilala ako, ginamit nya lang ay toothpaste na gawa sa propolis, galing Korea, gumaling ang kanyang almoranas, gawa ang propolis na ito sa Beehive .. ano po ang paliwanag nyo dito? salamat po


 


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