Hemorrhoidal rubber band ligation remains the gold standard for the treatment of complicated hemorrhoidal disease. From a patient point-of-view, the traditional technique is fraught with the real potential for significant complications as well frequent discomfort felt by the patient following the procedure. Mostly, the pains felt are related to placement of the bands in hemorrhoidal tissue that is in close proximity to sensory nerve enriched areas. A newer rendition of the classic approach to hemorrhoidal banding was invented in 1997 by laparoscopic surgeon Dr. Patrick J. O’Regan. The CRH O’Regan System represents a significant advancement in rubber band ligation. Fifteen counts of new technology are incorporated in the patents for this next-generation device, which dramatically improves upon traditional instrumentation.
Notably, the CRH O’Regan System is the first entirely disposable, single-use device for hemorrhoid removal. Cleared by the FDA in 1997, the CRH O’Regan procedure is 99.1% effective and can treat approximately 95% of all hemorrhoid patients.
A large 2005 prospective study of the CRH O’Regan System reported the lowest complication rate ever published at 16 out of 5,424 procedures, or 0.3%. Post-band bleed occurred in 8 patients (0.15%), post-band pain in 3 patients (0.2%) and post-band thrombosis in 5 patients (0.3%.). No other complications were observed.
Compared to conventional rubber band ligation, these figures demonstrate a ten-fold reduction in complications. Beyond this significant advance, the results showed the CRH O’Regan System to have lower recurrence (4.8%) than previous banding techniques (12%) or even hemorrhoidectomy (5-8%). A follow-up study in 2010, of 20,206 rubber band ligations in 6,690 patients confirms the 2005 study with 13% recurrence at mean of 42 months.
It remains that hemorrhoidal banding provides a greater long-term success in the treatment of hemorrhoidal disease and can be used in more advanced forms of complicated hemorrhoids.
It's True! More than ten million people visit a physician in the US each year with symptoms of hemorrhoids. Three out of four people will develop hemorrhoids at some time in their lives. While many people associate hemorrhoids with painful surgery, only a small percentage of patients actually require surgery. New comfortable office treatments have taken the fear out of hemorrhoids. This information has been prepared to help you understand them.
Most hemorrhoidal conditions, which are manifested by anorectal discomfort with or without rectal bleeding, are frequently managed successfully by increasing the water intake in diet as well as increased fiber. Fiber supplements such as psyllium can be used to increase one's dietary fiber intake. IRC is a widely accepted modality for the treatment of hemorrhoids, however, therapeutic interventions should follow conservative treatment. As with all cases of rectal pain and bleeding, the exclusion of cancer is paramount.
Hemorrhoids are swelling in the rectum or anal area that may protrude through the anus on straining. They usually contain enlarged veins and are most common in people over the age of 50.
Hemorrhoids can often be felt as a swelling in the area of the anus. There may be soreness, bleeding, discharge or itching.
We don't know for sure, but hemorrhoids are often found in people who either sit or stand a lot or who have low fiber diets or poor bowel habits.
No one knows for sure. Avoid straining or extensive sitting on the toilet. A diet rich in fluids, fruits, vegetables and fiber is desirable. If symptoms develop, see your doctor without delay.
Yes. "Internal" hemorrhoids develop inside the anus. The most common symptoms are bleeding during bowel movements or protrusion through the anus upon straining. "External" hemorrhoids develop around the anus and can be very painful, especially if a blood clot develops within them. They can be felt as a firm lump or lumps around the anus.
When treated early, hemorrhoids usually disappear within a week or two. By increasing fiber and fluids in your diet, your stool will soften thereby promoting more regular bowel movements. It also helps to eliminate excessive straining and to take warm baths. Most painful external hemorrhoids will responds to rest and warm sitz baths. Within a week the pain should subside. The firm lump should completely recede within 4-6 weeks. If pain is severe, the physician may decide to make a small incision under anesthesia and remove the clot to provide immediate relief.
Internal hemorrhoids can be treated in the doctor's office by ligation. A small rubber band is placed around the tissue above the hemorrhoid to cut off its blood supply. The hemorrhoidal tissue and band slough off a few days later and the sore that is left will heal. The CRH system produces mild discomfort and rare bleeding.
Infrared Coagulation(IRC) is the most widely used office treatment for hemorrhoids and is preferred over other methods because it is fast, well-tolerated by patients, and virtually problem free. A small probe contacts the area above the hemorrhoid, exposing the tissue to a burst of infrared light for about one second. This coagulates the veins above the hemorrhoid causing it to shrink and recede. The patient may feel a sensation of heat very briefly, but it is generally not painful. Therefore anesthetic is usually not required.
Generally not after either of the rocedures. Most patients return to a normal lifestyle the same day. There may be slight spot bleeding a few days later. Heavy straining or lifting should be avoided for a week and aspirin should not be taken for at least few days if feasible.
Many patients have more than one hemorrhoid. Therefore, most physicians recommend two or three visits at two week intervals, treating a different portion of the hemorrhoid tissue each visit.
Millions of patients have been treated with these nonsurgical techniques. Experience tells us that hemorrhoids treated do not recur as long as a high fiber diet is maintained along with plenty of daily fluids to ensure a proper bowel habit.
Optimal Nonsurgical Treatment of Hemorrhoids: A Comparative Analysis of Infrared Coagulation, Rubber Band Ligation, and Injection Sclerotherapy
Despite an abundance of nonsurgical hemorrhoid therapies, none has been consistently more efficacious. By combining data from multiple clinical trials in a meta-analysis., the present study compared the efficacy and complications of infrared coagulation, injection sclerotherapy, and rubber band ligation to determine the optimal non-operative hemorrhoid treatment.
All published clinical trials comparing the three methods were identified by computer search and review of appropriate English language journals. Five trials studying 863 patients satisfied all inclusion criteria. Results demonstrated that similar numbers of patients wee asymptomatic 12 months after treatment , regardless of initial therapy. However, significantly fewer patients undergoing rubber band ligation required additional treatment because symptoms had recurred.
Although rubber band ligation demonstrated greater long-term efficacy, it was associated with a significantly higher incidence of post treatment pain. In contrast, infrared coagulation was associated with both fewer and less severe complications. Thus, when all factors are considered, infrared coagulation may in fact be the optimal non-operative hemorrhoid treatment.
Reference: The American Journal Of Gastroenterology Vol.87.No11.1992