hemorrhoids

[-scott-]

what a fun issue. *sigh* i'm 3.25 yrs post, c6/7. anyway, i've been dealing w/ hemorrhoids for the past year or so, but recently they're getting progressively worse. i know this is a fairly common issue among sci folks, but have any of you had problems? if so... in what way? how have they affected you physically? have they affected bowel routines in any way? and... for the news i'm not too sure i want to hear... if they've been bad enough, what treatments were administered? thanks in advance...

[SCI-Nurse]

jmublueduck - At your level of injury, I am wondering if your comment "they have gotten worse" is related to problems of bleeding and/or AD. Hemorrhoids in SCI are common since most bowel routines involve suppositories, mini-enemas and digital stimulation. Some suggestions: 1)If you are having either of the two symptoms mentioned above, you should be seen by your doctor. 2) Digital stimulation - should be a gentle circular motion with an index finger that is gloved and well lubricated. This needs to be only long enough to relax the anal sphincter and stimulate peristaltic action 3) Your diet should include adequate fluid intake which should be at least 8 - 8oz glasses of water daily; this amount should be exclusive of caffeinated or alcoholic beverages as these act as diuretics and will deplete your body's fluid balance. A good fluid intake will contribute to a softer stool as will foods that are high in fiber content. 4) Are you using a stool softener; if not I would urge you to discuss this with your doctor.

And yes, if the hemorrhoids become unmanageable, then surgical removal may be the next step. But before you worry about that, be sure that you are doing all that you can to minimize irritation to these. If you have not seen a doctor recently re: this concern, I would urge you to do so. CRF

[-scott-]

(sorry to all reading this who may be a bit grossed out by any mental images - i know it's not the most pleasent subject)

SCI-nurse:
"they have gotten worse" refers to the fact that they have increased in size and number. very infrequently does bleeding occur, and I have never gotten AD from them. you're pretty on target w/ your suggestions; I follow them, w/ maybe the exception of monitoring my water intake, which i'm pretty sure is near what's recommended.

i saw a doctor over spring break (2 wks ago) and he looked at them & pretty much said not much could be done at this point... just to make sure i have enough fiber in my diet to soften the stool, in order that the BP goes as quickly as possible (I'm on a shower chair, which isn't too friendly to them).

regarding the "type" of hemorrhoids - am i correct in saying there are internal as well as external ones? reason being is that my PCA recently (w/in the past 2-3mo) noticed a larger hemorrhoid *inside* that apparently sticks out following sitting on the shower chair for any duration (in addition to >3 external ones). w/in the past week a 2nd, smaller internal one has appeared. any thoughts on this?

btw SCI-nurse, i have a few digital images if they would help at all. if they would, please email me @ jmublueduck@yahoo.com & i'll send them to you off-list.

[smokey]

I am currently having my internal roids ligated or banded. They were bleeding when I'd crap. You won't feel a thing except a little clammy sensation for a few days. You have to go a few times til they nip it down to nothing I guess. I also have an external roid that makes me feel clammy when I crap. The colo-rectal roid doc isn't real keen on popping that sucker out because you have to stay off it for a couple weeks and do sitz baths-kind of impossible for a guy in a wheelchair.

[Chunkyvomit]

Try Witch Hazel and Anusol Gel. The Witch Hazel is a liquid you pour on a cotton pad and gently apply to the hemorrhoids after each bm. Soak pad well (Makeup remover pads are perfect) and hold on the anus area for 2-5 min. The Anusol is an ointment. After the WH, apply the cream and gently push the hemorrhoids back in the rectum so you're not sitting on them. As mentioned elsewhere, drink lots, eat high fiber diet.

[-scott-]

thanks for the tips all.

chunkyvomit (interesting name, btw) or anyone: what's the objective of witch hazel? i just got some "tucks" pads w/ a 50% witch hazel content & started usingthem this morning.

things are still rough... the roids hurt & i'm scared they're not going to get better - just worse.

ah... what i'd give up for my body to work as it was created to... oh well. i'm going to bed. be blessed, all...

[TimS]

I developed this problem back in 1994. I started taking 100mgs of grape seed extract daily and in about 10 days the pain and problem was gone. Been taking it ever since and the problem has never returned.

Tim
http://2tim.net

[-scott-]

hey, that idea sounds like it's worth a shot - seems easy too. thanks for the tip TimS! how's it affect your diet (if at all)?

[Chunkyvomit]

I don't know the specific action or ingredients of Witch Hazel but I believe it has an affect on the swelling. I wonder if the tucks you mentioned, with a 50% WH solution, is ok. Buying a bottle of WH and applying it to a cotton pad may have a better affect as the solution isn't watered down... That's what my Dr. told me to do and he's a god in the treatment of sci patients circle.

Anyhow, hope it works for you. I know what a pain in the ass it can be.

[-scott-]

Originally posted by Chunkyvomit:

I wonder if the tucks you mentioned, with a 50% WH solution, is ok. Buying a bottle of WH and applying it to a cotton pad may have a better affect as the solution isn't watered down...

good point... I'm surprised I looked that over. I've only been using them 3 days & I haven't expected overnight results... but yeah, I agree w/ the concentration issue. ugh.

thanks...

[angel7]

jmublueduck,

I posted a topic on the Life Forum about my experiences with hemmoroids. It's called, "Isn't Life Grand."

Hope it helps.

Deb

[TimS]

hey, that idea sounds like it's worth a shot - seems easy too. thanks for the tip TimS! how's it affect your diet (if at all)?[/QUOTE]

It doesn't affect your diet, in fact it's an excellent supplement to take because it's great for circulation. Here's some info on it:
http://www.nutriteam.com/grapeseed.htm

Tim

[angus]

I deal w/ internal Hemorrhoids.... they suck! But my MD gave me a script for PROCTO-FOAM and there gone...

[crags]

Went to the roid MD today with the resolve to get them banded, based on the info posted here. He said he would do it, but should any manual stim accidentally dislodge it and rip off the pinched off roid, I'll have bleeding the likes of which I've never seen out that end before, plus I'll have to get in promptly to get the bleeding stopped.

Is this overexaggerated in terms of danger?

[SCI-Nurse]

crags - what is your injury level and how long have you had hemorrhoids? Have you had any conservative treatment for them? Does your diet include a good intake of fiber and fluids, both of which will result in a softer stool and therefore less irritation of the hemorrhoids.

Hemorrhoids are actually enlarged and tortuous walls of the hemorrhoidal veins in the rectum. Therefore, hemorrhoids are a condition of the vein wall; if disrupted, there will be bleeding. However, for a hemorrhoid to be "ripped" by manual stim, seems a bit of exaggeration as digital stim should be being done, with a gentle circular motion and a well lubricated finger or assistive device. Dig stim should not be a lengthy process, but rather for 15 to 20 seconds until peristalsis is activated (stimulated) or triggered. CRF

[crags]

I'm C7 for 14 years and do everything the right way in terms of food, fluids, fiber, stool softener, timing, minimizing digital stim, then doing it gently. Despite all of this it seems my bowel action has been slowing down to almost zero contractions in response to the suppository (therevac, now bullet for sev yrs). It's like they just died. They used to drop out on their own, now never, requiring more stim. After a suggestion, I've found circular gentle pressure on the outside of the anus often triggers a relaxation of the sphincter. This has cut my internal traumatic stim down at least 50%.

Regarding the "ripping" of the hemorrhoid. The rectal md thought that the ligation banding would result in a prominant "head" of the hemorrhoid that by it's supposed purpose, would be prominant and prone to disruption by stimulation, despite one's care.

Personally, after having limited success of the years with injections, I'd like to get banded. It's more of a final answer. I just don't know whether I should be concerned about the risk. I feel my caregivers would be able to stay away from that side and manage it.

[smokey]

Try the banding process. I'm currently having it done for internal roids and it is nothing. That's a bunch of crap that you'll crash and bleed like a rat on Decon if the roid gets ripped off. They fall off naturally a couple days after the banding procedure anyways. Just be a little more gentle with the digital stimulation for a couple days after the banding.

[alan]

I'm curious - how do they do these various procedures? I'm not asking for medical textbook details - simple descriptions will do.

My roids protrude after the bowel program is done, but retract after a while. Would I be a candidate for any of these procedures?

[Foolish Old]

psst... this was an issue in 2002... resolved now.

check the dates. Care to share the resolution?

[-scott-]

Care to share the resolution?
got a colostomy & eliminated the trauma to that area.

...and that increased my independence 10x too.

[Foolish Old]

got a colostomy & eliminated the trauma to that area.

...and that increased my independence 10x too.Thanks for the info.

[Le Type Français]

Scott, may I ask if you it reversed? You're not obligated to answer such person questions, so feel free to not do so.

[-scott-]

I have no desire to reverse it at this point. It's so much easier to manage than my previous bowel program & there's very little concern about accidents in public if I eat something my body doesn't like. I irrigate every other day & slap a mini pouch or a patch on, typically w/o any discharge until the next time I flush it out.

The pros outweigh the cons by a long shot for me.

[rdf]

Mine are very bad. I keep putting off getting a hemorrhoidectomy, but will have to get it done soon. I'm not a candidate for banding.

I imagine I'll make it another few years before I go the route -scott- went - sounds like a good solution.

Things start going to hell after 25 years in the chair - this is one of many problems I've been hit with the last couple of years. But god knows most peeps with SCI have it worse than I, and they're not bitchin, just getting on with life as best they can. I'll try to better emulate their attitude.

[Le Type Français]

Got you, I'd have done the same, Scott. Might as well as it seems far easier.

[SCI-Nurse]

You are not the first to make that suggestion for the exact reasons that you stated. Glad to hear that you are happy with your decision.
CKF

[lynnifer]

Things start going to hell after 25 years in the chair - this is one of many problems I've been hit with the last couple of years. But god knows most peeps with SCI have it worse than I, and they're not bitchin, just getting on with life as best they can. I'll try to better emulate their attitude.

In complete agreement here. Paralyzed at 12 and by 31, 32 things started to be problematic. It's been downhill ... I still have hope to get back where I was but I think it's going to take an awful lot of work (and not shift work!)

[MartyDavis]

I'm 30+ years post-injury, T-4 complete and over the decades my hemorrhoids gradually worsened to the point of contemplating surgery.

I spoke with many physicians, was evaluated in several clinics specializing in hemorrhoid treatment. I had three options:

A complete hemorrhoidectomy. Just short of an autopsy in the amount of cutting required, this surgery is still considered the gold standard in treatment of hemorrhoids. It's too bad that the surgery is so intense and the recovery period so long.

Procedure for Prolapsed Hemorrhoids (PPH), also known as a stapled hemorrhoidectomy. While this is much easier on the body and has a much shorter recovery time, there were many possible side-effects I did not like (loss of continence). Long-term studies indicated that it actually had more complications than a regular hemorroidectomy. (As a side note, the physician who performed my procedure ceased offering PPH after seeing the deleterious effects, even though he had been a proponent.)

Dopper-Guided Hemorrhoid Arterial Ligatation with Rectal-Anal Repair (DGHAL-RAR). This outpatient procedure is quick, nearly painless and offers nearly the same relief from hemorrhoids as a hemorrhoidectomy.

Since I had Stage 3 hemorrhoids I had to choose one of the above as rubber-band ligation, infrared coagulation, and other treatments would be ineffective.

On January 31 I underwent the DGHAL-RAR procedure and went home the same day. Very easy, no problems, no complications. Before the surgery I experienced very bad bleeding on several occasions and really wanted to stop that.

In the six months since the procedure I've been very pleased. Although my prolapse still occurs, the major bulk of hemorrhoids are gone. The prolapse is only temporary now and quickly retracts once I'm off the toilet.

I would very highly recommend checking out this procedure. It's well established in Europe and Asia and there is copious documentation and long-term studies.

[EyesOfTexas]

Dopper-Guided Hemorrhoid Arterial Ligatation with Rectal-Anal Repair (DGHAL-RAR). This outpatient procedure is quick, nearly painless and offers nearly the same relief from hemorrhoids as a hemorrhoidectomy.

...

On January 31 I underwent the DGHAL-RAR procedure and went home the same day. Very easy, no problems, no complications. Before the surgery I experienced very bad bleeding on several occasions and really wanted to stop that.

How is this different from the typical banding that is done on hemorrhoids?

[tarheelandy]

I had them before I was injured, but they sure are worse since my injury. I understand how I got them from straining before, but I don't get why we have them as SCI"S when we are doing dig stem( and thus, no straining)? There is no straining involved....And, is it when they start bleeding that you need to get concerned?

[SCI-Nurse]

You really need to get concerned before they start bleeding, but most of us always put things off until we can't take it anymore. Make sure that your diet has plenty of fruits, veggies and fluids in it - that always helps. And keeping your stool soft should also make a difference. The dig stim aggrevates the tissue, much like straining does - thus aggrevating the hemorrhoids.

CKF

[MartyDavis]

How is this different from the typical banding that is done on hemorrhoids?

Banding is only a viable treatment for small hemorrhoids up to second-degree, but it cannot be used for the larger ones.

[Anand1]

I am a T-6 complete paraplegic, 10 years post injury. I have had hemorrhoids for the past three year.In 2008, I consulted a colonrectal surgeon who put a scope in to confirm that it was only hemorrhoids causing the bleeding. He advised me to use Preparation H cream at the end of the bowel program and ensure a proper diet with iron supplement tablets on alternate days. This worked out for the most part until three weeks ago when I started having copious bleeding in the middle of the bowel program. it was a lot of blood that stopped only after I was done with the end of the program. There was no bleeding in between programs. I have no sensation in the area so pain is not an issue. I consulted the surgeon again. I have Grade III circumferential Hemorrhoids. I am also anemic [Hemoglobin of 10]. He advised me to undergo PPH [stapling hemorrhoidectomy].
He also told me that it would be best that I do not do my routine bowel program [every alternate day with 1 magic bullet supp & dig stim] for 3 weeks until it healed. His nurse suggested that i use fleet enema. I am incontinent and fleet enemas work only if it holds up in your rectum for the required duration of 5-10 minutes. Additionally, its extremely difficult to determine if you are done with the program without inserting a gloved finger.
Marty Davis, in his note, suggested DGHAL-RAR. While it seems to be a better procedure. It is not offered in Urbana, IL [where I reside]. There is only 1 surgeon in the midwest who does it. He is based in Chicago and attached to Rush University.
Could anybody provide me information on the post op bowel management program? Are there any dos and dont's I need to keep in mind? How long did it for it to settle down? Due to no sensation, pain is not an issue. Is the stapling procedure more prone to postop complications?
Thanks a lot in advance for any advise offered.

[hlh]

We are dealing with this issue for my father as well. He has additionally developed rectal prolapse, so it is just getting worse and worse for him.

Can you tell me who the doctor is at Rush that offers the less invasive procedure?

Good luck with your surgery and recovery.

My father is dreading the idea of surgery since he doesn't know how he can manage to post-op care if he can't do is bowel program. Are you going to have to hire assistance?

[SCI-Nurse]

We would never recommend the use of a Fleets enema for bowel care after any surgical procedure on the rectum.

Even without surgery, people with SCI who have no sensation have been known to do rectal damage with the tip of enema delivery systems.

We start bowel care 3 days after the procedure (with a full bowel clean out prior to the surgery and stool softeners started immediately post-op). We include laxatives (so there is more risk for accidents) and we do include suppositories, but not digital stimulation or manual removal for 7-10 days post op.

(KLD)

[xsfxsf]

Exactly what is the harm caused by these? My gastroenterologist said I should just leave them be. The bleeding is messy but not dangerous. And there is no pain thanks to the SCI.

[Anand1]

HLH,
I found out about Dr.Marc Brand from posting a query on a hemorrhoid website providing details on DGHAL-RAR.


After reading KLD's response, I am seriously considering his office. The surgeon at Urbana is very reputed but they seem to have no idea of postop management of PPH in paras and quads. I am considering getting a PCA for the initial postop management.
My insurance will not cover the procedure at Chicago so it will depend on how expensive the procedure is going to be.
XSFXSF,
You do not have to do anything about the hemorrhoids as long as the bleeding does not affect you. A procedure seems to be required when you become anemic or if the hemorrhoids become grade 3 or 4 and/or with rectal prolapse.
KLD,
Thank you for your prompt reply with required details.

[Anand1]

The contact numbers for Dr.Marc Brand [312-653-3506] that I posted earlier was wrong. Sorry about that. I contacted Dr.Brand at,

Program for Abdominal and Pelvic Health
Rush University Medical Center
1725 W. Harrison Street, Suite 810
Chicago, Illinois 60612
Tel: 312-942-7274 (tel:312-942-7274) ; Fax: 312-942-8562 (tel:312-942-8562)

Mary Patricia Kraus is the Program manager for Pelvic & Abdominal Health, at Rush University