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Thread: hemorrhoid surgery

  1. #1

    hemorrhoid surgery

    My husband is a c6 quad with bleeding hemorrhoids. He saw a surgeon today who said he is the worse case of hemorrhoids he has seen and needs surgery. However this dr. is a general surgeon (but was seen at a rehab hospital). He said my husband will need 2-4 weeks of bed rest possibly at a rehab type facility, but not one that is used to sci injurys.

    Do you think my husband should see a colon-rectal surgeon? Do general surgeons have this kind of experience? How do we find a colon-rectal surgeon who has experience with quads.

    What kind of experiences do other quads have with hemorrhoid surgery? The only other quad that we know that had this surgery had horrible experiences - with major disreflexia afterwards and inability to sit up for more that a very short time. He ended up having to quit his job. So we need to know if this is a usual response.

  2. #2
    Senior Member rdf's Avatar
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    Jul 2001
    Someplace between Nowhere and Goodbye
    Are the hemorrhoids the reason your husband went to the doc?
    Are the hemorrhoids causing him problems?

    If they're not, then I don't think there's a reason to get them removed. I know I have them, but I live with them...I don't know, is there a health risk with not doing anything about hemorrhoids? Lots of sci folks have them, and some just learn to live with them.

    It seems the surgeries used to treat hemorrhoids mean a lot of downtime.
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  3. #3
    He went to the dr. as part of a physical, but also has a small fistula- not causing any problems, but bleeds a bit. Told that would not heal until they can take care of the hemorrhoids

  4. #4
    Junior Member
    Join Date
    Jul 2006
    the land downunder
    I had mine removed this time last year the surgery was just perfomed by a general surgeon at my local hospital, I spent the night in hospital afterwards, then home the next day.
    From memory I wasn't able to do my bowel routine for 3 days afterwards so I just drank a lot and cut of the food,spent the first day at home in bed then was back up in my chair by the second day,the wound has a tiny amount of seeping but I just put a pad in my pants to help with that.
    I didn't suffer AD but I took strong pain meds to combat that from happening.
    By about day 7 or 8 the stitches had all but dissolved.
    I said in the first weeks after having them done that I would do it again anytime, I didn't find it to be a big deal at all to tell you the truth.

  5. #5
    I would recommend that he get another opinion from a colorectal surgeon. There are many new ways to treat hemorrhoids, and a colorectal surgeon is most likely the one who will be familiar and experienced with these. This is also the specialist who should be managing a anal fissure, which can be quite difficult to treat in someone with SCI. We have seen people have to have a temporary colostomy in order to get these to heal. The hemorrhoids themselves may not require treatment if he is not bleeding excessively.

    He would not need to be in a nursing home if you can manage him at home on bedrest. Even for traditional hemorrhoid surgery we only require 7 days of bedrest, and the AD can be managed with oral medications as long as it is anticipated and you are prepared.

    You are not likely to find a colorectal surgeon with a lot of SCI experience. I would recommend that you ask the surgeon you see to do some research on this prior to actually having surgery. There are several articles by Bard Cosman, MD that he can find with a literature review that would be helpful.


  6. #6
    Why is the fistula so hard to heal? He has had this small spot for a few years, and his regular dr. never seemed to know it was a fistula. It is about 3/4 of an inch from his anus. We are packing it now- (although the gause rarely stays in) Since we have been packing it- it seems to look worse and now bleeds when we pack it.
    We are near Philadelphia and do have some large university hospitals and other large hospitals near us. Do we just ask this surgeon to recommend some other dr. or should we ask the sci rehab hospital for a recommendation?

  7. #7
    Ohhhh, fistula. I'm an expert on those, sad to say. IMO a colorectal specialist is ESSENTIAL. If you had to pay for it out of pocket I'd still say this.

    My thinking is this....We have major problems but at least if your rectum is going to be frozen in place by paralysis, I prefer it to be frozen SHUT. Besides social embarrassment, the consequences of a flaccid anus appears to be devastation to the skin from sitting in stool all the time, which is what would happen if they weren't frozen shut.

    A surgeon that doesn't appreciate this may not be conservative about sparing the anal muscles when doing surgery. One bad decision or slip of the knife and voila-you're a quad sitting in dirty diapers for the rest of your days. I had to go over this concern with my surgeon several times. Luckily for me, her father was a c6 quad and she understood my fear. That surgeon was a godsend. If you're loaded with cash, you should fly to Oklahoma and get it done here because I can vouch for her.

    There are a few reasons fistulas are so hard to heal. One, they stay dirty. Two, the spasms in that area reduce circulation. Three, our hard stools from inactivity etc. plus bowel programs. We can't just leave the area alone like AB's do.

    A few years ago surgery was not the only choice for healing a fistula, just quickest and most radical. Another option was nitroglycerine paste applied to the anus. This reduced the spasm pressure, increasing circulation and allowing healing. (This had to be done in conjunction with sitz baths.)

    Let me look around, I'll get you some links to latest research and to my experience, sadly it's all chronicled on Carecure because I had such trouble finding doctors I was comfortable with.

    I think he should get it fixed. It's a permanent drain on your health and your skin, as time goes by it just gets worse. If I had to do it again, I would.
    Last edited by betheny; 10-07-2006 at 12:44 PM.

  8. #8
    My experience:

    It wasn't going to heal so I had it operated on in an outpatient facility. I had an anesthesiologist with me the whole time because of AD. Was never all the way out, had some kind of "chatty Cathy" anesthesia where I babbled nonsense the whole time but was never unconscious. It was called local anesthetic with some conscious sedation.

    Surgeon cut from the surface of the skin down to the fistula, basically laying it wide open. It isn't stitched up, has to simply heal from the inside up. It seemed like a deep crevice, and took some months to heal, probably a year before it was "right". I also used nitroglycerine paste on it when I could tolerate it but it bottomed my blood pressure out pretty bad so I wasn't consistent about it. (I'm not sure they still do this nitroglycerine thing; it was in vogue a few years ago.)

    At the same time she cut out some hemorrhoids. These were more superficial and were stitched with dissolving thread. This part was miserable for a month, maybe a bit less. Had anyone looked it would have looked like I sat on a coffee grinder. Lots of sitz baths, pain pills, laxatives and not much food is how I kept the bowel program issues to a minimum.

    I had one minor recurrence of this condition recently, I now know it was probably due to hyper-stress from my Graves disease. Colorectal doctor treated me with suppositories compounded of lidocaine, phenergan and flixoril (a muscle relaxer). These put me to sleep, but after 7 days of major suppository induced afternoon naps and long daily baths, the thing was healed.

    Things to keep in mind:

    1. A general surgeon isn't equipped to make the judgment calls required for fistula surgery in our cases.

    2. When you consult a colo-rectal surgeon, remember, it is their nature to want to operate. I suggest seriously talking with the surgeon. You need one good with a knife, but conservative about cutting. Emphasize that you want to spare the "anal ring" muscles. I like mine because she always wants to try non-surgical interventions first, such as her treatment for my minor recurrence. (Note: Fistulas tend to recur.)

    Fistula: Simple definition

    Definitive Treatment (from wikipedia but it looks pretty throrough)

    Definitive treatment of a fistula aims to stop it recurring. Treatment depends on where the fistula lies, and which parts of the anal sphincter it crosses.

    There are several options:

    * Doing nothing - a drainage seton can be left in place long-term to prevent problems. This is the safest option although it does not definitively cure the fistula.
    * Conversion to a cutting seton - this involves a similar process to a draining seton but the suture is tied tightly. This gradually cuts through the muscle and skin involved, leaving behind a small area of scarring. This cures the fistula in most cases, but can cause incontinence in a small number of cases, mainly of flatus (wind).
    * Lay-open of fistula-in-ano - this option involves an operation to cut the fistula open and let it heal naturally. This cures the fistula but leaves behind a scar, and can cause problems with incontinence. This option is not suitable for complex fistulae, or those that cross the entire anal sphincter.
    * Fibrin glue injection is a method explored in recent years, with variable success. It involves injecting the fistula with a biodegradable glue which should, in theory, close the fistula from the inside out, and let it heal naturally. This method is perhaps best tried before all others since, if successful, it avoids the risk of incontinence, and creates minimal stress for the patient.
    * Fistula plug is an "advanced" version of the fibrin glue method. It involves "plugging" the fistula with a "plug" made of porcine small intestine submucosa (sterile, biodegradable), fixing the plug from the inside of the anus with suture, and, again, letting the fistula heal "naturally" from the inside out. According to some sources, the success rate with this method is as high as 80%.
    * Endorectal advancement flap is a procedure in which the internal opening of the fistula is identified and a flap of mucosal tissue is cut around the opening. The flap is lifted to expose the fistula, which is then cleaned and the internal opening is sewn shut. After cutting the end of the flap on which the internal opening was, the flap is pulled down over the sewn internal opening and sutered in place. The external opening is cleaned and sutured. Success rates are variable and high recurrence rates are directly related to previous attempts to correct the fistula.

    Links to my fistula experiences:

  9. #9
    Thank you for all of this help. We will definitly locate a colorectal surgeon. From what I have been reading- the hemrrohoids are the least of his problem, but the fistula is much more of a concern. His fistula has never been infected, I'm hoping thats a good sign.
    Who is Bard Cosman? I have tried to find articles written by him online, and not found anything.

  10. #10
    Senior Member smokey's Avatar
    Join Date
    Jul 2001
    Massachusetts, USA
    lynnmom, I'm a C6-7 guy and just last week I had 3 internal hemorrhoids banded....again. No big deal really....could be done in an office setting. I had a little bleeding about a month ago and was pretty sure that hemorrhoids were the cause. It was the fifth time I've had them banded in the past few years. I had a colo-rectal surgeon diagnose and treat them. My understanding is that external hemorrhoids and anal fissures are more challanging to treat. By all means have a colo-rectal surgeon do the diagnosing and treating. Often times egos play a part in some doctor's decisions, sometimes they think they know everything and can do anything. Go to a specialist. Get it done once, get it done properly so you won't have to go back with secondary problems. Like KLD (who is the greatest by the way) said, the colo-rectal docs have the most experience with this type of thing.

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