STORY BYExcuse the expression, but hemorrhoids can be a real pain in the rear. Just ask Amy Von Blon, who will tell you quite frankly that it's a painful, itchy nuisance that no one needs to live with.
As a result of multiple pregnancies, Von Blon had a chronic problem with hemorrhoids, a condition in which veins around the anus or lower rectum become swollen and inflamed. Traditional therapies, such as hemorrhoidal creams and suppositories, provided no relief from the pain, itching and bleeding. So Von Blon opted for a new surgical procedure to alleviate the symptoms.
Unlike the traditional hemorrhoidectomy, which can result in extreme pain and a lengthy healing process, a minimally invasive procedure for prolapse and hemorrhoids puts patients on the short, fast road to recovery. Dr. Erik Wilson, assistant professor of surgery, at The University of Texas Medical School at Houston , offers this alternative approach.
To understand the procedure, you must first understand what causes hemorrhoids. Everyone has hemorrhoidal veins. If they stay in place, they shouldn't cause any problems, but chronic constipation or diarrhea, excessive weight, aging and pregnancy can cause veins to weaken.
Gravity takes over, and those veins, along with the mucosa, which is the lining of the anus, can slide down and become kinked and engorged with blood.
Hemorrhoids, which are not life-threatening, are one of the most common ailments among the adult population. The American Society of Colon and Rectal Surgeons estimates that as many as 50 percent of Americans will have hemorrhoids during their lifetime.
But just because hemorrhoids are common and benign doesn't mean patients should self-diagnose, Wilson cautions. A doctor needs to evaluate suspected hemorrhoids, especially if there is bleeding. This could be a sign of a more serious health problem, such as colorectal cancer.
If it is indeed a hemorrhoid, symptoms may only last a few days. For some people, however, it is a constant problem that may warrant surgery.
The older surgical method involves substantial cutting to remove the stretched veins. This includes cutting nerve-filled skin on the outside of the anus, which is why patients may experience so much pain, Wilson explains.
Until the wounds from surgery heal, every time the patient has a bowel movement, there may be extreme pain. Bleeding may occur, and there also is a high-risk of infection. Because of swelling and irritation, it may be 4-6 weeks before the pain stops.
With the minimally invasive technique, Wilson doesn't cut the skin because he isn't removing the whole hemorrhoid. Rather, he is stapling the veins and mucosa back into place. It's the same idea as a facelift. He's just tucking what droops back into its normal, youthful position.
The little bit of cutting and stapling that is required is done above the "pain line," Wilson says, so patients may only experience pain or pressure for two or three days.
"With this new surgical approach, some patients don't feel any pain at all," says Wilson, a partner in Minimally Invasive Surgeons of Texas. "It's a lot less traumatic. With the traditional surgery, every time patients had a bowel movement, they had to pray. It was that painful. Surgery was often far worse than the symptoms for at least six weeks."
Von Blon said she didn't experience any pain after the minimally invasive outpatient surgery, which is done under general anesthesia. She had the procedure on a Friday, and was cooking for her family the very next day. Since then, she hasn't had any problems with hemorrhoids.
Wilson says the rate of hemorrhoid recurrence after surgery is low. With the traditional hemorrhoidectomy, the rate of recurrence over a patient's lifetime is between 10-20 percent. With the newer, minimally invasive technique, the rate also is believed to be low. As with any surgery, Wilson warned, there is a risk of bleeding, infection, scarring and recurrence, but if done by an experienced surgeon, those risks are minimal.
Also, surgery may not be the best solution for everyone. "Hemorrhoids don't turn into cancer. They aren't life-threatening. They can just be a nuisance," Wilson said. "It may not require surgery, but if it bothers you so much that it is affecting your lifestyle, it's worth pursuing treatment. We can fix it, and now we can fix it with a treatment that offers far less pain and discomfort."
UPDATED: 11-20-2003
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Dr. Erik Wilson is assistant professor of surgery at the UT Medical School.
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Summer Carbon Monoxide Dangers
Generators used to cool off homes in hot summer months can cause death through carbon monoxide (CO) poisoning.
CO is an odorless, colorless gas that can kill or seriously and permanently injure people who inadvertently breathe in the noxious fumes emitted from generators in an enclosed space.
During hurricane season, emergency rooms see a rise in cases of CO poisoning from people bringing generators into their homes to provide power, often for cooling fans as well as cooking.
“During Hurricane Rita, we had a family of five die here in Houston for CO poisoning,” reminds UT Medical School Hyperbaric Medicine expert, Dr.Caroline Fife. “The Center for Disease Control and Prevention tracked deaths from CO poisoning due to combustion engines after Katrina and Rita and there was a dramatic increase.”
“Teak surfing”—holding on to the back of a power boat’s swim platform and being towed—is another danger. The boat’s exhaust pipe is in the face of the swimmer.
People riding in the back of pick-up trucks are at risk, too. Numerous cases have been cited of children poisoned by riding beneath tarpaulins or enclosed “cabs” in the back of the truck. In these cases, the trucks had a leak in the exhaust system or a rear-exiting tail pipe, not a side exit.
Fife also has seen this in boats with malfunctioning exhaust systems. She urges doctors and bystanders to pay special attention when groups of people begin to feel ill at the same time, particularly severe headache and nausea. Children often become symptomatic before adults.
“People associate CO poisoning with cold weather and northern states, but in the South, we see it a lot in summer with people just trying to stay cool,” Fife says.
