Hemorrhoids It is not Colonoscopy Chronicles’ intention to provide specific medical advice to users of its blog, instead we provide users with information to help them better understand their health, diagnosed conditions, and the current approaches related to treatment, prevention, screening, and supportive care. Colonoscopy Chronicles urges users to consult with a qualified health care professional for diagnosis and answers to their personal medical questions. One of the most common findings at the time of colonoscopy is that of hemorrhoids. While it may seem like a simple topic, I believe that hemorrhoids are highly misunderstood! Let’s start by discussing what hemorrhoids are. They are simply engorged veins near the anal opening. Misunderstanding number one is that many patients are under the impression that it is mandatory to treat and/or remove all hemorrhoids. That is not true. Since hemorrhoids are really not linked to an increased risk of colorectal cancer, and do not necessarily lead to anything more sinister, there is no reason that hemorrhoids automatically need to be treated or removed. I tell patients that the main reason to be aggressive with hemorrhoids is if they are causing significant symptoms. Most people with hemorrhoids do not have symptoms. Those who do have symptoms must decide if the symptoms are bothersome enough to warrant doing something about them. That is really “in the eye of the beholder”. How much a patient is willing to put up with varies from person to person. The second major misunderstanding regarding hemorrhoids is “If it hurts down there, it must be hemorrhoids”. The fact is, that hemorrhoids can certainly cause discomfort. However what patients perceive as pain from hemorrhoids is often from other causes. For example, an anal fissure-which is a small cut in the skin at the anal opening-can cause severe anal discomfort. Likewise, irritation of the skin right around the anus, from eczema, dermatitis, or yeast infections can cause discomfort . Taking a good history of the patients symptoms and doing a good physical examination are critical to diagnosing the source of a patient’s symptoms. While it seems self evident, an accurate diagnosis is critical in providing the proper care for a patient with pain in the anal/rectal area. I have seen all too many patients who were treated for hemorrhoids-sometimes even surgically, when the underlying source of their symptoms was not actually their hemorrhoids. In addition to discomfort, hemorrhoids can also bleed. This bleeding is often minor, and does not necessarily mandate aggressive treatment. On the other hands sometimes the bleeding is persistent and severe enough to warrant intervention. Examples of this are when the bleeding leads to frequent soiling of clothing, or is extensive enough to cause the patient to become anemic. It is important that what is perceived as hemorrhoidal bleeding is not from something more sinister such as a malignant tumor of the colon or rectum. Evaluation with colonoscopy may be necessary in order to rule out tumors or other lesions as a source of the bleeding. Once it has been determined that hemorrhoids are the source of a patient’s problems, then next issue is how to treat them. Bleeding, in my opinion, is best treated with either band ligation or surgical hemorrhoidectomy. I favor trying band ligation first, since it is less invasive, and generally well tolerated and effective. The technique I use employs the O’Regan hemorrhoid banding equipment made by CRH. (www.crhsystem.com)