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Subject: Treatment of Internal Hemorrhoids
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Surgical water-soluble lubricant
Anoscopes: disposable fiber optic or metallic
Preferred treatment devices:
Redfield infrared coagulator (Model #IRC 2100)
McGivney hemorrhoid rubber band ligator
Rectal symptoms: bleeding, itching, swelling, pain
Anal stenosis (relative due to discomfort of anoscope)
PITFALL: A diagnosis of “hemorrhoids” may conceal a colorectal cancer.
Pearl: All rectal bleeding must have a thorough colorectal examination. All occult blood in stool must have a colonoscopy.
PITFALL: Anoscopy performed for an anal fissure may cause excessive discomfort and is unnecessary.
Pearl: Anal fissures are most commonly located at the anterior and/or posterior midline. Look for the frequently associated anal skin tag.
PITFALL: Symptomatic hemorrhoids, even prolapsing, can regress and have an unremarkable external examination.
Pearl: Have the patient take an enema in the office to allow for symptomatic hemorrhoids and rectal prolapse to enlarge and prolapse.
Pearl: Any patient with bleeding is a candidate. Prolapse is not as effectively treated with this method.
Pearl: Any patient with bleeding, prolapse, or both is a candidate.
Infection, such as pelvic sepsis
Urinary retention (mandates examination to identify possible infection)
The infrared coagulator and the metal, slotted Ives anoscope are available from Redfield Corporation, 336 West Passaic Street, Rochelle Park, NJ (phone: 800-678-4472; http://www.redfieldcorp.com).
The McGivney hemorrhoidal ligator (including loading cone), latex O-rings (i.e., rubber bands), and McGivney hemorrhoid grasping forceps are available from Miltex Inc., 589 Davies Dr., York, PA 17402 (phone: 800-645-8000; http://www.ssrsurgical.com).