Monday, 25 July 2011

Painless Treatment of Haemorrhoids

Published in Panorama

Treating Piles the painless Way

Conventional surgery involving long hospitalization, substantial pain, immense cost and loss of productive man hours, fast seems to be giving way to laser and other forms of painless treatment modalities for various disorders. The good news for those suffering from second and early third degree haemorrhoids or piles as it is commonly referred to, comes in the form of Infrared Coagulation, a painless, Outpatient procedure.

In the first instance, what are the causes of haemorrhoids and who are the people at risk of suffering them? Dr.George John Emmatty, General Surgeon, Indian Specialist Medical Centre explains, "One or more factors may contribute to the problem. The most common causes are constipation and straining during stools, improper evacuation of stools, poor diet regimen which promote or aggravate constipation, pregnancy and derangement of the internal muscles of the anus. Even use of contraceptive pills can cause the condition."

The symptoms of piles include bleeding, itching, and very occasionally pain. However, true internal piles present with painless bleeding, says Dr.Emmatty and this happens because the blood vessels in the anal canal swell. While the condition can occur at any age and affects both sexes equally, it usually occurs around middle age. External piles on the other hand become red and painful and if they become clotted, they can cause intense pain in the anal region.

Elaborating on the position and degree of piles, Dr.Emmatty explains, "Normally there are three piles, detected at the position of the veins of the anal canal and the branches of the veins are in 3 positions: 3, 4 and 11 O’clock positions as in a clock. We talk of four degrees of piles, depending on whether they are in, or protrude. Grade I piles are those that protrude into, but do not prolapse out of the anal canal. Grade II piles prolapse on passing motion but spontaneously reduce. Grade III piles protrude and need to be physically pushed back into the anal region. Grade IV piles are those that stubbornly protrude and cannot be reduced or pushed back into the anal canal. These piles may develop thrombosis and gangrene."

While prevention is always better than cure, various treatment modalities exist to treat existing piles. These include rubber band ligation, cryosurgery, sclerotherapy, laser surgery, et al. However, treatment with the Infra Red Coagulator, an instrument that weighs roughly 3 kg, scores over these other invasive forms of treatment, particularly if the patient comes in the initial stages of the condition where it serves as a complete treatment modality, reveals Dr.Emmatty. "However, this treatment is effective only for II and early III degree piles and not for advanced III degree and IV degree haemorrhoids."

So how does this treatment work? Dr.Emmatty explains, "What we are essentially doing is, coagulating the blood vessels to the haemorrhoids because of which there is no blood supply to them; hence they shrink and die off. Earlier, we were obstructing this flow of blood to a part of tissue with the help of electrocoagulation. This involves a high voltage current being applied to the bleeding piles. This burns the tissues around and achieves clotting. But there are obvious drawbacks to this procedure. However, now we achieve the same result by using the infra red coagulator. By using this, the bleeding or blood flow to a part is blocked with infra red rays. We use infrared lights which provide a temperature of 100 degrees centigrade to coagulate each pile which takes about 1 1.5 seconds. Normally there are three piles and for one pile we may require one or two light sessions. Hence if we treat all the three piles together, it will take six light sessions involving a total of 9 seconds for the procedure to be completed."

The infra red rays are generated by a special halogen lamp and transmitted through a long tube. A special polymer tip made of Teflon or Sapphire is attached to the end of the tube which comes in contact with the tissue to be coagulated. According to Dr.Emmatty, this tip can be safely and easily shifted to another part of the tissue as it does not have a tendency to stick to the tissue itself. Also, the scope for overdose or underdose of radiation is avoided since a timer can be set according to requirement.

How does this treatment score over conventional modes? Firstly, it is a painless, outpatient procedure, a walk-in walk-out procedure. It’s quick, safe, simple and the whole procedure does not take more than 9 seconds at worst and can also be safely done on pregnant women. Since the amount of tissue to be coagulated is preset, the question of over or under dose does not arise, explains Dr.Emmatty.

Are there any risks involved in the procedure? "Usually we use local anesthetic jelly while doing the procedure. Since there is no nerve supply at the exact place where we are doing it, the patient does not feel any pain. Utmost, he may feel some warmth in the region for a few seconds."

Does the patient require any follow up medication following the procedure? "No," emphasizes Dr.Emmatty. "However, they have to take some warm water baths, that is, sit in warm water with salt added, for 15 minutes every day, for about a week."

What are the chances of piles recurring after this procedure, later on in life? Dr.Emmatty is once again emphatic: "While the recurrence rate is only 10%, it is important for these patients to take care of their diet so as not to be constipated. They require to take plenty of water and high fibre diet, plenty of fresh fruits and vegetables."

What is the success rate of Infra red Coagulation in comparison to existing treatment modalities? "It is 1%-2% higher than the other modes," reveals Dr.Emmatty candidly.


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