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To any one out there who has suffered with hemorrhoidal disease in fear of treatment, fear no longer.  There is hope and there is real progress in this area of surgical science.  Believe me, I suffered for years with anal swelling after BMs and pain, itching, bleeding at times and difficulty cleaning after BMs.  For those of you who have Hemorrhoidal Disease, you know what I am talking about.  Once the problem became bad enough to lead me into my local Walgreens as a "regular" and I had purchased every promising topical ointment, cream, frozen ice pack for hemorrhoids, dietary supplement, and scanned the internet for every breakthrough claim out there I rested upon a relatively new treatment that I learned about at a colorectal surgery course at the University of Minnesota.  The procedure has been around for years, but the technology is just really taking off here in the USA.  The procedure is called Transanal Hemorrhoidal Dearterialization or THD.  It has also been called Hemorrhoidal Arterial Ligation or HAL.  THD is a proprietary name for a product that combines a doppler probe with a sophisticated anoscope that allows the surgeon to meticulously isolate the terminal hemorrhoidal arterial branches that actually deliver blood into the hemorrhoidal plexus and allow engorgement to be a repeating problem.  Additionally, the surgeon may choose to do a "lift" procedure to restore the anus to how it was when you were a teenager.  This is called a "pexi".  Just a fancy name for a stitch that "lifts" the prolapsing anal lining back up into the anal canal towards the rectum.  The procedure is done on an outpatient basis and takes less than an hour.  You can watch it on youtube...just type in THD video.

I am now Post Op Day 5 after my procedure.  The first 48 hours were absolutely splendid.  I had NO pain.  I used tylenol and vicodin (sparingly).  I had begun a stool softener a few days prior to the procedure and recommend everyone take two enemas prior to the procedure to clear out solid stool waiting to come out.  After 2 days I experienced intense tenesmus=urgency to defecate without an actual stool.  This was my only complaint.  I had to use ointment into the anus to lubricate and then I had to push a bit to evacuate my first BM.  It was scary, but it gave me some relief.  There is swelling inside the anal canal from the sutures.  This is temporary and will subside in about 2 weeks.  I am now having morning tenesmus daily.  I think this is from the fact that the pelvis likes to accumulate blood while we sleep.  It is the lowest part of our body while we are on our backs in bed.  I am finding that yoga in the morning really helps.  I have had multiple successful BMs--with a little pushing--after doing basic yoga exercises.  I admit that I have put a pillow by a wall and done 1-2 minute headstands a couple of times and this has been the most effective way to reduce anal canal swelling.  I know it sounds crazy, but venous congestion occurs from gravity and the headstand reverses this long enough to actually allow me to get a normal stool out.  I am certain this will pass in another day or two and the headstand will be a funny story to tell other surgeons about.

So my post THD routine is:  Get up in the morning and have a drink of coffee, take a stool softener and eat a high fiber cereal.  Do yoga and have a BM.  Go about my normal "staycation" activities.  Take Tylenol if needed for mild ache.  No sitz baths at all.  My anus looks like new.  No bleeding of any note.  I feel great (after BMs especially).

Feel free to ask questions as I am a surgeon who performs this procedure as well. 

 ***this post is edited by moderator *** *** web addresses not allowed***

  Take care.

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Hemorrhoidal Artery Ligation is one of the most effective hemorrhoids treatment as far as I know. It is uncomfortable for sure and you can have a lot of pain after the surgery.

My neighbor had this procedure and she was in pain for a while, but since she was following all those possible instructions from the doctor, her recovery process was really successful.

She told me that this type of the treatment has been proposed as an efficacious, that this is very safe therapy while another one that is very common as well -  rubber band ligation (RBL) is a commonly used outpatient treatment. 

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How does this procedure compare with IRC?
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How does this procedure compare with IRC...less problems, ease, success rate? Thanks
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IRC is useful for bleeding, non-prolapsed internal hemorrhoids. It is not good for prolapsed internals or externals. IRC also does not address aching internal hemorrhoids. THD addresses the inflow of blood supply to the hemorrhoidal area on the interior. Combined with a "lift procedure" called a mucopexy, THD patients enjoy functional and anatomical improvement without a lengthy recovery.
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Hi,

i am planning to have THD next week and doctor has not decided yet if he will lift the hemmies back or just put the stiches. i was wondering, how long it will take for hemmies to shrink in that case? What is the reason for a doctor not lifting the hemmies back into the anus?

 

thanks

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Each surgeon judges the degree of prolapse at the THD. A mucopexy (lift) is appropriate to promote restoration of the anatomy. This does depend on what is observed during the procedure while you are under anesthesia. If you have a great deal of prolapse after BMs, tell your surgeon or even try taking a photo of your anus right after a BM (I know that sounds gross, but it is the only way for a surgeon to know how bad your prolapsing is).
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thank you.

Actualy, my doctor said that if the degree of prolapsing will define if he will left them or not, as the lifting in this case might cause a lot of discomfort after the surgery. My question is what happens in this case. Do the hemmies shrink after some time? and how long would that be?

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Just ligating the arterial inflow is the major part of your procedure. Over the next 6 weeks there will be improvement.
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I had this surgery Jan 31 (16 days ago) The first week was awful. Lots of pain. Lots of screaming when I had to go. Between stool softeners and fiber I was going 5-7 times a day....very painful. In the last day I have finally got to the point it is not as painful but it is full of blood. Even when I am passing gas there is blood. Is this normal? When will this stop?
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vmarz wrote:

DrD wrote:

To any one out there who has suffered with hemorrhoidal disease in fear of treatment, fear no longer.  There is hope and there is real progress in this area of surgical science.  Believe me, I suffered for years with anal swelling after BMs and pain, itching, bleeding at times and difficulty cleaning after BMs.  For those of you who have Hemorrhoidal Disease, you know what I am talking about.  Once the problem became bad enough to lead me into my local Walgreens as a "regular" and I had purchased every promising topical ointment, cream, frozen ice pack for hemorrhoids, dietary supplement, and scanned the internet for every breakthrough claim out there I rested upon a relatively new treatment that I learned about at a colorectal surgery course at the University of Minnesota.  The procedure has been around for years, but the technology is just really taking off here in the USA.  The procedure is called Transanal Hemorrhoidal Dearterialization or THD.  It has also been called Hemorrhoidal Arterial Ligation or HAL.  THD is a proprietary name for a product that combines a doppler probe with a sophisticated anoscope that allows the surgeon to meticulously isolate the terminal hemorrhoidal arterial branches that actually deliver blood into the hemorrhoidal plexus and allow engorgement to be a repeating problem.  Additionally, the surgeon may choose to do a "lift" procedure to restore the anus to how it was when you were a teenager.  This is called a "pexi".  Just a fancy name for a stitch that "lifts" the prolapsing anal lining back up into the anal canal towards the rectum.  The procedure is done on an outpatient basis and takes less than an hour.  You can watch it on youtube...just type in THD video.


I am now Post Op Day 5 after my procedure.  The first 48 hours were absolutely splendid.  I had NO pain.  I used tylenol and vicodin (sparingly).  I had begun a stool softener a few days prior to the procedure and recommend everyone take two enemas prior to the procedure to clear out solid stool waiting to come out.  After 2 days I experienced intense tenesmus=urgency to defecate without an actual stool.  This was my only complaint.  I had to use ointment into the anus to lubricate and then I had to push a bit to evacuate my first BM.  It was scary, but it gave me some relief.  There is swelling inside the anal canal from the sutures.  This is temporary and will subside in about 2 weeks.  I am now having morning tenesmus daily.  I think this is from the fact that the pelvis likes to accumulate blood while we sleep.  It is the lowest part of our body while we are on our backs in bed.  I am finding that yoga in the morning really helps.  I have had multiple successful BMs--with a little pushing--after doing basic yoga exercises.  I admit that I have put a pillow by a wall and done 1-2 minute headstands a couple of times and this has been the most effective way to reduce anal canal swelling.  I know it sounds crazy, but venous congestion occurs from gravity and the headstand reverses this long enough to actually allow me to get a normal stool out.  I am certain this will pass in another day or two and the headstand will be a funny story to tell other surgeons about.

So my post THD routine is:  Get up in the morning and have a drink of coffee, take a stool softener and eat a high fiber cereal.  Do yoga and have a BM.  Go about my normal "staycation" activities.  Take Tylenol if needed for mild ache.  No sitz baths at all.  My anus looks like new.  No bleeding of any note.  I feel great (after BMs especially).

Feel free to ask questions as I am a surgeon who performs this procedure as well. 

 ***this post is edited by moderator *** *** web addresses not allowed***

  Take care.


I had this surgery Jan 31 (16 days ago) The first week was awful. Lots of pain. Lots of screaming when I had to go. Between stool softeners and fiber I was going 5-7 times a day....very painful. In the last day I have finally got to the point it is not as painful but it is full of blood. Even when I am passing gas there is blood. Is this normal? When will this stop?


Be patient. Results vary from patient to patient. I have performed several of these and each patient responds differently. You will grow happier and happier with the procedure as it has time to work it's effect on your anal canal.
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I just had the surgery a couple weeks back, and although everything feels a lot better I am still bleeding and get really light headed and like I'm going to faint. Should I mention this to the surgeon at my follow up appointment or is it completly unrelated/irrelevant?
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I had my surgery on 2/22/2012' I have NOT stopped bleeding and the pain is like giving birth to a child. I am now setting in the ER waiting for a CT. There has not been one day I have not had some kind of problem using the restroom Each BM I have I have so much blood coming out it freaks me out. The Doctor is talking about keeping me in the hospital. You saying you had no pain is BS. I have read a larger number of blogs who all say the pain is so bad. Today's date is March 4 2012 . Count the number of days. 11 days later and I still have a problem using the restroom. To go per is like giving birth to 10 children at one time. I have to push so hard to pee. So what part of you having No pain I don't understand. Please tell me
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Dear DrD Please tell me how you had NO pain when everyone else in the world has had pain from hell. My wonderful Doctor told me herself that I would have a lot of pain. And after surgery she was told some have said they feel like pushing all the time. When I use the restroom I bleed so much it's like I just gave birth to a horse. I have been in the ER ( hospital ) 7 times. The ER doctor is talking about putting me in the hospital tonight because how bad I am in pain and bleeding. I had Surgery on 2/22/2012 it's now 3/4/2012 The number of days later. If I had to do this all over..sorry to say..I would of passed I was just told they are going to be giving me blood.. They is not right. Tell the truth.. I could of died from the surgery if I did come to te hospital today.
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There are numerous post-operative things that may occur following THD. Some people have more pain than others and this MAY be technique related on the part of the surgeon. However, surgeons want their patients to do well universally. No matter the issue, THD will give lasting relief to the vast majority of patients. It won't have the damaging effects on the anal canal that traditional hemorrhoidectomies can have. So even if you have some "bumps" in the road post-op they will pass and you should enjoy the benefits of the operation. Things will get better each month for the next year.
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