Hemorrhoid treatment update by a surgeon who just had THD

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. 

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

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?

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. 

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  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?