Hemorrhoid treatment update by a surgeon who just had THD

So DrD your telling me I'll be in this pain longer.? Like I said on my last post. I was in the ER at the time. And have been there 2 times after that. Yes your right each day does get better. But the pain and bleeding is still pretty much here. There isn't anytime I don't use the restroom I don't have a lot of blood. I have talked to my Doctor about this. She said each day it's going to get less. I do need you to know I Am a lady at 53 years old. If I was in my 20's there would be no way in hell I would do this. My first hemroid was in 1982 . I had surgery back there too. But the next day I was at work. This time I can't walk or less move. That's why I would tell anyone who is working..make sure to take 3 r 4 weeks off of work. Your really going to need it, When I had my first sugery back in 1982 I was left with a Tag. So this time my Doctor removed that too. That might be part of why I hurt so much too. Dear DRD. When did you have your surgery? How long was you laid up? As you being a Doctor I can see you going back to work. I have read a lot about this kinda surgery before I had it. And I did talk to 3 Doctors to make sure I did need the Surgery. As what each one said the same. Do have something to let you know...when you do this surgery one anyone..please make sure they get Lidocaine 5% . That helps so much. I told my Doctor about this wonderful stuff 3 days ago.. That works so great. Now she has told everyone else about it too. Here is anothere one for you Proctozone..this help too. Make sure everyone else know about this too I use the Lidocaine before and after I go to the restroom..noms you up where it helps the most..LOL I was told to use that wonderful ointment every 4 hour as needed..or more.. After I first got that ointment..it was like putting ice where you needed it the most..I would put it on every 1 hour or so..what was ok. Doesn't take a lot..less is best. So DRD..have you heard of the stuff? Are you letting others know about it?

Yes make sure you do..how are you feeling now If I may ask?
I had my surgery on 2/22/2012. I still have lots of pain and the bleeding is pretty bad.
You would think I was giving birth to a child with the pain and blood I am having.
I know how your feeling.
If the bleeding is still going on...GO TO THE ER RIGHT AWAY. Do not wait as I did for 3 days

DrD wrote:

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.

When you had a Bm...when it had to pee too. I have had so much pain doing both. I was like having another child.
I have been in and out of the ER for the PAIN. and unable to Pee.
they put a tub in so I could pee..It was like GOD jumped out of me at that time. The best thing ever. I was unable to pee for over 2 day. NOT a good thing. NO one told me to never wait that long.
as for having a a BM. Yes I would having a very hard time doing that too. The pain was like KILLING me.
I would never do this again. If I was told about how much pain I would be in..HELL NO WAY. I would put up with the Hemroids and keep them.
I do know after surgery My Doctor told my husband I had 2 tags outside and much more inside..Something I didn't even know .
I have had a lower GI ever 2 yrs become I was told sometime back if they find palits..I think I spilt it right you need it ever day after age 50..I am now 53 and had to see a doctor I know bad for me.
but back to getting the surgery I did.
I found this medication called Lidocaine 5% ointment. thats the best thing out there..Nums your litte BUTT right up. Don't feel a think. PUT the stuff on first think in the morning..and you don't feel athing later.
Good luck

Following THD some people are constipated and feel like they have to go all the time and other people have loose stools. This is hard to predict for individual patients, however, all of this passes quickly. The majority of patients I have treated return to work in one week and by the second week in my office they are feeling much better. Bleeding can occur after the procedure especially with bowel movements. This passes uneventfully in 99% of patients without requiring treatment at all.

Tami, I am sorry to hear of your severe post operative difficulties. I wish your experience had been as good as mine. I can only say that your description of your complications deserves the attention of your surgeon most of all. THD is a valuable procedure and has revolutionized the treatment of hemorrhoids for my patients and myself. The worldwide experience with the procedure continues to be positive overall. The scientific articles being produced about THD really do indicate great safety and efficacy. Best regards to you and I hope you feel better soon.

DrD wrote:

fralambbb wrote:

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

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).

Hello, I've just had THD (3 weeks ago) for large prolapsing internal hemmies. My problem is that the hemmies are still prolpasing. They're smaller than before the op, but still big as they were VERY big before the op! Has anyone else experienced prolasping post-op and how long did it take for things to shivel and retract? Please help as I feel like this has failed and i'm back to square one.

i just had this procedure on 8/30/2012,,,today is 9/11 i still feel like i have tohave a bowel movement. I take stool softner in am, drink 2cups coffee n eat a high fiber cereal,,I DONT HAVE ABOWL MOVEMENT? is this normal and when will it pass? I also ITCH on my butt? is that normal?

Hello,

 

I think my experience is negative but I am not sure yet 

 

I would like to say that this is a great forum, I learned more from here than from my doctor. I am a 25 yr old male who suffered from hemorrhoid since teen. Whenever I have a bowel movement my rectum would slightly prolapse and will be uncomfortable for about 20 minutes until it automatically slowly goes back (or I physically push it). Some times, one of this "prolapse" would remain there and form a painful thrombosed hemorrhoid which usually resolve in about a week to 10 days. I do not strain for BMs nor push hard yet my rectum still prolapse and will still get those hemorrhoid. My doctors tell me that the thrombosed hemorrhoids are external.

 

Last time I decided I am fed up and after reading about THD I thought this is a good option for me. I went to an "experienced" doctor with this procedure (according to him he did about 200 THD operations). At the time of the visit I had a throbmosed hemorrhoid which was in the "shrinking" stage. It was no longer painful. Upon examining me, he said that I have three hemorrhoid. One internal (which I never knew about, as I never had bleeding), one external hemorrhoid and one internal/external hemorrhoid as he called it which is the recently thrombosed one. He recommended the surgery to avoid having the problem and he told me that he can "lift" the rectum as well.

 

I did the procedure and today is day 8. After the operation he told me every thing went well and he is quite happy with the result. The post operation recovery was very painful and uncomfortable. I have very vigorous spasms (involuntary contractions) during BM's. On day 1 after taking liquid Lactulose, it provoked those spasms and allowed passing some stool but the pain of straining was extreme to say the least. I stopped taking it since then because I thought, my body is forcing those spasms on me anyway. I wasn't sure how bad my constepation was. During the later spasms/BMs I don't pass stool but pass pieces of blood/clots. Some times small pieces of blood coated dark stools are passed. However, I did not have a decent bowel movement until day 6. 

One the first week I did feel what could be a new external thrombosed hemorrhoid forming. When I say my doctor on day 4 he told me that this is not a hemorrhoid but rather a thrombosed hematoma which is supplied by a different network of arteries. He offered to lance it to remove the clot which will help relieve my pain. He did and that was taken care of. He told me that the reason I had it is that I am unlucky.

After that, as my bruise-type pain started to slowly ease, I started feeling like a foreign object is always in my anus. Before the surgery I would say this would have been a stuck stool ready to fall. However, obviously there is no stool. I did not put my finger to feel what is in there.

 

On day 6, and this is the important part, after getting really uncomfortable because of the constipation I decided to take a tablet laxative called Senokot. That did help with my constepation and allowed me to have a better BM on that day. During the night after a heavy dinner I sensed the urge to go and watched a video on the best position to pass stool while consetpated and applied that which helped in allowing a decent BM that night. However after that BM I felt like a decent size tube is prolapsing from my anus. It was very scary! I looked at the mirror and it was what I think is a new prolapsed internal hemorrhoid.I put my finger in and followed it along to about the second joint of my finger. It feels like a vein tube inside the wall of the rectum running from about 5 cm or more all the way to my anus and protruding. It is a very uncomfortable feeling but because I have been having all types of pain I can't tell when did it form.

This same prloapsed vein was seen forming in the next two BMs about 12 hours apart. Last seen, few minutes a go.

I went to see my doctor the very next day to express my deep worries about this new internal hemmerhoid. He examined me and said he could find any thing. I told him that I see it only after BMs and he told me that he can't find out for sure until he does a full colenscopy. 

 However, according to him he does NOT think that this is a new internal hemorrhoid. He thinks that this is a rectal swelling because of the operation. he told me that during the operation he lifted the prolapsed rectum and since I am still recovering this is likely to be a swelling rectum that will ease as I recover down the road and adjust to position. He says he can't confirm any thing until three weeks after the operation or even after by doing full colonscopy. I asked if he is wrong and it is indeed a new internal hemorrhoid how come it formed when he stitched the artery? He assured me that he stitched the main classical artery but told me there is a lot of arteries in the anus and he can't stich them all. It is possible that this one is supplied by different artery.

 

MY QUESTION is: Should I believe him in thinking that what I am seeing is just a post operation swelling or is it a new internal hemorrhoid that has formed which means this operation has in fact caused a new never existing before hemorrhoid despite?

 

On the positive side, my pain is easing to mild. The only pain I get is during BM. My other hemorrhoid seem to have "deflated" to a skin tag. It does swell a bit during BM.

 

P.S since the operation until now I am still bleeding. I see drops of blood every time I have a BM.

Out patient procedure ? A GP says it's either hem's or a pollup.

I have stage III internal (bleeding). I was wondering if I might be a candidate for THD. Unfortunately, I cannot find anyone who offers this procedure in the NYC area. Would you have a referral? I am also able to travel anywhere in our out of country to have the procedure done--so, a recommendation on the best surgeon would be appreciate too.

I agree with your statements 100%. I am on my 5th day of post THD and feeling almost like normal. I ran a light fever a couple of days after the procedure, and it took almost two days to have a BM. I have IBS so stool softeners are not an issue for me. I am slightly more tired than usual, but realize my body has been through a transition. I hope each passing day brings me closer to feeling great! Thank you for your input. It was well delivered and well appreciated.

Appreciate your candor in various posts. Am considering THD procedure but would prefer to utilize a surgeon who is not only a pioneer but also has vast experience w/ THD and a high degree of success i.e. a surgeon's surgeon who demonstrates the requisite degree of care. skill & judgement. Any recommendations or suggestions for locating such individuals would be much appreciated

Hi,

i am in London, UK and after much research i had THD procedure a week ago.........i am female, 63 years and have had a very active, sporty life and in the last couple of years i have really had to slow down due to prolapsing hemorrhoids......

everything i have read rings absolutely true and although i felt quite scared before and after, i think it was the right thing to do as i had seen my son go through stapled hemorrhoidectomy a year ago and that was truly awful!!

Anyway, i am now on day 7 after surgery and things are settling down and i am weaning myself off the painkillers and have just finnished a course of antibiotics which i was put on.........

My question is on bowel control.........i have a BM almost immediately after eating anything, how ever small and i may even need to go 2 or 3 times, small amounts: I feel like a Mr Whippey ice cream machine!!!  when standing or sitting i can feel that i am getting back control of my anus/sphincter and yet when i have the urge to go, i have to get to the wash room quickly or it will just come out.......i can stop my pee mid flow which is good but i seem to have lost control of the BM.......its horrible and if i walk far i know i will need to go and risk having an accident so i am not going very far from home yet.

 

Is this normal and will i get back to how i was before????

 

Thanks for help

Mrs P 

@ Hopefull and Intc2rd - question

I am very curious - what is your outcome for your prolapsing hemorrhoids that were still there after surgery

I am (was) in that exact situation, today is my 7 weeks after my surgery (I think as I still cannot get straight answer from my doctor) he did THD procedure on small prolapsing hemorrhoid (3rd degree) and removed 2 internal ones with classic hemorrhoidectomy -  I am not sure if those two procedures can be "mixed" but why not.

My recovery was not a cake walk but in two weeks I was back at work with no pain (so it might be just THD),

Anyway, after 14 days of "all is wonderful and I am so happy" I have noticed that the exact same hemorrhoid is petruding from my anus, needless to say, I was devastated as my decision to have that surgery done was more cosmetic one - hemorrhoids DID NOT bother me a bit.

Mu doctor stated that it is all swollen and is should subside - well it did not. As I learned, staples from THD procedure "let go" and the prolapse hemorrhoid return to its previous position and was actually worse.

As I asked what else can be done with that prolapsing hemorrhoid, I received an answer that I have to live with it as I am, after all, 50 years old female and this is just part of life. I could not believe his answer, the whole surgery I went through and I ended up with worse outcome then before!!!! Just a note, doctor I chose is well recognized and one of best in colon/rectal surgeon in San Antonio, Texas (I will be reviewing him and I am still considering filing a complaint).

At that point I seek second opinion, I choose, still young, female doctor and at the first visit I was very impress with her. I received clear explanations what is happening; she was trying to find out what was done to me during surgery few weeks ago.  She also informed me that "prolapse hemorrhoid" I have is, in fact, large skin tag and can be easily removed during in office procedure (which I did and I am so far quite happy - 2 days after procedure). She also found another internal hemorrhoid and scarring area inside caused by previous surgery.

I am very much hoping that this time I am going to fully recover. Originally I was convinced that since my doctor has vast experience in the procedure, outcome will be almost guaranteed, well, it did not work that way. I think that I was for that well established doctor, default case and he did not pay GOOD attention to what really I was asking to achieve by going through that surgery.  Not always famous and most experienced ones are the best to choose.

 

32yo- Male- 5'11"- 195lbs- It has been exactly 2 weeks since I had THD and a lateral internal sphincterotomy by Dr. Eufrocino Martinez in San Diego. Overall, I am moderately pleased, but very concerned about some things and still in some pain. I remember my first hem around the age of 14, and it came after a day of working an antique auction moving heavy furniture. I dealt with them for years. About 2 years ago they began prolapsing after bm and I would have to push them back in; this has become routine :(. Over the last 3 months the hems became debilitating, requiring an hour or two every morning waiting for the pain to subside and then until 5 pm or so the pain was palpable. I had to do something. I went to two docs; the first (Mark Tapscott) did an examination and I was in some serious pain; first time having that area checked. I had stage III internal hems and some external ones too. I also had an anal fissure that the doc said was probably causing lots of my pain. He gave me some cream and told me to come back... no way. I needed something done. So I found Dr. Martinez and he showed me the THD video. I did the research, read the papers... found something like 5% recurrence and about 18% pain. I had heard the horror stories about the old-school cut them out procedure so I decided on this.

Best advice I can give is to seriously think about what you are going to eat the first three days, because you are going to be in pain and you DO NOT want to be constipated (like I was). This is a tough one because the vicodin are the only thing that dulls the horrendous pain as they pack your colon with hard feces = bad deal.

So the first 3 days were horrible. I called the doc on day 4 morning and then night because no bm. Day 5 morning he ordered me some go light.... It was crazy getting that first one out. So much pressure. That was the hump, and it has been better since, but still rough. Every since I have been having daily bms. Still in pain AND I have bulges back there!

 The good news is that the prolapsing internal hems are no where to be found. Bad news is the left side bulges out during and after a bm. It is not red or bleeding but I don't think it looks normal. And then yesterday, day 13 post-op, a skin flap or something popped out. It looks like a hem, but it doesn't hurt particularly bad.

 

I am sitting in the tub now because I have at least an hour of pain after every bm. I hope that is still just because I am not healed. I am REALLY CONCERNED about the bulging anus and skin flap thing. 

Any insight would be greatly appreciated.

 

Thanks!