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BACKGROUND: Hemorrhoids are swollen veins around the anal canal. They can occur internally: when they form inside the anal canal, or external: when they swell near the opening of the anus. The condition is caused by excessive pressure on pelvic and rectal area veins. In a healthy individual, blood fills the tissue inside the anus to assist with bowel movements. Straining to move stool can cause the veins in the tissue to swell and stretch. Constipation and diarrhea can cause such pressure. Expectant mothers may also get hemorrhoids during their last six months of pregnancy due to increased pressure on the pelvic region. During labor, those hemorrhoids can worsen. Overweight individuals may also be more susceptible to developing them. Most often, internal and external hemorrhoids result in bleeding during bowel movements, itching and rectal pain. A doctor can diagnose hemorrhoids by either examining the rectum with a gloved finger or using a short, lighted scope to see inside the rectum.


TREATMENT: Most of the time, diet and bowel habit changes offer relief. To prevent and alleviate symptoms, doctors recommend increasing your fiber and water intake, using a stool softener, exercising, avoiding sitting or standing for extended periods, avoiding lifting heavy objects, and sleeping on your side if you're pregnant. Ointments can also help relieve the symptoms of hemorrhoids. Often, surgery is not required for hemorrhoids. The goal of nonsurgical treatment is to reduce the blood supply to the hemorrhoid so it shrinks or goes away. Hemorrhoids may be tied off with a rubber band or heat, lasers or electric current can be used to create scar tissue.


If other treatments fail to help patients, surgery may be the answer. External hemorrhoids can only be removed surgically if they are very large and uncomfortable or if you are having surgery on the anal area for another reason. Hemorrhoidectomy, or surgical removal of internal hemorrhoids, is a last resort option. An incision is made in the tissue surrounding the hemorrhoid. The vein inside is tied off to prevent bleeding and the hemorrhoid is removed.


A NEW OPTION: "The classical hemorrhoidalectomy, where you actually cut out hemorrhoids, is a very painful procedure," says Jeff Crooms, M.D., a general surgeon at Tallahassee Memorial Healthcare in Tallahassee, Fla. Now there's a new, minimally invasive option for treating internal hemorrhoids. It's called transanal hemorrhoidal dearterialization (THD). During the procedure, the problematic artery is located using doppler. A surgeon then uses an absorbable suture to ligate or "tie-off" the arterial blood flow, shrinking the bulging vein. It takes just 20 minutes to do and patients can go home the same day. "The stitch is run from inside toward the outside and then tied back inside and that kind of pulls also those external hemorrhoids a little bit inside, so it does help them a little bit as well," Dr. Crooms said. The following is an in-depth interview with Dr. Crooms on the procedure.

What is the new procedure for treating hemorrhoids?


Dr. Jeff Crooms: It’s a THD procedure, which stands for Transanal Hemorrhoidal Dearterialization. This is a newer procedure in the treatment of hemorrhoids. It works best for those hemorrhoids that are called internal hemorrhoids. If someone has large external hemorrhoids, it may help those just a little bit, but it is not designed for those specifically.


How does the THD procedure work?


Dr. Crooms: There is no incision. The way that the procedure is performed is that someone is in the operating room and normally asleep, although it could be done with a spinal anesthetic. Within the anal/rectal canal, you have a little speculum. Ultrasound technology allows you to identify the small hemorrhoidal arteries inside the anal/rectal canal. Then you have an absorbable suture that you are able to sew each of those arteries -- there are actually six of them, kind of in clockwise formation -- and you suture each of those little arteries. The idea behind that is it will cause the internal hemorrhoids to shrink and you run it in what you call a hemorrhoid pexi type of stitch, where the stitch is run from inside toward the outside and then tied back inside. That kind of pulls also those external hemorrhoids a little bit inside, so it does help them a little bit as well.


What is the alternative procedure to this?


Dr. Crooms: For hemorrhoidal disease, the classical hemorrhoidectomy, where you actually cut out hemorrhoids is a very painful procedure. There is a difference in the nerve supply inside the anal/rectal canal to outside on the skin, so anything that one does to the outside there is very painful. This is a procedure that is entirely inside the anal/rectal canal, so there is less pain associated with this. There are other alternative hemorrhoidal treatments from what we call a PPH procedure, which is a stapling procedure done inside the canal, which also has some good results. You can also use some infrared technology to ligate some hemorrhoidal vessels, as well. This is just a newer procedure that has good results, so far.


How long has this procedure been available to patients nationwide?


Dr. Crooms: The procedure itself has been around worldwide between two to three years. It just started in the United States in 2007 and then we brought it here to Tallahassee in January of 2008.


How long does the procedure take?


Dr. Crooms: The procedure itself usually takes around 30 minutes in the operating room. It’s done as an outpatient procedure, so patients do go home the same day. We do give them a prescription for pain medication just in case they need it, but most patients either don’t use any pain medicines or usually get by on just one prescription.


How long does it take for patients to get back to their normal activities?


Dr. Crooms: That always varies, depending on the degree of the hemorrhoid disease that the patients have, but there are reports of patients returning to work within two to three days. Certainly, sometimes it does take a little bit longer and may be up to a week to ten days if they are having significant discomfort. The reason for the discomfort in this procedure is because sometimes those sutures get real close to that skin edge, but classically, there’s a much faster recovery in comparison to a standard hemorrhoidectomy.


How long is the recovery from a standard hemorrhoidectomy?


Dr. Crooms: That recovery can be quite painful and thus patients are pretty much bedridden for anywhere from one to two weeks and still have a fair amount of discomfort for up to four to six weeks.


What are the risks of the THD procedure?


Dr. Crooms: There is always risk with any surgery, but the risk in this type of procedure is very minimal. When you think about a former hemorrhoidectomy, you always worry about injuring the sphincter muscles around the anus, and the risk for that with this type of procedure is practically negligible.


How many THD procedures have you done yourself?


Dr. Crooms: We’ve done around 50 since we’ve started here.


How could this procedure change someone’s quality of life?


Dr. Crooms: Hemorrhoid disease is very common. Hemorrhoids are blood vessels in the anal/rectal canal. They’re covered by the lining both internally and then externally with the skin and those can be quite bothersome. Many times, they will get very swollen. Patients will complain of irritation, bleeding, burning, and discomfort with bowel movements. It can be quite symptomatic to the patient and a real nuisance of always having to wear a pad, continually having to clean yourself, and those types of things. With this procedure that is less painful and not as debilitating, patients have an alternative to another treatment that will make their life much more comfortable. Many patients tell me, ‘I’ve lived with these for 10, 20 years or more just because I didn’t want to have an operation just because it was so painful.’


How has Catherine Hicks’ procedure impacted her?


Dr. Crooms: She had suffered for a number of years. She went through her procedure very well and returned to work very quickly and has come back in and seen us and seems to be very happy with the results that she has and is very happy that she chose this route to be treated.


Did she feel like she had run out of options?


Dr. Crooms: Certainly, most patients will try a number of treatments prior to getting to surgery, which they still should do. If you can be treated without surgery then I would certainly favor that, but when those therapies stop working for you and you continue to have trouble, that’s when you look towards surgery. You look towards all the options that are out there to treating the hemorrhoidal disease and choose the one that is best suited for your condition.


To what degree of hemorrhoid disease would this procedure be required?


Dr. Crooms: There are different degrees of hemorrhoids, from grade one to four. A lot of that, though, depends on how symptomatic someone is. Classically, this is going to work best for those hemorrhoids that would be considered grade two to three, of which they are symptomatic and do not respond to non-operative therapy.


If it’s an internal hemorrhoid, you would not be able to treat it from the outside, is that correct?


Dr. Crooms: Correct. This is ideally designed for those internal hemorrhoids because you’re running the stitch towards the outside and then tying it back inside. It will pull those external hemorrhoids a little bit towards the inside, so we’ll help those a little bit, but this is not classically designed for those large external hemorrhoidal skin tags.

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Hi Craig. Thanks for posting this. Is this in any way associated with your question on the procedure that you were wanting to get done?
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Yes it is, I think any information i can find that is relevant to this forum i will post here. It seems to me that the doctors never tell anyone the truth about what to expect with hemorrhiod surgery, so as much informmation about NEW/DIFFERENT procedures is a must before deciding about going under the knife.

What do you think ?
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Craig2 wrote:

Yes it is, I think any information i can find that is relevant to this forum i will post here. It seems to me that the doctors never tell anyone the truth about what to expect with hemorrhiod surgery, so as much informmation about NEW/DIFFERENT procedures is a must before deciding about going under the knife.

What do you think ?



Well, I think that doctors may not be well informed or may not really know about the new procedures which is why you may not have gotten any information. How old is the doctor that you're going to?
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I would say my doctor is in his late 40's or early 50's but you would think that doctors would like to stay to date with the latest technology hey. So i went back to my GP the other day and told him about my experience with my surgen and found out the reason i was recommended to was because they thought his sales pitch was good woh about that!! so i started asking my GP about some of the proceedures and he just shrugged his shoulders and said "you know more than me" this gives me a lot of confidence in finding a good surgen in Brisbane. So if anyone out there could recommend and good one let me know.
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I know what you are talking about. I had almost the same problem as you do have now.

I wanted to know more about hemorrhoids treatment and he told me all about it. That is why I also do believe that your doctor was not so into this theory and that he really doesn't know a lot about it. Forgive me if I am wrong.

But whenever you are wondering what you should do, should you do some surgery or not, that is just one more reason to call another doctor and see what he has to say.

Other opinion is very important. My mom was not sure in one doctor, who should do the procedure for her, so she went to see another one.

That was the best thing that she could do! 

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Craig2 wrote:

I would say my doctor is in his late 40's or early 50's but you would think that doctors would like to stay to date with the latest technology hey. So i went back to my GP the other day and told him about my experience with my surgen and found out the reason i was recommended to was because they thought his sales pitch was good woh about that!! so i started asking my GP about some of the procedures and he just shrugged his shoulders and said "you know more than me" this gives me a lot of confidence in finding a good surgin in Brisbane. So if anyone out there could recommend and good one let me know.



I have an appointment with a doctor in White Plains New York who does the THD procedure on Friday and will post back. My gastro doctor does not know much about the process and pretty much said I'm on my own becuase it is so new and very few doctors are doing it in the USA. He said his doctor friend that does the older school surgery of cutting out the hemorrhoids does not think the THD is really good. But I would rather try it first than go through the pain of the other method or banding. I know I have one big external one and unfortunately it sounds like the THD is better for internal ones,
so I will see what the doctor says after Friday and try and chat with one of her patients that has had it done to them.
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Well after months of trying to find a surgeon in Austraila who does this procedure i've finally been successful.
I'll be getting contacts from the conpany who sells the THD on a complete list of surgeons that preform this procedure.
Hopefully then i'll be rid of these life sucking hems!!
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Here in is the problem guys and gals,

A colorectal surgeon (proctologist) goes to school for an additional two to three years longer than an MD. (14 years total!) They train to specifically deal with non surgical and surgical procedures in the anus AS WELL AS PAIN MANAGEMENT! MD’s don’t and G.I’s don’t and Chiropractors don’t yet all these guys perform these procedures.

Can they? Sure, this MD quoted here says he has done 50 THD procedures. Is he qualified, sure…… the only qualifications are that he is an MD and takes that THD training, what 50hours.

So there you go.

You can take you new car to the dealer or the shop in the ghetto if it needs a new water pump, they might both be able to fix the problem……. Where would you take you brand new car?

To the dealer, why….. Because there trained to fix that type of car.

Take your rear to the rear doctor, not an MD. Not a G.I, Not a Chiropractor, If you decided to go to another type of doctor your going to increases the chance of sharing your own horror story here as well.

GET THE TRUTH AT

Buy the way the THD and the PPH are both excellent treatment options!

Brian McMullin

***edited by moderator*** web addresses not allowed
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I would stilll prefer the THD over the PPH any day after reading the horror stories on here and the fact it doesn't take a couple of days to get over it. Some times it can take up to 6 weeks of more but if you can get away with the THD I would have to recommend that as it's only a couple of days to get over it and they even if it doesn't work then you can think about the PPH.
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Yes I agree with you. I really like the THD as it is non invasive (Basicly sutures the hemorrhoids back to the rectal wall) and is almost pain free. My only reluctancy is that it has only been in use for about two years so there is no data as to it's overall effectvness or any complecations yet.

That being said it does seem like this could be the major breakthough for hemorrhoid suffers. Time will tell if it can mimic the effectiveness of the hemorrhoidectomy for stage 3+ and 4 hemorrhoids.

Hope so,

and very happy to hear that your fellling better!

If anyone has any questions about this procedure or others you can go to

Not only are the many diffrent surgical procedures there but you can watch video of most of them being preformed!

Not for the faint of heart though.

See you later,

Brian McMullin

***edited by moderator*** web addresses not allowed
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Thank you, this information was very helpful
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I had THD three years ago. It was easy, done under sedation not general anesthesia. I took Tylenol and a tiny bit of Rx pain meds at night for a few days.
I had stage three internals, spontaneous bleeding if I stood for less than 10 minutes, at the time of THD.
I was immediately back to all my loved old activities like hiking, gardening, physical work. I am soo glad that I searched to find a surgeon who did this after reading so many horror stories.
Really - this was easy and effective, with no complications (and I believe the literature does not show any - I'd done a lot of research before hand, but now don't remember it all - I've moved on in life!).
Best of luck everyone!
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I interviewed my surgeon for THD ahead of time and discussed how many they had done and any complications. Because THD is only suturing, it is not a procedure that requires years of training. My doctor was a general surgeon. Suturing is pretty basic. And it worked easily and effectively.
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Craig2 wrote:

BACKGROUND: Hemorrhoids are swollen veins around the anal canal. They can occur internally: when they form inside the anal canal, or external: when they swell near the opening of the anus. The condition is caused by excessive pressure on pelvic and rectal area veins. In a healthy individual, blood fills the tissue inside the anus to assist with bowel movements. Straining to move stool can cause the veins in the tissue to swell and stretch. Constipation and diarrhea can cause such pressure. Expectant mothers may also get hemorrhoids during their last six months of pregnancy due to increased pressure on the pelvic region. During labor, those hemorrhoids can worsen. Overweight individuals may also be more susceptible to developing them. Most often, internal and external hemorrhoids result in bleeding during bowel movements, itching and rectal pain. A doctor can diagnose hemorrhoids by either examining the rectum with a gloved finger or using a short, lighted scope to see inside the rectum.


TREATMENT: Most of the time, diet and bowel habit changes offer relief. To prevent and alleviate symptoms, doctors recommend increasing your fiber and water intake, using a stool softener, exercising, avoiding sitting or standing for extended periods, avoiding lifting heavy objects, and sleeping on your side if you're pregnant. Ointments can also help relieve the symptoms of hemorrhoids. Often, surgery is not required for hemorrhoids. The goal of nonsurgical treatment is to reduce the blood supply to the hemorrhoid so it shrinks or goes away. Hemorrhoids may be tied off with a rubber band or heat, lasers or electric current can be used to create scar tissue.


If other treatments fail to help patients, surgery may be the answer. External hemorrhoids can only be removed surgically if they are very large and uncomfortable or if you are having surgery on the anal area for another reason. Hemorrhoidectomy, or surgical removal of internal hemorrhoids, is a last resort option. An incision is made in the tissue surrounding the hemorrhoid. The vein inside is tied off to prevent bleeding and the hemorrhoid is removed.


A NEW OPTION: "The classical hemorrhoidalectomy, where you actually cut out hemorrhoids, is a very painful procedure," says Jeff Crooms, M.D., a general surgeon at Tallahassee Memorial Healthcare in Tallahassee, Fla. Now there's a new, minimally invasive option for treating internal hemorrhoids. It's called transanal hemorrhoidal dearterialization (THD). During the procedure, the problematic artery is located using doppler. A surgeon then uses an absorbable suture to ligate or "tie-off" the arterial blood flow, shrinking the bulging vein. It takes just 20 minutes to do and patients can go home the same day. "The stitch is run from inside toward the outside and then tied back inside and that kind of pulls also those external hemorrhoids a little bit inside, so it does help them a little bit as well," Dr. Crooms said. The following is an in-depth interview with Dr. Crooms on the procedure.

What is the new procedure for treating hemorrhoids?


Dr. Jeff Crooms: It’s a THD procedure, which stands for Transanal Hemorrhoidal Dearterialization. This is a newer procedure in the treatment of hemorrhoids. It works best for those hemorrhoids that are called internal hemorrhoids. If someone has large external hemorrhoids, it may help those just a little bit, but it is not designed for those specifically.


How does the THD procedure work?


Dr. Crooms: There is no incision. The way that the procedure is performed is that someone is in the operating room and normally asleep, although it could be done with a spinal anesthetic. Within the anal/rectal canal, you have a little speculum. Ultrasound technology allows you to identify the small hemorrhoidal arteries inside the anal/rectal canal. Then you have an absorbable suture that you are able to sew each of those arteries -- there are actually six of them, kind of in clockwise formation -- and you suture each of those little arteries. The idea behind that is it will cause the internal hemorrhoids to shrink and you run it in what you call a hemorrhoid pexi type of stitch, where the stitch is run from inside toward the outside and then tied back inside. That kind of pulls also those external hemorrhoids a little bit inside, so it does help them a little bit as well.


What is the alternative procedure to this?


Dr. Crooms: For hemorrhoidal disease, the classical hemorrhoidectomy, where you actually cut out hemorrhoids is a very painful procedure. There is a difference in the nerve supply inside the anal/rectal canal to outside on the skin, so anything that one does to the outside there is very painful. This is a procedure that is entirely inside the anal/rectal canal, so there is less pain associated with this. There are other alternative hemorrhoidal treatments from what we call a PPH procedure, which is a stapling procedure done inside the canal, which also has some good results. You can also use some infrared technology to ligate some hemorrhoidal vessels, as well. This is just a newer procedure that has good results, so far.


How long has this procedure been available to patients nationwide?


Dr. Crooms: The procedure itself has been around worldwide between two to three years. It just started in the United States in 2007 and then we brought it here to Tallahassee in January of 2008.


How long does the procedure take?


Dr. Crooms: The procedure itself usually takes around 30 minutes in the operating room. It’s done as an outpatient procedure, so patients do go home the same day. We do give them a prescription for pain medication just in case they need it, but most patients either don’t use any pain medicines or usually get by on just one prescription.


How long does it take for patients to get back to their normal activities?


Dr. Crooms: That always varies, depending on the degree of the hemorrhoid disease that the patients have, but there are reports of patients returning to work within two to three days. Certainly, sometimes it does take a little bit longer and may be up to a week to ten days if they are having significant discomfort. The reason for the discomfort in this procedure is because sometimes those sutures get real close to that skin edge, but classically, there’s a much faster recovery in comparison to a standard hemorrhoidectomy.


How long is the recovery from a standard hemorrhoidectomy?


Dr. Crooms: That recovery can be quite painful and thus patients are pretty much bedridden for anywhere from one to two weeks and still have a fair amount of discomfort for up to four to six weeks.


What are the risks of the THD procedure?


Dr. Crooms: There is always risk with any surgery, but the risk in this type of procedure is very minimal. When you think about a former hemorrhoidectomy, you always worry about injuring the sphincter muscles around the anus, and the risk for that with this type of procedure is practically negligible.


How many THD procedures have you done yourself?


Dr. Crooms: We’ve done around 50 since we’ve started here.


How could this procedure change someone’s quality of life?


Dr. Crooms: Hemorrhoid disease is very common. Hemorrhoids are blood vessels in the anal/rectal canal. They’re covered by the lining both internally and then externally with the skin and those can be quite bothersome. Many times, they will get very swollen. Patients will complain of irritation, bleeding, burning, and discomfort with bowel movements. It can be quite symptomatic to the patient and a real nuisance of always having to wear a pad, continually having to clean yourself, and those types of things. With this procedure that is less painful and not as debilitating, patients have an alternative to another treatment that will make their life much more comfortable. Many patients tell me, ‘I’ve lived with these for 10, 20 years or more just because I didn’t want to have an operation just because it was so painful.’


How has Catherine Hicks’ procedure impacted her?


Dr. Crooms: She had suffered for a number of years. She went through her procedure very well and returned to work very quickly and has come back in and seen us and seems to be very happy with the results that she has and is very happy that she chose this route to be treated.


Did she feel like she had run out of options?


Dr. Crooms: Certainly, most patients will try a number of treatments prior to getting to surgery, which they still should do. If you can be treated without surgery then I would certainly favor that, but when those therapies stop working for you and you continue to have trouble, that’s when you look towards surgery. You look towards all the options that are out there to treating the hemorrhoidal disease and choose the one that is best suited for your condition.


To what degree of hemorrhoid disease would this procedure be required?


Dr. Crooms: There are different degrees of hemorrhoids, from grade one to four. A lot of that, though, depends on how symptomatic someone is. Classically, this is going to work best for those hemorrhoids that would be considered grade two to three, of which they are symptomatic and do not respond to non-operative therapy.


If it’s an internal hemorrhoid, you would not be able to treat it from the outside, is that correct?


Dr. Crooms: Correct. This is ideally designed for those internal hemorrhoids because you’re running the stitch towards the outside and then tying it back inside. It will pull those external hemorrhoids a little bit towards the inside, so we’ll help those a little bit, but this is not classically designed for those large external hemorrhoidal skin tags.


I enjoyed this information and feel more knowable about hemorrhoids
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