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Three Rivers Endoscopy Center
MOON TOWNSHIP, PA • 725 Cherrington Parkway • 412.262.1000
CRANBERRY, PA • Brush Creek Commons II • 125 Emeryville Dr. • 724.772.3660
Number 097
January 4, 2012
Robert Fusco, MD Robert Fusco, MD
Welcome to another e-newsletter from the Center for Digestive Health & Nutrition. Our physicians, nurse practitioner, and registered dietician provide this information to help improve awareness in matters of health and nutrition. Each issue - which now goes out to thousands of our patients and other readers - focuses on a particular topic that we feel will be of interest. PLEASE FEEL FREE TO SHARE WITH FRIENDS AND FAMILY.

If you suffer from painful or bleeding hemorrhoids, you are not alone. Most adults in this country eventually develop hemorrhoids - half of us have them by age 50. Hemorrhoids do not discriminate, afflicting the mighty as well as the humble. They have tormented people for centuries. We are all at risk. Treatment alternatives in the past were either ineffective or very painful. Now there is an exciting new simple non-invasive treatment which is highly effective. Interested? Read on...

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Simple Cure for Hemorrhoids!

by Robert Fusco, MD

We are excited to announce that our office is now offering the patented CRH‐O’Regan Hemorrhoid Banding System - a simple non-surgical no-stitch technique for the removal of painful or bleeding internal hemorrhoids

backside Internal hemorrhoids are one of the most common causes of rectal complaints in this country. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the prevalence of hemorrhoids in the United States is 10.4 million people, with approximately 1 million new cases diagnosed every year. They usually occur after age 30 and are caused by lack of dietary fiber, constipation, diarrhea, straining with bowel movements, and heavy lifting. Hemorrhoids are especially common after pregnancy.

What Are Hemorrhoids?
First of all, hemorrhoids are not cancer and never turn to cancer. Rather, they are simply varicose veins that just happen to be located at the wrong place at the wrong time. Hemorrhoids only occur in the last inch of the rectum called the anal canal. They are never found further within the colon. All of us normally have many small veins in this area to allow circulation of blood. Straining to eliminate - especially when constipated - causes these veins to temporarily swell. Repeated straining causes them to remain swollen. Then they are termed hemorrhoids.

Hemorrhoids come in two types, classified by location (see illustration below). Those located around the outside of the anal opening are called external hemorrhoids. Internal hemorrhoids are located just about 1/2 inch inside the anal opening. This distinction is important since external hemorrhoids are covered by normal skin which has many pain receptors, whereas internal hemorrhoids lack any nerve fibers and are usually less sensitive.

Temporary Relief Fails
Home remedies such as creams such as Preparation H, suppositories, and warm baths may offer temporary relief from hemorrhoidal symptoms. Prescription drugs are not much better. For most people, hemorrhoids won't go away without medical intervention. Instead, they can become worse over time, growing in size and number. For years, people often delayed treatment due to fear of painful medical procedures, a prolonged recovery, and time lost from work. But, there is something new...

CRH O’Regan System
We are now offering our patients the patented CRH O’Regan System for the definitive treatment of internal hemorrhoids. This single-use needleless disposable device treats all grades of internal hemorrhoids and can be utilized without special bowel preparation or anesthesia. You can eat normally and you don’t need a driver. There is no need for painful surgery or a prolonged recovery as seen with past techniques. This highly effective, minimally invasive procedure is performed in our offices in just a few minutes, and most patients are able to return to work the same or next day.

How Does This Work?
The CRH O’Regan System treats the hemorrhoids, not the symptoms - making products like Preparation H unnecessary. During the brief procedure, we use a small rubber band to ligate or "'tie off" the tissue just above the internal hemorrhoid where there are few pain-sensitive nerve endings. Unlike traditional banding techniques that use a metal-toothed clamp to grasp the hemorrhoid itself, we use a gentle suction device, reducing the risk of pain and bleeding. The banding procedure works by causing focal scarring of the rectal lining and thus cut off the blood supply to the hemorrhoid. This causes the hemorrhoid to shrink and eventually disappear. Patients won’t even notice when this happens or be able to spot the rubber band in the toilet. Once the hemorrhoid is gone, the internal wound usually heals over several weeks.

How Many Bands Are Necessary?
There are three sites where hemorrhoids form frequently, and it is not uncommon for all three sites to require treatment. We generally only band one hemorrhoid site at a time in separate visits, as multiple bandings have been found to increase complications. Also, some extremely large hemorrhoids may require additional banding sessions. Thus, multiple bands may be used in severe cases, but one to three is standard. Most patients require 3 treatments at two-week internals, and 95% of patients are able to avoid surgery using this technology.

Can You Treat External hemorrhoids?
Yes. Most hemorrhoidal symptoms are from dilated internal hemorrhoids and or anal fissures. The banding of internal hemorrhoids usually shrinks the external hemorrhoids as well and is highly effective in relieving the symptoms of pain and bleeding. After banding is completed there may be an external component or skin tag that persists, but usually they do not cause much in the way of symptoms. An acute thrombosis of an external hemorrhoid can be very painful and may require drainage. Our offices do NOT offer skin tag removal or drainage of thrombosed hemorrhoids, but can refer you to an experienced surgeon.

How Painful Is This?
Soon after the procedure some patients may experience a feeling of fullness or a dull ache in the rectum. This can typically be relieved with Tylenol and is usually gone by the following day. However, over 99% of patients treated with this technique have no significant pain. Compared to the pain of surgery, this procedure can be considered "painless." The procedure is also quite safe. Minor complications are rare and simply treated. Less than 0.2% of patients treated with this advanced technique experience significant post-procedure pain or bleeding (compared to the 4 - 29% noted as the chief complaint after other rubber banding techniques). Unlike surgery, no serious complications such as sepsis have been reported in the over 250,000 cases.

Who Should NOT Have This Procedure
The vast majority of adults with recurrent symptomatic internal hemorrhoids that have failed conventional therapy are excellent candidates for the CRH O’Regan System procedure. However, this procedure should NOT be performed certain individuals:

  • Those in whom the diagnosis is not clear. They may require additional diagnostic testing before or sometimes after the treatments are performed.
  • Anticoagulants other than aspirin (Coumadin, Plavix, Arixtra, Pradaxa, Xarelto)
  • Cirrhosis of the liver and portal hypertension
  • Active Idiopathic Proctitis, Ulcerative Colitis, Crohn's Colitis.
  • Radiation Proctitis
  • Pregnant individuals should wait until several months after delivery
  • Those with anal fissures, fistulas, thrombosed hemorrhoids, or other active anorectal diseases should delay treatment.

Preventing More Hemorrhoids
While the recurrence rate is generally low with banding, continuation of poor bowel habits can increase the risk of new hemorrhoid formation. In general, you should avoid straining with a bowel movement and not spend a lot of time on the toilet catching up on your reading. We suggest that if a bowel movement is not successful within two minutes that you abandon the effort and try again later. This two-minute rule can help keep you from straining during bowel movements without realizing it.

highfiberfoods High fiber foods add bulk and softness to the stool to reduce constipation and straining. If you are troubled by hemorrhoid symptoms, you should gradually increase the fiber in your diet to about 30 grams a day and drink more fluid, eight or more cups of fluid a day. (Coffee, tea, cola, or alcohol don't count) If you start looking, fiber is easy to find. It is present in many fruits, vegetables, bran cereals, and wheat bran. You should add foods such as bran cereal, pears, raspberries, green beans, asparagus, broccoli, corn, kale, peas, Brussels sprouts, squash, yams, sauerkraut, zucchini, and cooked dried beans. Eat fruits raw and leave skins on. Use only 100% whole wheat bread (not "wheat bread").

benefiber With today's hectic lifestyles, it is not always possible to get enough fiber by diet alone. In addition to eating more fiber-containing foods, we suggest that you take try taking a fiber supplement daily. The two most common are those made with psyllium seed, such as Metamucil, and those made with methlycellulose, such as Citrucel. We prefer Benefiber, however, as it is tasteless and grit-free. It can be taken in a beverage or simple added to a meal. It does not alter the consistency of the meal. You can find a collection of recipes that incorporate Benefiber HERE. Fiber supplements are best taken with a meal, not between meals.

If constipation and straining persist, after adding high fiber foods, fiber supplements fluid to your diet, an over-the-counter stool softener may help. They are harmless and not habit forming like a stimulant or herbal laxative. We suggest Colace tablets (2 tabs at bedtime) or Miralax powder (one 17 gm dose with dinner) which can also be hidden in a beverage.

We Can Help You
In our practice, both Dr. Robert Fusco and Dr. Renee Flannagan have undergone special training in this technique and would be happy to see you for a consultation. If you, or someone you know, have this problem and would like to schedule an appointment, please call 412 262.1000. Each case is different. New patients with symptoms suggesting hemorrhoids may require additional testing to confirm the diagnosis before treatment can commence.

Your first appointment with our office will probably be the longest, as it involves a consultation, obtaining a medical history, making a diagnosis of your problems and formulating a treatment plan. We suggest you allot up to an hour. Subsequent treatment sessions will be shorter, around 15-30 minutes total. After a hemorrhoid banding procedure, we recommend that you refrain from vigorous activities the rest of the day and resume full activity the next day. Most patients with office jobs find they can return to work immediately following their appointment.

Key Points to Consider about the CRH O’Regan System
  • Treats internal hemorrhoids (although may also improve external hemorrhoids)
  • Does not remove external anal skin tags
  • Most patients require 3 treatments. Rarely a 4th treatment is required
  • Quick (only takes a few minutes)
  • Convenient (no anesthesia, fasting, or bowel prep required. No driver needed.)
  • Minimal time lost from work (back to work same or next day)
  • Painless (No needles or stitches. No significant pain 99% of the time)
  • Highly effective (Avoids major surgery in 99% of cases. Only 5% recurrence rate)
  • Proven (good track record)
  • Safe (Minor complications in 0.3%. No major complications in over 250,000 cases)
  • Covered by most insurance plans and Medicare

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