What are Hemorrhoids?

Hemorrhoids, also known as piles, are swollen veins in the lower part of the anus and rectum, similar to varicose veins. When the walls of these vessels are stretched, they become irritated.

Hemorrhoids have a number of causes, although often the cause is unknown. They may result from straining during bowel movements or from the increased pressure on these veins during pregnancy. Hemorrhoids can either be internal or external. Internal hemorrhoids develop within the anus or rectum. External hemorrhoids develop outside of the anus. Hemorrhoids are also known as piles.

Hemorrhoids are very common, with about 50 percent of adults experiencing the symptoms of hemorrhoids by age 50.

External hemorrhoids are the most common and most troublesome. Hemorrhoids cause pain, severe itching, and difficulty sitting. Fortunately, many effective options are available or treatment.

What are the Symptoms of Hemorrhoids?

Signs and symptoms of hemorrhoids include:

• Painless bleeding during bowel movements. You might notice small amounts of bright red blood on your toilet paper or in the toilet bowl.
• Itchingor irritation in the anal area.
• Discomfort, pain or soreness in the anal region.
• Lumpsprotruding from the anal region.
• Swelling in the anal region.
• Feces may leak out unintentionally.

Although hemorrhoids are painful, they aren’t life-threatening and often go away on their own without treatment. If you have them often, you may develop symptoms of anemia, such as weakness and pale skin due to blood loss, though this is rare.

Hemorrhoid Types

Hemorrhoids can be either internal or external:

Internal hemorrhoids

Internal hemorrhoids are deep inside the rectum and not visible from outside. They are normally painless. Often, the first sign that internal hemorrhoids are present is rectal bleeding.

Straining can sometimes push an internal hemorrhoid so that it protrudes through the anus, this is called a protruding or prolapsed hemorrhoid and can be painful.

External hemorrhoids

External hemorrhoids are under the skin around the anus and are therefore visible. Because there are more sensitive nerves in this part of the body, they are normally more painful. Straining when passing a stool may cause them to bleed.

What causes Hemorrhoids?

Experts aren’t sure what causes hemorrhoids to develop. Possible factors include:

• Straining during bowel movements
• Sitting for long periods of time on the toilet
• Chronic diarrhea or constipation
• Obesity
• Pregnancy
• Anal intercourse
• Low-fiber diet

Hemorrhoids are more likely with aging because the tissues that support the veins in your rectum and anus can weaken and stretch.

Hemorrhoid Diagnosis

A visual examination of your anus may be enough to diagnose hemorrhoids. To confirm the diagnosis, your doctor may do a different examination to check for any abnormalities within the anus. This check is known as a digital rectal exam. During this exam, your doctor inserts a gloved and lubricated finger into your rectum. If they feel anything abnormal, they may order an additional test called a sigmoidoscopy.

A sigmoidoscopy involves your doctor using a small camera to diagnose an internal hemorrhoid. This small fiber-optic camera, called a sigmoidoscope, fits into a small tube and then inserts into your rectum. From this test, your doctor gets a clear view of the inside of your rectum so that they can examine the hemorrhoid up close.

Hemorrhoid Treatment Options

Treatment for hemorrhoids can occur at home or at a doctor’s office.

Pain relief

To minimize pain, soak in a warm tub of water for at least 10 minutes every day. You can also sit on a warm water bottle to relieve the pain of external hemorrhoids. If the pain is unbearable, use an over-the-counter medicated suppository, ointment, or cream to relieve the burning and itching.

Fiber supplements

If you’re constipated, you can also use an over-the-counter fiber supplement to help soften your stool. Two common supplements of this type are psyllium and methylcellulose.

Home remedies

Symptoms can be relieved in the following ways. However, they will not eliminate the hemorrhoids:

• Topical creams and ointments. Over the counter creams or suppositories, which contain hydrocortisone, are available; there are also pads which contain witch hazel, or a topical numbing agent.
• Ice packs and cold compresses. Applying these to the affected area may help with the swelling.
• Sitz bath using warm water. The sitz bath is placed over the toilet. Some pharmacies sell them. These may relieve the burning or itching symptoms.
• Moist towelettes. Dry toilet paper may aggravate the problem.
• Analgesics– some painkillers, such as aspirin, ibuprofen, and acetaminophen (Tylenol) may alleviate the pain and discomfort.

Medical procedures

If home treatments aren’t helping with your hemorrhoids, your doctor might recommend getting a rubber band ligation. This procedure involves the doctor cutting off the circulation of the hemorrhoid by placing a rubber band around it. This causes loss of circulation to the hemorrhoid, forcing it to shrink.

If rubber band ligation isn’t an option in your case, your doctor may perform injection therapy, or sclerotherapy. In this procedure, your doctor injects a chemical into the blood vessel directly. This causes the hemorrhoid to reduce in size.

Preventing Hemorrhoids

The best way to prevent hemorrhoids is to keep your stools soft, so they pass easily. To prevent hemorrhoids and reduce symptoms of hemorrhoids, follow these tips:

• Nutrition. Eating plenty of fiber-rich foods, such as fruits and vegetables, as well as whole grains, means stools will nearly always be soft. Similarly, drinking plenty of fluids (excluding alcohol) helps keep stools soft. Over the counter fiber supplements also ease constipation.
• Straining. When using the toilet, try not to strain, this creates pressure in the veins in the lower rectum.
• Go when needed. You should not wait if you need to use the toilet. The longer the wait, the drier the stools will be.
• Physical activity. Sitting or standing still for long periods of time puts pressure on the veins. Physical activity also helps stool move through the bowel, so bowel movements are more regular.
• Keep body weight down. Being overweight significantly raises your risk of having hemorrhoids.

Hemorrhoid Prognosis and Complications

Complications from hemorrhoids are rare, but can include:

• Blood clots in the swollen vein
• Bleeding
• Iron deficiency, anemia caused by blood loss

With proper treatment, you’ll likely experience an improvement. Following your doctor’s directions and maintaining a regimen, including exercise and avoiding sitting for long periods of time, that reduces hemorrhoid symptoms can also improve your outlook.

What is Venous Insufficiency?

Venous insufficiency is a problem with the flow of blood from the veins of the legs back to the heart. It’s also called chronic venous insufficiency or chronic venous stasis.

Veins have valves that keep the blood moving in one direction-toward the heart. In venous insufficiency, the valves in the veins of the leg don’t work right. So fluid pools in the legs. This can lead to problems that include varicose veins.

What causes venous insufficiency?

Venous insufficiency is sometimes caused by deep vein thrombosis and high blood pressure inside leg veins.

Risk factors for venous insufficiency include:

• Age
• Family history of this condition
• Female gender (related to levels of the hormone progesterone)
• History of deep vein thrombosisin the legs
• Obesity
• Pregnancy
• Inactivity (Sitting or standing for long periods)
• Swelling of a superficial vein (phlebitis)
• Muscle weakness, leg injury or trauma
• Tall height
• Smoking

Symptoms of venous insufficiency

The symptoms of venous insufficiency affect the legs and include:

• Swelling of the legs or ankles (edema)
• Pain that gets worse when you stand and gets better when you raise your legs
• Leg cramps
• Aching, throbbing, or a feeling of heaviness in your legs
• Itchy and tingly legs
• Weak legs
• Thickening and hardening of the skin on your legs or ankles
• Skin that is changing color, especially around the ankles
• Irritated or cracked skin when you scratch it
• Wounds or ulcers that are slow to heal on the legs or ankles
• Varicose veins
• A feeling of tightness in your calves

How is venous insufficiency diagnosed?

Your doctor can diagnose venous insufficiency by examining your legs and by using a Duplex Ultrasound to test the speed and direction of blood flow in the veins.

He may also use a Venogram, during which your doctor will put a contrast dye into your veins that causes your blood vessels to appear opaque on an X-ray, thus allowing your doctor to see a clearer picture of the blood vessels.

Treatment for venous insufficiency

The most common treatment for venous insufficiency is prescription compression stockings that apply pressure at the ankle and lower leg. They help improve blood flow and can reduce leg swelling. However, treatment for venous insufficiency depends on many factors including:

• Cause of your condition.
• Specific symptoms.
• Severity of your condition.
• Tolerance for medications and procedures.

Depending on these factors, treatment can include different strategies.

Improve blood flow

• Wear compression stockings.
• Exercise regularly
• Do not it or stand for long periods.
• Do not cross your legs when seated.
• Keep your legs elevated when possible.

Medication

Some of the medications that may help with this condition are:

• Diuretics that draw extra fluid from your body.
• Trental (Pentoxifylline). A medication to improve blood flow.
• Anticoagulants (blood-thinners).

Your doctor may recommend more invasive treatments depending on the severity of your symptoms. These procedures include:

• Sclerotherapy. Salt water (saline) or a chemical solution is injected into the vein. The vein hardens and is eventually absorbed into the body.
• Small surgical cuts (incisions) are made in the leg near the damaged vein. The vein is removed through one of the incisions.
• Procedures that can be done in a provider’s office or clinic, such as using a laser or radiofrequency.
• Varicose vein stripping, used to remove or tie off a large vein in the leg called the superficial saphenous vein.

What can you do to prevent venous insufficiency?

If there is a history of venous insufficiency in your family, you may lessen your chances of developing the condition by following these steps:

• Avoid sitting or standing in one position for a long time; stand up and move around frequently.
• Avoid smoking.
• Exercise regularly.
• Maintain a healthy body weight.

Chronic venous insufficiency tends to get worse over time. However, it can be managed if treatment is started in the earl

Before a baby boy is born, its testicles are located high in the belly and as it develops inside the mother, the testicles drop down into the scrotum (the sac that holds the testicles). In some cases though, the testicle may not drop down on its own and may stay high up in the abdomen or groin area. This condition is called undescended testicles or cryptorchidism.

What is an Orchidopexy?

An Orchidopexy is an elective surgery that is performed to lower the testicles into the scrotum; it can be scheduled at the parent’s earliest convenience. It is usually performed on babies from 9 to 15 months old.

How is an Orchidopexy performed?

Your child will be given a general anesthetic to ensure that he sleeps during the operation.

Depending on the location of the testicle, one or two small incisions are made in the scrotum, the groin, or the abdomen to allow the surgeon to reach the testicle and move it to the scrotum. Sometimes another surgical method called laparoscopy is used to move undescended testicles when they are located high in the inguinal canal or in the abdomen.

The operation usually takes about one hour per testicle.

An Orchidopexy is usually an outpatient procedure, which means that the surgery is done on the day your child comes to the hospital and will stay just a few hours, until he wakes up from the surgery. He will probably not have to stay at the hospital overnight.

What to expect after an Orchidopexy?

Your son will probably feel sore for a few days following the surgery; his doctor will probably prescribe a pain-reliever such as codeine or acetaminophen for this. Be sure to follow the doctor’s directions.

You will be told how to care for your child’s dressing and your child’s surgeon will also give you instructions for bathing him after surgery.

Your son may begin to eat and drink a little at a time and resume normal eating and drinking as long as he is feeling well.

If you notice a fever higher than 101.4˚F, bleeding or foul smelling drainage from the area around the incision, call the doctor who performed the surgery right away.

For at least 2 weeks following the surgery, your son should avoid games, sports, rough play, bike riding, and other activities where there is a risk of injury to the genitals.

The doctor will do a follow-up exam usually within 2 to 3 months after the operation to ensure everything is well.

Important considerations

Orchiopexy is considered a safe and reliable procedure that has relatively few risks. It is best to choose a surgeon and hospital staff with experience in this procedure and in the special needs of children.

• Placing undescended testicles in the scrotum may help prevent infertility and may reduce the risk of testicular cancer.
• Surgery can boost a boy’s self-esteem. An empty or partially empty scrotum can make a boy feel bad about himself and his body, especially during the teen years.
• This surgery helps lower the risk of injury to the testicle. If the testicles are in the groin area, a boy has a higher risk for sports injuries and discomfort from seat belts.

Some doctors recommend a testicular biopsy during orchiopexy if the undescended testicle is in the abdomen or if the child has genital defects, such as hypospadias, or a genetic disorder. In this test, a small sample of tissue is taken from the testicles and then examined.

Usually the outcome of orchiopexy is good, and the testicle is moved into the scrotum. But success rates vary by where the testicle is located at the time the surgery is done. Generally, this treatment works well in almost all of the males who need it.

Circumcision is the surgical removal of the foreskin, which is the skin covering the tip of the penis. It’s fairly common in the United States and parts of Africa and the Middle East, but less common in Europe and some other countries.

Some families have their sons circumcised for religious reasons, but circumcision can also be a matter of family tradition, personal hygiene or preventive health care. For others, however, circumcision seems unnecessary or disfiguring. After circumcision, it isn’t generally possible to re-create the appearance of an uncircumcised penis.

Circumcision is usually performed on the first or second day after birth. The procedure becomes more complicated and riskier in older babies, children, and men.

Why is Circumcision done?

The procedure is a religious or cultural ritual for many Jewish and Islamic families, as well as certain aboriginal tribes in Africa and Australia. The use of circumcision for medical or health reasons is an issue that continues to be debated. The American Academy of Pediatrics (AAP) says the health benefits of circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision.

Circumcision might have various health benefits, including:

• A decreased risk of urinary tract infections.
• A reduced risk of some sexually transmitted diseases in men.
• Protection against penile cancer and a reduced risk of cervical cancer in female sex partners.
• Prevention of balanitis (inflammation of the glans) and balanoposthitis (inflammation of the glans and foreskin).
• Prevention of phimosis (the inability to retract the foreskin) and paraphimosis (the inability to return the foreskin to its original location).

What are the Risks?

The most common complications associated with circumcision are bleeding and infection. Side effects related to anesthesia are possible as well.

Some problems associated with circumcision are:

• Pain
• Risk of bleeding and infection
• Irritation of the glans
• The foreskin might be cut too short or too long
• The remaining foreskin might reattach to the end of the penis, requiring minor surgical repair

• Increased risk of meatitis (inflammation of the opening of the penis)

How is a Circumcision performed?

Circumcisions are usually done by a pediatrician, obstetrician, family medicine doctor, surgeon, or urologist. It is usually performed in a hospital nursery, usually within the first 10 days of the child’s birth. For older children and adults, the procedure is usually performed in a hospital or surgery center on an outpatient basis. In all of these cases, you will be asked to sign a consent form.

During the newborn circumcision, your son will lay on his back with his arms and legs secured. An anesthetic is given via injection or cream to numb the penis. There are several techniques for performing circumcision. The choice of which technique is used depends on the physician’s preference and experience. The three major methods of circumcision are the Gomco clamp, the Plastibell device, and the Mogen clamp. Each one works by cutting off circulation to the foreskin to prevent bleeding when the doctor cuts the foreskin.

The procedure takes about 15 to 30 minutes.

After the procedure

It usually takes about seven to 10 days for the penis to heal. The tip of the penis is likely to be sore at first, and the penis might look red, swollen or bruised. You might notice a yellow crust on the tip of the penis as well.

If your newborn is fussy as the anesthetic wears off, hold him gently — being careful to avoid putting pressure on the penis.

It’s OK to wash the penis as it heals. For newborns, change the bandage with each diaper change, and apply a dab of petroleum jelly to the tip of the penis to keep it from sticking to the diaper. Change your baby’s diaper often, and make sure the diaper is loosely fastened. If there’s a plastic ring instead of a bandage, it will drop off on its own — usually within about a week. Once the penis heals, wash it with soap and water during normal bathing.

Call your child’s doctor if your child has any of the following:

• Continued fussiness (in babies)
• Increased pain (in children)
• Trouble with urination
• Fever
• Foul-smelling drainage
• Increased redness or swelling
• Persistent bleeding
• A plastic ring that doesn’t fall off after two weeks

Recovery in adults

Your doctor will give you specific instructions on how to care for your incision and lessen your pain.

In general, you should return to work and daily activities when you feel comfortable. Avoid strenuous exercise, such as jogging or weight lifting, for the first four weeks of your recovery or until your doctor gives their approval. Walking is the best way to exercise during your recovery. Try to walk a little more than usual each day.

You should also typically avoid sexual activity for six weeks after the procedure. Follow the instructions from your doctor about sexual activity.

Call your doctor if you have any of the following:

• Increased pain
• Trouble urinating
• Bleeding
• Signs of infection, including fever, increased redness, swelling, or drainage

Commonly referred to as an Upper Gastrointestinal Endoscopy or EGD, it is a procedure that allows your doctor to look at your esophagus, stomach and the first part of the small intestine (duodenum) and is used to diagnose and treat conditions in the upper gastrointestinal tract.

The procedure is done using a long, thin, flexible viewing tool called an endoscope that has a small light and video camera at one end. The endoscope is inserted in your mouth and then slowly and gently pushed down your throat, through your esophagus and stomach, and into the beginning of your small intestine.

The endoscope sends images to a monitor in real-time, allowing your doctor to look for inflammation, bleeding, ulcers or infection.

Small tools may also be inserted into the endoscope. These tools can be used to:

• Take tissue samples for a biopsy.
• Remove things such as food that may be stuck in the upper GI tract.
• Inject air or fluid.
• Stop bleeding.
• Do procedures such as endoscopic surgery, laser therapy, or open (dilate) a narrowed area.

What are the Reasons for Doing an EGD?

An upper gastrointestinal endoscopy may be done to diagnose and treat problems in your upper gastrointestinal tract.

Many times it is used to identify the cause of unexplained symptoms such as:

• Trouble swallowing
• Unexplained weight loss
• Upper belly pain or chest pain that is not heart-related
• Continuous vomiting for an unknown reason
• Bleeding in the upper gastrointestinal tract

It can be used to identify problems such as:

• Inflammation of the esophagus (esophagitis) or the stomach (gastritis)
• Gastroesophageal reflux disease (GERD)
• A narrowing (stricture) or blockage of the esophagus
• Enlarged and swollen veins in the esophagus or stomach (Esophageal varices)
• Barrett’s esophagus, a condition that increases the risk for esophageal cancer
• Damage caused by swallowing caustic substances such as household detergents
• Infections of the upper gastrointestinal tract
• Crohn’s disease
• Celiac disease
• Hiatal hernia
• Ulcers
• Cancer

The procedure is also used to treat a variety of issues:

• Control bleeding
• Remove tumors or growths (polyps)
• Open (dilate) narrowed areas
• Remove things that may be stuck
• Perform laser therapy
• Insert a tube used for tube feeding into the stomach
• Band abnormal veins in your esophagus (esophageal varices)

An endoscope can also be used to take tissue samples (biopsies) or gastrointestinal fluid samples. An EGD may also be used to check your stomach and duodenum after undergoing a surgery.

Your healthcare provider may have other reasons to recommend an upper GI endoscopy.

What are the Risks of an EGD?

Complications are rare during an upper gastrointestinal endoscopy, though like any procedure there are certain risks, such as:

• Bleeding
• Infection
• There is a slight risk of perforation in your esophagus, stomach or upper small intestine. If this happens, you may need surgery to fix it.

There may be other risks that are unique to you, be sure to talk to your doctor about any concerns before the procedure.

How do you prepare for an EGD?

Before having an upper gastrointestinal endoscopy, be sure to inform your doctor if you:

• Are sensitive to or allergic to any medicines, latex, tape or anesthesia medicines
• Are pregnant or believe you might be pregnant
• Have a history of bleeding disorders; take any blood-thinning medicines such as aspirin or other medicines that affect blood clotting. You may need to suspend their use before the procedure.
• Have diabetes or take insulin
• Have had any surgery or radiation treatments in your esophagus, stomach or upper part of your small intestine
• Have any heart problems

You will be asked not to eat or drink anything for 8 hours before the test. Having an empty stomach allows your doctor a clear view of your stomach during the test.

You may be asked to sign a consent form stating that you understand the risks and agree to have it done.

You will be awake during the procedure, but you will be given a sedative to help you relax so you should arrange to have someone take you home after the test.

How is an EGD performed?

An upper gastrointestinal endoscopy may be performed in a doctor’s office, a clinic or a hospital; an overnight stay is usually not required.

The procedure is done as follows:

• You will be asked to remove any clothing, jewelry, dentures or anything else that might interfere with the procedure. You will be given a gown to wear.
• You will receivemedicine into a vein to help you relax. You should feel no pain and not remember the procedure.
• Your heart rate, blood pressure, respiratory rate, and oxygen level will be checked during the procedure.
• A local anesthetic may be sprayed into your mouth to prevent you from coughing or gagging when the scope is inserted. A mouth guard is used to protect your teeth and the scope.
• You then lie on your left side.
• You will not be able to swallow the saliva that may collect in your mouth during the procedure. This happens because the tube is in your throat. The saliva will be suctioned from your mouth from time to time.
• The scope is inserted through the esophagus (food pipe) to the stomach andduodenum. Air is put through the scope to make it easier for the doctor to see.
• The lining of the esophagus, stomach, and upper duodenum is examined.Biopsies can be taken through the scope. Biopsies are tissue samples that are looked at under the microscope.
• Different treatments may be done, such as stretching or widening a narrowed area of the esophagus.

After the test is finished, you will not be able to have food and liquid until your gag reflex returns (so you do not choke).

The test lasts about 5 to 20 minutes.

What happens after an EGD?

After the test, you will be observed for 1 to 2 hours until the medicines wear off. If your throat was numbed before the test, you should not eat or drink until your throat is no longer numb and your gag reflex has returned to normal. This is to prevent you from choking. You might experience a sore throat or pain when swallowing for a few days after the test, this is completely normal.

When you are fully recovered, you can go home. You will not be able to drive or operate machinery for 12 hours after the test. You may go back to your usual diet and activities, unless otherwise instructed by your doctor. Do not drink alcohol for 12 to 24 hours after the test.

Be sure to call your immediately if you have any of the following:

• Symptoms of infection, such as fever or chills
• Redness, swelling, or bleeding or other drainage from the IV site
• Shortness of breath of dizziness
• Belly pain, nausea, or vomiting
• Black, tarry, or bloody stools
• Trouble swallowing
• Throat or chest pain that gets worse

Your doctor may be able to talk to you about some of the findings right after your endoscopy. However, the medicines you get to help relax you may impair your memory, so your doctor may wait until they fully wear off.