IRC - Non-Surgical "No Stitch" Treatment
for Internal Hemorrhoids Now Available
by Robert Fusco, MD
Welcome to the Club!
If you suffer from painful or bleeding hemorrhoids, you are not alone. Hemorrhoidal symptoms have tormented people for centuries. They do not discriminate, afflicting the mighty as well as the humble. Pregnancy, childbirth, heredity, aging, lack of dietary fiber, and constipation are common hemorrhoid triggers, but the real problem is gravity. Hemorrhoids are probably impossible to prevent given pressure that our upright posture creates on the blood vessels and delicate tissues of our lower regions. More than 50% of adults are eventually affected and over 10 million Americans seek help from a physician each year because of distressing hemorrhoidal symptoms. While many people associate hemorrhoids with painful surgery, you may be surprised to learn that only a small percentage of patients require surgery. A fast and simple incisionless office procedure called Infrared Coagulation, or IRC, has taken fear out of hemorrhoid treatment.
What are hemorrhoids?
First of all, hemorrhoids are not cancer and do not turn to cancer. Hemorrhoids are simply enlarged veins. When they occur in the legs, we call them varicose veins. When they occur in the rectum, they are called hemorrhoids, or "piles." Hemorrhoids only occur in the last inch of the rectum, called the anal canal, and 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 stool - especially when constipated - causes these veins to temporarily swell. Repeated straining over time causes them to remain swollen. Then, they are termed hemorrhoids.
Outside vs Inside
Hemorrhoids come in two types, classified by location. 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 pain fibers and are usually painless.
What are the symptoms?
While many adults develop hemorrhoids in their lifetime, most do not have symptoms. When they do, the most common symptom of internal hemorrhoids is bright red blood covering the stool, on the toilet tissue, or in the toilet bowl. If internal hemorrhoids become large and loose enough, they may drop down and protrude, or prolapse, through the anal opening when you strain to have a bowel movement. This prolapsed hemorrhoid can be felt as a bulge and may cause a dull rectal pain.
Internal hemorrhoids are sub-classified by the degree of prolapse:
- Grade I internal hemorrhoids don't prolapse at all.
- Grade II drop down with a bowel movement but then pop back up inside spontaneously.
- Grade III must be manually pushed back inside the anus.
- Grade IV cannot be manually reinserted and are the most severe.
By definition, external hemorrhoids are always outside the anal opening. They rarely bleed, but can cause embarrassing rectal itching and soreness. Occasionally, a blood clot can form within an external hemorrhoid turning it blue. This so-called thrombosed hemorrhoid usually causes sudden severe rectal pain and often requires a trip to the Emergency Department or surgeon's office.
How does your doctor know?
An accurate diagnosis is an important first step in treatment. Any adult who has rectal symptoms - especially bleeding - should call their doctor to schedule an appointment. Hemorrhoids are seldom medically serious by themselves, but without proper testing, you can't assume that rectal bleeding is caused by hemorrhoids. Rectal bleeding can also be a sign of colorectal cancer or polyps. This caution applies even to those who have been previously diagnosed with hemorrhoids because you never know when new bleeding is due to a new problem. Your doctor has several diagnostic tools at his disposal to accurately evaluate the source of rectal bleeding and determine what treatment is best advised. Testing will include a digital rectal exam with a gloved finger and a "scope" test to look inside and visualize exactly what is wrong. In some cases, a simple short scope test of the lower colon, called flexible sigmoidoscopy, may be sufficient. In most cases your doctor will suggest colonoscopy - a more complete and thorough examination of the entire colon.
Simple treatment may suffice
Once hemorrhoids are diagnosed, the decision to treat depends on how bothersome they have become. In most cases, aggressive treatment is not necessary. Minor hemorrhoids may benefit from simply eating more high fiber foods which add bulk and softness to the stool and reduces constipation and straining. A daily dose of a fiber supplement (Metamucil) and stool softener (Colace) is often helpful. These substances are safe for long term use and not habit-forming like other laxative products.
Time takes its toll
Because they don't want to undergo surgery to remove their hemorrhoids, many people endure the bleeding, discomfort, and aching of hemorrhoids - using over-the-counter salves and suppositories to get some temporary relief. These products may soothe the symptoms, but they don't make hemorrhoids disappear. In most cases, hemorrhoids don't simply "go away." The truth is that over the years, hemorrhoids often get worse unless treated. Then surgery may be unavoidable.
IRC: Infrared Coagulation
When conservative measures fail, more definite treatment is needed. While many people fear the possibility of a painful hemorrhoid operation, in fact only a small percentage of patients require invasive surgery. Several non-surgical alternatives for symptomatic internal hemorrhoids are now available. One such alternative is Infrared Coagulation, or IRC, a spin-off of laser technology.
Over the past 20 years, IRC has become the world's leading office procedure for internal hemorrhoids. With over 10,000 installations worldwide and millions of satisfied patients, IRC has proven to be an effective, safe, and well-tolerated procedure with remarkably few complications. We are now pleased to offer the new digital Redfield IRC 2100™ procedure to our patients.
Who is a candidate for IRC?
The best candidate for IRC treatment is one with symptomatic grade I or II internal hemorrhoids that have failed conservative therapy. Some minor grade III internal hemorrhoids can be treated. Surgery is generally recommended for individuals who have large 3rd degree or 4th degree hemorrhoids, acutely thrombosed hemorrhoids, symptomatic external hemorrhoids, or individuals who have failed less aggressive therapy. IRC cannot be performed on external hemorrhoids.
Preparing for IRC?
There is no need for special laxative or dietary preparation. The patient may eat normally before and after the procedure. They may take all normal medications except certain "blood thinners". Patients on Coumadin (warfarin) require special instructions. As sedation or anesthesia are not required, they may come alone and plan to resume normal non-strenous activities the same day. We suggest that they wear loose comfortable clothing that can be easily removed.
How is IRC performed?
The patient lies comfortably on their left side. After performing a gloved digital rectal exam, the doctor will insert a short, hollow, lighted instrument a few inches into the anal canal.
This device, called an anoscope, allows the doctor to inspect the anal canal and directly visualize the internal hemorrhoids. A small probe is placed above the hemorrhoid and a few 1.5 second bursts of infrared light are applied. Similar to a "spot welder," this infrared light quickly coagulates and seals the vessels that provide the hemorrhoid with blood. In the same way that blocking a stream dries up a lake, IRC coagulates the "feeder veins" that deliver blood to the hemorrhoids. Without a blood supply, the hemorrhoids gradually shrink and recede over the next few weeks.
Does it hurt?
Insertion of the anoscope is uncomfortable, but not painful. While patient sensitivity may vary, most patients report feeling only a brief sensation of heat and pressure during IRC, but not sharp pain. As there is no surgical incision, local or general anesthesia is not required. The procedure usually takes less than 10 minutes.
Are there any side-effects?
Every medical procedure has some risk. Potential IRC risks would include infection, bleeding, and pain - but, fortunately, these are quite rare. Typically, there are no post-treatment after-effects with IRC and most patients return to a normal lifestyle the same day. Some may experience a dull rectal discomfort and slight spot bleeding for a few days. This is normal. Minor bleeding may also occur 7 to 14 days after the treatment when the scab comes off. Heavy straining or lifting should be avoided and aspirin not taken for a few days. For any discomfort, we recommend taking 2 Extra-Strength Tylenol and a Sitz bath (soaking in a tub) for 20 minutes three times a day over the next 2 or 3 days as needed. It is important that patients keep their stools soft and avoid prolonged straining. Patients are advised to eat a high fiber diet (bran cereal, fresh fruits, vegetables) and drink lots of fluids and use a stool bulking agent (Metamucil) and/or a stool softener (Colace 100 mg) daily for a few weeks.
How many visits are required?
Only the doctor can make that determination. The number of treatments will depend upon the severity of symptoms, the number and location of the hemorrhoids, and the patient's individual response to the procedure. A typical case requires three to four sessions spaced apart to allow healing.
Will the hemorrhoids come back?
Million of patients have been treated with IRC over the past 20 years. Experience tells us that over 85% of hemorrhoids treated with IRC do not return. A sensible high fiber diet and proper bowel habits, such as avoiding straining or prolonged reading on the toilet, will also help.
Is IRC covered by my insurance?
While health insurance policies and coverage vary, IRC is a well recognized FDA-approved procedure that is covered by most insurers including Medicare. If patients have any questions about authorization and coverage, our staff can assist them.
Summary
All rectal bleeding in adults must be taken seriously and evaluated carefully. When hemorrhoids are found and do not respond to initial treatment, Infrared Coagulation (IRC) may be an option. IRC has revolutionized the treatment of early stage symptomatic internal hemorrhoids. It is a safe, effective, and well-tolerated non-surgical procedure that can be performed in the doctor's office. There is no incision and no need for anesthesia. Recovery is quick and comfortable. IRC allows patients to avoid the severe pain and threat of infection which often accompanies an invasive procedure. IRC has passed the test of time with millions of satisfied patients over the past 20 years. If you have any additional questions about IRC, please consult your doctor.
Hemorrhoids: Inside and Out |
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This is a photo taken during a colonoscopy examination. This is a view of the inside of the anus seen as the scope is turned back on itself just inside the rectum. You can see the black scope as it enters the colon. This so-called "retroflexed view" allows the doctor to see if bleeding is caused by rectal cancer or, as in this case, internal hemorrhoids. Internal hemorrhoids such as these can now be successfully treated by non-surgical infrared coagulation, or IRC. [VIDEO]
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This photo was taken during a recent colonoscopy. However, this photo was taken on the outside of the anus. You can see a large cluster of external hemorrhoids encircling the anal opening. External hemorrhoids such as these cannot be treated by IRC. In most cases, conservative treatment is suggested. However, if they thrombose and develop a painful blood clot, surgery is required.
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June 6, 2007
