DR. MAMODIAS HEMORRHOID TREATMENT SCHEME

Hemorrhoid Caused by

• Abnormal distension of the arteriovenus anastomosis(anal cushions) causes bleeding

• Downward displacement or prolapse of the anal cushions/hemorrhoids

• Destruction of the anchoring connective tissue system

Other causes are

• Backflow of venus blood

• Increase in I A pressure

• Pressure exerted on the hv by foetus

• Heavy meal causes Vascular distension and causes bleeding and discomfort in gfthe hemorrhoid cushions

• Abnormal rhythm of contraction exert greater force of contraction of anal sphincter causes pain.

And should be treated

• To relieve intrarectal pressure

• To obliterate superior hemorrhoid vessels

• To cause fixity of the pile mass

• Reduction in size of pile mass

Dr.Mamodia`s Hemorrhoid Treatment Scheme (HTS)

Comprises

• Sphincter dilatation

• Treatment of associated disease

• IRC for 1st & 2nd degree hemorrhoids

• 3rd & 4th degree with improved technique of IRC and mcgween suction band ligator 14 mm diameter at 15 to 20 mm of hg

• Practice of yoga and deep expiratory excercises helps in passing easy motion and perineal and perianal excercises strengthens the levators and sphincters responsible for holding the pile mass in position

• All degree internal hemorrhoids are effectively treated with IRC in one sitting only. no side effects or complications noted.

Methods:

through local and systemic examination and proctologic counseling to the patient about dietary and defaectory habits, procedure performed in left lateral position under inferior hemorrhoid block 0.5%bopivacaine with 1:200000 adrenaline

Sphincter tone assessed if tone increased due to overactive sphincter or anal fissure, lateral sub cutaneous internal sphinctertomy was done in routine, anoscopy done and each hemorrhoid area visualized, infrared coagulator of lumatech germany with improvised technique of 1.75secs/pulse was applied depending upon the size of pile mass and prolapse above the pile mass and on rectal mucosa at 3 to 5 applications 3 to 4 cm above the dentate line, this was repeated for another hemorrhoids. Lax rectal mucosa or pile mass treated with McGivney hemorrhoidal suction ligator of 14mm diameter at 15 to 20 mm of hg in the last part of the gut where the gut lining is not sensitive to pain. Up to three to four haemorrhoids are treated at one time using this method .Light pack kept over each pile mass to be removed while passing stool. It is completely blood less procedure patient stands up from operation table and puts on trousers and walks to the bed. All patients taught to do pranayama of deep inspiratory/expiratory excercises which overcomes the operative trauma. Patient feels pleasant, discharged after passing urine in 1 to 2 hours. Local patients follow up 5th day and out station patients by phone, follow up done after 15 days,3 months 6 months after 1 year,then each year by person or phone.

For severe hemorrhoid bleeding IRC with increased pulse rate of 1.75 to 2.00 secs/ pulse applied above the pile mass in rectal mucosa and directly over the bleeding point under LA. Bleeding stops immediately

For prolapsed interno external or strangulated hemorrhoids, gentle digital rectal examination relaxes the sphincters and hemorrhoids reposited in the anorectal region and the procedure is performed immediately.

The external hemorrhoids are treated with low pulse rate 1 to 1.25secs/pulse applied directly over the ext hemorrhoids resulting immediate shrinkage of the vessels and the swollen hemorrhoids causing immediate reduction in size .the large external hemorrhoids are excised the bleeding vessels are coagulated with IRC

A very comman associated problem of fibrosed anal papillae are coagulated directly with IRC

All anal fissures are treated with lateral sub cutaneous internal sphincterotomy done on left anterior anal region in between external and internal sphincter .this causes no wound.no need of any dressing

Dr. Mamodia has 45 years experience of treating anorectal diseases and rich follow up of more than 9500 patients suffering from all grades of hemorrhoids for 15 years operated with HTS with less than 3% recurrences as compared to international standards of 10 to 15% with all procedures in one sitting only. 3rd and 4th grades hemorrhoids have excellent results with one application only while international standards require multiple sittings in 1st and 2nd grades hemorrhoids only.

The above procedure is done in local anaesthesia in most acceptable lt lateral position

• Patients discharged in 2-3 hours after passing urine

• Patient stand and walks out of the hospital in cheerful mood

• The next day patient passes motion comfortably and applies cream himself with no dressing

• For 10 to 15 days slight bleeding and pain only due to normal healing process.

frequency of passing stools 3-4 times normalises in 2 weeks time

No complication or side effects noted

What are the benefits of Hemorrhoid Treatment Scheme

HTS procedures are fast, easy to perform. It`s minimally invasive and patients experience less pain postoperatively, allowing them to return to work much sooner. HTS treats the patho physiological changes by obliterating the hemorrhoid vessels, causing fixity of the rectal mucosa to the muscularis and anchoring the pile mass in the rectum. The large pile masses with mucosal prolepses having obstructing symptoms treated by suction ligation. The procedure is performed in local anesthesia, as an out patient procedure. which is patient friendly and cost effective without any complication and performed without risk. It does not require postoperative dressing. It fulfils to correct all the path physiological changes

The main advantageof the procedure is that no repeated application of IRC to pile mass needed

RBL applied to 3rd and 4th grades of pile.The advantage of 14mm diameter pulls large mass of pile thereby prolapses reduced instantly.

all the three and accessory piles are treated at one sitting

Conflict Of Interest

With MIPH, HAL and milligan morgon hemorrhoidectomy. all these procedures are done in general or saddle block anaesthesia, invasive and post operative complications like bleeding, pain are much more with these procedures MIPH and HAL procedures do not cause adherence and fixity while HTS causes adherence and fixity of the hemorrhoids to the muscularis. recurrences and late complications are least MIPH and HAL does not deal external hemorrhoids and anal papillae while IRC causes effective regression

HTS is a new approach to the treatment of all degrees of hemorrhoids as an outpatient procedure in one sitting and is non surgical. 97%of the operated patients are going well with no relapses in 15 years follow up

Prevention Of Hemorrhoids

Eat high-fiber foods. Eat more fruits, vegetables and grains. Doing so softens the stool and increases its bulk, which will help lessen the straining that can cause hemorrhoids.

Drink plenty of liquids. The exact amount of water and other fluids you should drink each day

Consider fiber supplements. Over-the-counter products such as Metamucil and Citrucel can help keep stools soft and regular. Check with your doctor about using stool softeners. If you use fiber supplements, be sure to drink at least eight to 10 glasses of water or other fluids every day. Otherwise, fiber supplements can cause constipation or make constipation worse. Add fiber to your diet slowly to avoid problems with gas.

Exercise. Stay active to reduce pressure on veins, which can occur with long periods of standing or sitting, and to help prevent constipation. Exercise can also help you lose excess weight Daily morning walk

Practise of yoga vajra son,bhunghason, tadason and paschimotanasan Avoid long periods of standing or sitting. If you must sit for long periods, don`t use an inflatable doughnut cushion to pad your chair. It can increase the pressure on the veins in the anus.

Don`t strain. Straining and holding your breath when trying to pass stool creates greater pressure in the veins in the lower rectum.

Deep expiration causes pressure over the intestine, stimulates intestine motility and helps in passing stool easily Go as soon as you feel the urge. If you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass.


Before Traetment	After Traetment


88 years old patient having history of heart attack, having prolapsed interno external Hemorrhoids operated shows before and after HTS treatment and is getting up


Post Operation, Patient is getting up his own	Patient is ready to walk after the treatment