Hemorrhoids, Reflux

Hemorrhoids

Hemorrhoids are very common. As a reminder, initial steps for patients with hemorrhoid flare-ups (swelling, discomfort, bleeding) are:

1. Avoid constipation — prunes, miralax, other laxatives prn.

2. Sitz baths tid.

3. Preparation H or hydrocortisone suppositories (remember it’s ideal to not continue this past 1-2 weeks of treatment).

4. Aloe wipes, tucks pads.

5. Lidocaine ointment is an option.

If hemorrhoids are more complicated or persistent, they do warrant evaluation by surgeons with expertise in hemorrhoidal disease. We offer the full spectrum of treatments such as banding, Hemwell, and surgery. We can also do these at the time of colonoscopy as it is important to rule out colonic sources of bleeding such as cancers. Hemorrhoid emergencies are rare, but it is good to remember strangulated hemorrhoids are incarcerated prolapsed hemorrhoids with the appearance of ischemia — these are very painful, tender, and need urgent operation and antibiotics.

GERD

Many patients complain of GERD. Remember that treatment and diagnostic steps include the following:

1. Weight loss plan if overweight.

2. Avoid eating within 3 hours of bed time or lying flat (especially fatty foods and alcohol).

3. Diaphragm breathing exercises (https://www.coberhernia.com/other-services).

4. No smoking or other inhalational agents.

5. A short trial of PPIs or H2 blockers (e.g. Omeprazole over the counter for 2-4 weeks).

If symptoms persist or there are risk factors for esophageal cancer (e.g. history for smoking, alcohol, or symptoms such as dysphagia), an esophagram with barium would be warranted which can also evaluate for a hiatal hernia. If indicated, we can also perform biopsies and direct visualization with an EGD. Sometimes reflux does go on to require surgery and we can offer the full spectrum of procedures including endoscopic techniques.