The pain and discomfort from hemorrhoids can be debilitating. The swollen and inflamed veins impact more than 15-million people in the US. While there are many treatments out there, most are either ineffective or have serious side effects. Now there is a new non-invasive treatment that is making these bleeding blood vessels disappear almost effortlessly.
Thomasine Brown is finally able to relax after enduring a painful problem for two years.
"Excruciating pain," Thomasine Brown, told Ivanhoe. "I couldn't even sit straight up, because the hemorrhoids were just that bad."
The bus driver could hardly work and was finally driven to seek help.
"I had to keep bouncing from cheek to cheek because of the one that was on the outside," Ms. Brown said.
It's a problem Doctor Sergey Kantsevoy sees every day.
"It's uncomfortable, it makes life miserable and in the past the only option was to go for surgery," Doctor Sergey Kantsevoy, M.D., Ph.D., of the Mercy Medical Center in Baltimore, MD told Ivanhoe.
Now a new FDA cleared device offers an easy, less painful alternative.
"One therapeutic session, we never have to repeat it and the patient never complains of any pain or discomfort," Doctor Kantsevoy explained.
Known as the HET Bipolar System, the device is made up of a small plastic tube and built-in treatment window that's placed in the rectum.
"And you capture with that device the hemorrhoid," Doctor Kantsevoy said.
Once captured, radiofrequency energy is used to cut off the blood supply to the vessel.
"And because no blood comes in there, the hemorrhoids shrink and disappear," explained Doctor Kantsevoy.
The outpatient procedure takes under a minute.
"No recovery, no lost time from work," said Doctor Kantsevoy.
Thomasine Brown says, "I felt immediate relief right after."
It's a simple treatment that gave Thomasine her life back.
The HET Bipolar System is currently used in the treatment of folks with grade one, two, or three hemorrhoids. The most serious cases—grade four, must be sent to surgery.
BACKGROUND: Hemorrhoids, also called piles, are swollen and inflamed veins in your anus and lower rectum. Hemorrhoids may result from straining during bowel movements or from the increased pressure on these veins during pregnancy, among other causes. Hemorrhoids may be located inside the rectum (internal hemorrhoids), or they may develop under the skin around the anus (external hemorrhoids). By age 50, about half of adults have had to deal with the itching, discomfort and bleeding that can signal the presence of hemorrhoids. (SOURCE: http://www.mayoclinic.com/health/hemorrhoids)
SYMPTOMS: Signs and symptoms of hemorrhoids may include:
· Painless bleeding during bowel movements
· Itching or irritation in your anal region
· Pain or discomfort
· Swelling around your anus
· A lump near your anus, which may be sensitive or painful
· Leakage of feces
LATEST TECHNOLOGY: Several minimally invasive technologies are available to treat hemorrhoids. The use of energy to deliver heat and coagulate target lesions is commonly practiced. Now, there is a new bipolar tissue ligator that combines constant tissue compression and temperature guidance. The HET Bipolar Forceps and Monitor have been granted a CE mark and FDA clearance. The treatment occurs in a pain free zone and uses low radiofrequency, bipolar energy to occlude the superior hemorrhoidal blood supply resulting in the reduction of the blood flow to the corresponding hemorrhoid. Because of HET's unique and proprietary design, the tissue is compressed and treated in a transverse direction above the "Dentate Line", where there is an absence of or much fewer pain receptors. This results in a near pain-free procedure with proven long-term clinical outcomes. (SOURCE: http://www.ncbi.nlm.nih.gov/pmc/articles; http://hetsystem.com/hetdevice)
Dr. Sergey Kantsevoy, MD, PH.D., at the Mercy Medical Center in Baltimore, MD, talks about a new treatment option for hemorrhoids.
If we can talk a little bit about hemorrhoids and just the scope of the problem. How big of a problem is this in the United States?
Dr. Kantsevoy: In every developed country it's a huge problem, because hemorrhoids affect at least five to ten percent of the population. United States alone probably ten million people have hemorrhoids and have complaints related to hemorrhoids. People lose a lot of work days, it's uncomfortable, it makes life miserable and in the past the only option was to go for surgery to eliminate the hemorrhoids.
Now there are new options?
Dr. Kantsevoy: There are new options. The options for nonsurgical treatment of hemorrhoids were available for a long time. Unfortunately those options are either too painful when effective or less painful, but not effective. If they are not effective then they require numerous treatment sessions, probably ten, twenty treatment sessions. When they are effective they also cause a lot of pain and then afterwards people cannot work for a few days; they have to take pain medicine and even some few patients develop life threatening illnesses with this non-surgical treatment of hemorrhoids. That's why out of dissatisfaction with all that I started to look for alternatives and then find out that recently Food and Drug Administration approved new treatment of hemorrhoid and that's what we try to do here.
Tell us how the bipolar system is different?
Dr. Kantsevoy: It's called anoscope meaning that it's a small plastic device like a tube with handle and with a treatment window with build-in atraumatic forceps in it. You put that device into the patient's rectum and capture the rectal tissue proximal to the hemorrhoid. Hemorrhoids are just blood vessels engorged with blood and that's why it's bleeding and that's why it's so big; so you capture the blood vessel, which fits the hemorrhoids and you deliver thermal energy at about fifty five degrees Centigrade (which is approximately about one hundred and thirty five Fahrenheit). That cauterize the blood supply to hemorrhoid and then the hemorrhoid shrinks and disappears.
What's the recovery time like?
Dr. Kantsevoy: The patient wakes up and goes home. No recovery, no time lost from work.
Is it covered by insurance?
Dr. Kantsevoy: Yeah it's covered very well by insurance.
So it's pretty pain free?
Dr. Kantsevoy: Completely pain free. Mild discomfort, because you are touching somebody's rectum but it's not to the level of pain. We did a formal study in patients who were allowed to take Tylenol or pain medicine on demand and nobody asked for pain medicine, not a single patient.
Then you typically would do this then while someone's having a colonoscopy?
Dr. Kantsevoy: If we don't know the cause of bleeding then we do colonoscopy to discover the cause and after that if it is hemorrhoids we treat it right away, by the end of the procedure. If we already know from previous study the cause of treatment then we can do it as outpatient. When patients come we do it and don't even need to do colonoscopy for that.
How dangerous are hemorrhoids?
Dr. Kantsevoy: Hemorrhoids by itself can cause significant blood loss. I saw patients who were so anemic that they required blood transfusion; they were not able to function properly, they could not enjoy life so it's life threatening if you're losing a lot of blood. The treatment of hemorrhoids can also be dangerous and life threatening so it's not a simple nuisance it's real problem that needs to be addressed.
Dr. Kantsevoy: The previous nonsurgical treatment consists of application of rubber bands to grab the hemorrhoids and cut out the blood supply; unfortunately it's a really dirty area; it's the rectum; so there is a lot of stool and bacteria. When the rubber bands were applied then they would cause necrosis in that area; and after that this necrotic area could get infected and patients could even develop pelvic sepsis and it's life threatening illness.
How many cases would you say where that happens?
Dr. Kantsevoy: Unfortunately you can never predict whether your patient will or will not have a problem. So you just have to tell everybody that this is a potentially life threatening treatment. Not like the other non-surgical treatment that we are currently using: during the treatment with HET we did not have any problem.
I think that's something a lot of people don't realize and I don't think people realize hemorrhoids can be life threatening, they think of it more as a nuisance.
Dr. Kantsevoy: It is a nuisance in most people, but if the bleeding continues then it becomes a medical problem. I saw people who had undiagnosed anemia and after we treated them for hemorrhoids and the bleeding stopped their anemia went away. Those people spent a significant amount of money to investigate the cause of their anemia and they were having endoscopy, colonoscopy, numerous blood transfusions and all the treatment the needed was to eliminate their hemorrhoids.
Are there any symptoms?
Dr. Kantsevoy: Yes, there is a prolapse. When hemorrhoids get so big that they are falling out of the rectum; then it causes discomfort, people cannot sit properly, it causes a lot of itching and that is symptoms. It may even become incontinent in stool; all these symptoms related to hemorrhoids.
Are there any other diseases or problems like you said with anemia? Are there any other imbalances or diseases or problems in the body that we have?
Dr. Kantsevoy: Not hemorrhoids itself, but let's say if you have a patient who had blood flow restricted by coronary artery disease, those patients need to have a high count of hemoglobin to carry oxygen. If they are bleeding from hemorrhoids this can provoke a heart attack; in people with bad coronary arteries. There are other problems, such as people with chronic lungs diseases, if they don't have enough oxygen, because of their anemia that can provoke their illness too.
How long does the procedure take?
Dr. Kantsevoy: Ten seconds per each hemorrhoid branch. The average person usually has three hemorrhoidal branches: at seven o'clock, three o'clock and eleven o'clock positioning if you imagine it as a clock wise. If you have only three then it will take less than a minute, probably thirty, forty seconds. Some people have more than three then it will take a little longer, but I have not had a single patient where it took longer than a minute to treat.
And then after that they can go home and back to their normal activity?
Dr. Kantsevoy: Back home to normal activity, yes.
Who would this particular procedure be best for; are there certain candidates or do the hemorrhoids have to be at a certain level?
Dr. Kantsevoy: We started to do it for people with grade one and grade two hemorrhoids. Grade one hemorrhoids, which are small and not prolapsing out of the rectum. Grade two hemorrhoids are a little bigger so from time to time they prolapse out of the rectum and person can feel it with their finger, that there is some extra tissue coming out of the rectum, but they return back spontaneously, they don't need any measures to return it back. So this is a grade two, which we treat and grade one. However we started now to extend it to grade three. Grade three means that hemorrhoids prolapse out of the rectum and the person needs to push it down himself or herself. They don't go back spontaneously. There is also grade four which means the hemorrhoids prolapse and cannot be pushed back into the rectum. Those we did not touch so far, we send those to surgery.
When you do get hemorrhoids; can the body heal itself?
Dr. Kantsevoy: It depends on the grade. With Grade one if you normalize bowel movements, stop drinking alcohol, and stop eating spicy food then there is a very good chance that it will go away. If it is grade two then they'll probably continue to stay there; not even a normalized bowel movement will reverse the process.
How do you prevent hemorrhoids in the first place?
Dr. Kantsevoy: Through a good lifestyle. Be good to your gut, avoid constipation from early ages; eat a lot of fruits and vegetables and drink plenty of fluid to have regular daily bowel movements without straining; and good hygiene; eliminate all reading materials in the bathroom.
That's something I never heard before about the bathroom.
Dr. Kantsevoy: It's extremely important, very important not to do.
FOR MORE INFORMATION, PLEASE CONTACT:
Mercy Medical Center
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