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Dr. Komoroff

Dear Doctor K: I've suffered with bleeding hemorrhoids for many years. My doctor suggested surgery. Is this risky?

Dear Reader: Hemorrhoids are swollen veins in the anus. Internal hemorrhoids are located inside the anus but can sometimes push out through the opening of the anus. External hemorrhoids are located at the rim of the anus. Both types can cause bleeding, itching and discomfort.

My Harvard Medical School colleague, Dr. William Kormos, recently talked about surgical treatments for hemorrhoids in the Harvard Men's Health Watch. Here is what he discussed:

Some procedures can be done in a doctor's office, but only on internal hemorrhoids. One such procedure is really "low tech": rubber band ligation (RBL). In RBL, the doctor places a small band around an internal hemorrhoid to cut off its blood supply. Ligation can cause minor pain.

Another office-based technique is infrared photocoagulation (IPC). IPC uses infrared light to heat and scar the hemorrhoid. IPC causes less pain than RBL, but it may be less effective for severe hemorrhoids.

The final office-based treatment is sclerotherapy. The doctor injects an irritating chemical solution into the hemorrhoid or surrounding area. This solution triggers a reaction that causes the hemorrhoid to shrink. (I've put an illustration of these three office-based procedures at tulsaworld.com/DrK.)

When office-based treatments don't work, hemorrhoids may have to be surgically removed. This is called hemorrhoidectomy. The surgery is effective for both internal and external hemorrhoids.

A final surgical option is hemorrhoid stapling. In this procedure, a special device staples and removes hemorrhoid tissue. Used only for internal hemorrhoids, stapling is less painful than hemorrhoidectomy and appears to be almost as effective.

Write Dr. K at www.AskDoctorK.com or c/o Universal Uclick, 1130 Walnut, Kansas City, MO 64106

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