- Internal Hemorrhoids
- Causes, Symptoms & Treatments for Internal Hemorrhoids
- What are Internal Hemorrhoids?
- What Causes Internal Hemorrhoids?
- What do Internal Hemorrhoids Look Like?
- How do You Treat Internal Hemorrhoids?
- When your colonoscopy reveals that you have diverticulosis, hemorrhoids, or both
- In most cases, you won’t know they’re there. But if things change, home remedies often help.
- Hemorrhoid Symptoms and Diagnosis: Internal and External Hemorrhoids
- Common Hemorrhoid Symptoms to Watch For
- Internal Hemorrhoids vs. External Hemorrhoids
- How Hemorrhoids Are Diagnosed by Your Doctor
- Hemorrhoid Treatments
- Rubber Band Ligation
- Infrared coagulation (IRC)
- Treatment of hemorrhoids at the time of colonoscopy
- Digestive Health Associates
Causes, Symptoms & Treatments for Internal Hemorrhoids
- What are Internal Hemorrhoids?
- What causes internal hemorrhoids?
- The Most Common Symptom of Internal Hemorrhoids is Bleeding
- Different Kinds of Hemorrhoids Can Cause Similar Symptoms
- Do I Have Internal Hemorrhoids?
- What do Internal Hemorrhoids Look Like?
- How do You Treat Internal Hemorrhoids?
- Hemorrhoid Home Remedies
- Effective But Invasive Professional Hemorrhoid Treatment Options
- Minimally Invasive Professional Hemorrhoid Treatment Options
What are Internal Hemorrhoids?
Internal hemorrhoids form when blood vessels inside the rectum become swollen and engorged. Although they form in the lowest part of the rectum, internal hemorrhoids are still far enough inside that you may not even know that they’re there. In fact, everyone actually has internal hemorrhoids, but we only notice them once they become a problem! Once they do become an issue, symptoms of internal hemorrhoids vary depending on their severity, but the most common symptom is rectal bleeding.
Because internal hemorrhoids are located in an area without any nerve endings, they do not cause pain. If you are experiencing pain, it may be from a different condition such as external hemorrhoids, anal fissures or spasm.
Many people are able to get temporary relief from sitz baths and ointments/creams, but such remedies are unlikely to cure your hemorrhoids as they do not resolve the underlying issue.Because anal bleeding is a common symptom of internal hemorrhoids as well as colon cancer, it is always recommended that you see a medical professional for diagnosis if you are experiencing such symptoms. Your doctor may recommend a longer lasting treatment for your internal hemorrhoids, such as hemorrhoid banding or hemorrhoidectomy.
What Causes Internal Hemorrhoids?
Hemorrhoids result from an increase in pressure in the veins of the rectum, typically from too much straining. Common causes of internal hemorrhoids include:
- Constipation and diarrhea – these conditions both put undue stress on the rectal area either by straining too much (constipation) or frequent bowel movements (diarrhea). These issues can often be resolved with diet and lifestyle changes, but may also be associated with other conditions like IBS and IBD
- Diet high in fat and/or low in fibre – such a diet can affect our bowel movements, causing constipation or diarrhea. As described above, this can put undue pressure on the rectum and increase time sitting on the commode.
- Pregnancy and childbirth – many women develop hemorrhoids during pregnancy or during childbirth due to the increased pressure of carrying a growing fetus and the straining during childbirth.
- Obesity – people who are obese are at a higher risk of developing both internal and external hemorrhoids, not only because of increased pressure around the rectum, but also because obesity is often associated with poor diet and a sedentary lifestyle.
- Long periods of sitting – regular activity is an important aspect to prevent hemorrhoids and other anorectal health issues.
If you want to prevent internal hemorrhoids from forming, making some simple lifestyle changes such as increasing the amount of fiber in your diet and engaging in regular exercise may help. Unfortunately, sometimes there is nothing we can do to prevent internal hemorrhoids.
What are the Symptoms of Internal Hemorrhoids? (Sub Topics = Bleeding Hemorrhoids, Anal Bleeding, Bleeding, Blood, Pain)
Symptoms of internal hemorrhoids vary depending on their severity. Small internal hemorrhoids may only cause some light bleeding, however, when the hemorrhoid tissue begins to prolapse, or protrude outside the anus, you may start to notice itching, swelling, and even soiling (all due to that loosened tissue). The most common symptom of internal hemorrhoids is anal bleeding.
Because internal hemorrhoids are located in an area without any nerve endings, they do not cause pain. If you have internal hemorrhoids and are experiencing pain, it is most likely the result of an associated condition, such as anal fissures.
The Most Common Symptom of Internal Hemorrhoids is Bleeding
Internal hemorrhoids can worsen over time, but since there are very few pain-sensing nerves in the lower rectal area, you are unlikely to feel any pain. In fact, the most common symptoms of mild internal hemorrhoids is bleeding. You can read more about hemorrhoid bleeding on our blog: here. Pain that is associated with internal hemorrhoids is in fact typically caused by an anal fissure or by external hemorrhoids.
Different Kinds of Hemorrhoids Can Cause Similar Symptoms
When internal hemorrhoids do progress, they will often protrude outside the anus, becoming prolapsed hemorrhoids. An internal hemorrhoid that has reached this stage can cause some external hemorrhoid-like symptoms, such as itchiness and swelling. Since prolapsed hemorrhoids and external hemorrhoids can cause similar symptoms, it’s sometimes difficult to know which is which without a doctor’s professional diagnosis. It is also not uncommon for both to be present at once.
Additional reading: You can read about prolapsed hemorrhoids in several of our blog posts: Prolapsed Internal Hemorrhoids, What is a Prolapsed Hemorrhoid, and Rectal Prolapse or Hemorrhoids?.
Do I Have Internal Hemorrhoids?
Only a qualified physician can accurately diagnose internal hemorrhoids. Additionally, because bleeding is a common symptom of colorectal cancer as well as internal hemorrhoids, it is recommended you see a physician right away if you are experiencing any rectal symptoms. If you’re still uncertain about whether you should see a doctor about your symptoms read out blog post titled “Do I have to see my doctor if my hemorrhoids are bleeding?”.
What do Internal Hemorrhoids Look Like?
Internal hemorrhoids are located inside the anal canal, so unless they prolapse (slide) to the point of protruding outside of your anus, you will not see anything.
Symptoms are typically a better indication of internal hemorrhoids. Whether you’re feeling excess tissue around the anus or you’re seeing a small amount of blood on the toilet paper, your symptoms may indicate a hemorrhoid problem.
The only time you may see an internal hemorrhoid is if the disease becomes advanced enough to prolapse or protrude outside the anus. This typically happens during a bowel movement and in many cases the tissue will go back in on its own. In other cases, you may have to push the tissue back in.
The below diagram depicts the location of an internal hemorrhoid:
Since the only way to know if you have internal hemorrhoids is to call a doctor near you and schedule a consultation, we recommend you search our database for a doctor near you that is able to diagnose and, if appropriate, treat your hemorrhoids.
How do You Treat Internal Hemorrhoids?
There are a number of internal hemorrhoid treatment options available to those experiencing symptoms. Common treatments fall into a few categories:
Hemorrhoid Home Remedies
At-home hemorrhoid treatments are often appealing to those suffering from internal hemorrhoid symptoms as they can be discreetly utilized in the comfort of your own home. Some examples include:
- Ointments/creams or suppositories such as Preparation H
- Sitz baths
- Other (somewhat controversial) natural treatments such as apple cider vinegar or aloe vera
Unfortunately, all too often, hemorrhoid sufferers spend endless time and money on home remedies such as creams, suppositories, and warm baths, trying to cure their hemorrhoids but getting nothing but temporary relief from some of their symptoms. Home remedies can keep symptoms in check for a few hours at a time, but without professional treatment, hemorrhoids can continue to get progressively worse. You must resolve the underlying issues to get rid of your hemorrhoids for good.
If you have recurring hemorrhoids, consult a medical professional for alternative options for treating internal hemorrhoids.
Effective But Invasive Professional Hemorrhoid Treatment Options
If you have been unhappy with home remedies such as those described above, it is likely that you have already turned to a medical professional to get rid of your hemorrhoids for good. Unfortunately, you may have been told that your only options for treating your internal hemorrhoids are methods fraught with complications that require you to take time off work, such as:
- Traditional hemorrhoid banding
- Surgery or hemorrhoidectomy
If you have spoken with a doctor before and been offered only ineffective conservative treatment options (e.g. ointments, sitz baths, etc.) or the above invasive procedures, you’re not alone. This is why so many people suffer their symptoms in silence. It may be time to speak with a physician about other options to get rid of your hemorrhoids.
Minimally Invasive Professional Hemorrhoid Treatment Options
Today, there are a number of non-invasive internal hemorrhoid treatment methods available from medical professionals that do not have the complications and downtime associated with the options above. That is why it’s important to speak with a doctor to learn about your treatment options. Some of these options include:
- Hemorrhoid banding with the CRH O’Regan System®
- Infrared coagulation (also known as “IRC”)
Many of these minimally invasive methods of internal hemorrhoid treatment, such as infrared coagulation, are only effective on smaller hemorrhoids and while they may provide symptomatic relief for longer than home remedies, symptoms often recur sooner than if treated with more invasive options.
The CRH O’Regan System®, however, provides both the low complication rate of these non-invasive options and the low recurrence rate of surgery.
Learn more about your treatment options >
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What causes hemorrhoids?
Hemorrhoids may develop as a result of repeated straining during bowel movements or chronic constipation or diarrhea.
What are the symptoms of hemorrhoids?
The following are the most common symptoms of hemorrhoids. However, each individual may experience symptoms differently. Symptoms may include:
- Bright red blood present on the stool, toilet paper or in the toilet bowl
- Irritation and pain around the anus
- Swelling or a hard lump around the anus
The symptoms of hemorrhoids may resemble other medical conditions or problems. Always consult your child’s doctor for a diagnosis.
How are hemorrhoids diagnosed?
The presence of blood in the stool can be indicative of other digestive disorders, including colorectal cancer, so thorough evaluation and proper diagnosis is important.
Diagnosing hemorrhoids may include:
- Physical examination. This is done to check the anus and rectum and look for swollen blood vessels that indicate hemorrhoids.
- Digital rectum examination (DRE). The doctor inserts a gloved, lubricated finger into the rectum to check for abnormalities.
- Anoscopy. A hollow, lighted tube useful for viewing internal hemorrhoids is inserted into the anus.
- Proctoscopy. A lighted tube, which allows the doctor to completely examine the entire rectum, is inserted into the anus.
- Sigmoidoscopy. A diagnostic procedure that allows the doctor to examine the inside of a portion of the large intestine, and is helpful in identifying the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.
- Colonoscopy. A procedure that allows the doctor to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered. Learn more about colonoscopy.
What is the treatment for hemorrhoids?
Specific treatment for hemorrhoids will be determined by your child’s doctor, based on:
- The child’s age, overall health and medical history
- Extent of the condition
- The child’s tolerance of specific medicines, procedures or therapies
- Expectations for the course of the condition
- The family’s opinion or preference.
Medical treatment of hemorrhoids is aimed at relieving symptoms and may include the following:
- Sitting in plain, warm water in the tub several times a day
- Ice packs to reduce swelling
- Application of hemorrhoidal creams or suppositories.
Your child’s physician may also recommend increasing fiber, fluids or laxatives to soften stools. A softer stool lessens pressure on hemorrhoids caused by straining. Good sources of fiber include fruits, vegetables and whole grains. Bulk stool softeners or fiber supplements, such as psyllium (Metamucil) or methylcellulose (Citrucel), may also be recommended.
In some cases, it is necessary to treat hemorrhoids surgically. Several surgical techniques are used to remove or reduce internal and external hemorrhoids. These include the following:
- Rubber band ligation. A rubber band is placed around the base of the hemorrhoid inside the rectum to cut off circulation to the hemorrhoid. The hemorrhoid then gradually shrinks and withers away within a few days.
- Sclerotherapy. A chemical solution is injected around the blood vessel to shrink the hemorrhoid.
- Electrical or laser coagulation or infrared photo coagulation. Techniques that use special devices to burn hemorrhoidal tissue.
- Hemorrhoidectomy. A surgical procedure that permanently removes the hemorrhoids.
When your colonoscopy reveals that you have diverticulosis, hemorrhoids, or both
In most cases, you won’t know they’re there. But if things change, home remedies often help.
Updated: November 14, 2019Published: December, 2017
Image: © ttsz, JFalcetti/Thinkstock
You received good news after your last colonoscopy: no cancer or precancerous polyps. But with the good news came with a surprise finding: though you don’t have symptoms, you do have diverticulosis and hemorrhoids. The news may be puzzling, but don’t worry. “Both conditions are common and usually don’t cause any problems,” says Dr. Kyle Staller, a gastroenterologist at Harvard-affiliated Massachusetts General Hospital.
Diverticulosis is the term used to describe the presence of diverticula — pouch-like structures that sometimes form in the muscular wall of the colon and bulge outward. “Between 40% and 60% of people have them, and they get more common as we age. They tend to cluster in the sigmoid colon, just above the rectum,” Dr. Staller says.
Diverticulosis only causes symptoms if one of the diverticula bleeds or gets infected. “When bleeding does occur, it tends to be intense for a short period, but usually stops on its own. We don’t know the cause of the diverticular bleeding, only that something injures a blood vessel in the pouch,” Dr. Staller says. “Even if bleeding stops on its own, you can still lose a considerable amount of blood, so you should see a doctor.”
In some people, diverticula can get infected. That’s called diverticulitis. But it’s not as common as having diverticulosis. “The lifetime rate of diverticulitis is low, between 4% and 15% of those with diverticulosis,” says Dr. Staller.
It’s not clear why or how diverticulitis develops. Age, obesity, a lack of exercise, and a low-fiber diet are risk factors for the condition. So is eating red meat.
Typical symptoms of diverticulitis include lower abdominal pain, more often on the left side; fever; and change in bowel habits, either loose stools or constipation. “Most people with diverticulitis will have pain in the left lower part of the abdomen, but no bleeding,” says Dr. Staller. Your doctor will likely order a CT scan to look for active signs of inflammation.
Treatment is typically antibiotics for seven to 10 days. People with more severe disease, such as an abscess (pocket of infection) or pus that needs drainage, often need hospitalization for intravenous antibiotics.
It’s not clear yet if we can prevent diverticulosis or diverticulitis. Exercising, controlling your weight, and eating less red meat and more fiber may help. “Some data suggest that more fiber reduces the risk of both developing diverticula and getting symptoms if you already have them,” Dr. Staller says.
Adults should get 25 to 30 grams of dietary fiber every day from foods such as beans, whole grains, vegetables, and fruits. A fiber supplement may also help. But add fiber to your diet slowly, since you can get gas and bloating if you increase your fiber intake too fast.
What about the warning that eating foods with small seeds can add to diverticulitis risk? “There used to be a theory that seeds, nuts, and popcorn increased the risk of diverticulosis and diverticulitis, because they might lodge in the pouches and cause irritation or infection. However, that’s never been proved. Seeds and nuts are an important source of fiber,” says Dr. Staller.
Hemorrhoids have a bad rap, but we all have these pillow-like clusters of veins in the lining of the lower part of the rectum and anus, which help play a role in preventing stool leakage. When they become enlarged, however, they are anything but helpful and can even contribute to some leakage in addition to pain, itching, and bleeding.
What causes hemorrhoids to swell? “The veins are anchored by connective tissue. If the tissue is weakened, the hemorrhoids bulge out,” Dr. Staller explains. The weakened tissue may be caused by a combination of genetics and pressure from sitting on a toilet too long or straining to have a bowel movement. Pregnancy is also a common trigger.
When hemorrhoids in the lower rectum (internal hemorrhoids) swell, they may bleed, and you may see bright red blood in the toilet. But you won’t feel the hemorrhoids unless they extend beyond the anus and become itchy.
The hemorrhoids most people complain about (called external hemorrhoids) are located outside the anus. If they become swollen, the overlying skin becomes irritated, erodes, and may itch or hurt. A clot can form inside the hemorrhoid, which can be very painful.
Treatment and prevention
Hemorrhoids are typically diagnosed from a medical history and physical exam. Home remedies are usually effective to treat external hemorrhoids. Sitting in a warm bath may help soothe an irritated hemorrhoid. And lifestyle changes can also make a difference. “Avoid sitting and straining on the toilet for long periods, and make sure stool moves along,” says Dr. Staller. He suggests increasing dietary fiber intake; using stool softener, such as docusate (Colace); or using a gentle laxative if you’re constipated, such as polyethylene glycol 3350 (Miralax).
Dr. Staller does not recommend using over-the-counter creams, which are steroids thought to help shrink inflammation. “There’s no evidence they work,” he says.
Internal hemorrhoids that are bothersome are usually resolved with minimally invasive procedures performed in a doctor’s office.
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Hemorrhoid Symptoms and Diagnosis: Internal and External Hemorrhoids
Itching, pain, and bleeding in the anal area are common signs of hemorrhoids.
Symptoms of hemorrhoids include pain around the anus, especially when sitting, or pain during bowel movements. Thinkstock
Hemorrhoids occur when veins in the skin around the anus or in the lower rectum get swollen and inflamed. It’s not exactly clear what causes people to get hemorrhoids, but there are some common, accepted risk factors and conditions that lead to their development.
Aging can decrease muscle tone in the area, weakening the tissue and causing hemorrhoids to bulge, while obesity and pregnancy can increase the risk for hemorrhoids due to increased pressure on tissue in the area. (1)
Repeated straining to make a bowel movement, as well as constipation, are also associated with hemorrhoids.
Hemorrhoids are generally not dangerous or life-threatening, but they may be painful.
Common Hemorrhoid Symptoms to Watch For
The following signs and symptoms may indicate hemorrhoids:
- Bright red blood on toilet paper, in stool, or in the toilet bowl after a bowel movement
- Anal itching
- Pain around the anus, especially while sitting
- Pain during bowel movements
- One or more hard, painful lumps around the anus
If you have any symptoms of hemorrhoids, try to avoid excessive straining, rubbing, or cleaning around the anus.
Doing these things can make any irritation and itching worse, and can sometimes lead to bleeding.
Internal Hemorrhoids vs. External Hemorrhoids
There are two main types of hemorrhoids:
Internal Hemorrhoids These hemorrhoids develop inside the lower rectum. Internal hemorrhoids usually don’t hurt, but they often bleed painlessly, resulting in bright red blood you might notice when you go to the bathroom and wipe.
Most of the time, internal hemorrhoids are not visible to the naked eye. But in some cases, internal hemorrhoids may protrude through the anus, which is known as becoming prolapsed. When this happens, they will usually shrink back inside the rectum on their own. Protruding hemorrhoids can become irritated and itchy, and patients may find it difficult to clean themselves after a bowel movement.
Internal hemorrhoids are categorized by how prolapsed they are, which helps determine how they should be treated.
Grade 1 hemorrhoids means there is no prolapse. A prolapse that goes back in by itself is categorized as grade 2. Prolapse that needs to be pushed back in by the patient is considered grade 3. Grade 4 is when the prolapse can’t be pushed back in. (2)
External Hemorrhoids These hemorrhoids develop under the skin around the outside of the anus. They can be itchy or painful, and may feel lumpy.
External hemorrhoids are called thrombosed hemorrhoids when a blood clot develops within the hemorrhoid. The increased pressure can be very painful, especially within the first 48 hours after it develops. (1)
Thrombosed hemorrhoids tend to be bluish in color due to the clot. Sometimes the blood clot will go away on its own, but because the clot has stretched the skin, it may result in an anal skin tag — excess skin left when the blood clot in a thrombosed hemorrhoid is absorbed by the body. Skin tags do not require removal, but if it’s particularly bothersome to a patient, excision is an option. (1)
If a thrombosed hemorrhoid has been present for longer than two days, the pain has often peaked and you might try home treatments while waiting for the clot to clear up on its own. When the clot first forms, it can be very painful; if you make it to your doctor’s office during this time, an in-office surgical procedure, involving local anesthesia and excision of the hemorrhoidal tissue, may be available. (2)
RELATED: 8 Myths You’ve Been Told About Hemorrhoids
How Hemorrhoids Are Diagnosed by Your Doctor
See your doctor if you think you might have hemorrhoids, especially if you notice bleeding from your anus or rectum, or have bloody stools. Your doctor will want to rule out more serious problems that can cause bleeding from the anus or rectum, such as cancer.
Hemorrhoid symptoms may also be similar to those of other anal and rectal problems, including anal fissures, abscesses, warts, and polyps.
Your doctor will ask about your medical history and will ask you to describe your symptoms. Questions about your eating habits, toilet habits, and enema and laxative use are likely to come up. (3)
Your doctor will also perform a physical exam to look for lumps or swelling, prolapsed internal hemorrhoids, external hemorrhoids, skin irritation, skin tags, and anal fissures, which are small tears in the anus that can result in itching and bleeding. (3) This will involve a visual examination of the area.
Your doctor may also perform a rectal exam to diagnose internal hemorrhoids, check the muscle tone of your anus, and check for blood in the stool. This is done with a gloved, lubricated finger (called a digital rectal examination) and a tool called an anoscope.
An anoscope is a type of endoscope — a hollow, lighted tube that is inserted a few inches into the anus to help the doctor see any problems inside the lining of the rectum. This procedure is performed in the doctor’s office and doesn’t require anesthesia. (3)
Your doctor may also recommend additional tests to rule out other causes of bleeding, especially if you are over age 40.
These tests may include:
Colonoscopy After you’re sedated with medicine, your doctor uses a thin, flexible tube called a colonoscope to look at the inner lining of your colon.
A colonoscopy can help discover ulcers, polyps, tumors, and other areas of inflammation or bleeding.
Sigmoidoscopy This procedure is similar to a colonoscopy, but it uses a shorter tube called a sigmoidoscope to examine the lining of the rectum and the sigmoid colon (the lower part of the colon).
Barium Enema X-ray This is a special type of X-ray of the colon and rectum in which your doctor inserts a liquid solution containing barium sulfate into the rectum. The solution helps highlight specific areas in the colon for your doctor to examine in the X-ray images.
RELATED: 4 Signs Your Hemorrhoids Warrant a Doctor’s Visit
Additional reporting by Deborah Shapiro.
© Provided by Oath Inc. Lauren Riccotone with her two children. (Photo courtesy of Lauren Riccotone)
As a nurse, Lauren Riccotone had always been proactive about her health care, but in 2015 she was young and healthy and didn’t think twice about the occasional spot of blood that appeared on her toilet paper. “I thought it was just a hemorrhoid or something I ate — I wasn’t too worried,” Riccotone, now 37, recalls.
Her husband, Chris, still urged her to get a colonoscopy — a procedure, done under sedation, to evaluate gastrointestinal problems, such as changes in bowel habits and rectal bleeding, as well as to detect colorectal polyps and cancer in either the large intestine (colon) and rectum. She agreed, and on the day of the colonoscopy, they got an unexpected surprise. “I went through all the preparation for the procedure, including a pregnancy test,” Lauren tells Yahoo Lifestyle. “But just as I was getting ready to have anesthesia, the results came in: I was pregnant.”
Thrilled by the unexpected news, Lauren decided to put off the colonoscopy, as she didn’t want to subject her unborn baby to anesthesia. She sailed through her pregnancy, and Lauren and her obstetrician attributed the occasional bleeding to pregnancy-related hemorrhoids or constipation. On January 9, 2016, she gave birth to baby girl Charlie Elizabeth.
© Provided by Oath Inc. Lauren Riccotone with her husband Chris. (Photo courtesy of Lauren Riccotone)
Caught up in the realities of new motherhood, Lauren didn’t even think to reschedule her colonoscopy. But two weeks after giving birth, disaster struck: “I went to the bathroom and suddenly there was blood everywhere, from both my rectum and vagina,” she recalls. “I was so dizzy and weak I could barely stand.”
Concerned that it was some sort of delivery complication, Chris rushed from his job as a paramedic to bring Lauren to the emergency room. She was diagnosed with colitis, or inflammation of the colon lining. “I had a two-week-old I was trying to nurse, so I managed to get discharged after about 48 hours with the condition that I get an immediate colonoscopy,” she says.
She went in expecting a diagnosis of hemorrhoids and left stunned: Lauren had stage 3B colorectal cancer. “When I woke up from the procedure, the nurse gave me a big hug and told me she was getting my husband, which I thought was weird,” she remembers. “Even after getting the news, I was in total shock. I didn’t cry — I was in total disbelief. I was so young, and I had no family history of colon cancer. It just didn’t seem possible.”
Since Lauren was a nurse, and her husband a paramedic, they were well versed in the local medical community and were able to get a next day appointment with Sanjay Reddy, MD, a surgical oncologist at Fox Chase Cancer Center in Philadelphia. “The tumor was so large that Dr. Reddy told me it would have perforated my intestine within days,” she says. But she walked out with Reddy’s cell phone number and a sense of reassurance. “I automatically really liked him — I came in with a ton of questions and he sat down with me and made sure to go through them all,” Lauren says. “I felt very comfortable in his care.”
In March 2016, Reddy performed surgery. “It killed me to be separated from my daughter — the surgery was on Good Friday, and Chris brought her to visit on Easter, and all I could think was thank god she is so little she won’t remember that Mommy is sick,” says Lauren.
© Provided by Oath Inc. Lauren Riccotone with her kids and husband Chris at Disney. (Photo courtesy of Lauren Riccotone)
But Lauren’s ordeal wasn’t over yet. She had to immediately start six months of chemotherapy, which meant that she not only had to battle bone-crushing nausea and exhaustion, but also had to stop nursing her daughter. Her mother took an early retirement so that she could temporarily move into Lauren’s home and help her with Charlie. Midway through her chemo, Lauren returned to work, but had to call out of her first day when blood work revealed that her white blood cell count was so low that it would be dangerous to allow her to work in an emergency room.
Finally, by February 2017, it appeared that the end was in sight. Lauren had finished chemotherapy and was enjoying time with her husband, baby and two dogs. She was still experiencing some residual nausea and fatigue, which her doctors reassured her was due to recovering from chemotherapy. But when she ended up in the emergency room with a stomach bug, Lauren got another surprise: She was pregnant again. “I hadn’t ever gotten my period back, but I had just assumed that the chemotherapy had put me into premature menopause,” she explains.
Overjoyed, Lauren began planning for her second pregnancy. Since she was expecting, her follow-up CT scans to check for cancer had to be put on hold. Her son Michael was born in August 2017. A month later she had her first scan, only to learn that there were spots on her lung. Her colon cancer had metastasized and spread to her lungs. She would require immediate surgery.
Lauren was devastated. “Here I was again, with a newborn and a cancer diagnosis,” she says. But she was determined and sprang into action. “We knew we would need around the clock care for a month, and Michael was only four weeks old, so I wrote out a schedule from 7 a.m. to 10 p.m. every day and family members and friends took turns coming out to watch the kids while I was recovering,” she says.
Once she recovered, Lauren went back to work. “I would work the night shift, leave work at 7 a.m., go to chemo at 8 a.m., and sleep in the chemo chair while I knew my kids were at home with my mom,” she says. Now, 16 months later, Lauren is still disease free and determined to stay that way. The five-year survival rates for stage four colon cancer are only 14 percent, according to the Colorectal Cancer Alliance, but Lauren is confident she will beat those odds. “I have so much to live for — every time I come home from work and see my kids so healthy and happy, it motivates me to keep fighting,” she says.
In the meantime, Lauren has also thrown herself into advocacy work to raise awareness with younger adults about the disease. Colon cancer and rectal cancers are rising in Gen Xers and millennials at record rates: About 30 percent of new rectal cancers, for example, are now diagnosed in people younger than age 55, double what they were in 1990, according to a 2017 study published in the Journal of the National Cancer Institute.
“I work in the ER of a large health system, so I deal with cancer, including cancer in younger people, every day,” Lauren says. “But a lot of people my age doesn’t recognize that it can happen to them.”
If you have any signs of colon cancer, such as bleeding, diarrhea, or constipation that doesn’t go away after a few days, see your doctor immediately. “Even some physicians will brush off bleeding in a 30-year-old as hemorrhoids,” Lauren says. “But it should still always be checked out with a colonoscopy.”
Video: Mayo Clinic Minute: The importance of a colonoscopy (Courtesy: Mayo Clinic)
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Rubber Band Ligation
Internal hemorrhoids are one of the most common causes of rectal complaints and bleeding in the country. In spite of conservative management and topical creams often patients tend to have ongoing symptoms. We are currently using the OCRH O’Regan System for definitive treatment of internal hemorrhoids. This highly effective, minimally invasive procedure is performed in our offices in just a few minutes, and most patients return to work that same day. We make recommendations to reduce the chance of recurrence later (currently 5% in two years). Typically, we treat one hemorrhoid at a time in separate visits.
During the brief and painless procedure, we use a small rubber band to ligate the tissue just above the internal hemorrhoid where there are few pain-sensitive nerve endings. Unlike traditional banding techniques that use a metal-toothed clamp to grasp the tissue, we use a gentle suction device, reducing the risk of pain and bleeding. The banding procedure works by causing focal sclerosis of the rectal mucosa and thus interrupting the blood supply to the hemorrhoid. This causes the obliteration of the hemorrhoid. Patients won’t even notice when this happens or be able to spot the rubber band in the toilet. Once the hemorrhoid is gone, the internal wound usually heals over several weeks.
Soon after the procedure, some patients may experience a feeling of fullness or a dull ache in the rectum. This can typically be relieved with Tylenol. However, over 99% of patients treated with our method have no significant pain or complication. In fact, thanks to design improvements, this procedure has a ten-fold reduction in complications compared to traditional banding. The new instrument is smaller, affording greater comfort for patients and better visualization for the physician. Unlike other devices, this is a single-use instrument that is disposable.
Infrared coagulation (IRC)
As an alternative to the rubber band ligation, we also offer treatment using infrared coagulation. IRC does not require any special preparation or anesthesia. This is an office based procedure that uses a probe to deliver a two-second pulse of light energy to the base of a hemorrhoid. This results in cutting off the blood supply to the hemorrhoid causing it to shrink and recede. The procedure is very quick and essentially painless. It is considered one of the safest treatment modalities for treatment of internal hemorrhoids.
Treatment of hemorrhoids at the time of colonoscopy
Aside from colorectal cancer (CRC) screening, rectal bleeding is one of the most common indications for referral of patients for colonoscopy. In the vast majority of these cases, the source of bleeding is typically internal hemorrhoids. However once a diagnosis is rendered the management of internal hemorrhoids is not always effective with topical creams. The most beneficial, simple and widely implemented in-office treatment of internal hemorrhoids is rubber band ligation (RBL). This procedure has typically required multiple visits and anoscopy in order to band each of the three major columns of internal hemorrhoids. With advent of endoscopic band ligation, it is possible to consolidate this treatment to a single procedure.
Since most of the diagnostic colonoscopies are performed to evaluate rectal bleeding and internal hemorrhoids are the most common cause of such bleeding (especially in younger patients), it makes sense to treat the source of the bleeding at the time of the colonoscopy. Given the fact that the patient is already prepped, sedated and monitored during the colonoscopy, ligation of internal hemorrhoids only adds another 5-10 minutes to the endoscopic procedure. Hence this one-step combined procedure provides both diagnostic and therapeutic benefit to the patient with hemorrhoidal bleeding.
Both Dr. Hira and Dr. Ender perform IRC and Rubber band ligation in our office.
Digestive Health Associates
What is colonoscopy?
Colonoscopy is an examination of the colon, also called the large intestine, which is the last 5-6 feet of the intestinal tract, ending in the rectum. The examination is performed with a long flexible and steerable tube (colonoscope) which is about the diameter of a finger. The tip of the tube lights the interior of the colon and projects a color image on high definition video monitors. A variety of instruments may be passed through the colonoscope, allowing the doctor to sample tissue, remove small growths, and perform a variety of treatments.
What is a high-quality colonoscopy? (click for more information)
What is an “open access” colonoscopy?
Many patients who are thinking about having a colonoscopy performed prefer to avoid a traditional doctor’s office visit with the gastroenterologist prior to scheduling their procedure. Office visits provide an excellent opportunity to meet face-to-face with the doctor and talk in detail about the procedure, but they are also costly and time consuming, and require time away from work and other life activities that many people don’t wish to spare.
In some cases the information that a patient and doctor needs to prepare for the safe and effective performance of an endoscopy can be obtained in other ways. Our “open access” program is designed with your easy access in mind. Our experienced registered nurses obtain your health history through a convenient telephone interview process at which time they will answer any questions you have about the planned procedure. The information you provide is entered into your permanent Digestive Health electronic medical record and forwarded to the physician for final review and approval in advance of your procedure date. The forms needed for registration at the time of your procedure are available here.
We are able to offer open access services at this time on a limited case-by-case basis. In some instances an “open access” procedure is not the best option. Either the patient or the doctor may decide that an office visit before scheduling the procedure is the best way to go. Open access services are not a covered benefit of the Medicare program.
I feel fine. Why is my primary care doctor making me go for a colonoscopy?
Colon cancer is the concern. Unfortunately it is a common killer, representing the second leading cause of cancer-related death. Most people with early colon cancer feel perfectly well. Fortunately though, early colon cancer can be detected by colonoscopy at early stages, before it has spread outside the colon. Early stage colon cancer is often highly curable. More importantly, the common growths (polyps) from which most colon cancers may slowly arise (colonic adenomas, or adenomatous polyps) can be detected and removed during a colonoscopy, resulting in the potential prevention of colon cancer. Experts believe that colon cancer deaths may be up to 90% preventable by regular colonoscopy, and that colon cancer itself may be up to 70% preventable.
All individuals should undergo colon cancer screening at or before the age of 50.
Where should I schedule my procedure? (click for more information)
Our doctors perform colonoscopy in Durango at the Southwest Endoscopy Center and at Mercy Regional Medical Center’s endoscopy center, which is located in the outpatient surgical area.
I have a family history of colon cancer. When should I get checked?
While most cases of colon cancer occur in people with no familial risk factors, individuals who have a close relative who has had colon cancer, particularly at a young age, are at increased risk themselves for developing colon cancer. They should be initially examined at a younger age, and examined more often, than individuals without risk factors. A familial risk is also conferred when close relatives have had common benign colon polyps (adenomas), particularly when the polyps have occurred at a young age, have occurred in large numbers or have been “advanced” under the microscope or large in size, such as those requiring surgical rather than endoscopic removal.
When doctors ask about a family history of colon cancer or colon polyps we want to know how many blood relatives have had these diagnoses, at what age, and how close the relative was or is to the patient. Relatives are commonly described as “first-degree” (meaning a parent, sibling or child), “second-degree” (meaning grandparent, aunt, uncle, niece or nephew) or “third-degree (meaning great-grandparent or first cousin).
About one out of every four patients in whom colon cancer is diagnosed have a family history of colon cancer. In 16-20% of cases the affected family member is a first-degree relative. Studies show that having a family history of colon cancer increases the risk of developing the disease in the following manner:
- general population: 6% lifetime risk
- third-degree relative: 7% lifetime risk
- second-degree relative: 8% lifetime risk
- first-degree relative who developed cancer at age > 50: 12% lifetime risk
- first-degree relative who developed cancer at age < 50: 22% lifetime risk
- two first-degree relatives: 30%
There are a few uncommon but well-defined familial genetic colon cancer syndromes in which many relatives develop colon cancer at very young ages. Hereditary non-polyposis colon cancer (HNPCC, Lynch syndrome) and familial adenomatous polyposis (FAP) are examples. If these syndromes are suspected you will need to discuss your family and personal history with us in detail and we will discuss referral for genetic testing with you.
In general, we recommend that individuals with a family history of colon cancer be classified and screened as follows:
- high risk (first-degree relative with colon cancer or polyp diagnosed at age < 60, or two first-degree relatives diagnosed at any age): colonoscopy at age 40 or 10 years younger than the earliest diagnosis, whichever is earliest; repeat at 5 year intervals
- some increased risk (first-degree relative with colon cancer or colon polyp at age > 60, or two or more second-degree relatives with colon cancer: colonoscopy at age 40
We understand that it is distressing to live with the knowledge that you have an increased statistical risk of developing a serious and potentially fatal disease such as colon cancer. However, there is good news. Regular colonoscopy can dramatically reduce the probability that you will develop colon cancer. Recent studies also show a new “silver lining” related to colon cancer family history. While having a family history of colon cancer does increase your chance of developing the disease, it also is associated with a decreased risk of cancer recurrence and cancer-related death, compared to individuals who have colon cancer but no family history, when an advanced colon cancer occurs and is being treated with chemotherapy.
I’ve heard that the “colon cleanse” is the worst part of the procedure. What should I expect? What can I do to make it easier?
A clean colon is essential for a safe and effective colonoscopy. If the doctor encounters residual waste material during a colonoscopy it may be necessary to stop the procedure before it is completed, and retained waste may hide serious problems, such as flat polyps or cancers.
Gastroenterologists use a variety of methods and products to cleanse the colon of all waste prior to a colonoscopy examination. Our preferred cleansing program uses a 4 liter (approximately 1 gallon) slightly salty-tasting fluid which is taken orally and passes all of the way through the gastrointestinal tract, resulting in diarrhea which becomes increasingly clear, and ultimately takes on the appearance of urine. This fluid is a prescription product which is typically furnished as a powder in a 1 gallon plastic jug, to which water must be added prior to beginning the cleansing procedure. Some products contain optional flavor packs which may make the “prep” more tolerable. Many patients have found that having a few wedges of lime nearby can also help, serving as something to suck on at the completion of each glass of solution, which helps cut the salty flavor. Using a straw may also help. Placing the straw tip as far back into your mouth as possible allows the fluid to “bypass” many of your taste buds. Swishing diluted flavored soda pop in your mouth, and then spitting, after each glass may also help. Moist anal cleansing wipes (Preparation H Medicated Wipes or similar generic products) can make the later stages of the prep much easier.
The product provided often depends on what the pharmacist has available or what your insurer may allow. A generic preparation (PEG-3350 and electrolytes for oral solution) is often dispensed. Common brand named products include GoLytely®, NuLytely® and CoLyte®.
Our standard preparation instructions allow for consumption of regular food (avoiding fruits and vegetables containing seeds and fibrous foods) until about 6:00 p.m. of the evening prior to examination, after which only “clear liquids” are allowed until your procedure is completed. At about 6:00 p.m. you will begin drinking the prep solution. You will need to drink half of the jug (2 liters) in less than 2 hours. You will then take two laxative tablets (bisacodyl 5 mg). The remaining liquid prep should be refrigerated and must be consumed the following morning, over less than two hours, such that all oral intake is completed at least 2 hours prior to your arrival at our facility. It is very important from the standpoint of sedation safety that you have absolutely nothing by mouth (NPO in medical terminology) for at least 2 hours prior to your procedure.
While individuals respond to the preparation differently, most will develop a feeling of fullness, bloating and distension after drinking a few glasses. Some people even report that they feel as if they will explode! Occasionally, vomiting occurs. While these symptoms are unpleasant, it is important to try to stay on course with your drinking. Generally within 1-3 hours after starting the prep solution a bowel movement will occur and the sensation of distension will ease. Diarrhea may rapidly follow. You should plan to stay near a toilet until the frequency of your bathroom visits slows down. Most patients can get a few hours of sleep, though some will be kept up by diarrhea. Your body’s response to drinking the evening dose of solution may guide you with respect to how early you need to start your morning cleansing, and what to allow with regard to driving time and planning restroom availability during transportation to our facility.
While we believe that our standard preparation generally provides the safest, best tolerated and most reliably effective cleansing available, some individuals have difficulty tolerating such large volumes of fluids. Based on your medical history, intermediate volume liquid preps (HalfLytely®, MoviPrep®, SUPREP®, Prepopik™) or tablet-based cleansing preparations (Visicol®, OsmoPrep®), may be appropriate. A popular over-the-counter option, the MiraLAX/Gatorade prep, is another option for some patients.
Potentially serious kidney problems (acute nephrocalcinosis leading to the need for dialysis and renal transplantation) and electrolyte abnormalities (with related cardiac rhythm irregularities) may result from bowel cleansing for colonoscopy with phospho-soda. At Digestive Health we discontinued the routine use of phospho-soda (nonprescription Fleet® Phospho-soda, generic phospho-soda, Visicol®, OsmoPrep®) for colonoscopy cleansing in November 2005. The FDA issued an alert on December 11, 2008 warning of the risk associated with the use of these agents. The C.B. Fleet company responded immediately by issuing a voluntary recall of their over-the-counter Phospho-Soda products and asked healthcare professionals to cease the use of these products for bowel cleansing prior to colonoscopy.
Medical Literature Search: Phospho-soda problems
What happens after I arrive and check in?
Once you’ve completed the cleansing preparation the rest of the procedure is generally easy. You will need to check in at least 45 minutes before your actual planned colonoscopy “start” time to allow for registration and admission to the Southwest Endoscopy Center, changing into a medical gown in a private preparation area, a preprocedure nursing assessment, placement of an IV line to allow administration of sedatives during your procedure, and a presedation physician assessment of your general health status and airway (mouth, throat and neck). Your family member or a friend is welcome to stay with you during this time. When all preprocedure preparations have been completed you will be taken by stretcher to the procedure room (where family members may not be with you), where a variety of monitoring devices (electrocardiographic skin electrodes, blood pressure cuff, finger oxygen sensor) will be placed. Either a nasal tube or an oxygen mask will be secured into position to provide oxygen during the procedure and allow for monitoring of exhaled carbon dioxide levels.
Once everything is ready and your gastroenterologist is in the room, a nurse anesthetist will administer a sedative under the doctor’s direction. A second nurse or technician will assist the doctor. Colonoscopy usually takes about 15 minutes of actual instrument-in-the-body procedure time, though technically demanding procedures may occasionally take twice this long. Most patients sleep through their procedure and begin to awaken shortly after it is completed, prior to being taken by stretcher back to their preparation area, where they are monitored for a few minutes during recovery from sedation. While the procedure itself is typically painless, some abdominal discomfort and distension from the air used to hold the colon open for examination is common. This sensation usually subsides in a few minutes with some passing of odorless gas, which we require of our patients, regardless of usual social considerations.
Most of our patients are ready to be discharged home about 20 minutes after the completion of their procedure, after reviewing their written procedure report and any necessary instructions with our nursing staff. Top