Rectal bleeding is one of the most common and worrisome surgical conditions encountered. In the vast majority of cases, rectal bleeding arises form “internal” hemorrhoids, which are vascular cushions (typically three in number), located within the lower rectum. Internal hemorrhoids are normal anatomic features in man, and act as mini “air-bags” under normal circumstances. If these internal hemorrhoids enlarge, due to chronic constipation, the hemorrhoids become engorged and bleed, resulting in rectal bleeding.
Adequate treatment of rectal bleeding requires two procedures: Colonoscopy, to exclude more serious sources of bleeding, such as cancer, polyps or diverticular disease), and “rubber band ligation” of the internal hemorrhoids. Both procedures may be performed at the same setting, making the procedure convenient, safe, and effective and with minimal discomfort.
Typically, humans have three internal hemorrhoids “3, 7 and 11 o’clock”, as seen on a on a clock face. Since rectal bleeding may arise from any one of the three internal hemorrhoids. Common sense dictates that all three should be ligated at the same time, to avoid returning on three separate occasions, to ligate one hemorrhoid at a time.
Traditionally, patients experiencing rectal bleeding undergo a colonoscopy, then return to the physician’s office three times, to undergo ligation of each individual hemorrhoid, once at a time. Dr Armstrong pioneered the procedure of “synchronous” colonoscopy, and three-quadrant hemorrhoidal ligation, performed at the same time, whilst still under sedation. This algorithm is safe, efficient and convenient for patients. Why come to the doctor’s office 4 times, when once will suffice?
After a colonoscopy, to exclude more serious pathology, all 3 internal hemorrhoids are ligated using a suction-ligator, wherein a tiny rubber band is placed around the base of each hemorrhoid, which cuts off the blood supply to the hemorrhoid, which the shrivels-up, and drops off after roughly 10 days or so.
Colonoscopy and three quadrant hemorrhoidal ligation is safe, effective and convenient. Typically, patients experience very little discomfort, and usually return to work the next day. Importantly, patients should avoid blood thinners, including aspirin, for about 10 days before and after the procedure, to avoid unnecessary bleeding.