Rubberband man to the rescue

WRITTEN BY: DOCTOR GIFFORD-JONES , Sun Media 2008-11-15 6:06:00 AM

Would Woodrow Wilson have negotiated a more lasting peace treaty following World War I if he had not suffered from tight-fitting shoes? Would Napoleon have won the Battle of Waterloo if he had not been suffering from hemorrhoids (piles) while sitting on his horse? Such small but painful annoyances might have determined history. But unlike Napoleon, patients today no longer have to endure the pain of hemorrhoids.

Piles affect 90% of the population at some time in their lives. And in spite of being a common condition, little research has been done on this problem. After all, cancer and cardiovascular research is well respected, but what doctor wants to tell people he's a pile expert?

Due to this lack of research on piles, the only way to treat hemorrhoids for years was either to suffer the pain and embarrassment or go for surgical excision. This meant that large numbers of pile sufferers, hearing disturbing stories from friends of rectal pain following surgery, decided it was better to live with the devil they knew than face unknown post-operative ones.

A recent study by Dr. Venkatesh Shanmugam, a surgeon at Aberdeen Royal Infirmary in Scotland, claimed that surgery is the best treatment for patients suffering from severe hemorrhoids. Several readers saw this article and asked me if this is true. But today I suspect that most doctors would elect, instead, the new rubber-band treatment to treat their own piles.

Dr. Warren Rudd, Director of the Rudd Clinic for Colon and Rectal Surgery in Toronto, was an early pioneer in developing the rubber-band technique. In addition, he also uses cryosurgery to freeze the pile.

During this procedure, a rubber-band is placed around the neck of the hemorrhoid. The pile is then frozen using nitrous oxide. This cuts off the blood supply to the frozen hemorrhoid and several days later the pile drops off. This leaves a raw area that heals over a two to three week period. Most patients require one or two more visits to destroy remaining hemorrhoidal tissue.

This technique has several advantages. It's an office procedure that does not require an anesthetic. There's no chance that too much tissue could be removed causing narrowing of the anal opening, and no risk of post-operative pain and bleeding.


The rubber-band approach is effective in about 90% of cases. The most common complication is a small blood clot occurring at the anal area. This happens in 3% of cases and normally subsides with time and warm compresses.

But people who believe they're suffering from piles should ask themselves this question. Are their annoying symptoms actually due to hemorrhoids? If not, surgery or the rubber-band technique will not relieve their symptoms.

These patients may be afflicted with a common, but overlooked condition called "Anusitus". It's an inflamed area just inside the anus. Anusitis causes a small amount of discharge around the anal canal. This constant wetness macerates the skin resulting in multiple tiny cracks that then trigger itching.

Patients often complain of a burning sensation inside and outside the anus and leakage that stains underwear. There's no swelling, but blood is often found on toilet paper. Occasionally bleeding occurs. And inserting a finger into the anus causes pain.

Luckily, relief of this symptom is as close as the refrigerator. There's nothing new about the use of cold temperature (cryosurgery) to relieve pain and swelling in sports injuries. But few people are aware it can be used to treat anusitis.

"Anurex" is a reusable probe containing a cold gel. It's inserted into the rectum like a rectal suppository after being cooled in the refrigerator's freezer for at least one hour. The probe is then left in the rectum for six minutes, removed, washed and placed back in the refrigerator. It's used twice a day for two weeks, then once a day for two weeks.

Anurex is available in most Canadian pharmacies.

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