Prolapse and Hemorrhoids (PPH)

For people with severe internal hemorrhoids, there is a new surgical procedure being done at St. Mary Medical Center that is proving dramatically less painful than traditional hemorrhoid surgery.

Dr. Richard Goldstein and his partner, Dr. Anne-Marie Marcoux, are among a handful of colorectal surgeons on the East Coast to perform PPH (Procedure for Prolapse and Hemorrhoids). PPH utilizes a Hemorrhoidal Circular Stapler, manufactured by Ethicon Endo-Surgery, a division of Johnson & Johnson, as an alternative approach to the surgical treatment of hemorrhoids.

Dr. Goldstein has performed more than a dozen procedures using PPH, and calls himself a ‘true believer’ in the merits of the new procedure. "As someone who personally has undergone traditional hemorrhoid surgery, I wished this procedure had been available for me," said Dr. Goldstein. "And as a colorectal surgeon with more than 20 years experience, I am very excited to be able to provide people with relief from a distressing problem without them having to suffer the great discomfort of traditional surgical methods."

In the PPH procedure, the prolapsed tissue is drawn into the device that removes a donut-shaped amount of excess tissue. The remaining hemorrhoidal tissue is then secured back to its original position within the rectum lining using titanium staples applied in a circular pattern by the stapling device. Internal stapling has been used in surgical procedures for more than 20 years. The staples do not need to be removed and the process restores the normal anatomy of the anal canal.

Because the tissue removed is internal, in an area above the anus, the nerve endings are less sensitive than external tissue and the patient does not feel the sharp pain of a traditional hemorrhoidectomy.

The PPH procedure is completed in about 20 minutes, using a short-acting spinal anesthesia. Most patients go home the same day and return to work and normal activities in 2 to 4 days, and require significantly less pain medication, said Dr. Goldstein. In a traditional hemorrhoidectomy, normal recovery time is estimated to be about 10 days.

Prolaspse, often referred to as piles, is a common condition, especially in people over age 50, in which the hemorrhoid tissue enlarges and descends in the anal canal.

The most common symptoms of hemorrhoidal prolaspe are pain, bleeding and discharge.

Dr. Goldstein strongly cautions patients to never assume that rectal bleeding is from hemorrhoids until they have been evaluated by a physician, because bleeding is also a warning sign of colorectal cancer.

 Colorectal Cancer Awareness. Colorectal cancer is the second leading cause of cancer deaths. Although highly preventable and curable if detected and treated early, many people do not get the recommended screenings. A digital rectal exam and fecal occult blood test are recommended annually beginning at age 40, and a sigmoidoscopy or colonoscopy are recommended every 5 to 10 years, beginning at age 50. People at increased risk include those with a personal or family history of colorectal polyps or cancer, as well as a history of breast, uterine or ovarian cancers, chronic ulcerative colitis or Crohn’s disease.

Colorectal cancer often has no symptoms when first developing and can only be detected through regular screenings.

• Avoid foods high in fat
• Eat plenty of vegetables, fruits and high-fiber foods
• Stop smoking
• Use alcohol only in moderation