Transcription:

Scott Webb (Host): Hemorrhoids are common and most of the time, thankfully, surgery is not needed to deal with them. And joining me today to tell us more about the signs, symptoms, and treatment options is Dr. Paul Broderick. He's a board-certified proctologist with the Franciscan Physician Network.

Host: This is the Franciscan Health Doc Pod. I'm Scott Webb. So, doctor, thanks so much for your time today. I was just mentioning to you that I know what hemorrhoids are and what folks do to deal with them, but it's great to have your expertise today. So maybe the most basic question here, what are hemorrhoids?

Dr. Paul Broderick: Yeah. It's a topic of some taboo, things on TV, and sometimes it's some jokes and what have you. But I like to say that it's like getting hit in the face with a pie. It's funny until it happens to you.

Host: Right.

Dr. Paul Broderick: And yeah, it's embarrassing, but rather common. So, what are hemorrhoids? Hemorrhoids are groups of vessels, some call it columns of vessels that are anatomically supposed to be there. So, somebody says, "Oh, I don't have any," congratulations, you don't have any problems with them. But anatomically, yes, those vessels are there. But if there becomes some dilation, inflammation, irritation of such, then it can bring a variety of unpleasantries associated with it

Host: Yeah. And so, everybody has them. It's a matter of whether we have a problem with them. So, how do we know we have problem? What are the unpleasantries, as you say?

Dr. Paul Broderick: Yeah. So, it can be a whole range of symptoms. And I'll put a bit of I'll say a disclaimer, but everything that's sore and irritated gets called "hemorrhoids," okay? Well, there's other pathology that can occur there. Yes, hemorrhoids are very common. And it's an anatomical norm. But if somebody should have a variety of symptoms such as anything from maybe hygiene challenges, discomfort with bowel movements, some itching, yes to bleeding of varying amounts. Those are common symptoms, but those all deserve to have an appropriate evaluation. I recommend people start with their primary care physician because other things can do that that may be much more of a health concern than what hemorroids are. Hemorrhoids are benign veins. They don't get to where they transform into something bad or let's say harmful. But there are such things that can occur there, including types of cancer. So, everything gets called hemorrhoids, let's make sure they are. And so, yeah, that's very important.

Host: Yeah. So then, let's talk about that, the diagnosis. I'm assuming patient history, that kind of thing. And as you say, maybe start with your primary, be referred to a specialist. But in general then, after a patient history, is it really more of a visual test? How do you diagnose?

Dr. Paul Broderick: So yeah, you hit on some good topic there. Quite a bit of some good medicine is getting a good history. What are some of the challenges? What might have brought this on? How long has this been going on? All those things figure into perhaps the degree of evaluation exam or the treatments that may come.

And yeah, so somebody's got some issues, they've had these problems. They've maybe tried something over-the-counter and they're embarrassed. And so, finally, they can go to their family doctor and/or a specialist. But yes, it's a visual, meaning first the doctor's going to feel around. Is there lumps, bumps, something that's not supposed to be there? Number two, yeah, there's a little plastic tube that you look at the area. And so, are these inflamed? Is there bleeding? Is there some other pathology of concern?

And so, there are external hemorrhoids which are covered with skin. There are internal hemorrhoids that are covered with the lining of the GI tract, and those deserve different approaches, therapies. And depending on the doc's comfort with these things, some family doctors are comfortable with how we do this, others either hadn't had much exposure to it or they've got a specialist nearby that they have a good relationship with and, boom, just get them right to them. That works out well for both.

Host: Yeah. Is there an age range? When we think about who's at the greatest risk per se? Is this likely to happen to older folks after the age of 40, something like that?

Dr. Paul Broderick: Yeah. That is certainly the case. So, aging doesn't help a lot of things, so tissues change, et cetera. One of the more common issues or if it first shows up for people is for women in childbearing years. So, the pregnancy itself, the delivery itself, maybe multiple pregnancies, the additive effects of things, that can certainly affect women's odds with those. So yeah, a number of women may have initially some in their 20s. For men sometimes who have very physical work, "I'm young, I'm strong. I can lift that," then over some years it maybe accumulates, all that straining. So yeah, I see a number of people in their 20s. But is it purely an age factor? Yes, it is. They tend to be more common over 40 and to 50. And some of that too is maybe when the women are completely confident they're not going to be having any more babies, and it hasn't gotten any better and, yes, it has gotten to be more of a problem, so now they're ready to address something, where maybe they're at a different point in their life.

Host: Yeah, I see you mean. Definitely, yeah, at that point in time to see Dr. Broderick and no more kids coming. So, let's talk then about treatment options. First of all, will they go away on their own? Are there home remedies? Do you recommend over-the-counter medications? What's the progression here in terms of like sort of the path of least resistance, working our way up to the more severe treatment options, if you will?

Dr. Paul Broderick: Yeah, that's a great question. And let's say the hemorrhoids themselves may not go away. However, the swelling or inflammation or the symptoms with them may fade. And foundationally, hydration, lean diet with fiber, so we can be as regular as we may be able to be as far as having bowel movements, but a good fiber diet, perhaps stool softeners to get through a phase is foundational regardless. So throughout the treatment spectrum, that's very important. The roles of say topical medications, including over-the-counter, et cetera, yes, there's definitely a role there. Again, we often combine that with the other modalities because it's somewhat foundational. So, they can certainly have some anti-inflammatory effects, some soothing effects.

Let me do a little bit of some coaching on things about, you know, let's try to avoid some training, some things that physically could aggravate some things. Number one, that level, people do that, things get better, guess what? I don't see them, or they don't see their family doc, they've calmed down, okay, great. And so, let's say that's that approach has not been enough. And so, there are prescription medications. Again, there are more potent anti-inflammatories and often the primary care physicians are comfortable at that level and most of them aren't set up for handling things beyond that. So yeah, there's certainly a role for that.

And so often a family doctor will say, "We'll try these. And in the meantime, I'll get you an appointment with doctor, you know, so-and-so." And so, what's the next level? There's pretty broad spectrum of people that fit into a non-surgical procedural spectrum. And so, there's a few out there. The two most common by far non-surgical treatments, the one that's been around the longest is called hemorrhoid banding or hemorrhoid ligation. So if things are wanting to turn out and bleeding and swelling, literally a little band is used to strangle that redundant tissue. Sounds kind of scary, but people do it real well. Well, I see people from a couple hours away and they drive back, they're fine. It's very powerful. That's been around for many decades. And the reason it's around is because it works.

There's another common technique where some light energy is delivered to the base of the hemorrhoids to cause some things to shrivel and essentially set the clock back. But it's not an excision. Again, few seconds, very tolerated, people drive themselves home, go back to work, et cetera, et cetera. Like any tool, it has its strengths, it has its limits. And so, there are times where either the situation or someone's been so afraid of the situation, and they may show up and the non-surgical things are no longer applicable. And yes, there is a role for surgery. Let's say, "Oh, boy, that's the last thing I want." True. But you could say that about most any surgery. But yes, there is still a role for traditional hemorrhoidectomy. See, that's scary.

Yeah, the first week or two, like any surgery, isn't much fun. If there's an upside to that, people that have put up with this so long are just really such a point of misery, that the reward, the return is so immense, that they're grateful. But it's natural to be reluctant, and it's embarrassing, it's all these things that people commonly wish to avoid, understandably. But yeah, surgery does have a role. It's outpatient. People are asleep for it. But that's when things have really separated out. We've done the foundational. We've tried, you know, perhaps non-surgical if it's applicable. But again if people are there, the relief is welcomed and they're glad.

Host: I'm sure.

Dr. Paul Broderick: But it's like any surgery, it's no fun the first week or two especially.

Host: Yeah. Yeah, I'm sure. I guess the million-dollar question doc is do you ever really get rid of them? I know you said we always have them. But the problems that folks have with hemorrhoids, do you ever really get rid of them? Or once you've had them, are they more likely to come back? Is it more about managing hemorrhoids? How does that work?

Dr. Paul Broderick: Yeah. All of that to some degree. And what I mean by that is some people are more prone to them, like some people are maybe more prone to kidney stones or maybe someone's more prone to varicose veins in their lower legs. So, some people are a bit more prone to them. And so, there is a role for what would be managing the symptoms generally in that nonsurgical realm on top of the conservative diet, et cetera, to have that person not necessarily progress to a natural stage to where, you know, they have surgery like dad did or something of that nature.

Host: Oh, dad and his hemorrhoids, you know.

Dr. Paul Broderick: Yeah. So, there is a group of people that, yeah, it is a bit of a management approach. I tell people even in the non-surgical treatment realm, I say, "Your trigger's going to be lighter. And one, you're not going to want to put up with the symptoms. Two, it's not as scary as you thought and made up. And three, you understand, you know, now if we don't, where it may be headed.

Host: Right.

Dr. Paul Broderick: And so people are like, "Yeah, I'm not putting up with something for two years again when I can go in a visit and a trip and few seconds treatment and I'm back on my way." Yeah, suffering with something kind of day in, day out doesn't make sense.

Host: No, it doesn't. And I told you before we got started today, and I don't know what it says about me, but I was really eager to learn more about hemorrhoids today. I don't know why, but I was. And I have, and I really appreciate your time. So, thanks so much. You stay well.

Dr. Paul Broderick: Thank you. Nice talking to you, Scott.

Host: And for more information, visit franciscanhealth.org and search hemorrhoids.

And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.