PPH (Procedure for Prolapse and Hemorrhoids). The Proctologist.

Medically reviewed by: Gary H. Hoffman, MD

Hemorrhoids.  A Fact Of Life.  PPH And The Proctologist.

are a fact of life.  Why?  Because all of us are born with them.  Hemorrhoids, or more accurately, hemorrhoidal cushions, encircle the anus and facilitate an easy passage of stool (bowel movement) through the anal canal.  Hemorrhoids are normal.  However, when they enlarge and cause symptoms, they are no longer normal.

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Hemorrhoids are composed of arteries, veins, nerves and connective tissue.  They are most commonly found in three distinct areas of the rectum, the right anterior position, the right posterior position and the left lateral position.

Hemorrhoids.  More Uncomfortable Facts.

Hemorrhoids can be located above an embryological line in the anal canal called the dentate line.  In this case they are termed internal hemorrhoids.  Or, the hemorrhoids may reside below (closer to the anal opening) the dentate line, in which case they are termed external hemorrhoids.  They present with differing sets of symptoms, depending on where they are located with respect to the dentate line.  And, external hemorrhoids can actually reside entirely within the anal canal, and may not be externally located at all.

While external hemorrhoids may present with swelling, a lump or with difficulty keeping the anal opening clean, internal hemorrhoids may bleed, cause itching, cause a discharge or may prolapse (protrude) from the anal opening.

Most patients know when the need for definitive treatment is at hand.  They have tried all non-surgical remedies, to no avail.  Most have already seen a colon and rectal surgeon, also known as a Proctologist or Coloproctologist.  Most patients have wisely ruled out other, more serious causes for the symptoms, and are ready for treatment.

PPH.  Procedure For Prolapse And Hemorrhoids.  Help Is On The Way.

While several surgical options exist, a newer, more high tech procedure is available and is associated with much less pain after the hemorrhoidectomy.  It is called PPH, or Procedure for Prolapse and Hemorrhoids.  It is also known as a stapled hemorrhoidectomy or hemorrhoidopexy.  First described in the early 90’s, it rose to the forefront of surgical treatment in 2002 when it was approved for use by the FDA.  Many studies exist showing that when performed by a trained colorectal surgeon, patients report a reduction in postoperative pain and a quicker return to the activities of daily life.

How Does PPH Work?

Briefly, PPH is performed as an outpatient procedure using a “twilight sleep”.  It can be performed in an outpatient setting at a surgical center or at Cedars-Sinai Medical Center.  The instrument is inserted into the anal canal and closed around the excess hemorrhoidal tissue.  The stapler is fired and the tissue is cut.  A double row of titanium staples is used to reapproximate the rectal mucosa (lining) and return it to its normal anatomical position.  It should be noted that PPH is used to treat only internal hemorrhoids.  There are no classical pain fibers in the internal hemorrhoids and so post operative discomfort is minimized when compared with a traditional surgical hemorrhoidectomy.  PPH cannot be used to treat external hemorrhoids, which are heavily endowed with pain fibers.

Los Angeles Colon and Rectal Surgical Associates.

If you think that you require treatment, make an appointment to see one of the surgeons at Los Angeles Colon and Rectal Surgical Associates.  They are knowledgeable in all aspects of anorectal and colon diseases and can answer your questions about hemorrhoids and PPH, or Procedure for Prolapse and Hemorrhoids.  (310)273-2310

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