Hi. A month ago, my piles flares and subsided after given daflon but it left a piece of skin there. Then this month I started to have constipation again despite eating plenty fruits and vege, so I tried probiotic and got bowel movement again - very nice everyday. Then on 3rd day the hemorrhoid flares again, this time not too swollen but I got sore pain and terrible itch in anus. Went to kpj to see if they will remove the pile but they said it s very small only and its not bleeding. I was given medication and fibers. The piles/skin tag is small most of the time but the itch and soreness especially after bowel movement and at night is terrible. It will swell after I went to toilet, whenever I squat down and when I walk a lot, sometimes have wetness on it. 2 weeks have pass and I have been on vege, rice and fruits diet, but the condition still the same. Are there any good colorectal in klang valley area to recommend? I had been to kpj 3 times seeing a general surgeon, so I am thinking to see colorectal specialist.

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This post has been edited by momusu: Dec 7 2013, 08:20 AM

Are they sure it is just a skin tag ?

It may be an external pile. That's what I have now, after surgery to remove
some pretty huge internal hemorrhoids in 2003.

An experienced and reputable colorectal surgeon is Dr Akhtar Qureshi in
Sunway Medical Center.

Dr Anantharachagan is a general surgeon in Sentosa Medical Center, but
quiet experienced in hemorrhoids and colorecal surgery too.


Rubber band ligation, or banding, is not suitable for external hemorrhoids,
because they lie below the dentate line, where it is full of nerves and will
cause excruciating pain.

Dr Mohd Anis, who practises in SJMC as well, ligated me there a couple of
times over two decades ago, and the pain was horrendous for a couple of days.
I could barely sit down and felt as if someone or something was grabbing my
skin there all the while.


The latest treatment for internal ones appears to be HAL, or hemorrhoid artery ligation.

http://www.youtube.com/watch?v=TLM_FSw_DME



http://www.youtube.com/watch?v=H6NVQzfQzkQ


Otherwise, if surgey is required, these are newest cutting devices :

1. Starion thermal welding
2. Ligasure bipolar diathermy
3. Harmonic scalpel
4. Laser


Make sure you don't go for the staple method (which I had), or else you
may end up with lots of problems.

Dr Samuel Tay in Sunway also uses Ligasure.


This clinic in PJ also appears to have Ligasure.

http://klinikbuasir.com/index.php/hubungi


Starion is now known as Microline.

http://www.microlinesurgical.com/company/a...roline-surgical


Ligasure.

http://surgical.covidien.com/products/vessel-sealing


http://www.youtube.com/watch?v=x9e4ArimjVU

http://www.youtube.com/watch?v=gDNyKfG9Bug

http://www.youtube.com/watch?v=6BWscApj-d8

http://www.youtube.com/watch?v=qcaP58wOses



Randomized Trial Comparing a Starion™ and
a Harmonic Scalpel™ Hemorrhoidectomy.

http://www.coloproctol.org/search.php?wher...vmode=PUBREADER



Prospective, randomized, controlled trial of Starion vs Ligasure
hemorrhoidectomy for prolapsed hemorrhoids.


http://www.ncbi.nlm.nih.gov/m/pubmed/17587087/



Comparison of Ligasure Hemorrhoidectomy with
Conventional Ferguson’s Hemorrhoidectomy.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002768/




This post has been edited by Tham: Nov 28 2013, 08:41 PM

No, I didn't push it. Since I went to KPJ 2 weeks ago, I have been faithfully taking the psyllium husk fiber they prescribed. I have bowel movement everyday since then (I used to be able to have bowel movement after 4 or 5 days). I even googled for the correct way to bowel movement - suck in breath, hold it and let it come out by itself. Still that piece of piles still comes out, slightly swelling and very sore. After washing, it popped back 'inside' but carry with it the terrible itch. The itch is no joke, so terrible that (sorry for the graphic) that all I wanted to do it stick my finger inside and scratch it! I have been sleeping in sitting position for days because sitting position seemed to help with the itch a little.

At first, I was put on Daflon 6 pills per day, until the 5th day, I got hives all over my body probably because of allergy. I stopped taking it now cause even when I take it, the itch is still there. Oral steroid and anti histamine doesn't help too.

On the other hand, the stool seemed to contain lots of undigested food, very wet and 'burn' my anus even though I am not eating spicy food.

It's confirmed a hemorrhoid. Problem is it flares, pains and itch but will not be swollen enough for the surgeon to help me remove it. Worse, it always went 'inside' whenever they checked me. The surgeon at KPJ and the GP I went, both said it's because my skin near the anus is too dry. But I have took all the precaution not to irritate the skin - no scrubbing, no toilet paper, just wash with flowing water, sitz bath, wear cotton pants but still the itch is there. I woke up once or twice at night just to sit in the sitz bath to ease the itch.

Dr Akhtar Qureshi is good? I see his schedule in Sunway Medical site and he's available tomorrow. Maybe I'll go to him tomorrow. I just hope he's willing to do something about that hide-and-seek piles.

Seriously, I am considering to just gulp down chillies and hot stuffs to make it swell and bleeding so they will cut it off

This post has been edited by lowlowc: Nov 28 2013, 09:26 PM

Hemorrhoids will tend to itch sometimes, even mine.

You also probably have some mild eczema there.

Yours prolapses, then goes back in spontaneously, so you probably
just have second degree internal hemorrhoids, quite mild.

If you see Akthar Qureshi, he will probably just give you Xyloproct
or Proctosedyl cream, something you can buy yourself anywhere.

These contains some mild steroid like hydrocortisone to reduce the
inflammation and itch, plus aesculin (from horse chestnut) to improve
the venous blood flow there a bit, and thus shrink it a litle.

Otherwise, go down to TM Shafi, a small homeopathic shop at the
row of shophouses opposite YMCA in Brickfields. They have homeopathic
pile creams which are usually quite moisturising, so may reduce the
dry skin and itch.


Another time and tested remedy is salt, i.e. sitz baths. Buy Cosway's
Zara Dead Sea Salts, blue in color. Sprinkle say two tablespoonsfuls in
a small tub which just about fits your toilet bowl, add in fairly hot water,
then sit there for at least 15 minutes.

I am sure that will relieve the itch and pain somewhat.

That was what I did way back in December 2003, when, coming home
after the surgery (stapled plus diathermy), I was in really bad pain.

So my sister came over, prepared the above sitz bath, and luckily the
pain subsided after that.

If you can't get the salt, ordinary table salt, or those cheap rock sea salts
from the supermarket will do.

Dr Anantha also advised my father to do that after he had removed his
piles many years ago. Surprisingly, my father said he had hardly any pain
from the surgery, while mine, like many others, was like the end of the world.

I think those brownish colored Himalaya rock salts are also suitable.


My elder brother had an acute attack too not too long ago, after I thought
all the while that he was one of the lucky ones with no hemorrhoids.

He surfed the net, then made an ice pack and placed it there.

Also bought Daflon, took a loading dosage of 6 tabs the first day, then 4
the next two days, then 2 daily.

It subsided.




This post has been edited by Tham: Nov 28 2013, 10:41 PM

Thanks for the info you gave.I did sitz bath every day with rock salt, it did took away the itch but not for long.

I had tried Protosedyl for 2 weeks now, sometimes it works a little, sometimes sting my skin. I really hope the doctor won't be giving me anymore medication, cause they just slighly easen the itch, not cut off the problem.

Now thinking back, is it possible that the itch reaction on my pile is triggered by probiotic I first took before the pile flares up? Also I noticed the itch has worsen today after I ate a spoonful of plain yogurt. Possible?

Yes, it's quite possible.

Probiotics are after all bacteria, and just like antibiotics,
can trigger off allergies or other reactions in some people.

Just stop them for a couple of weeks and see how it goes.

Even fiber doesn't agree with me very well. If I take Metamucil,
I will get cramps the whole night long.

Finally someone agrees with me that probiotics can trigger adverse reaction. I have been searching long for connection between itchy anus and probiotic but nothing come out. Only today I tried the keyword allergy and probiotics and now it seemed clear. It does trigger itchy skin and hives, just too bad of all the places to itch, it has to be that part.

I didn't ended up going to Sunway because of the price, but went to Tung Shin. I was asked to lie sideway and tried to push out the piles. It was diagnosed as almost level 3. Unlike previous surgeon, he recommend removing it if it's hindering my daily activity, so I agreed. Will be doing both colonoscopy (to see any underlying answer to why I can't get normal bowel movement) and surgery on Monday. Somehow, I feel very gan cheong now.

So which surgeon did you see there ?

Was it Lim Chwen Loong or Muthu ?

Did you ask him which device he is going to use ?

I see Dr Lim. He showed me a diagram of the process. Something like this but I cannot be sure.



I'm so sorry, I woke up early in the morning, not enough sleep, straight away went to hospital, happy that he's going to operate it and totally forgot the instruments you recommended to me.

This post has been edited by lowlowc: Nov 29 2013, 05:53 PM

Staple method.

If he does a good job, then good. If not, you'll have problems - bleeding,
intense pain, stenosis (narrowing of your anus).

The staple is made by Johnson & Johnson ...... in Mexico.

Looks very flimsy, plastic, like a kid's toy ray gun.

Costs at least ...... $1,000.

You should have asked for the harmonic scalpel, Starion or Ligasure,
but anyway, it's already scheduled.

How much is he charging you ?

I'll call back the doctor's assistant tml to ask what's the method because after looking at the video you gave it looked la bit like HAL pulak. I do remember him mention the surgery takes 20 minutes only.

As for charges, I did not ask, going to let my company insurance settle it and have taken the letter of guarantee.

One thing though, is there anything I should do after the surgery to speed up the healing. My mum told me to drink pati ikan haruan, or eat the fish for faster healing of the wound but I'm skeptical since a lot of food seemed to trigger my itchy anus recently.

Another colleague who had surgery to remove a few 3 and 4 degree piles 2 years ago, swears applying Gamogen/minyak gamat to that wound speed up her recovery.

After reading more info, a lot of people introduce sitz bath. I am thinking to buy a proper sitz bath (currently using pail and sea salt) and Epsom salt. Is Epsom salt better than rock salt. I know they're different properties and there's mixed review for both. Or the Cosway one is better?

As for the probiotic reaction, I had stop it the moment the symptom appears, it's been more than 2 weeks now but do you think it still need more time to clear the allergy symptom?

This post has been edited by lowlowc: Nov 30 2013, 02:21 AM

please do check how much it is...i would like to know

My uncle just discharged from Sentosa about a month ago and it cost 3K++.

Not sure the method of his surgery though.

Shit! I called back and they said it's stapler method. Tham, the staple method you had previously is in 2003, right? What are the complications you have after that, other than the pain? Relapse?

Andrekua, how's your uncle now?

Abubin, will let you know when I see the bill. For now, I don't bother. I just let my company insurance settles money matter and I'm now worried about the procedure only.

Yes, the snakehead fish, Haruan, Channa striatus is documented
to have wound healing, pain reducing and energy-boosing properties.

It would also be a good idead to take it to reduce high blood pressure,
depression, prevent/treat Alzheimer's and as an adaptogen.

This means that the fish would be a good antiaging food.



Therapeutic potential of the haruan (Channa striatus):
from food to medicinal uses.

'' This review updates research findings on potential uses of Channa striatus,
beyond the traditional prescription as a wound healer, pain reliever and energy
booster to include its properties as a ACE-inhibitor, anti-depressant and
neuroregenerative agent. The fish appears to have wide-ranging medical uses
and should be studied more intensively to unearth its other properties and
mechanisms of action. ''


http://www.ncbi.nlm.nih.gov/pubmed/23713236




Wound healing effect of Haruan (Channa striatus) spray.

http://www.ncbi.nlm.nih.gov/pubmed/21722317



The wound healing properties of Channa striatus-cetrimide cream
- wound contraction and glycosaminoglycan measurement.

http://www.ncbi.nlm.nih.gov/pubmed/11025135




Antinociceptive activity of Channa striatus (haruan) extracts in mice.

http://www.ncbi.nlm.nih.gov/pubmed/9254114




Fatty acid and amino acid composition in haruan as a
potential role in wound healing.

http://www.ncbi.nlm.nih.gov/pubmed/7835642

Intense pain and heavy bleeding the first night. The pethidine injection
lasted me only an hour. Had to bear with the pain the rest of the night.

I had stenosis for the first two months. The stools which came out
were pencil-thin.

I also had fecal impaction twice the first two months. Had to dig it out
with my fingers.


Luckily, improved by the third month.

The surgeon was probably not too skilled nor experienced enough in
the use of the staple.


The staple also has a high rate of relapse.

Within two years, an external hemorrhoid came back.


But is Dr Lim is skilled in this method, you should have no problems,
reduced pain and faster recovery, I guess.



Reinterventions for specific technique-related complications of
stapled haemorrhoidopexy (SH): a critical appraisal.

http://www.ncbi.nlm.nih.gov/m/pubmed/18766410/



Stapled hemorrhoidopexy is associated with a higher long-term
recurrence rate of internal hemorrhoids compared with conventional
excisional hemorrhoid surgery.

http://www.ncbi.nlm.nih.gov/m/pubmed/17665254/




Obstructed defecation after stapled hemorrhoidopexy: a report of four cases.

http://www.ncbi.nlm.nih.gov/m/pubmed/20583519/?



Agraffectomy after low rectal stapling procedures for hemorrhoids and rectocele.

http://www.ncbi.nlm.nih.gov/m/pubmed/21695440



Obliteration of the rectal lumen after stapled hemorrhoidopexy: report of a case.

http://www.ncbi.nlm.nih.gov/m/pubmed/18670815/






This post has been edited by Tham: Nov 30 2013, 01:37 PM

I think I will try to seek if any restaurant in my area has Sang Yue dish. I don't think I can cook for the time being and my family is in Johor.

Fecal impaction. I had that before when I have to dig, a very bad experience. Will pharmacy bought enema help?
Did you change the diet after that, or the relapse still happens after the change of diet?


This post has been edited by lowlowc: Nov 30 2013, 02:42 PM

Maybe you can try this.


http://www.rakuten.com.my/shop/caringpharm...HF0005_0191081/



Enemas may help, or maybe Dulcolax (bisacodyl), but if the impaction
is really bad with the stools already hard, that won't work.

This is why doctors have to do it for patients who come in with fecal impaction
- if the stools are way too far in the rectal area, obviously you can't dig it out
yourself.

Dr Anantha in Sentosa says he has to do it such patients who pay him an
emergency visit sometimes, even young people.

I didn't really change my diet, but as it is, everyone tends to get hemorrhoids.
I can't really tolerate fiber anyway, as I have IBS.

Stresses in life, including lack of sleep, can also cause or aggravate them.
The Chinese believe that lack of sleep (as in my case too) causes heatiness
to form in the liver ( ''kah foh'').

Lack of sleep can also result in a low ''Chi'' (life force), so your anus will
tend to drop out.


The staple method doesn't really cut away the hemorrhoids, rather it retracts
them further up the rectum, so that would explain the high relapse rate.

How is it that you never even asked what device he is going to use when
he examined you and advised surgery during the whole consultation, after
I had given you all that info ?

Akhtar Qureshi uses the harmonic scalpel, and I think he also has Starion
and/or Ligasure. That was why I advised you to go to him. He also uses the
staple, but he said he is very selective, due to the high relapse rate and risk
of complications.

Otherwise, Samuel Tay in Sunway also has Ligasure, as mentioned earlier.
I enquired from the Ligasure distributors here some years ago, and they
mentioned that he was one of the doctors with this device.

I did not select Anantha at that time, even though he did an almost painless
job on my father with diathermy alone, because he did not use the staple,
which I thought was the ''in thing'' at that time. Sentosa was poorly equipped
too then, with no harmonic scalpel. They probably have now, as well as the
other devices.

Sea Cucumbers Fast Track Organ Regrowth By Healing Their Wounds.

http://www.sciencedaily.com/releases/2007/...71017194617.htm



Regeneration of the radial nerve cord in the sea cucumber Holothuria glaberrima.

http://link.springer.com/article/10.1186%2F1471-213X-9-3



Regeneration of the enteric nervous system in the
sea cucumber Holothuria glaberrima.

http://www.ncbi.nlm.nih.gov/pubmed/10205023