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Dr. Jasbir Makker
July 6, 2021

The taboo topic of hemorrhoids can make it difficult for physicians to properly address diagnosis and treatment with their patients. We connected with Dr. Jasbir Makker to get some insight on hemorrhoids and hemorrhoid treatment.

Dr. Makker is a distinguished clinician at Bronx Care Health system, and Assistant Clinical Professor at Mt Sinai ICAHN school of Medicine, New York, and American University of the Caribbean School of Medicine. Having received his MD degree from Bronx Care Health Systems in 2012, Dr. Makker undertook his gastroenterology training and has been an Attending Physician in the Gastroenterology and Hepatobiliary Division, Department of Internal Medicine at Bronx Care Health Systems since 2016. He became a Fellow at American College of Physicians (FACP) in 2018 and was unanimously selected by the committee for Fellow at American College of Gastroenterology (FACG) in 2021.

His ongoing research interests are motility disorders, non-alcoholic fatty liver disease, colorectal screening, and hemorrhoids. He is the Associate Editor for several scientific journals and has also published several peer-reviewed articles. Dr. Makker’s patient care philosophy is centered on patient education. He believes that a patient and their family’s thorough understanding of a diagnosis is a vital step of the treatment process. Dr. Makker is currently performing procedures at Mid-Bronx Endoscopy Center, LLC, a PE GI Solutions partnering center.

Dr. Makker went in-depth on the topic of hemorrhoids so that physicians can easily drive their patients directly to this article to get more information on the topic immediately after diagnosis or as a proactive measure if a patient is within the predominant age demographic for them (50 and above). This content addresses the many questions that patients are often too uncomfortable to ask their physician and can assist with educating patients on the taboo topic.

What are hemorrhoids?

Hemorrhoids are swollen and inflamed veins inside and/or outside the rectum and anus.

Is it abnormal to have them?

Hemorrhoids, which is the other name for anal cushions, are a normal part of human body and most of us have them to maintain continence. In some patients, these anal cushions become inflamed and swollen when they are referred to as hemorrhoids.

How common are they?

Hemorrhoids affect both men and women, and they can occur at any age. After age 50 more, they become much more common and more than half of those 50 and over have them.

What are the types of hemorrhoids?

There are two types of hemorrhoids – external and internal. External hemorrhoids are the ones which you usually see or feel outside your rectum. Internal hemorrhoids are the ones which you usually cannot see or feel as they are inside your rectum. In some cases, internal hemorrhoids start sticking out of your anus. They may go back inside spontaneously or require pushing them back inside manually.

Why do I have them?

Hemorrhoids are a common result of excessive straining to have a bowel movement. They can also develop during pregnancy. Lifting heavy weights regularly, obesity, eating less fiber in the diet, and having chronic diarrhea or constipation also can increase your chances to have hemorrhoids.

What are the common symptoms?

Hemorrhoids commonly lead to bleeding from rectum which maybe noticed as blood on toilet paper or blood in the toilet bowl. It may also cause other symptoms like pain or discomfort in the rectum, itching around the anus, mucus like discharge from rectum, lump around the anus, and prolapse.

How do I know it is hemorrhoids and not something else?

Rectal bleeding and pain, which are a common complaint of people with hemorrhoids, may occur with other diseases. Hence, it is important to see your physician to get a correct diagnosis and exclude other diseases.

What are other treatment options?

They can be treated surgically or with non-surgical techniques – like banding, sclerotherapy, or infrared photocoagulation. Hemorrhoid banding is the most effective and best of all the available office-based treatment options. The procedure attempts to reduce vascularity and increase fixation of the hemorrhoids to the underlying muscle.

Are over the counter hemorrhoid creams helpful?

Most of the milder symptoms can resolve within one week of use of these over the counter creams. However, if the problem persists, it is important to see a physician for further treatment.  Additionally, these creams only temporarily provide relief from hemorrhoids, but they do not make them go away and problem usually recurs in few weeks or months.

What is hemorrhoid banding?

This is an office-based procedure utilizing CRH O’Regan System where a disposable plastic syringe like tube is inserted into the rectum, gentle suction is created to hold the inner lining above the hemorrhoids into this tube, and an elastic band is placed above the internal hemorrhoids. This band eventually cuts off the blood supply to hemorrhoids leading to shrinkage of these hemorrhoids.

Is it a useful procedure?

Hemorrhoid banding can typically treat hemorrhoids in more than 90 % of cases. Complication rate is only 1%.

Who should avoid hemorrhoid banding?

Patients who are pregnant and/or have portal hypertension (commonly occurs with liver cirrhosis).

How long does it take?

The procedure typically takes 60 seconds or less than 60 seconds to complete.

Will I be awake during the procedure?

The procedure utilizes CRH O’Regan system which is fast and painless and does not require sedation during the procedure.

Is the procedure painful?

Most patients do not complain of any pain after the procedure. The most reported symptoms after the procedure are rectal fullness or the urge to use the bathroom which may last one to two days.

How do I prepare for hemorrhoid banding?

Bowel preparation is typically not required prior to hemorrhoid banding. In rare cases, stool in the rectum may impair your doctor’s examination and, in such cases, you may be asked to take enema in the morning on the day of the procedure.

There is no fasting required prior to the procedure.

How many times do I need to see a doctor for hemorrhoid banding?

Most of the patients have three columns of hemorrhoids and hence require three banding procedures. As a safety precaution and to minimize the risk of complications, only one band is placed each office visit, subsequent bands are placed at a gap of two to three weeks. In some cases, less or even more than 3 hemorrhoid bands may be required.

Do I need to take off from work for getting hemorrhoid banding?

For most the patients , hemorrhoid banding does not require any down time, and most of the patients resume normal activities right after the procedure.

Will I need to come with someone who can drive me home from the procedure?

Most of the patients return to normal activities right after the procedure and do not require any such arrangement.

Will I be able to do my activities or is there any restrictions after hemorrhoid banding?

You can do your normal activities after hemorrhoid banding. You can sit, bathe, and do other routine work. There is no need to miss your work on the day of the procedure unless your work involves strenuous activities (operating heavy machinery, vigorous labor, etc.).

How long does it take to heal after the procedure?

The recovery time varies for each patient. With the use of CRH O’Regan method, a banded hemorrhoid falls off in two to three days, and it may take one to two weeks for the tissues to heal completely. Most of the patients do not feel pain during the recovery, and those who do feel pain typically respond well to over-the-counter medications like acetaminophen.

Can hemorrhoids come back after completing hemorrhoid banding?

Hemorrhoids can come back after the banding procedure but are less likely.

How can I prevent hemorrhoids?

Focus on a diet rich in fiber (like vegetables, fruits and whole grains), consider taking over-the-counter fiber supplements (such as Metamucil or Citrucel), or take the laxatives prescribed by your doctor. Be sure to drink an adequate amount of water each day, unless a medical condition prevents you from doing so.

When you have the urge to use the bathroom, don not delay and go for a bowel movement right away. Do not sit on the toilet seat for long time, maintain a healthy body weight, and try to exercise regularly as it helps moving your bowels at a regular interval.


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