Hemorrhoidal Bleeding & Stage 4 Cirrohsis

[shadyspatti]

My husband had a colonoscopy done this morning and we were told that he had Hemorrhoidal Bleeding caused by the pressure of the blood. He is also Hep C (found out 10/08), Stage 4 Cirrohsis (found out 2/09) He was also a non responder to treatments. Doctor told us Feb 2010 that he may live a year. But can anyone explain this bleeding. And it not just a little on the tissue paper.

Patti

[Bill1954]

Hi again; sure, I remember you posting in here before. Sorry to hear of the problems.

I don’t believe all varices require immediate band ligation. I’ve heard of others doing the watch ‘n wait with stage 1 and 2 varices, if my memory serves me. Hopefully someone going through this right now will add their thoughts; HectorSF is really helpful with issues revolving around cirrhosis in here.

I imagine as long as the doctors are monitoring things he’ll be okay; this stuff sneaks up on folks that aren’t in the medical loop and can be problematic, for sure.

Is there an NP or PA at the clinic you might be able to discuss this with? You might also talk about the ‘TIPS’ procedure too; I’m not sure it’s indicated for your husband at this juncture, but you might want to at minimum become informed in case it comes up later. Have they prescribed a beta blocker for him yet?

--Bill

[shadyspatti]

Hi Bill,
Thanks for the quick response. You have helped me before. He does have portal hypertension, that was diagnosed in Feb 10. The doctor said that this was the cause. I asked the doctor about another endoscopy this morning, his reply was he didn't expect it to be that much different. But when he did the first one he said it was about a 1-2 varies. And a Dr he was seeing at the Mayo said it was more like a 2-3. He is nolonger able to go to the Mayo because of insurance changes. The doctor just didn't explain this very well. We see him next month, but I don't want to wait until next month to get a better explanation.

[Mary4now]

and maybe its completely different in combination with portal hypertension, that is all I know about Hemorrhoids

[Mary4now]

Hemorrhoids are hemorrhoidal tissue at the anus which fills with blood to cushion the bowel movement at the anus, this tissue is fed blood much like arterial blood which does not have any valves (so that it can quickly go to the area) it takes a little bit for the blood to be reabsorbed.  If there is pressure at the anus, sitting on the toilet to long, pushing, constipated, this tissue fills with blood stretches and sometimes creates blood clots.  very painful.
Walking moves the blood back into the system, swimming, lots of water, Metamucil w/ lots of water,,,,, It can take a while for this to resolve itself and if you are noticing blood you should be careful of blood clots, you will know because you will have grape size sacks hanging down that really hurt and do not go away.
These are the answers that I came up with during my horrendous bout.
IF you have blood clots you will need a surgeon (not a doc) excise the tissue so that it can drain..... and they will remove some of the clots.  

Sometimes these sacks can hemorrhage and you can actually bleed out.... Sometimes the hemorrhoidal tissue stretches so much w/ blood that it avulses.
Just drink lots of water, watch whats going on, be grateful it is only hemorrhoidal bleeding, but take allot of TLC

[Bill1954]

Hi there,

Sorry to hear of your husband’s diagnosis and subsequent problems.

You should talk to his doctor and have him clarify whether this bleeding is the result of true hemorrhoids or if it’s due to rectal varices from portal hypertension; it sounds like maybe the later.

Wikipedia has an article on this; you can read through it here:

http://en.wikipedia.org/wiki/Portal_hypertension

As the liver becomes scarred as a result of the HCV infection, blood from the GI tract becomes obstructed and can’t travel through the portal vein efficiently. This causes portal hypertension, or elevated blood pressure in the portal tract (not to be confused with high blood pressure that you measure with a arm cuff).

This blood then seeks other paths, sometimes leading to bleeding/hemorrhaging of the esophagus, stomach or rectum. His doctor will likely prescribe meds to lower his blood pressure, and he should also have periodic endoscopies to monitor for future bleeds.

Here’s an article on esophageal varices:

  http://en.wikipedia.org/wiki/Esophageal_varices

Good luck to both of you,

--Bill