Hi All. I've been a long time forum observer and poster. I was an avid cyclist and developed severe sage 4 hemorrhoids. Nothing really could be done except for the flu hemorroidectomy but two surgeons advised against it. After suffering for over a year, I saw a CR surgeon for a third opinion who had just received training and approval to offer THD surgery at Middlesex Hospital in CT. It's done on an out patient basis under sedation or general anesthesia. Basically the surgeon inserts a locator that finds the hemorrhoid and then the device ties it off, cutting the blood flow...a hemorrhoidectomy with excising the hemorroid so there's no trauma. I was home a few hours later and up and about. The next day I was throwing a football with my son and 3 days back to work. Like with most stage 3 and 4 cases, there is a fissure but because of all the pain and other prolapse you don't notice it until the hems are healed.That took longer to figure out. I was able to get it to heal thanks to nifedipine cream but still had pain. I found a specialist at Yale who deals with rectal pain and had an Anorectal Manometry, that examines the muscles. Because of the hems and fissures, that area we found learned to tense up when a BM was coming. By tensing the sphincter it made it difficult and painful to pass a stool, so though it felt like a fissure what I really had was more akin to a torn muscle. I had to re-learn how to go putty and relax that muscle again through biofeedback. It worked! So I recommend THD but it's often not a panacea for people who've had years of problems down there. Just keep at it and be vigilant. Am I perfect to this day? No, sometimes I forget to do what the biofeedback taught me and i have a bad day of discomfort. Just keep at it.

How does biofeedback work, Richlen?

Richlen, Thanks for sharing. I live in CT and hopefully healing with the help of botox but could please let us know the doctors names for the procedure you had? It's always good to have options.