Commonly Asked Questions
It is helpful to come prepared with questions for your doctor. If you are seeking a second opinion for a chronic, reoccurring condition, be sure to bring information detailing when your symptoms started, how your symptoms have changed over time and other information you feel is important.
You should also bring:
Pertinent prior medical records including operative and pathology reports, laboratory tests, and hospital discharge summaries
Dr. Nowain performs most of his procedures at an outpatient facility called La Peer Health Systems. La Peer is located near the Center for GI Health office in Beverly Hills, CA. Certain procedures may need to be done in a hospital setting at Cedar-Sinai Medical Center.
Yes, we accept Medicare. If you are unsure what your insurance covers, please talk with our staff and we would be happy to help you determine what is covered.
Both men and women are equally likely to develop hemorrhoids.
Pressure on the rectum causes hemorrhoids to form. This pressure can come from prolonged sitting, constipation, straining and even diarrhea. Pregnancy, obesity and heavy lifting are also associated with hemorrhoids. During the third trimester of pregnancy — and even more so during the delivery process — the uterus lowers down and puts pressure on the anus and forms hemorrhoids.
Most adults will experience hemorrhoids at some point in their life. People with jobs that require sitting all day, truck drivers, weight lifters and cyclists are examples of demographics that are more likely to develop hemorrhoids.
Symptoms of internal hemorrhoids include pain, itching, burning and blood in the stool. If large enough, internal hemorrhoids can prolapse or bulge and cause further discomfort.
No. If internal hemorrhoids expand in size, they can prolapse out of the rectum and look very similar to external hemorrhoids – making it very difficult to distinguish between the two. That’s why it is very important to have a doctor diagnose your hemorrhoids.
No, hemorrhoids are not a risk factor for colon cancer.
Approximately 50% of adults experience internal hemorrhoids. While hemorrhoids do cause anal bleeding, several other conditions can cause it as well, including colon cancer, inflammatory bowel disease and anal fissures. Your doctor may want to perform a variety of tests to determine the exact cause of the bleeding. If you are experiencing anal bleeding, you should contact a GI doctor.
To diagnose hemorrhoids, your doctor will perform a thorough and painless examination. Not all bulges on the outside of the anus are external hemorrhoids. It is possible for internal hemorrhoids to prolapse or bulge out, and most prolapsed internal hemorrhoids can be treated by hemorrhoid band ligation.
Yes – the treatment for internal hemorrhoids and external hemorrhoids are different. See our hemorrhoids treatment page for more information.
Hemorrhoid Banding FAQ
There are no nerve endings on internal hemorrhoids, so hemorrhoid band ligation should not cause pain. Some patients may experience a mild sensation of fullness, dull pressure, or feel the need to use the restroom temporarily. However, most patients leave the examining room without feeling any discomfort.
Yes, hemorrhoid banding is commonly used to treat hemorrhoids. However, not all hemorrhoid banding procedures are the same. Some are more comfortable, and some have lower risks of complication. Hemorrhoid banding simply refers to placing a band around the hemorrhoid to stop the blood flow. The methods used to handle the hemorrhoids, as well as the size of the tools, can differ.
There are three areas, called columns, where internal hemorrhoids can occur. The safest way to perform hemorrhoid band ligation is by banding one column at a time during different sessions that are separated by two-week intervals. This minimizes the risk of irritation and allows the procedure to be performed safely. Most patients require an average of three sessions (one on each column) before their hemorrhoids are cured, some patients require less than three sessions, and others require more than three (the same column sometimes needs to be banded more than once). To get the best results, your doctor will tailor your treatment according to your individual needs.
Unfortunately, hemorrhoid banding cannot be performed during pregnancy. If you have hemorrhoids and plan on getting pregnant, you should have the hemorrhoids treated beforehand. If left untreated, hemorrhoids can increase in size and frequency, and the strain of pregnancy – which itself can cause hemorrhoids – might make your existing hemorrhoids more severe.
It depends. While healing time from this procedure is brief, we recommend that you take it easy following the appointment. If you have a job that requires vigorous work, we recommend that you take the day off. If you have an office job, you could theoretically return to work later in the day. Just remember that everyone heals differently.
Hemorrhoid band ligation is 95% effective for curing internal hemorrhoids. To prevent them from recurring, patients should avoid the habits that caused the hemorrhoids to occur in the first place.
DO: Eat a high fiber diet and consume adequate amounts of water daily.
DON’T: Strain during bowel movements or sit for prolonged amounts of time (both on and off the toilet).
The CRH O’Regan system for hemorrhoid banding, used by Dr. Nowain, was approved by the FDA in 1997.
Colon cancer is any cancer that forms in the tissues of the colon. (Colorectal cancer forms in either the colon or rectal tissue.) Colon cancer generally develop slowly over a period of years, during which there are few, if any, symptoms. The only way to identify colon cancer is through colonoscopy screenings to identify and remove colon polyps before they turn into cancerous tissue.
A colon polyp is a small growth in the lining of the colon. Polyps are either benign or pre-cancerous. The only way to diagnose a pre-cancerous polyp is through laboratory testing.
Colon cancer is the second leading cause of cancer death in the U.S., with about 150,000 new cases of colorectal cancer each year – and 50,000 deaths.
The best way to prevent colon cancer is through a healthy diet, regular exercise, maintaining a healthy weight, and regular colon cancer screenings.
Those without a family history of colon cancer should begin screenings at the age of 50. There is an increasing incidence of colon cancer in patients who are in their 40’s so early screening needs to be considered on a case by case basis. African-Americans, who are more susceptible to the disease, should begin screenings at the age of 45. If you have a family history of colon cancer, you should begin screening 10 years before the age at which your relative was diagnosed (i.e. if your father was diagnosed with colon cancer when he was 52, you should receive your first colonoscopy at the age of 42).
On average, you should have a colonoscopy every 10 years. With Third Eye, a panoramic retroscope (backwards-facing cameras) is added to provide a more complete view of the colon lining during the procedure, allowing both forward (anterograde) and backward (retrograde) views during the procedure – and increasing the likelihood of detecting and removing colon polyps. But frequency of future colonoscopies is determined by the type, size, and quantity of any polyps that are found during your initial exam. Your doctor will discuss your individual results with you to determine the appropriate timing for your next colonoscopy.
The answer depends on your family history of the disease and your overall health. If you are 75 and in good health, it is recommended to continue screenings. Ultimately, you should discuss this with your doctor.
The Third Eye colonoscopy uses the Third Eye Retroscope, a backward-viewing camera, along with a standard, forward-viewing colonoscope to provide a more comprehensive view of the colon. The retrograde, or backward, view further enhances a GI doctor’s ability to locate and remove pre-cancerous colon polyps. Like a “rearview mirror” in a car, the Third Eye colonoscopy allows gastroenterologists to see areas that would normally act as “blind spots” during a standard colonoscope – including behind folds in the colon wall, where polyps can be hidden. This camera extends beyond the tip of the colonoscope, automatically turning 180 degrees to provide a retrograde view. Now, doctors can simultaneously observe two video images, the forward view of the colonoscope and the retrograde image of the Third Eye.
Yes. Colonoscopies are viewed as necessary procedures and generally covered by insurance, including Medicare.
No. You cannot eat solid food before a colonoscopy. Clear liquids, however, are allowed. It is important to have an empty bowel so your doctor can easily spot any polyps. The last time you should have anything by mouth is 6 hours before your procedure. See our pre-colonoscopy instructions for more information.
No. Patients are sedated during the procedure, and are discharged home the same day without pain.
No. During the procedure you will be sedated and though you may feel fine afterwards, the medication is still in your system. You will need someone to drive you home.
Yes. Air is introduced into the colon during a colonoscopy so the doctor can get a good view of the lining of the intestines. Most patients do not wake up feeling gassy or bloated, but for the few patients who do experience gas, the symptoms are mild and usually short-lived. We use carbon dioxide gas which is rapidly absorbed and minimizes any bloating symptoms.
EGD and Capsule Endoscopy Questions
An endoscopy is a procedure in which a small, flexible scope is inserted through the mouth to view the esophagus, stomach, small intestines, colon or rectum.
An upper endoscopy is a procedure used to visualize the esophagus, stomach, and the first portion of the small intestines. The doctor can visualize and provide therapeutics at the same time during an upper endoscopy.
A gastroenterologist is specially trained in performing endoscopic techniques to diagnose and treat gastrointestinal issues.
No. It is uncommon to have pain during or after an endoscopic procedure. Patients are sedated and should not feel pain or remember the experience.
Yes. Another person must drive you home if you are having a procedure done with sedation. Since you will likely be groggy after the procedure, it is also beneficial to have someone with you to talk to the doctor.
Yes. Air is introduced during an endoscopy so the doctor can get a good view of the lining of the intestines. Most patients do not wake up feeling gassy or bloated. For the few patients who do experience gas, symptoms are mild and usually short-lived. We use carbon dioxide gas which is rapidly absorbed and minimizes any bloating symptoms.
A capsule endoscopy is a less invasive procedure used to view the small intestines. Instead of the doctor inserting the endoscopy, you swallow a small pill that contains a light and camera. It takes over 50,000 pictures of your intestines over an 8-hour period, during which time you wear a small recorder around your waist that allows the doctor to download the images on his computer. The pill camera is disposable, and does not require retrieval.
Generally, yes. Both procedures are considered necessary diagnostic procedures and are often covered by insurance. Our office can authorize the procedure with your insurance carrier prior to the procedure.