Hemorrhoids

Hemorrhoids

What are hemorrhoids?

Hemorrhoids are a nuisance, but rarely a serious problem.  Most adults will deal with hemorrhoids at some point in life.  The rectum and anal canal is rich in blood supply.  Hemorrhoids are dilated blood vessels in these areas.  They are not growths, polyps, nor tumors.  Unfortunately, the symptoms of hemorrhoids can mimic symptoms of more serious disorders, such as colorectal cancer.

There are two types of hemorrhoids, internal and external.  The external hemorrhoids can be seen and felt outside of the anal canal.  Internal hemorrhoids are up inside the rectum and cannot be easily seen or felt.  An examination to evaluate the inside of the rectum is needed to diagnose internal hemorrhoids.

What causes hemorrhoids?

Everyone may experience symptoms of hemorrhoids at some point or another.  Common causes of hemorrhoids include constipation, diarrhea, obesity, prolonged standing, pregnancy or straining to pass stools.  Any activity that increases pressure in the rectal area can cause hemorrhoids.  You do not need to have any of these issues to develop hemorrhoids, however.  Some individuals have significant hemorrhoids without obvious risk factors.

What are the symptoms of hemorrhoids?

The most common symptoms of hemorrhoids include pain, itching, burning, bleeding and a palpable lump near the anal canal.  On occasion, a hemorrhoid can develop a blood clot within the vessel that causes increased pain and hardness of the hemorrhoid.  This is called a thrombosed hemorrhoid.  Hemorrhoids can bleed, sometimes significantly.  The classic pattern of bleeding is fresh red blood seen streaking the outside of the stool, dripping into the toilet water, or on the toilet paper.  Hemorrhoids do not cause cancer.  Unfortunately, hemorrhoidal bleeding can mimic rectal cancer, as well as other problems within the rectum.  Colonoscopy or flexible sigmoidoscopy is the only certain way to assure there is not a rectal cancer as the source of rectal bleeding.  Your doctor can help you to decide if minor rectal bleeding is from a hemorrhoid or a more serious source.

What treatments are available for hemorrhoids?

Treatment of hemorrhoids can be challenging.  The first rule of treatment is to keep stools soft and easy to pass.  This is best accomplished with increased fiber.  Increase dietary fiber or use bulking agents, such as Metamucil, Citrucel or Benefiber, for a goal of 20-30 grams per day.  Make sure to drink plenty of water, as fiber without water is less helpful.  Avoid straining when passing stools, as straining exerts extra pressure on already dilated hemorrhoids.

For bothersome external hemorrhoids, avoid rubbing after bowel movements and instead dab for cleanliness.  Keep the area clean and dry.  Don’t be afraid to apply talcum powder to assist with drying or even use a hair dryer.  When itching occurs, local remedies such as witch hazel or Preparation H can be soothing.  Sitz baths can help decrease swelling – these are accomplished by adding Epsom salts to lukewarm bath water.

For internal hemorrhoids, a couple of options exist to eliminate large, swollen hemorrhoids.  Ligation is performed during colonoscopy or flexible sigmoidoscopy, and involves placing a tiny rubber band around the base of a dilated hemorrhoid.  Circulation is stopped and the hemorrhoid falls off.  Repeat treatments are often necessary.  Infrared photocoagulation is also performed during colonoscopy or flexible sigmoidoscopy and involves treating a hemorrhoid with an infrared laser, which burns and destroys the hemorrhoid.  Again, repeat treatments may be necessary.

Surgery is available for both internal and external hemorrhoids.  Since it can be quite painful, oftentimes surgery is reserved for thrombosed hemorrhoids, hemorrhoids which bleed profusely, or otherwise recurrently problematic hemorrhoids.  Your physician can help you to decide which, if any, treatment is best for you.

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