Hemorrhoids

Definition

Hemorrhoids, which are also called piles, are swollen and inflamed veins in your anus and rectum. They may result from straining during a bowel movement or the increased pressure on these veins during pregnancy, among other causes.

A sometimes embarrassing topic of discussion, hemorrhoids are common. By age 50, about half of adults have had to deal with the itching, bleeding and pain that often signal the presence of hemorrhoids.

Fortunately, effective medications and procedures are readily available to treat hemorrhoids. In many cases hemorrhoids may require only self-care and lifestyle changes.

Symptoms


Hemorrhoid symptoms usually depend on the location:

  • Internal hemorrhoids. You can’t see or feel these hemorrhoids. But straining or irritation from passing stool can injure a hemorrhoid’s delicate surface and cause it to bleed. You may notice small amounts of bright red blood on your toilet tissue or in the toilet bowl water. Because internal anal membranes lack pain-sensitive nerve fibers, these hemorrhoids usually don’t cause discomfort. Occasionally, straining can push an internal hemorrhoid through the anal opening. If a hemorrhoid remains displaced (prolapsed), it can cause pain and irritation.
  • External hemorrhoids. These hemorrhoids tend to be painful. Sometimes blood may pool in an external hemorrhoid and form a clot (thrombus), causing severe pain, swelling and inflammation. When irritated, external hemorrhoids can itch or bleed.

Causes

Hemorrhoids can develop from any increase in pressure in the veins in the lower rectum. Common sources of pressure and hemorrhoid causes include:

  • Constipation and the accompanying straining
  • Diarrhea and the continuous expulsion of loose stools
  • Sitting or standing for a long time, especially sitting on the toilet
  • Obesity
  • Pregnancy and childbirth

It’s also possible to inherit a tendency to develop hemorrhoids.

When to seek medical advice

As a general rule, see your doctor if your hemorrhoids don’t improve with self-care, cause pain, or bleed frequently or excessively.

A common sign of internal hemorrhoids is rectal bleeding. But rectal bleeding can occur for other reasons, so see your doctor to rule out more serious conditions or diseases. Other causes of bleeding in the lower gastrointestinal tract include colorectal or anal cancer.

If the onset of your hemorrhoids occurs along with a marked change in bowel habits or if you’re passing black, tarry or maroon stools, consult your doctor without delay. These types of stools can signal more extensive bleeding elsewhere in your digestive tract.

Seek emergency care if you notice large amounts of rectal bleeding, lightheadedness, dizziness or faintness.

Tests and diagnosis

Your doctor may determine if you have external hemorrhoids simply by looking. For internal hemorrhoids, your doctor may want to conduct an examination with a rubber-gloved finger. But even this technique may be inconclusive because internal hemorrhoids are often too soft to detect by a rectal examination.

In this case your doctor may want to examine the lower portion of your colon and rectum with an anoscope, proctoscope or sigmoidoscope. A more extensive examination could include an examination of the entire colon and rectum using a flexible fiber-optic colonoscope. This will help exclude bleeding lesions not only in the rectum but also in the entire colon. Close follow-up is necessary, however, and continued bleeding despite hemorrhoid treatment requires additional examinations.

Treatments and drugs


In many cases hemorrhoid treatment involves steps that you can take on your own. But sometimes medications or surgical procedures are necessary.

Medications
If your hemorrhoids are producing only mild discomfort, your doctor may suggest over-the-counter creams, ointments or pads containing witch hazel or a topical anti-inflammatory agent containing hydrocortisone. This local treatment, in combination with daily warm baths, may relieve your symptoms.

Surgical or other procedures
If a blood clot has formed within an external hemorrhoid, your doctor can easily remove the clot with a simple incision, which may provide prompt relief.

For persistent bleeding or painful hemorrhoids, your doctor may recommend:

  • Rubber band ligation. Your doctor places one or two tiny rubber bands around the base of an internal hemorrhoid to cut off its circulation and the hemorrhoid falls off. This simple procedure — called rubber band ligation — is done in the doctor’s office and is effective for many people.
  • Sclerotherapy. In this procedure, your doctor injects a chemical solution around the blood vessel to shrink the hemorrhoid.
  • Infrared light. A one- or two-second burst of infrared light cuts off circulation to small, bleeding, internal hemorrhoids.
  • Surgery. If other procedures haven’t been successful or if you have large hemorrhoids, your doctor can remove tissue in a procedure called hemorrhoidectomy. The surgery is done with either a local anesthetic combined with sedation, a spinal anesthetic, or a general anesthetic. Surgery can be performed on an outpatient basis or you may require an overnight hospital stay. While you may experience discomfort after the procedure, medications can be used to relieve your pain. Soaking in a warm bath also can ease your discomfort.
  • Stapling. This procedure, which blocks blood flow to hemorrhoidal tissue, is a relatively new treatment technique. While some experts point out that this procedure involves less pain than surgery and allows an earlier return to work, there are drawbacks as well. Stapling has been associated with a greater risk of hemorrhoidal recurrence and prolapse compared with open surgery. Talk with your doctor about what might be the best option for you.

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Prevention

To help prevent hemorrhoids or hemorrhoidal flare-ups:

  • Eat high-fiber foods. Eat more fruits, vegetables and grains. Doing so softens the stool and increases its bulk, which will help lessen the straining that can cause hemorrhoids or worsen symptoms from existing hemorrhoids.
  • Drink plenty of liquids. The exact amount of water and other fluids you should drink each day varies and depends on your age, sex, health, activity level and other factors.
  • Consider fiber supplements. Over-the-counter products such as Metamucil and Citrucel can help keep stools soft and regular. Check with your doctor about using stool softeners. If you use fiber supplements, be sure to drink at least eight glasses of water or other fluids every day. Otherwise, fiber supplements can cause constipation or make constipation worse. Add fiber to your diet slowly to avoid problems with gas.
  • Exercise. Stay active to reduce pressure on veins, which can occur with long periods of standing or sitting, and to help prevent constipation. Exercise can also help you lose excess weight that may be contributing to your hemorrhoids.
  • Avoid long periods of standing or sitting. Sitting too long, particularly sitting on the toilet for long periods, can increase the pressure on the veins in the anus.
  • Don’t strain. Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum.
  • Go as soon as you feel the urge. If you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass.

Lifestyle and home remedies

You can temporarily relieve the mild pain, swelling and inflammation of most hemorrhoidal flare-ups with the following self-care measures:

  • Use topical treatments. Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or use pads containing witch hazel or a topical numbing agent.
  • Keep the anal area clean. Bathe (preferably) or shower daily to cleanse the skin around your anus gently with warm water. Soap isn’t necessary and may aggravate the problem. Gently drying the area with a hair dryer after bathing can minimize moisture, which can cause irritation.
  • Soak regularly in a warm bath. Do this several times daily.
  • Apply cold. Apply ice packs or cold compresses on the anus to relieve swelling.
  • Use a sitz bath with warm water. A sitz bath fits over the toilet. You can get one at a medical supply store or some pharmacies.
  • Don’t use dry toilet paper. Instead, to help keep the anal area clean after a bowel movement, use moist towelettes or wet toilet paper that doesn’t contain perfume or alcohol.
  • Take oral medications. You can use acetaminophen (Tylenol, others), aspirin or ibuprofen (Advil, Motrin, others) temporarily to help relieve your discomfort.

These self-care measures may relieve the symptoms, but they won’t make the hemorrhoid disappear. See your doctor if you don’t get relief in a few days, or sooner if you have severe pain or bleeding.