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Hemorrhoids

 

Hemorrhoids, often called piles, are clusters of veins in the anus, just under the membrane that lines the lowest part of the rectum and anus. They occur when veins in your rectum enlarge from straining or pressure.

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

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

Causes

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

Constipation and the accompanying extra straining

Sitting or standing for excessive lengths of time

Obesity

Heavy lifting

Pregnancy and childbirth

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

Signs and Symptoms

Symptoms usually depend on the location of the hemorrhoids:

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. Because internal membranes lack pain-sensitive nerve fibers, these hemorrhoids usually don't cause discomfort. However, you may experience a feeling of fullness in your rectum following a bowel movement. Occasionally, straining can push an internal hemorrhoid through the anal opening. If a hemorrhoid remains displaced (prolapsed), it can cause a constant dull ache. When irritated, it can itch or bleed.

External hemorrhoids. These hemorrhoids tend to be painful. Sometimes blood may pool in an external hemorrhoid and form a clot (thrombus), causing severe pain and inflammation. When irritated, external hemorrhoids can itch or bleed.

Treatment

In most cases treatment of hemorrhoids 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 a topical anti-inflammatory agent containing hydrocortisone. This, 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 should provide prompt relief.

For painful or persistent hemorrhoids, your doctor may recommend:

Tying off a hemorrhoid. A doctor ties one or two tiny rubber bands around the base of an internal hemorrhoid to cut off its circulation. Within 7 to 10 days, the hemorrhoid painlessly falls off. This simple, practically painless procedure called rubber band ligation is done in a doctor's office and is about 75 percent effective.

Sclerotherapy. A chemical solution is injected around the blood vessel to shrink the hemorrhoid.

Infrared light. A 1- or 2-second burst of infrared light also can cut off circulation to an internal hemorrhoid. You may experience some warmth during the procedure called infrared photocoagulation and a little bleeding within a few days.

Laser therapy. In this procedure called laser coagulation a laser beam vaporizes hemorrhoidal tissue.

Freezing. This technique, cryosurgery, freezes the affected tissue, cutting off circulation and destroying the hemorrhoidal tissue.

Electric current. Bursts of electric current shrink a hemorrhoid in a procedure similar to infrared photocoagulation.

Surgery. If other procedures haven't been successful or if you have a large hemorrhoid, your doctor can remove tissue in a procedure called hemorrhoidectomy. The more extensive the removal of tissue, the lesser the chance of recurrence but the greater the discomfort. Surgery typically involves a 1- or 2-day hospital stay - a longer recovery period than other methods of hemorrhoid removal.

 

Prevention

To 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.

Drink plenty of liquids. Drink at least 6 to 8 cups of water or other liquids daily to soften your stool and make it easier to pass.

Try fiber supplements. Over-the-counter products such as Metamucil 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 6 to 8 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.

Avoid long periods of standing or sitting. If you must sit for long periods, don't use an inflatable "donut" cushion to pad your chair. It 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.

Self Care

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

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 that can cause irritation.

Soak in a warm bath three or four times daily.

Apply ice packs or cold compresses on the anus for 10 minutes up to four times a day.

If a hemorrhoid has prolapsed, gently push the hemorrhoid back into the anal canal.

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.

Use moist towelettes or wet toilet paper after a bowel movement instead of dry toilet paper.

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.