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Hemorrhoids
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Featured
Article: What are Hemorrhoids, and how
are Hemorrhoids prevented
What are hemorrhoids?
The term hemorrhoids refers to a condition in which the veins around
the anus or lower rectum are swollen and inflamed.
Hemorrhoids may result from straining to move stool. Other
contributing factors include pregnancy, aging, chronic constipation
or diarrhea, and anal intercourse.
Hemorrhoids are either inside the anus (internal) or under the skin
around the anus (external). (
What are the symptoms of hemorrhoids?
Many anorectal problems, including fissures, fistulae, abscesses, or
irritation and itching (pruritus ani), have similar symptoms and are
incorrectly referred to as hemorrhoids.
Hemorrhoids usually are not dangerous or life threatening. In most
cases, hemorrhoidal symptoms will go away within a few days.
Although many people have hemorrhoids, not all experience symptoms.
The most common symptom of internal hemorrhoids is bright red blood
covering the stool, on toilet paper, or in the toilet bowl. However,
an internal hemorrhoid may protrude through the anus outside the
body, becoming irritated and painful. This is known as a protruding
hemorrhoid.
Symptoms of external hemorrhoids may include painful swelling or a
hard lump around the anus that results when a blood clot forms. This
condition is known as a thrombosed external hemorrhoid.
In addition, excessive straining, rubbing, or cleaning around the
anus may cause irritation with bleeding and/or itching, which may
produce a vicious cycle of symptoms. Draining mucus may also cause
itching.
How common are hemorrhoids?
Hemorrhoids are very common in both men and women. About half of the
population have hemorrhoids by age 50. Hemorrhoids are also common
among pregnant women. The pressure of the fetus in the abdomen, as
well as hormonal changes, cause the hemorrhoidal vessels to enlarge.
These vessels are also placed under severe pressure during
childbirth. For most women, however, hemorrhoids caused by pregnancy
are a temporary problem.
How are hemorrhoids diagnosed?
A thorough evaluation and proper diagnosis by the doctor is
important any time bleeding from the rectum or blood in the stool
occurs. Bleeding may also be a symptom of other digestive diseases,
including colorectal cancer.
The doctor will examine the anus and rectum to look for swollen
blood vessels that indicate hemorrhoids and will also perform a
digital rectal exam with a gloved, lubricated finger to feel for
abnormalities.
Closer evaluation of the rectum for hemorrhoids requires an exam
with an anoscope, a hollow, lighted tube useful for viewing internal
hemorrhoids, or a proctoscope, useful for more completely examining
the entire rectum.
To rule out other causes of gastrointestinal bleeding, the doctor
may examine the rectum and lower colon (sigmoid) with sigmoidoscopy
or the entire colon with colonoscopy. Sigmoidoscopy and colonoscopy
are diagnostic procedures that also involve the use of lighted,
flexible tubes inserted through the rectum.
What is the treatment?
Medical treatment of hemorrhoids is aimed initially at relieving
symptoms. Measures to reduce symptoms include warm tub baths several
times a day in plain, warm water for about 10 minutes
application of a hemorroidal cream or suppository to the affected
area for a limited time
Preventing the recurrence of hemorrhoids will require relieving the
pressure and straining of constipation. Doctors will often recommend
increasing fiber and fluids in the diet. Eating the right amount of
fiber and drinking six to eight glasses of fluid (not alcohol)
result in softer, bulkier stools. A softer stool makes emptying the
bowels easier and lessens the pressure on hemorrhoids caused by
straining. Eliminating straining also helps prevent the hemorrhoids
from protruding.
Good sources of fiber are fruits, vegetables, and whole grains. In
addition, doctors may suggest a bulk stool softener or a fiber
supplement such as psyllium (Metamucil) or methylcellulose
(Citrucel).
In some cases, hemorrhoids must be treated endoscopically or
surgically. These methods are used to shrink and destroy the
hemorrhoidal tissue. The doctor will perform the procedure during an
office or hospital visit.
A number of methods may be used to remove or reduce the size of
internal hemorrhoids. These techniques include
Rubber band ligation. A rubber band is placed around the base of the
hemorrhoid inside the rectum. The band cuts off circulation, and the
hemorrhoid withers away within a few days.
Sclerotherapy. A chemical solution is injected around the blood
vessel to shrink the hemorrhoid.
Infrared coagulation. A special device is used to burn hemorrhoidal
tissue.
Hemorrhoidectomy. Occasionally, extensive or severe internal or
external hemorrhoids may require removal by surgery known as
hemorrhoidectomy.
How are hemorrhoids prevented?
The best way to prevent hemorrhoids is to keep stools soft so they
pass easily, thus decreasing pressure and straining, and to empty
bowels as soon as possible after the urge occurs. Exercise,
including walking, and increased fiber in the diet help reduce
constipation and straining by producing stools that are softer and
easier to pass.
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