Hemmorhoids

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WHAT ARE HEMORRHOIDS?

The term hemorrhoid is commonly used to describe the symptoms caused by hemorrhoids, since hemorrhoids exist in all healthy persons. Hemorrhoids (HEM-uh-roids), also called piles, are swollen and inflamed veins in your anus and lower rectum. Hemorrhoids may result from straining during bowel movements or from the increased pressure on these veins during pregnancy, among other causes. Hemorrhoids may be located inside the rectum (internal hemorrhoids), or they may develop under the skin around the anus (external hemorrhoids). Hemorrhoids are common ailments. By age 50, about half of adults have had to deal with the itching, discomfort and bleeding that can signal the presence of hemorrhoids. Fortunately, many effective options are available to treat hemorrhoids. Most people can get relief from symptoms by using home treatments and making lifestyle changes.

SYMPTOMS

Signs and symptoms of hemorrhoids may include:

• Painless bleeding during bowel movements — you might notice small amounts of bright red blood on your toilet tissue or in the toilet bowl
• Itching or irritation in your anal region
• Pain or discomfort
• Swelling around your anus
• A lump near your anus, which may be sensitive or painful
• Leakage of feces

Hemorrhoid symptoms usually depend on the location. Internal hemorrhoids lie inside the rectum. You usually can’t see or feel these hemorrhoids, and they usually don’t cause discomfort. But straining or irritation when passing stool can damage a hemorrhoid’s delicate surface and cause it to bleed. Occasionally, straining can push an internal hemorrhoid through the anal opening. This is known as a protruding or prolapsed hemorrhoid and can cause pain and irritation. External hemorrhoids are under the skin around your anus. When irritated, external hemorrhoids can itch or bleed. Sometimes blood may pool in an external hemorrhoid and form a clot (thrombus), resulting in severe pain, swelling and inflammation.

WHEN TO SEE A DOCTOR

Bleeding during bowel movements is the most common sign of hemorrhoids. But rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer. Don’t assume that bleeding is coming from hemorrhoids without consulting a doctor. Your doctor can do a physical examination and perform other tests to diagnose hemorrhoids and rule out more-serious conditions or diseases. Also consider seeking medical advice if your hemorrhoids cause pain, bleed frequently or excessively, or don’t improve with home remedies. If your hemorrhoid symptoms began along with a marked change in bowel habits or if you’re passing black, tarry or maroon stools, blood clots, or blood mixed in with the stool, consult your doctor immediately. These types of stools can signal more extensive bleeding elsewhere in your digestive tract. Seek emergency care if you experience large amounts of rectal bleeding, light-headedness, dizziness or faintness.

CAUSES

The veins around your anus tend to stretch under pressure and may bulge or swell. Swollen veins (hemorrhoids) can develop from an increase in pressure in the lower rectum. Factors that might cause increased pressure include:

• Straining during bowel movements
• Sitting for long periods of time on the toilet
• Chronic diarrhea or constipation
• Obesity
• Pregnancy
• Anal intercourse
• Low-fiber diet

Hemorrhoids are more likely as you get older because the tissues that support the veins in your rectum and anus can weaken and stretch with aging.

COMPLICATIONS

Complications of hemorrhoids are rare but include:

• Chronic blood loss from hemorrhoids may cause anemia, in which you don’t have enough healthy red blood cells to carry oxygen to your cells. This may result in fatigue and weakness.
• Strangulated hemorrhoid.If blood supply to an internal hemorrhoid is cut off, the hemorrhoid may be “strangulated,” which can cause extreme pain and lead to tissue death (gangrene).

TESTS & DIAGNOSIS

Your doctor may be able to see if you have external hemorrhoids simply by looking. Tests and procedures to diagnose internal hemorrhoids may include:

• Examination of your anal canal and rectum for abnormalities.During a digital rectal exam, your doctor inserts a gloved, lubricated finger into your rectum. He or she feels for anything unusual, such as growths. The exam can give your doctor an indication of what further testing might be appropriate.
• Visual inspection of your anal canal and rectum.Because internal hemorrhoids are often too soft to be felt during a rectal examination, your doctor may also examine the lower portion of your colon and rectum with an anoscope, proctoscope or sigmoidoscope. These are scopes that allow your doctor to see into your anus and rectum.

Your doctor may want to do a more extensive examination of your entire colon using colonoscopy. This might be recommended if:

• Your signs and symptoms suggest you might have another digestive system disease
• You have risk factors for colorectal cancer
• You’re older than age 50 and haven’t had a recent colonoscopy

 TREATMENTS

Most of the time, treatment for hemorrhoids involves steps which you can take on your own (such as lifestyle modifications). But sometimes medications or surgical procedures are necessary.

Medications

If your hemorrhoids produce only mild discomfort, your doctor may suggest over-the-counter creams, ointments, suppositories or pads. These products contain ingredients, such as witch hazel or hydrocortisone, which can relieve pain and itching, at least temporarily. Don’t use an over-the-counter cream or other product for more than a week unless directed by your doctor. These products can cause side effects, such as skin rash, inflammation and skin thinning.

Minimally invasive procedures

If a blood clot has formed within an external hemorrhoid, your doctor can remove the clot with a simple incision, which may provide prompt relief. This is mostly helpful within the first 48 hours. For persistent bleeding or painful hemorrhoids, your doctor may recommend another minimally invasive procedure. These treatments can be done in your doctor’s office or other outpatient setting. Rubber band ligation. Hemorrhoid Ligation is a procedure during which a latex band is placed around the neck of the hemorrhoid (or pile). The pile then shrinks away over the next couple of weeks. When the hemorrhoid shrinks, there may be some irritation or burning from the raw surface until it heals. For a few days after the procedure patients must avoid excessive coffee, cola, alcohol, spices, heavy lifting and strenuous exercise. Two to four visits will be needed to complete the treatment. A sigmoidoscopy and colonoscopy may be required to ensure there is no other problem higher up causing your symptoms. Most patients with hemorrhoids will have success with this treatment.

Advantages of the Procedure

• No hospitalizations
• No general anesthesia
• Less time lost from work – most patients return to work and resume normal activities the same day
• Fewer serious complications in this procedure (i.e., no narrowing of the anal opening or serious bleeding, and there is rarely an infection)
• With this method, the early recurrence rate is reduced to about 15% and late recurrences average about 20%. Hemorrhoids may recur if you strain during bowel movements, sit on the toilet and read, etc.

Post Treatment Precautions and Risks

• Constipation and straining at stool must be avoided; this is extremely important. If you have this tendency, take natural wheat bran or other bulk forming laxative daily.
• Bleeding: Spotting may occur when the hemorrhoid shrinks, which is usually minor. Occasionally you may have a gush of blood in the toilet during a bowel movement, in which case do the following.
  • Lie face down on the bed with your stomach over the edge and place your head on a pillow on the floor so that your bottom is as high as possible – for 15-20mins to allow the bleeding to stop by gravity.
  • After that, lie face down on your bed with four pillows under your hips to keep your bottom elevated for an hour. If the bleeding returns, do these steps again. It is very rare (approximately 1 in 1000) that this will not stop the bleeding. If possible, apply lubricated gauze directly. If it continues, please call the clinic.
  • If you experience periodic bleeding after the treatment is over, it is from anal irritation
• Burning/raw, irritating sensation: Stop all coffee, alcohol, spices (i.e. onions, pepper and garlic)
• If you are unable to urinate, please call the clinic or go to the nearest emergency department at a hospital. A urinary catheter may (rarely) need to be inserted at the hospital.
• Local infection or abscess formation may rarely happen.
• Injection (sclerotherapy).In this procedure, your doctor injects a chemical solution into the hemorrhoid tissue to shrink it. While the injection causes little or no pain, it may be less effective than rubber band ligation.
• Coagulation (infrared, laser or bipolar).Coagulation techniques use laser or infrared light or heat. They cause small, bleeding, internal hemorrhoids to harden and shrivel. While coagulation has few side effects, it’s associated with a higher rate of hemorrhoids coming back (recurrence) than is the rubber band treatment.

Surgical procedures

If other procedures haven’t been successful or you have large hemorrhoids, your doctor may recommend a surgical procedure. Surgery can be performed on an outpatient basis or you may need to stay in the hospital overnight.

• Hemorrhoid removal.During a hemorrhoidectomy, your surgeon removes excessive tissue that causes bleeding. Various techniques may be used. The surgery may be done with a local anesthetic combined with sedation, a spinal anesthetic or a general anesthetic. Hemorrhoidectomy is the most effective and complete way to treat severe or recurring hemorrhoids. Complications may include temporary difficulty emptying your bladder and urinary tract infections, postoperative bleeding and rarely incontinence. Most people experience some pain after the procedure. Medications can relieve your pain. Soaking in a warm bath also may help.
• Hemorrhoid stapling.This procedure, called stapled hemorrhoidectomy or stapled hemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. Stapling generally involves less pain than hemorrhoidectomy and allows an earlier return to regular activities. Compared with hemorrhoidectomy, however, stapling has been associated with a greater risk of recurrence and rectal prolapse, in which part of the rectum protrudes from the anus. Talk with your doctor about what might be the best option for you.

Home Remedies

You can often relieve the mild pain, swelling and inflammation of hemorrhoids with home treatments. Often these are the only treatments needed.

• Use topical treatments.Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or use pads containing witch hazel or a numbing agent.
• Soak regularly in a warm bath or sitz bath.Soak your anal area in plain warm water 10 to 15 minutes two to three times a day. A sitz bath fits over the toilet. You can get one at most drugstores.
• 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. Avoid alcohol based or perfumed wipes. Gently dry the area with a hair dryer after bathing.
• Don’t use dry toilet paper.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.
• Apply cold.Apply ice packs or cold compresses on your anus to relieve swelling.
• Take oral pain relievers.You can use acetaminophen (Tylenol, others), aspirin or ibuprofen (Advil, Motrin, others) temporarily to help relieve your discomfort.

With these treatments, hemorrhoid symptoms often go away within a week. See your doctor if you don’t get relief in a week, or sooner if you have severe pain or bleeding.

PREVENTIONS

The best way to prevent hemorrhoids is to keep your stools soft, so they pass easily. To prevent hemorrhoids and reduce symptoms of hemorrhoids, follow these tips:

• Eat high-fiber foods.Eat more fruits, vegetables and whole grains. Doing so softens the stool and increases its bulk, which will help you avoid the straining that can cause hemorrhoids or worsen symptoms from existing hemorrhoids.
• Drink plenty of fluids.Drink eight to ten glasses of water and other liquids (not alcohol, not caffeinated) each day to help keep stools soft.
• Consider fiber supplements.Most people don’t get enough of the recommended amount of fiber — 25 grams a day for women and 38 grams a day for men — in their diet. Studies have shown that over-the-counter fiber supplements, such as Metamucil and Citrucel, improve overall symptoms and bleeding from hemorrhoids. These products help keep stools soft and regular. Your local pharmacist would be a great resource to help you select the best fiber supplement for you. If you use fiber supplements, be sure to drink at least eight glasses of water or other fluids every day. Otherwise, the supplements can cause constipation or make constipation worse.
• 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.
• Stay active to help prevent constipation and to reduce pressure on veins, which can occur with long periods of standing or sitting. Exercise can also help you lose excess weight that may be contributing to your hemorrhoids.
• Avoid long periods of sitting.Sitting too long, particularly on the toilet, can increase the pressure on the veins in the anus.