Hemorrhoids (Piles)

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Hemorrhoids

 

Introduction

Hemorrhoids, often called piles, are swollen and

inflamed veins in your anus and rectum. They may

result from straining when having a bowel movement or

the increased pressure on these veins during

pregnancy.

A sometimes embarrassing topic of discussion,

hemorrhoids are common. By age 50, about half of

adults deal with the itching, 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

this condition may require only self-care and

lifestyle changes.

Hemorrhoids

Hemorrhoids are engorged veins in your lower rectum.

Internal hemorrhoids are usually painless, but tend to

bleed. External hemorrhoids may cause pain.

Signs and symptoms

Signs and 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 anal 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 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 include:

 

* Constipation and the accompanying extra

straining

* Diarrhea and the continuous expulsion of loose

stools

* Sitting or standing for a long time

* Obesity

* Heavy lifting

* Pregnancy and childbirth

 

It's also possible to inherit a tendency to develop

hemorrhoids.

Screening and diagnosis

As a general rule, see your doctor if your hemorrhoids

don't improve with self-care, cause pain, or bleed

frequently or excessively.

The most common sign of internal hemorrhoids is rectal

bleeding. But because rectal bleeding can occur for

other reasons, 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.

A 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, to 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.

Treatment

In many 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 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:

 

* Banding hemorrhoids. 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. A chemical solution is injected

around the blood vessel to shrink the hemorrhoid.

* Infrared light. A 1- or 2-second burst of

infrared light can cut 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

local anesthetic combined with sedation, a spinal

anesthetic, or general anesthetic. It's usually done

as an outpatient or overnight hospital stay. While you

may experience discomfort after the procedure,

medications can be used to relieve your pain. Soaking

in a warm bath can also ease your discomfort. Some

newer surgical techniques may decrease the amount of

pain that some people experience.

 

Rubber band ligation of hemorrhoid

To remove a hemorrhoid using rubber band ligation,

your surgeon inserts the ligator through a scope in

the anal canal, grasping the hemorrhoid with forceps.

Sliding the ligator's cylinder upward releases rubber

bands around the base of the hemorrhoid. Rubber bands

cut off the hemorrhoid's blood supply, causing it to

wither and drop off.

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.

* 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 to 10 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

doughnut 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:

 

* 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.

* Push back a prolapsed hemorrhoid. If a

hemorrhoid has prolapsed, gently try pushing 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.

* Don't use dry toilet paper. Use moist towelettes

or wet toilet paper after a bowel movement instead.

* Take oral medications. Acetaminophen (Tylenol,

others), aspirin or ibuprofen (Advil, Motrin, others)

may relieve your discomfort.

 

 

 

 

 

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