What are hemorrhoids?
The term “hemorrhoids” generally refers to swollen inflamed rectal veins (also known as hemorrhoidal veins). When they are internal, the primary symptom is painless bright red rectal bleeding. This often shows up on the stool or on the toilet paper. When the hemorrhoids are external, patients often feel a tender lump just outside the anus. External hemorrhoids can be very painful. They can cause itching as well. Sometimes internal hemorrhoids enlarge and protrude outside the anal canal. These prolapsed hemorrhoids can be quite annoying, because they cause pain, bleeding and itching. They make it difficult for the patient to wipe clean after a bowel movement.
How common are hemorrhoids?
By age 50 nearly half of all Americans have hemorrhoids. Many patients are embarrassed by their symptoms and only about 5 percent seek medical care.
What causes hemorrhoids?
Anything that increases pressure in the rectal (hemorrhoidal) veins can lead to hemorrhoids. Constipation, diarrhea, straining to have a bowel movement, prolonged sitting, pregnancy, weight lifting, obesity and alcohol abuse are just some of the reasons why patients develop symptomatic hemorrhoids.
How are hemorrhoids diagnosed?
The history is important in diagnosing hemorrhoids. Bleeding, pain, itching, and a newly discovered lump or bump outside the anus help make the diagnosis. External hemorrhoids have a characteristic blue or purple appearance and are tender to touch. Your doctor will probably examine the anus and rectum with his lubricated gloved finger. This helps diagnose internal hemorrhoids and exclude other anal conditions like fissures. Occasionally a small scope called an anoscope is used to examine the anus and lower rectum. Colonoscopy or flexible sigmoidoscopy is often used to exclude more serious conditions like colon cancer and colon polyps especially in patients over age 50.
How are hemorrhoids treated?
Most hemorrhoids respond well to life style changes and diet. Patients should avoid straining. They should not sit on the toilet for prolonged periods of time. Increased fiber in the diet will allow the stool to pass more easily and help in wiping clean. Bland diet will improve itching. Other measures include:
- Fiber supplements
- Stool softeners
- Weight loss
- Reduce alcohol consumption
- Avoiding heavy lifting
- Over the counter hemorrhoidal creams
- Sitz baths (soaking in the bathtub)
- Prescription suppositories or creams (especially useful for bleeding, itching and pain)
If the patient does not respond to these treatments, they may require more invasive approach such as:
- Rubber band ligation. This is an office procedure where small rubber bands are applied to internal hemorrhoids causing them to fall off in a few days. A scar forms in the area where the hemorrhoid was located. This helps prevent recurrence.
- Intrared coagulation. A small probe is placed in the rectum and heat is applied to the hemorrhoid thereby destroying it.
- Sclerotherapy. A chemical is injected in the hemorrhoid. This causes it to scar and helps destroy it
- Formal hemorrhoid surgery. This is performed by a general or colon and rectal surgeon in the operating room. The hemorrhoidal tissue is removed.
If you are having problems with hemorrhoids, please feel free to make an appointment.