Hemorrhoids are swollen blood vessels in and around the anus and lower rectum. They stretch under pressure and are similar to varicose veins in the legs. Hemorrhoids are either internal or external.
Internal (inside) Hemorrhoids – develop inside the anus. They are painless and sometimes bleed a lot during bowel movements. They may also protrude during bowel movements. If they protrude from the anal opening and cannot be pushed back, they can cause severe pain.
External (outside) Hemorrhoids – develop under the skin around the anus and can easily be felt or seen as a lump. They bleed when broken by straining, rubbing, or scratching.
Causes
The exact cause of hemorrhoids is unknown. The major contributing factor appears to be too much pressure on the veins in the rectum. If the pressure continues, the veins become enlarged and protrude.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
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Straining when trying to pass a stool
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Chronic constipation or diarrhea
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Sitting on the toilet for long periods of time
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Pressure on the veins from pregnancy and childbirth
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Advancing age
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Obesity
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Family members with hemorrhoids
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Chronic cough
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Liver disease
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Chronic use of enemas or laxatives
Symptoms
In most cases, symptoms will go away within several days. Although many people have hemorrhoids, not all experience symptoms.
Common symptoms include:
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Bleeding from the anus that may appear:
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Anal itching and burning
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Swelling and pain during bowel movements
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Sensitive lumps of various sizes around the anus
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor will examine the anus and rectum to look for swollen blood vessels and perform a digital rectal exam. This is accomplished by inserting a gloved, lubricated finger into the rectum to feel for abnormalities.
Bleeding from the rectum or blood in the stool can be a symptom of other digestive diseases or colon cancer. It is important to see a doctor if you have any rectal bleeding.
Treatment
Initial medical treatment of hemorrhoids is aimed at relieving symptoms. Measures to reduce symptoms include:
Sitz Baths – sitting in plain, warm water 2-3 times a day for about 10 minutes each time
Ice Packs – putting cold packs on the anus for short durations to relieve pain and swelling
Medication – applying hemorrhoidal creams or suppositories to the affected area
High-fiber Diet – Eating more whole fresh fruit, raw, or cooked vegetables, and whole grains has been consistently shown to reduce symptoms of hemorrhoids, including bleeding. In contrast, spicy foods have been shown not to worsen the symptoms of hemorrhoids, so you do not need to avoid them.
Fluids – drinking six to eight, 8-ounce glasses of nonalcoholic fluids daily to soften stools
If these treatments provide insufficient relief, one of several nonsurgical procedures may be used to shrink or destroy the hemorrhoidal tissue. These procedures, which are generally performed in a doctor’s office, include:
Rubber Band Ligation – a rubber band placed around the base of the hemorrhoid to cut off circulation and force the hemorrhoid to wither away within a few days
Sclerotherapy – a chemical solution is injected near the blood vessel to cause scarring and shrinkage of the hemorrhoid
Coagulation Therapy – the use of electricity (direct current electrotherapy), laser, or infrared light (photocoagulation) to shrink the hemorrhoidal tissue
If nonsurgical procedures are either not an option or fail to resolve the problem, surgical management is the final option:
Hemorrhoidectomy – permanent removal of hemorrhoids by cutting the hemorrhoidal tissue away. Some of the newest surgical treatments involve using stainless steel staples. While favored by many surgeons, there is some evidence that more traditional techniques produce more consistent and long-lasting relief.
Prevention
The best way to prevent hemorrhoids is to keep stools soft so they pass easily. The following practices can help:
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Eating a high fiber diet
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Exercising regularly, especially walking
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Emptying bowels as soon as possible after the urge occurs
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Avoiding the overuse of laxatives
RESOURCES:
American Society of Colon and Rectal Surgeons
http://www.fascrs.org
National Digestive Diseases Information Clearinghouse
http://digestive.niddk.nih.gov/index.htm
CANADIAN RESOURCES
The Canadian Association of Gastroenterology (CAG)
http://www.cag-acg.org
The College of Family Physicians of Canada
http://www.cfpc.ca/
References:
Alonso-Coello P, Guyatt G, Heels-Ansdell D, et al. Laxatives for the treatment of hemorrhoids. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD004649.
Altomare DF, Rinaldi M, La Torre F, et al. Red hot chili pepper and hemorrhoids: the explosion of a myth: results of a prospective, randomized, placebo-controlled, crossover trial. Dis Colon Rectum. 2006 Jul;49(7):1018-1023.
American Society of Colon and Rectal Surgeons website. Available at: http://www.fascrs.org.
Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005393.
National Institutes of Health, National Institute of Diabetes, Digestive, and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health/digest/pubs/hems/hemords.htm.
