Hemorrhoids – Overview
Hemorrhoids (HEM-uh-roids), also known as piles, are veins which are swollen in the anus and lower rectum, similar to varicose veins. Hemorrhoids can grow inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids).
About three out of four adults will have hemorrhoids from time to time. Often the cause is unknown for hemorrhoids but it might have some causes
There are effective options which are available in treating hemorrhoids. Many people get cured with home treatments and changes in their lifestyle
Hemorrhoids – Symptoms
The Signs and symptoms of developing hemorrhoids is usually dependent on the type of hemorrhoid.
These are developed under the skin around the anus. Signs and symptoms may include:
- Itching or irritation in the anal region
- Pain or discomfort
- Swelling around the anus
Internal hemorrhoids lie inside the rectum. It can’t be seen or felt, and they rarely cause discomfort. When passing stool it can cause straining or irritation:
- Bleeding which is painless during bowel movements. Small amounts of bright red blood on toilet tissue or in the toilet might be noticed.
- A hemorrhoid to push through the anal opening (prolapsed or protruding hemorrhoid), pain and irritation can be experienced
If blood pools in an external hemorrhoid and a clot is formed which is known as thrombus, it can result in:
- Severe pain
- A hard lump near the anus
If during bowel movements having bleeding or having hemorrhoids that don’t improve after a week of home care, the doctor should be consulted.
Rectal bleeding should not be assumed due to hemorrhoids, especially if there are changes in bowel habits or if the stools change in color or consistency. Rectal bleeding can happen with other diseases, including colorectal cancer and anal cancer.
Emergency care should be sought if having large amounts of rectal bleeding, lightheadedness, dizziness or faintness.
Hemorrhoids – Causes
The veins tend to stretch under pressure around the anus and may bulge or swell. Hemorrhoids can help in developing from increased pressure in the lower rectum due to:
- Pressure during bowel movements
- Sitting for long periods of time on the toilet
- Having chronic diarrhea or constipation
- Having anal intercourse
- Eating a low-fiber diet
- Regular heavy lifting
The risk of hemorrhoids increases with age that’s because the tissues that are supporting the veins in the rectum and anus can weaken and stretch. This can also occur in pregnancy, because the weight of the baby puts pressure on the anal region.
Rarely there are complications of hemorrhoids which may include:
- Anemia can be caused rarely from chronic blood loss from hemorrhoids, in which healthy red blood cells are not enough to carry oxygen to the cells.
- If the blood supply to an internal hemorrhoid is cut off, severe pain can be caused if the hemorrhoid may be strangulated
- Blood clot.Sometimes, a clot can form in a hemorrhoid known as thrombosed hemorrhoid. Although not harmful but it can be severely painful and sometimes needs to be lanced and drained.
The best way is that the stools should be kept soft to prevent hemorrhoids, so they pass easily. To prevent hemorrhoids and decrease the symptoms of hemorrhoids, follow below tips:
- Consume more fruits, vegetables and whole grains. Eating high fiber foods helps to soften the stool and increases its bulk, which will help to avoid the straining that can cause hemorrhoids. Add fiber to the diet gradually to avoid problems with gas.
- Drinking six to eight glasses of water and other liquids (not alcohol) every day to help keep stools soft.
- Consider fiber supplements.Most people don’t consume enough of the suggested amount of fiber which is 20 to 30 grams a day in their diet. Researches have shown that over-the-counter fiber supplements, such as psyllium (Metamucil) or methylcellulose (Citrucel), can help in improving the overall symptoms and bleeding from hemorrhoids.
If use fiber supplements are used, be sure to drink at least eight glasses of water or other fluids each day. Otherwise, the supplements may cause or worsen constipation.
- Straining and holding the breath when trying to pass a stool creates greater strain in the veins in the lower rectum.
- Go as soon as feeling the urge when wanting to pass a bowel movement and if the urge goes away, the stool could dry out and be harder to pass.
- Stay active to help in the prevention of constipation and to decrease pressure on veins, which can happen with standing or sitting for long periods. Exercise can also help in losing excess weight that might be adding to the hemorrhoids.
- Sitting too long should be avoided, particularly on the toilet, as it can increase the pressure on the veins in the anus.
External hemorrhoids might be seen by the doctor. Internal hemorrhoids diagnosis might include evaluation of the anal canal and rectum.
- Digital examination is conducted where the doctor inserts a gloved, lubricated finger into the rectum for feeling anything unusual, such as growths.
- Visual inspection may be conducted because internal hemorrhoids are often too delicate to be felt during a rectal exam, the doctor might evaluate the lower portion of the colon and rectum with an anoscope, proctoscope or sigmoidoscope.
The doctor might want to evaluate the entire colon using colonoscopy if:
- The signs and symptoms recommend that another digestive system disease might be present
- Having risk factors for colorectal cancer
- Candidate is middle-aged and haven’t had a recent colonoscopy
Mild pain, swelling and inflammation of hemorrhoids can be relieved often with home treatments.
- Eating high-fiber foods.
- Using topical treatments by applying an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or using pads containing witch hazel or a numbing agent.
- The anal area should be soaked in plain warm water for 10 to 15 minutes for about two to three times a day. A sitz bath also fits over the toilet.
- Oral pain relievers can be used such as acetaminophen (Tylenol, others), aspirin or ibuprofen (Advil, Motrin IB, others) temporarily to help relieve the discomfort.
Within a period of one week with these treatments, hemorrhoid symptoms often go away. If these treatments don’t relieve within a week see the doctor, or sooner if experiencing severe pain or bleeding.
If only mild discomfort is produced by the hemorrhoids, the doctor might suggest over-the-counter creams, ointments, suppositories or pads. These products have ingredients such as witch hazel, or hydrocortisone and lidocaine, which can relieve the pain and itching temporarily.
An over-the-counter steroid cream should not be used for more than a week unless instructed by the doctor because it can thin the skin.
External hemorrhoid thrombectomy
If a painful blood clot (thrombosis) has developed within an external hemorrhoid, removal of the hemorrhoid can be done by the doctor, which can provide prompt relief. This procedure is conducted under local anesthesia and is most effective if conducted within 72 hours of formation of a clot.
Minimally invasive procedures
For continuous bleeding or painful hemorrhoids, one of the other minimally invasive procedures available may be recommended by the doctor. These treatments can be conducted in the doctor’s office or other outpatient setting and usually anesthesia is not required.
- Rubber band ligation. One or two tiny rubber bands are placed around the base of an internal hemorrhoid to cut off its circulation. The hemorrhoid diminishes and falls off within a week.
Hemorrhoid banding can have discomfort and may cause bleeding, which might begin two to four days after the procedure is conducted but the severity is rare. Sometimes, consequential complications can occur.
- Injection (sclerotherapy).A chemical solution into the hemorrhoid tissue is injected by the doctor to shrink it. While little or no pain is caused by the injection, it might be less effective than rubber band ligation.
- Coagulation (infrared, laser or bipolar).Laser or infrared light or heat is used in coagulation techniques. Small, bleeding internal hemorrhoids to harden and shrivel are caused. There are few side effects with coagulation and usually causes little discomfort.
The requirement for a surgery is for only a small percentage of people with hemorrhoids. However, if having large hemorrhoids and other procedures conducted were unsuccessful, the doctor might recommend one of the below:
- Hemorrhoid removal (hemorrhoidectomy).By selecting one of several techniques, the surgeon removes excessive tissue that causes bleeding. The surgery can be conducted with local anesthesia in combination with sedation, spinal anesthesia or general anesthesia.
The most effective and complete way to treat severe or recurring hemorrhoids is hemorrhoidectomy. Temporary difficulty emptying your bladder can be a complication, which can result in urinary tract infections. This complication happens mainly after spinal anesthesia.
After the procedure most people experience some pain, which can be relieved by medication. Soaking in a warm bath also might also be helpful.
- Hemorrhoid stapling. This procedure also called stapled hemorrhoidopexy, blocks the flow of blood to hemorrhoidal tissue. It is generally used only for internal hemorrhoids.
Stapling usually involves less pain compared to hemorrhoidectomy and allows for earlier return to regular activities. Compared with hemorrhoidectomy, however, stapling has been affiliated with a greater risk of recurrence and rectal prolapse, in which some of the rectum protrudes from the anus.
Bleeding, urinary retention and pain can be some complications, as well as, rarely, a life-threatening blood infection (sepsis). Doctor should be consulted with for the best options
Preparation for appointment
If having signs and symptoms of hemorrhoids, an appointment should be made with the regular doctor. If required, the doctor might refer to specialists including a doctor with expertise in the digestive system (gastroenterologist) or a colon and rectal surgeon for examination and treatment.
Below are some suggestions to help in getting ready for the appointment.
Any pre-appointment restrictions should be made aware. When appointment is made, ask if there’s anything needed to be done in advance.
Make a list of:
- Symptoms and when they were noticed
- Important personal information,such as typical bowel habits and diet, especially the fiber intake
- All medications, vitamins or supplementsbeing taken, including doses
- Questions to ask the doctor
Your doctor is likely to ask the following, including:
- Discomfort with symptoms
- Typical bowel habits
- Amount of fiber the diet contains
- If anything seems to improve the symptoms
- If anything appears to worsen the symptoms
- Family history of hemorrhoids or cancer of the colon, rectum or anus
- Any changes in bowel habits
- During bowel movements, any blood on toilet paper noticed, dripping into the toilet or mixed into the stools
Steps should be taken to soften the stools prior to the appointment. Consume more high-fiber foods, such as fruits, vegetables and whole grains, and consider an over-the-counter fiber supplement, such as Metamucil or Citrucel. Drink six to eight glasses of water a day to help in relieving the symptoms.