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Hemorrhoids: The Basics

  • All
  • Overview
  • Symptoms & Causes
  • Diagnosis
  • Treatment

What are hemorrhoids?

A hemorrhoid is a dilated (swollen) rectal vein. While humans have blood vessels in every part of our bodies, a hemorrhoid is located primarily in the anorectal region. You are usually not even aware of veins in that area until they become inflamed or enlarged. That’s when these veins can cause pain, discomfort, and, in some cases, bleeding. Hemorrhoids, in general, are a benign condition, but they can be annoying. You may experience burning, itching, and, in some cases, bleeding. If you have bleeding from your rectum, consult your physician.

How common are hemorrhoids?

Approximately 10 million Americans suffer from hemorrhoids. That’s approximately 4 to 5% of the population. People who are at greater risk of hemorrhoids tend to be a little bit older (generally 45 to 65 years of age). However, in the younger age group, one out of three athletic males may experience hemorrhoids. Hemorrhoids are also very common during pregnancy because of increased intra-abdominal pressure, which then causes pressure down in the rectal area.

Is there a cure for hemorrhoids?

Technically, yes. You can destroy or remove the enlarged vein. However, destroying the vein is usually not necessary because there are effective treatments that can help relieve symptoms such as burning and itching.

How can you prevent hemorrhoids?

There are some simple ways to prevent hemorrhoids from developing. One tip is to consume enough fiber in your diet (anywhere from 20 to 35 grams of fiber daily). Consume enough liquids, especially water, to help you avoid becoming constipated. When you are using the toilet, avoid straining.

What are the symptoms of hemorrhoids?

The symptoms of hemorrhoids vary depending on whether they are located internally (inside the rectum) or externally (outside the rectum). Internal hemorrhoids are usually painless. However, if these enlarged veins are scratched or abraded, you may see some blood coming from the rectum or on the toilet tissue. External hemorrhoids have a different nerve supply, similar to the nerve supply of your skin, so external hemorrhoids are generally more painful than internal hemorrhoids are. If you notice bleeding from any type of hemorrhoids, contact your physician.

What are the causes of hemorrhoids?

Hemorrhoids are often caused by increased intra-abdominal pressure, which then causes pressure in the rectal region and the veins surrounding it. Most commonly, people who suffer from hemorrhoids are constipated. They don’t take in sufficient amounts of fluid or fiber from their diet. More fiber attracts more water into the intestines and colon and helps soften the stool, which helps relieve constipation.

What are anal fissures?

Anal fissures are cracks or sores in the region of the anal sphincter. It’s similar to a chapped lip, which is a little crack or a fissure along the lip margin. If you have this kind of crack in the area of your anal sphincter, that is called an anal fissure. This is usually due to some minor irritation or inflammation and is not the same as a hemorrhoid.

How are hemorrhoids diagnosed?

To diagnose an internal hemorrhoid, the physician will place an instrument – either an anusscope or a proctoscope – into the anorectal canal so they can see any hemorrhoids. Internal hemorrhoids are located above a particular anatomic region, so they are higher up in the anorectal canal with a different nerve supply. External hemorrhoids are located right at the anal-rectal connection or even more externally. External hemorrhoids are diagnosed by direct observation.

What is a colonoscopy?

A colonoscopy is an exam of the colon or large intestine. In a colonoscopy, the physician, (oftentimes a gastroenterologist) will insert a long flexible tube with a light source and an operative channel into the rectum. A colonoscopy examines the large intestine to look for sources of bleeding, such as polyps, tumors, or hemorrhoids.

How do I know if I have hemorrhoids?

You might not. If you are not experiencing symptoms, you may not notice anything. However, if you are experiencing rectal pain (especially if this pain has been going on for 1-2 weeks) or notice rectal bleeding, you should bring it to the attention of your primary care physician for examination.

How are hemorrhoids treated?

Treatment options for hemorrhoids include consuming sufficient fiber (25-35 grams per day), consuming enough fluids, and using topical medications either for symptom relief or inflammation help. Other options include performing band ligation, hemorrhoidectomy, sclerotherapy, topical techniques, and/or home remedies.

What is band ligation?

Band ligation (or banding) is an outpatient, office-based technique where the physician attaches a banding device to a short proctoscope or a colonoscope and inserts it into the anorectal canal. The physician then places a band around the dilated vein. Eventually the band will cut through the vein, and you’ll just pass it in several days as if you are having a bowel movement. This destroys the vein and eliminates the hemorrhoid. You may notice a little discomfort or even some blood streaking for a few days after the band has passed, but this is generally benign and with good anal hygiene should not be a problem.

What is a hemorrhoidectomy?

A hemorrhoidectomy is a surgical removal of the hemorrhoidal veins. This is a more invasive procedure performed by surgeons. In a very small number of cases, the anal sphincter may be compromised such that a patient may experience some seepage of stool or even anal incontinence after the surgery.

What is sclerotherapy?

Sclerotherapy is a form of treatment for protruding or dilated hemorrhoidal veins. The physician injects a needle into a vein and then infuses a sclerosing agent. This particular agent will cause scarring within the vein, and the dilated vein gradually shrinks. In some instances, there may be residual scars and sometimes these scars can cause ulceration in the region of the hemorrhoidal vein. In a small number of cases, it may have an effect on the anal sphincter, such that a patient may subsequently experience episodes of incontinence or the seepage of stool after this therapy.

What are topical techniques?

Topical techniques that are used in an outpatient setting may be thermal ablation (heat) or cryotherapy (cold). These therapies apply some form of energy to destroy the enlarged vein. Thermal techniques, such as laser therapy or thermal ablation, use heat to destroy the vein. Cryotherapy techniques use cold to freeze and destroy the hemorrhoidal vein.

What is a sitz bath?

A sitz bath is a form of a topical therapy for treating dilated painful hemorrhoids. A patient with hemorrhoids sits in 2-3  inches of warm water (usually in a bathtub) for 10 to 15 minutes, 2-3 times a day. The warm, gentle water enhances circulation in the hemorrhoidal veins and causes the rectal muscles to relax so that these dilated, sometimes even protruding, veins can recede back into the rectal canal. A sitz bath can also help to minimize pain from dilated and protruding hemorrhoids. Don’t add bubble bath or anything else to the water for a sitz bath.

What home remedies are there for hemorrhoids?

Some other home remedies one could try would be to apply Vaseline or petroleum jelly to the toilet tissue so that when you wipe yourself after each bowel movement, you’ve applied a lubricant, which could also heal an inflamed or irritated area. After application, you might want to sit on a firm surface for anywhere from 30 seconds to a minute. That may help reduce the swelling, or even pop your protruding hemorrhoids back into place. You could also try some witch hazel (an astringent) which may help soothe inflammation and also helps shrink protruding hemorrhoidal veins.

What is witch hazel?

Witch hazel is an astringent solution. It helps shrink a dilated vein when applied topically. It also has some soothing properties to help relieve pain and itching.  It is a plant-based solution, so it is a natural treatment for hemorrhoidal veins.

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