Hemorrhoids
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The term hemorrhoids refers to a condition in which the veins
around the anus or lower rectum are swollen and inflamed.
Hemorrhoids may result from straining to move stool. Other
contributing factors include pregnancy, aging, chronic constipation
or diarrhea, and anal intercourse.
Hemorrhoids are either inside the anus (internal) or under the
skin around the anus (external).
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Many anorectal problems, including fissures, fistulae, abscesses,
or irritation and itching (pruritus ani), have similar symptoms and
are incorrectly referred to as hemorrhoids.
Hemorrhoids usually are not dangerous or life threatening. In
most cases, hemorrhoidal symptoms will go away within a few days.
Although many people have hemorrhoids, not all experience
symptoms. The most common symptom of internal hemorrhoids is bright
red blood covering the stool, on toilet paper, or in the toilet
bowl. However, an internal hemorrhoid may protrude through the anus
outside the body, becoming irritated and painful. This is known as a
protruding hemorrhoid.
Symptoms of external hemorrhoids may include painful swelling or
a hard lump around the anus that results when a blood clot forms.
This condition is known as a thrombosed external hemorrhoid.
In addition, excessive straining, rubbing, or cleaning around the
anus may cause irritation with bleeding and/or itching, which may
produce a vicious cycle of symptoms. Draining mucus may also cause
itching.
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Hemorrhoids are very common in both men and women. About half of
the population have hemorrhoids by age 50. Hemorrhoids are also
common among pregnant women. The pressure of the fetus in the
abdomen, as well as hormonal changes, cause the hemorrhoidal vessels
to enlarge. These vessels are also placed under severe pressure
during childbirth. For most women, however, hemorrhoids caused by
pregnancy are a temporary problem.
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A thorough evaluation and proper diagnosis by the doctor is
important any time bleeding from the rectum or blood in the stool
occurs. Bleeding may also be a symptom of other digestive diseases,
including colorectal cancer.
The doctor will examine the anus and rectum to look for swollen
blood vessels that indicate hemorrhoids and will also perform a
digital rectal exam with a gloved, lubricated finger to feel for
abnormalities.
Closer evaluation of the rectum for hemorrhoids requires an exam
with an anoscope, a hollow, lighted tube useful for viewing internal
hemorrhoids, or a proctoscope, useful for more completely examining
the entire rectum.
To rule out other causes of gastrointestinal bleeding, the doctor
may examine the rectum and lower colon (sigmoid) with sigmoidoscopy
or the entire colon with colonoscopy. Sigmoidoscopy and colonoscopy
are diagnostic procedures that also involve the use of lighted,
flexible tubes inserted through the rectum.
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Medical treatment of hemorrhoids is aimed initially at relieving
symptoms. Measures to reduce symptoms include
- warm tub baths several times a day in plain, warm water for
about 10 minutes
- application of a hemorroidal cream or suppository to the
affected area for a limited time
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Illustration reprinted with permission
from the American Society of Colon and Rectal Surgeons. Artist: Russell
K. Pearl, M.D. |
Preventing the recurrence of hemorrhoids will require relieving
the pressure and straining of constipation. Doctors will often
recommend increasing fiber and fluids in the diet. Eating the right
amount of fiber and drinking six to eight glasses of fluid (not
alcohol) result in softer, bulkier stools. A softer stool makes
emptying the bowels easier and lessens the pressure on hemorrhoids
caused by straining. Eliminating straining also helps prevent the
hemorrhoids from protruding.
Good sources of fiber are fruits, vegetables, and whole grains.
In addition, doctors may suggest a bulk stool softener or a fiber
supplement such as psyllium (Metamucil) or methylcellulose
(Citrucel).
In some cases, hemorrhoids must be treated endoscopically or
surgically. These methods are used to shrink and destroy the
hemorrhoidal tissue. The doctor will perform the procedure during an
office or hospital visit.
A number of methods may be used to remove or reduce the size of
internal hemorrhoids. These techniques include
- Rubber band ligation. A rubber band is placed around
the base of the hemorrhoid inside the rectum. The band cuts off
circulation, and the hemorrhoid withers away within a few
days.
- Sclerotherapy. A chemical solution is injected around
the blood vessel to shrink the hemorrhoid.
- Infrared coagulation. A special device is used to burn
hemorrhoidal tissue.
- Hemorrhoidectomy. Occasionally, extensive or severe
internal or external hemorrhoids may require removal by surgery
known as hemorrhoidectomy.
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The best way to prevent hemorrhoids is to keep stools soft so
they pass easily, thus decreasing pressure and straining, and to
empty bowels as soon as possible after the urge occurs. Exercise,
including walking, and increased fiber in the diet help reduce
constipation and straining by producing stools that are softer and
easier to pass.
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