Hemorrhoids

Hemorrhoids are enlarged veins in the anus or lower rectum. They often go unnoticed and usually clear up after a few days, but can cause long-lasting discomfort, bleeding and be excruciatingly painful. However, effective medical treatments are available.

Hemorrhoids (also called piles) can be divided into two kinds, internal and external. Internal hemorrhoids lie inside the anus or lower rectum. External hemorrhoids lie outside the anal opening. Both kinds can be present at the same time.

More than 75% of Americans have hemorrhoids at some point in their lives, typically after age 30. Pregnant women often develop hemorrhoids, but the condition usually clears up after childbirth. Men are more likely than women to suffer from hemorrhoids that require professional medical treatment.

Precisely why hemorrhoids develop is unknown. Researchers have identified a number of explanations for hemorrhoidal swelling, including the simple fact that people's upright posture places a lot of pressure on the anal and rectal veins. Aging, obesity, pregnancy, chronic constipation or diarrhea, excessive use of enemas or laxatives, straining during bowel movements, and spending too much time on the toilet are considered contributing factors.Heredity may also play a part in some cases. There is no reason to believe that hemorrhoids are caused by jobs requiring, for instance, heavy lifting or long hours of sitting, although activities of that kind may make existing hemorrhoids worse.

The most common symptom of internal hemorrhoids is bright red blood in the toilet bowl or on one's feces or toilet paper. When hemorrhoids remain inside the anus they are almost never painful, but they can prolapse (protrude outside the anus) and become irritated and sore. Sometimes, prolapsed hemorrhoids move back into the anal canal on their own or can be pushed back in, but at other times they remain permanently outside the anus until treated by a doctor.

Small external hemorrhoids usually do not produce symptoms. Larger ones, however, can be painful and interfere with cleaning the anal area after a bowel movement. When, as sometimes happens, a blood clot forms in an external hemorrhoid (creating what is called a thrombosed hemorrhoid), the skin around the anus becomes inflamed and a very painful lump develops. On rare occasions theclot will begin to bleed after a few days and leave blood on the underwear. Athrombosed hemorrhoid will not obstruct blood flow.

Hemorrhoids can often be effectively dealt with by dietary and lifestyle changes. Softening the feces and avoiding constipation by adding fiber to one's diet is important, because hard feces lead to straining during defecation. Fruit, leafy vegetables, and whole-grain breads and cereals are good sources offiber, as are bulk laxatives and fiber supplements such as Metamucil or Citrucel. Exercising, losing excess weight, and drinking six to eight glasses a day of water or another liquid (not alcohol) also helps. Soap or toilet paper that is perfumed may irritate the anal area and should be avoided, as should excessive cleaning, rubbing, or wiping of that area. Reading in the bathroom is also a bad idea, because it adds to the time one spends on the toilet and may increase the strain placed on the anal and rectal veins. After each bowelmovement, wiping with a moistened tissue or pad sold for that purpose helps lessen irritation. Hemorrhoid pain is often eased by sitting in a tub of warmwater for about 10 or 15 minutes two to four times a day (sitz bath). A coolcompress or ice pack to reduce swelling is also recommended (it should be wrapped in a cloth or towel to prevent direct contact with the skin). Many people find that over-the-counter hemorrhoid creams and foams bring relief, but these medications do not make hemorrhoids disappear.

When painful hemorrhoids do not respond to home-based remedies, professionalmedical treatment is necessary. Rubber-band ligation is probably the most widely used of the many treatments for internal hemorrhoids, and the least costly. This procedure is performed in the office of a family doctor or specialist, or in hospital on an outpatient basis. An applicator is used to place one or two small rubber bands around the base of the hemorrhoid, cutting off its blood supply. After 3 to 10 days with the bands, the hemorrhoid falls off, leaving a sore that heals in a week or two. Because internal hemorrhoids are located in a part of the anus that does not sense pain, anesthetic is unnecessary. Although there can be minor discomfort and bleeding for a few days after the bands are applied, complications are rare and most people are soon able toreturn to work and other activities. If more than one hemorrhoid exists or if banding is not entirely effective the first time (as occasionally happens),the procedure may need to be repeated a few weeks later. After five years, 15-20% of patients experience a recurrence of internal hemorrhoids, but in most cases all that is needed is another banding.

External hemorrhoids, and some prolapsed internal hemorrhoids, are removed byconventional surgery in a hospital. Depending on the circumstances, this requires a local, regional, or general anesthetic. Surgery does cause a fair amount of discomfort, but an overnight hospital stay is usually not necessary. Full healing takes two to four weeks, but most people are able to resume normal activities at the end of a week. Hemorrhoids rarely return after surgery.

Hemorrhoids do not cause cancer and are rarely dangerous or life-threatening.However, because colorectal cancer and other digestive systemdiseases can cause anal bleeding and other hemorrhoid-like symptoms, people should always consult a doctor when those symptoms occur.

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