Hemorrhoids
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 or may be attributed to other factors such as pregnancy, aging, chronic constipation or diarrhea, and anal intercourse. Hemorrhoids may occur either inside the anus (internal) or under the skin around the anus (external).
Hemorrhoids are common in both men and women. About one-half of the population of the United States has hemorrhoids by age 50. Hemorrhoids are also common among pregnant women. The pressure of the fetus on the abdomen, as well as hormonal changes, cause the hemorrhoidal vessels to enlarge.
For most women, however, hemorrhoids caused by pregnancy are a temporary problem.
Common Symptoms
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.
Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching 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.
Diagnosis
A thorough examination and proper diagnosis by a doctor is important any time bleeding from the rectum or blood in the stool occurs. The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal examination to feel for abnormalities. Closer evaluation of the rectum for hemorrhoids requires an examination with either 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) via a sigmoidoscopy or the entire colon by a colonoscopy. Sigmoidoscopy and colonoscopy are diagnostic procedures that also involve the use of light, flexible tubes inserted through the rectum. During your procedure the gastroenterologist may remove small tissue specimens (biopsies). These tissue samples are then microscopically examined by a pathologist - a physician who specializes in the diagnosis of disease via microscopic examination of a tissue sample - to determine what disease or condition you have. The pathologist's diagnosis is often the key to determining the need for further treatment.
Treatment Options
Medical treatment of hemorrhoids is aimed initially at relieving symptoms. Measures to reduce symptoms include the following:
• Ten-minute tub baths several times a day in plain, warm water
• Application of a hemorrhoidal cream or suppository to the affected area for a limited time
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 – resulting in a softer, bulkier stools. A softer stool makes emptying the bowels easier and lessens the pressure on hemorrhoids caused by straining.
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 these procedures during an office or hospital visit. A number of methods may be used to remove or reduce the size of internal hemorrhoids, including the following:
• 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.
Questions To Ask Your Healthcare Provider
• What treatment option is best for me?
• How are hemorrhoids prevented?
• What dietary changes are recommended?
• Are there lifestyles changes I need to make?