What are hemorrhoids?
Hemorrhoids (HEM-uh-roids), also called piles, are swollen veins inside and around the anus and lower rectum. Everybody has these veins. They normally serve to form a vascular cushion that allows us to be continent. The problem occurs when they become too engorged with blood that they cause symptoms.
Doctors use a toothlike line called the dentate line, which is found 2cm from the verge of the anus, to classify hemorrhoids into 3 categories based on where they are located compared to that line.
-Internal hemorrhoids are located above the dentate line. They are usually painless because the upper portion of the anal canal has no pain nerve fibers. However, they may hurt if they drop down (prolapse) and protrude out of the anus.
-External hemorrhoids are located below the dentate line. They may be painful since the lower part of the anal canal has lots of pain nerve fibers.
-Internal-external hemorrhoids cross the dentate line.
What are the symptoms of hemorrhoids?
The symptoms of hemorrhoids would vary from person to person and from time to time. Sometimes, a person may have hemorrhoids and not even know it or feel any symptoms until a doctor discovers them on examination. The following are common symptoms of hemorrhoids.
-Bleeding: The most common presentation is bright red, painless rectal bleeding during defecation. You may see bright red blood on the toilet paper, feces, and sometimes in the toilet bowl.
-Prolapse or drop out of the anus.
-Pain
-Difficulty cleaning after bowel movements.
-Itchy anus.
-Leakage of feces.
-Thrombosed hemorrhoid: Sometimes, a clot may form inside hemorrhoids. This is called a thrombosed hemorrhoid and can be very painful. Some of these need to be lanced and drained.
What causes hemorrhoids?
Hemorrhoids have multiple causes. Many times, the specific cause of hemorrhoids in someone is unclear. However, increased pressure in and around the anus and anal canal is thought to be a major factor in most cases.
-Factors that predispose a person to hemorrhoids include “Older age, constipation, straining (including exercise), gravity, lack of dietary fiber, increased intra-abdominal pressure (due to pregnancy, obesity, or ascites), multiple vaginal deliveries, irregular bowel habits (constipation/diarrhea), family history, and functional venous insufficiency within hemorrhoidal veins.” AFP Journal
How common are hemorrhoids?
About 50% of Americans 50 years or older have some hemorrhoid-related symptoms. 1 in 20 Americans of any age has hemorrhoids. Three out of four people will have hemorrhoids at some point in their lifetime. They are more common between 45 years and 65 years.
How are hemorrhoids diagnosed?
Hemorrhoids are commonly overdiagnosed. Have a doctor see you and do a digital rectal examination with or without anoscopy.
When should you see a doctor?
Talk to your doctor if you have frequent bleeding with or without bowel movements, painful hemorrhoids, or if you have tried home treatments for a week without improvement. Call your doctor immediately or go to the emergency room if you are losing large amounts of blood from your bottom or are experiencing lightheadedness, dizziness, or feel like passing out.
How do you prevent and treat hemorrhoids?
TREATMENT OF CONSTIPATION
Treat constipation with dietary changes, behavioral changes, and when needed stool softeners and laxatives.
A) Dietary changes
-High-fiber diet: Eat more high-fiber foods like whole grains, fruits, and vegetables to increase the bulk of the stool. The recommended dietary fiber intake is between 20 and 35 grams per day.
-Drink lots of water: Drink at least 2 Liters or 67 ounces per day. That is eight 8-oz glasses of water.
-Fiber supplements: If you are is still passing hard stools after dietary fiber and increased water intake, take either psyllium husk (Metamucil), or methylcellulose (Citrucel), or wheat dextran (Benefiber), or calcium polycarbophil (Fibercon). Take as directed.
-Prunes and prune juice: Prunes are helpful for treating constipation.
B) Behavioral changes
-Schedule toilet times right after meals to take advantage of the gastrocolic reflex.
-Don’t hold back the urge to defecate. If you feel like you need to have a BM, you should go right away and not hold back.
-Use Squatty Potty or small step stool. Place your feet on a Squatty Potty or small step stool instead of on the floor to straighten the anorectal junction.
C) Stool softeners and laxatives
–Stool softener: If you’re still constipated, try a stool softener daily.
–Laxative: If all of the above don’t work, try an over-the-counter laxative like polyethylene glycol (Miralax).
HYGIENE AND COMFORT CARE
–Hygiene: Keep the anal area clean. Bathe or shower daily to cleanse the skin around your anus gently with warm water. You may use Balneol as a cleanser.
-Avoid chemical irritants such as alcohol-based wipes, perfume wipes, etc. Gently pat the area dry or use a hair dryer on cool.
-Avoid physical irritation: After bowel movements, use moist towelettes or wet toilet paper that doesn’t contain perfume or alcohol to clean the area. Don’t use dry toilet paper.
–Sitz bath: Warm sitz baths about 10 to 15 minutes 2-3 times per day and after each BM will relax the anal sphincter and improve blood flow to the anal mucosa facilitating healing. Get Sitz bath kit or portable bowl from a drugstore. A bathtub may be used for a sitz bath by filling it with 2-3 inches of warm water and adding Epsom salt. Don’t add soap and bubble bath. Wipe thoroughly with a towel or blow dry after each sitz bath
-Hemorrhoid cream or suppository containing hydrocortisone, or pads containing witch hazel or lidocaine are found over the counter and can be used for symptom relief.
-Cold treatment: Place ice packs or cold compresses on your anus to relieve swelling.
-Pain medication: Take acetaminophen (Tylenol), aspirin or ibuprofen (Advil, Motrin) to relieve pain.
MINIMALLY INVASIVE TREATMENT
-Rubber band ligation of internal hemorrhoids: If you have symptomatic internal hemorrhoids, your doctor may put one or more small rubber bands around the base of an internal hemorrhoid to cut off its blood supply. Deprived of blood, the hemorrhoids then die. The band and hemorrhoid fall off after a few days. The tissue at the base of the hemorrhoids heals off with some scarring. This procedure works for many people but may produce some discomfort, bleeding, and may need to be repeated to treat the symptoms.
-Laser, infrared, or bipolar coagulation: A coagulation procedure uses a laser or infrared light or heat is used to burn and cut off blood supply to internal hemorrhoids. Hemorrhoids treated this way recur more frequently than with rubber banding.
–Sclerotherapy: With this procedure, your doctor injects a chemical solution (usually, phenol in oil) into hemorrhoidal tissue, causing it to shrink and for a scar. This procedure may be less painful than rubber band ligation, however, it is also less effective.
HEMORRHOID SURGERY
If you continue to have symptoms from hemorrhoids after trying some of the treatments above, your doctor may determine that you need surgery. There are two common options for surgery.
–Hemorrhoidectomy (hemorrhoid removal) is the most complete and effective method to treat recurring or severe hemorrhoids. Ask your doctor if this method is right for you.
–Stapled hemorrhoidopexy of internal hemorrhoids – This method uses a circular stapling gun to cut off the blood flow to the hemorrhoid tissue. This is less painful than hemorrhoidectomy, however, it is also less effective because hemorrhoids recur more frequently. Ask your doctor if this is the right method for you.
THROMBOSED HEMORRHOIDS
If you get a painful thrombosed external hemorrhoid, your doctor may lance and drain the hemorrhoid to remove the clot. This incision and drainage (External hemorrhoid thrombectomy) is usually done within 72 hours of the clot forming because that’s when it’s most effective. This may provide immediate pain relief.