What are 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. Other cont
ributing factors include pregnancy, aging, chronic constipation or diarrhea, and anal
Hemorrhoids are either inside the anus (internal) or under the skin
around the anus (external).
What are the symptoms of hemorrhoids?
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.
How common are hemorrhoids?
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.
How are hemorrhoids diagnosed?
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
Sigmoidoscopy and colonoscopy are diagnostic procedures that also
involve the use of lighted, flexible tubes inserted through the rectum.
What is the treatment?
Medical treatment of hemorrhoids is aimed initially at relieving
symptoms. Measures to
reduce symptoms include
· tub baths several times a day in plain, warm water for about 10
· application of a hemorroidal 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.
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
· Hemorrhoidectomy. Occasionally, extensive or severe internal or
external hemorrhoids may require removal by surgery known as
How are hemorrhoids prevented?
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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