Hemorrhoids

A common cause of hemorrhoids is simply the standing position, in which all the blood above the rectum exerts pressure on the rectal and anal areas. Other conditions which contribute to hemorrhoids are: poor bowel habits, constipation, diarrhea, pregnancy, obesity, and especially frequent straining when having a bowel movement. However, some patients will have none of these conditions and still develop hemorrhoids.

Hemorrhoids can produce several uncomfortable, but non-serious problems.

• Thrombosis and Pain—A blood clot in the hemorrhoid may cause severe pain and usually demands immediate medical attention.
• Bleeding—Hemorrhoids can ooze fresh red blood, whether located externally or internally. External hemorrhoids often cause dripping of blood from the anus while sitting on the toilet. The blood might also be seen as soiling of the underwear. Internal hemorrhoids that bleed may produce fresh blood in the stool.
• Itching and Irritation—External hemorrhoids can be itchy, especially if the area is moist and irritated.

Hemorrhoids do not develop into cancer. However, both hemorrhoids and cancer can cause rectal bleeding. In fact, many disorders can be the cause of rectal bleeding. When rectal bleeding occurs in persons over age 30, and especially in those over age 50, it should be considered a serious problem until an exact diagnosis is made. The physician who directly examines the rectal area can make the specific diagnosis.

Treatment of hemorrhoids varies depending on where they are, what problems they are causing, and how serious they are. Often, time and the normal process of healing clear hemorrhoids with little or no specific treatment.

When hemorrhoids require treatment, the following general measures are recommended:

Conservative Treatment

1. Keep the anal area clean, using a mild soap and gentle dabbing after a bowel movement. Avoid vigorous rubbing of the area. 2. Keep the anus and hemorrhoids as dry as possible, using talcum powder and a pad of soft tissue to absorb moisture.
2. Eat a diet high in fiber (bran) and roughage. Fiber and bran retain water in the stool, producing soft, bulky stools which are easier to pass and reduce the tendency to develop hemorrhoids. Bulking agents, such as Metamucil, Effersyllium, Konsyl, Citrucel, and Per Diem Fiber, are available in drug stores. These also come in less expensive generic versions.
3. Avoid straining when having a bowel movement.
4. When thrombosis, pain, and tenderness occur, a 10 to 20 minute hot tub bath two to four times daily brings heat to the area, provides relief from the pain, and promotes healing. This is called a hot Sitz bath.
5. Ligation
6. A common method of treating internal hemorrhoids is to use a small rubber band to tie off the base of the swollen vein. The blood circulation stops and the hemorrhoid then falls off. Repeat treatments are sometimes necessary.

Infrared Photocoagulation

An infrared light source can be used to coagulate internal hemorrhoidal veins. Often, more than one treatment is necessary.

Band ligation

A new and effective technique involves placing rubber bands around internal hemorrhoids. This technique is done as an outpatient and is often painless. To achieve desired benefit, several sessions may be required.

Surgery

Surgery is sometimes recommended in treating hemorrhoids. It usually is reserved for:

• Acute, painful clot (thrombosis) of hemorrhoids
• Profusely or continuously bleeding hemorrhoids
• Longstanding, irreversible, and large hemorrhoids
• When other treatment is unsuccessful The physician evaluates each patient’s case to determine the appropriate treatment.

To Prevent Hemorrhoids

• Eat plenty of fiber, bran, or roughage, or use a bulking agent to maintain regular, soft bowel movements.
• Do not delay or try to prevent a bowel movement when the urge is present.
• Exercise, especially aerobic, may help produce more regular bowel movements.
• Drink plenty of liquids and eat regularly scheduled meals.
• Keep the area around the anus clean and dry.