Hemorrhoids

Hemorrhoids are abnormally swollen veins in the rectum and anus. They are much like varicose veins you might see on a person's legs. When bulging hemorrhoidal veins are irritated, they can cause surrounding membranes to swell, burn, itch, become very painful and bleed.

There are two kinds of hemorrhoids – internal and external:

  • The internal vessels can swell to form internal hemorrhoids. Internal hemorrhoids, unless they are severe, cannot be seen or felt, unlike external hemorrhoids.
  • Likewise, the external vessels can swell to form external hemorrhoids. External hemorrhoids can be seen around the outside of the anus and, many times, can be felt.

Symptoms

Pain, itching and bleeding are common symptoms of hemorrhoids. Hemorrhoids inside the rectal opening are usually painless, but often bleed and cause a feeling of fullness. This may result in an urge to have a bowel movement even when there is no stool present. Straining to have a bowel movement can aggravate the problem. Bleeding from internal hemorrhoids usually occurs at the end of the bowel movement. You may notice that the stool is streaked with blood, blood may drip into the toilet bowl, or it may appear on the toilet paper when you wipe. Rectal bleeding can be a signal of a more severe problem and should be evaluated. Other symptoms include increased moisture or itching around the rectum or finding a small bulge that is very tender to the touch outside the rectum.

Causes

The most frequent causes of hemorrhoids include:

  • Frequent sitting
  • Straining with bowel movements (from constipation or hard stools)
  • Diarrhea
  • Sitting on the toilet for a long time
  • Severe coughing
  • Childbirth
Prevention

Hemorrhoids are very common, but the following may be helpful in preventing hemorrhoids:

  • Maintain a healthy body weight – being overweight increases the chances of developing hemorrhoids.
  • Eat a high-fiber diet.
  • Exercise regularly.
Treatment

Medical treatment for hemorrhoids involves relieving symptoms and may include:

  • Sitting in plain, warm water in the tub several times a day
  • Ice packs to reduce swelling
  • Application of hemorrhoidal creams or suppositories

Your physician may also recommend increasing both fiber and fluids to soften stools. A softer stool reduces pressure on hemorrhoids caused by straining. Good sources of fiber include fruits, vegetables and whole grains. Bulk stool softeners or fiber supplements, such as psyllium (Metamucil) or methylcellulose (Citrucel) may also be recommended.

In some cases, it is necessary to treat hemorrhoids surgically.

Several surgical techniques can remove or reduce internal and external hemorrhoids, including:

  • Rubber band ligation A rubber band is placed around the base of the hemorrhoid inside the rectum to sever circulation to the hemorrhoid. The hemorrhoid then gradually shrinks and withers away within a few days.
  • Sclerotherapy A chemical solution is injected around the blood vessel to shrink the hemorrhoid.
  • Electrical or laser coagulation or infrared photo coagulation This technique uses special devices to destroy hemorrhoidal tissue.
  • Hemorrhoidectomy This surgical procedure permanently removes the hemorrhoids. Recovery can be lengthy.
  • THD (Transhemorrhoidal Hemorrhoidal Dearterialization) Utilizing a specialized doppler probe, the colorectal surgeon is able to identify and ligate the hemorrhoidal arteries. This results in decreased blood flow to the hemorrhoid cushions. Typically pain is less when compared to a hemorrhoidectomy.