Although hemorrhoids can be unpleasant and painful, they are easily treated and very preventable. As hemorrhoids generally get worse over time, doctors suggest that they should be treated as soon as they appear.
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Here are some key points about hemorrhoids. More detail and supporting information is in the main article.
- women are more likely to get hemorrhoids while pregnant
- the likelihood of developing hemorrhoids increases as a person ages
- hemorrhoids occur when the veins surrounding the anus are engorged or dilated (enlarged)
- sometimes medicines and surgery are needed to treat hemorrhoids
When the veins around the anus or in the rectum are dilated (enlarged) or engorged with blood, the patient has hemorrhoids.
They can occur for the following reasons:
- Pregnancy - they occur more commonly in pregnant women because, as the uterus enlarges, it presses on the vein in the colon, causing it to bulge.
- Aging - hemorrhoids are most common among adults aged 45-65. This does not mean, however, that young people and children do not get them.
- Diarrhea - especially when chronic.
- Chronic constipation - straining to move stool puts additional pressure on the blood vessels' walls.
- Sitting - for long periods (especially on the toilet).
- Lifting - especially heavy objects repeatedly.
- Anal intercourse - which can cause hemorrhoids or worsen existing ones.
- Obesity - often dietary related, such as not following a high-fiber diet.
- Genetics - some people inherit a tendency to develop hemorrhoids.
Common symptoms of hemorrhoids
Hemorrhoids can be either internal or external.
Symptoms of hemorrhoids often include:
- Painless bleeding - the patient may notice bright red on the toilet paper or in the toilet bowl.
- Itching - or irritation in the anal area.
- Discomfort - pain or soreness in the anal region.
- Lumps - protruding from the anal region.
- Swelling - in the anal region.
- Feces - may leak out unintentionally.
Symptoms can be unpleasant or alarming but they are usually not a cause for concern.
Hemorrhoids can be either internal or external:
Internal hemorrhoids are deep inside the rectum and not visible from outside. They are normally painless. Often, the first sign that internal hemorrhoids are present is rectal bleeding.
Straining can sometimes push an internal hemorrhoid so that it protrudes through the anus, this is called a protruding or prolapsed hemorrhoid and can be painful.
External hemorrhoids are under the skin around the anus and are therefore visible. Because there are more sensitive nerves in this part of the body, they are normally more painful. Straining when passing a stool may cause them to bleed.
Anyone experiencing the symptoms outlined above should contact a doctor. Bear in mind that other things, including colorectal and anal cancers, can cause rectal bleeding. It might be a mistake to assume that anal bleeding is simply the result of hemorrhoids and, because of this, decide not to see a doctor.
A doctor can carry out a physical examination and perform other tests to determine whether or not hemorrhoids are present. These tests may include a digital rectal exam - a manual inspection by the doctor using a gloved, lubricated finger.
If symptoms include significant amounts of bleeding, dizziness, and a fainting sensation, the individual should seek emergency care immediately.
Treatments for hemorrhoids
In the majority of cases, simple measures will alleviate symptoms while the problem gets better on its own. However, medicines and even surgery may sometimes be needed.
Hemorrhoid home treatments
Specialist ultrasonic device for hemorrhoid surgery.
Symptoms can be relieved in the following ways. However, they will not eliminate the hemorrhoids:
- Topical creams and ointments - over the counter (OTC) creams or suppositories, which contain hydrocortisone, are available; there are also pads which contain witch hazel, or a topical numbing agent.
- Ice packs and cold compresses - applying these to the affected area may help with the swelling.
- Sitz bath using warm water - the sitz bath is placed over the toilet. Some pharmacies sell them. These may relieve the burning or itching symptoms.
- Moist towelettes - dry toilet paper may aggravate the problem.
- Analgesics - some painkillers, such as aspirin, ibuprofen, and acetaminophen (Tylenol) may alleviate the pain and discomfort.
Most hemorrhoid medicines are OTC; they include ointments, pads, or suppositories. Such active ingredients as hydrocortisone and witch hazel are known to relieve itching and pain. If these medicines are ineffective after a week of treatment, you should consult with your doctor.
Nonsurgical Treatment Options
The most common type of nonsurgical hemorrhoid removal technique is rubber band ligation. This is an office procedure for internal hemorrhoids, where an elastic band is placed on the base of the hemorrhoid to cut off blood supply. The hemorrhoid will either shrink or fall off.
Another procedure is sclerotherapy, where a solution is injected into an internal hemorrhoid, producing a scar that cuts off blood supply to the hemorrhoid.
Infrared photocoagulation and electrocoagulation are two other options.
Surgery may involve a hemorrhoidectomy (complete removal of the hemorrhoids) or stapling, where a prolapsed hemorrhoid is tacked back into place. These procedures are performed under general anesthesia, and most patients can go home on the same day as the surgery.
If a patient's stools are always soft, the chance of developing hemorrhoids is greatly reduced. The risk of hemorrhoids can be reduced in the following ways:
- Nutrition - eating plenty of foods rich in fiber, such as fruits and vegetables, as well as whole grains, means stools will nearly always be soft. Similarly, drinking plenty of fluids helps keep stools soft (this does not include alcohol). Over the counter fiber supplements also ease constipation.
- Straining - when using the toilet, try not to strain, this creates pressure in the veins in the lower rectum.
- Go when needed - people should not wait if they need to use the toilet. The longer the wait, the drier the stools will be.
- Physical activity - sitting or standing still for long periods puts pressure on the veins. Physical activity also helps stool move through the bowel, so bowel movements are more regular.
- Keep body weight down - being overweight significantly raise a person's risk of having hemorrhoids.
Hemorrhoid prognosis and complications
In general, hemorrhoids are treated successfully and without complication, especially if treatment starts early. Although rare, the following complications can arise:
- Strangulated hemorrhoid - if blood supply to the hemorrhoid is cut off, it may become strangulated. This can cause significant pain.
- Anemia - if there is significant, chronic blood loss from the hemorrhoids, anemia (inadequate red blood cell levels) can occur.
- Blood clots - sometimes, blood may accumulate and form a thrombus (clot), which can be painful; the area will swell and become inflamed.