Hemorrhoids

Hemorrhoids are dilated (enlarged) veins which occur in and around the anus and rectum. They may be external (outside the anus) or internal (inside the rectum).

They are a fairly common source of pain and are rarely serious, but can be extremely troublesome. Some of the symptoms are similar to symptoms of a more serious disease, so it is important to have them evaluated by your Gastroenterologist.

Symptoms

• Pain
• Itching
• Irritation
• Burning
• Bleeding

What causes Hemorrhoids?

• Constipation (straining to pass stool)
• Pregnancy
• Sitting or standing for long periods
• Sitting on the toilet for long periods of time
• Chronic cough
• Heavy lifting
• Too much strenuous exercise

Complications???

• Thrombosis and Pain - A blood clot in the hemorrhoid may cause severe throbbing pain.
• Bleeding—Both external and internal hemorrhoids can ooze fresh red blood. External hemorrhoids often cause dripping of blood from the anus while sitting on the toilet. Blood may also be seen on your underwear. Internal hemorrhoids that bleed may produce fresh bright red blood in the stool.
• Itching and Irritation—External hemorrhoids can be itchy, especially if the area is moist and irritated.

Do Hemorrhoids cause Cancer?

Hemorrhoids do not develop into cancer. There are a number of disorders that can cause bleeding, so it is essential to seek medical evaluation to determine the cause. When rectal bleeding occurs in persons over age 30, and especially over age 50, it should be considered a serious problem until the exact diagnosis is made.

Treatment

The goal of treatment is to determine the cause and help relieve symptoms. Each treatment plan is determine by the severity involved.

Conservative treatment

• Keep the anal area clean, using mild soap and gentle dabbing after a bowel movement. Avoid vigorous rubbing of the area.
• Keep the anus and hemorrhoids as dry as possible, using talcum powder and a pad of soft tissue to absorb moisture.
• Eat a high fiber diet. Fiber and bran retain water in the stool, producing soft, bulky stools which are easier to pass and reduce the tendency to develop hemorrhoids. There are a number of over the counter bulking agents available.
• Avoid straining when having a bowel movement
• Soak for 10 to 20 minutes in a hot bathtub two to four times per day to help relieve pain and promote healing. This is called a hot Sitz bath.

Ligation

A small rubber band is used to tie off the base of the swollen vein. The blood circulation stops and the hemorrhoid then falls off. This may need to be done several times.

Infrared Photocoagulation

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

Lasers

A laser directs a high intensity light beam at the tissue, producing heat that coagulates or cauterizes the hemorrhoid. This procedure is still in the developmental stage.

Surgery

Occasionally surgery is recommended for treating hemorrhoids. This is usually reserved for:

• Acute, painful clot (thrombosis) hemorrhoids
• Profusely or continuously bleeding hemorrhoids
• Longstanding, irreversible and large hemorrhoids

Preventing Hemorrhoids . . .

• Eat a high fiber diet or use commercial bulking agents to
  maintain regular, soft bowel movements
• Do not delay or prevent a bowel movement when the urge
  is present
• Exercise
• Drink plenty of liquids
• Keep the area around the anus clean and dry

Summary

• Hemorrhoids are a very common disorder and often times
  clear up by themselves.
• Treatment is usually simple and effective, however, occasionallysurgery is required.
• Hemorrhoids can mask a more serious disorder and therefore
  must be evaluated by a physician.