What Are Hemorrhoids?

Definition

Hemorrhoids (also known as "piles") are dilated or bulging veins of the rectum and anus, caused by increased pressure in the rectal veins. Fifty to seventy-five percent of all Americans develop hemorrhoids.

Description

Hemorrhoids involve the blood vessels that line the anus. Pressure on the walls of the rectum weakens the muscles that support the hemorrhoidal vessels. They then become enlarged and lose their support and result in a sac-like protrusion inside the rectal canal (called internal hemorrhoids) or under the skin around the anus (called external hemorrhoids). If the internal hemorrhoid pushes out of the anal opening, this hemorrhoid is called a prolapsed hemorrhoid. Sometimes, blood can pool in an external hemorrhoid, forming a clot (thrombus). This hemorrhoid is called a thrombosed external hemorrhoid. Hemorrhoids can occur at any time, but become more common with advancing age. Younger people, pregnant women and women who have had children are most apt to develop hemorrhoidal problems. The condition occurs more frequently in some families.

Causes

The causes of hemorrhoids include:

• habitually straining (due to constipation)
• diarrhea
• coughing
• sneezing
• vomiting
• prolonged sitting
• pregnancy (pressure on the lower abdomen caused by the uterus)
• sedentary lifestyle
• eating a low-fiber diet
• overweight
• standing or lifting too much
• cirrhosis of the liver
• anal intercourse
• anal or rectal infection

Symptoms

The most common symptoms of hemorrhoids are:

• small amount of blood in the stool or on the toilet paper after wiping
• incomplete bowel movements
• rectal itching
• soft lump felt at the anal opening

Note: Bleeding from the rectum should be reported to the doctor. Bleeding could be a symptom of other medical conditions, such as inflammation of the intestines, anal fissures (crack in the lining of the anal canal), rectal polyps and/or colorectal cancer.

Diagnosis

To diagnose hemorrhoids, the doctor will do a rectal examination. The doctor places a gloved and lubricated finger into the rectum to feel for abnormalities. External hemorrhoids can be diagnosed by a visual and/or rectal examination. To diagnose internal hemorrhoids, the doctor will insert a thin tube-like instrument (called an anoscope) into the lower few inches of the rectum. The anoscope has a light at the end and an eyepiece at the front for viewing into the anal canal. To look for other sources of bleeding, the doctor may perform a colonoscopy (an examination of the inside of the colon) or a sigmoidoscopy (an examination of the rectum and the last part of the colon - the sigmoid colon).

Treatment

Medical treatment of hemorrhoids is initially aimed at relieving symptoms. Measures to reduce symptoms include:

• warm tub or sitz baths several times a day in plain, warm water for about 10 minutes
• ice packs to help reduce swelling
• application of petroleum jelly, cortisone creams, hemorrhoidal cream (such as Preparation-H) or suppositories to the affected area
• wearing cotton underwear and loose clothing
• cleaning the anus after each bowel movement by patting gently with moist toilet paper or moistened pads
• taking acetaminophen or aspirin

For hemorrhoids that don't respond to self-care measures, there are some other techniques to alleviate the hemorrhoids: For treatment of internal hemorrhoids, one of five methods is usually used: 1. Rubber Band Ligation - This procedure involves placing a small rubber band at the base of the internal hemorrhoid. The band cuts off blood supply to the hemorrhoid, causing it to shrivel up and fall off in about four to seven days. 2. Injection Sclerotherapy - This procedure involves injecting a chemical solution into the mucous membrane near the hemorrhoid. This chemical causes inflammation and closure of the veins, thereby shrinking the hemorrhoid. 3. Infrared Photocoagulation - This procedure involves directing an infrared light to coagulate (clot) the dilated veins of the hemorrhoid. This causes the hemorrhoids to shrink, since the blood does not flow through the coagulated blood vessels. 4. Laser Coagulation - This new procedure involves the application of an electric current to the hemorrhoids. The electric current, emitted by an electrode probe, triggers a chemical reaction that shuts down the blood supply in the hemorrhoid and causes the inflamed tissue to shrink. 5. Hemorrhoidectomy - This procedure involves surgically removing the hemorrhoid groups in the anal canal, and is performed with a scalpel, cautery device or laser. For the treatment of external hemorrhoids, one of three methods is used: 1. Infrared Photocoagulation 2. Laser Coagulation 3. Hemorrhoidectomy For the treatment of a prolapsed hemorrhoid, a hemorrhoidectomy is recommended. For the treatment of a thrombosed external hemorrhoid, drainage of the hemorrhoid or a hemorrhoidectomy is recommended.

Self Care

Most hemorrhoids heal on their own in a week or two. Hemorrhoids have a tendency to return unless something is done to prevent them. The most effective preventive measures are:

• Eat between 25 and 30 grams of fiber a day.
• Drink at least 8 glasses of water a day.
• Increase your amount of daily physical activity.
• Add stool softeners or laxatives to diet. Consult with the doctor regarding the prolonged use of stool softeners and laxatives.
• Lose weight.
• Change bowel habits. Respond to the urge to defecate and stay relaxed to avoid straining.
• Exercise the buttocks muscles.
• Practice good personal hygiene. Keep the anal area clean and avoid using rough toilet paper.

Questions

Are there any tests needed to make sure the symptoms are not caused by something else? What type of hemorrhoids are they? What type of treatment do you recommend to correct the problem? Should a specialist be consulted? Can you explain how the procedure is done? How effective is this treatment? If this involves one of the newer procedures, how many of these procedures have you performed?