Symptoms and Treatment of Hemorrhoids

Hemorrhoids are swollen and inflamed veins in your anus or rectum. There are two types of hemorrhoids, internal and external.

The external veins swell to form external hemorrhoids. They can be seen around the outside of the anus.

Internal hemorrhoids are located inside the rectum. Internal hemorrhoids cannot be seen or felt, but may bleed.

Hemorrhoids are most common during middle age, in pregnant women, people who are obese, and in people who are frequently constipated or have frequent diarrhea. People with liver disease are also more likely to develop hemorrhoids. They do not cause cancer and are rarely life threatening.

What causes hemorrhoids?

Hemorrhoids form because of repeated excess pressure in the rectal or anal veins, usually from straining to pass a bowel movement. Straining causes the blood to enlarge and swell, causing bulging veins. Once a rectal vein has been stretched, it is difficult to get rid of it.

Overeating, inadequate exercise, and prolonged sitting, especially on the toilet, can cause hemorrhoids to form.

What are the symptoms?

The most common symptoms of hemorrhoids include:

Bleeding during a bowel movement. A few drops can be seen on the stool, in the toilet bowl, or on the toilet paper.
Itching

Rectal pain. Pain may be experienced when you clean the anal area.

The first symptom of an internal hemorrhoid is blood that can be seen on the stool, toilet paper, and in the toilet bowl. An internal hemorrhoid can protrude through the anal opening.

With external hemorrhoids, a blood clot forms as a result of painful swelling or a hard lump. This condition is known as a thrombosed external hemorrhoid.

How are hemorrhoids diagnosed?

Bleeding may be a symptom of other digestive diseases, including colon cancer, so it is important to get a thorough examination and diagnosis as soon as possible. The doctor begins with a visual examination of the anus to look for swollen blood vessels, followed by an internal examination. For the internal examination, the doctor inserts a gloved and lubricated finger into the anus to look for abnormalities.

If a closer evaluation is needed, the doctor uses an anoscope, a hollow, lighted tube that is useful in diagnosing hemorrhoids or a proctoscope which allows the doctor to view the entire rectum.

To rule out other causes of gastrointestinal bleeding, the doctor may order a sigmoidoscopy or a colonoscopy. These procedures involve the use of lighted, flexible tubes inserted through the rectum.

How are they treated?

Treatment for hemorrhoids may include:

Eating a high fiber diet

Drinking more water

Increase exercise

Warm tub or sitz baths several times a day

Ice packs to reduce swelling

Application of petroleum jelly, cortisone cream, or hemorrhoidal creams (Preparation H)

Wearing loose clothing and cotton underwear

Patting gently with moistened pads to clean the anus after a bowel movement

Stool softeners

Change in bowel habits (avoid straining)

If hemorrhoids fail to respond to self- care measures, other methods can be used.

Rubber band ligation- The patient is laid down on the left side with the knees drawn up. An anoscope is inserted into the anal opening. The hemorrhoid is then grasped by an instrument and a device places a rubber band around the base of the hemorrhoid. This causes the hemorrhoid to shrink and die, and in about a week, it falls off.

The procedure can be performed in the doctor's office. The doctor will ask you if the bands are too tight. A medicine may be injected into the bands if they are too painful.

After the procedure, you may feel pain, fullness in the abdomen, and an urge to defecate. Pain usually lasts for one to two days. You may use a mild pain reliever and sit in a sitz bath (shallow tub of water) for fifteen minutes at a time. Bleeding may occur for seven to ten days after surgery when the hemorrhoid falls off, however, it usually stops by itself.

Only one or two hemorrhoids are done at a time, and additional areas can be done at four to six week intervals. About 80% of people experience relief with the rubber band ligation.

Injection Sclerotherapy- A chemical solution is injected into the mucous membrane near the hemorrhoid. This chemical causes inflammation and closure of the veins, and the hemorrhoid shrinks.

Hemorrhoidectomy- This procedure involves removing groups of hemorrhoids in the anal canal by using a scalpel, cautery device, or laser.