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Hemorrhoids

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Hemorrhoids exist in everyone, but are only sometimes symptomatic. This occurs when blood vessels located in the anorectal region become swollen or inflamed. Hemorrhoids may be internal (inside the anus) or external (outside the anus).

Symptoms of Hemorrhoids

Symptoms of external hemorrhoids may include painful swelling or a hard lump near the anus, which may be a blood clot. Symptoms of internal hemorrhoids include bleeding (bright red blood on stool or toilet paper), and itching. An internal hemorrhoid may protrude through the anus, and cause pain and irritation. Some individuals with hemorrhoids have no symptoms.

Hemorrhoid symptoms can resemble other conditions, including fissures, fistula, abscesses, or irritation and itching, called pruritis ani. Constipation and diarrhea may exacerbate hemorrhoids, or cause similar symptoms. Consulting your physician when you have any of these symptoms, such as blood in stool, is important to determine the exact cause of your symptoms.

Risk Factors for Hemorrhoids

Pregnancy increases the risk of hemorrhoids, as does chronic constipation and chronic diarrhea. Hemorrhoids tend to run in families, and the risk increases with age.

Diagnosis of Hemorrhoids

Your physician will examine the perianal area for swollen blood vessels, and also perform a digital rectal exam using a gloved, lubricated finger, to detect any abnormalities in the region. He or she will also use an anoscope or proctoscope to view the anal tract.

To rule out other causes of bleeding, your physician may examine the entire colon or large intestine with colonoscopy, or just the bottom section, using sigmoidoscopy.

Treatment for Hemorrhoids

Treatment for hemorrhoids will depend on your age, health, your medical history, the extent of your condition, and your tolerance for certain treatments and medicines. Symptom relief usually includes taking warm sitz (tub) baths several times a day for 10-15 minutes to shrink blood vessels and soothe itching and irritation; using witch hazel wipes to reduce irritation; and using cream or suppository to help shrink hemorrhoids. Cortisone creams are not recommended. Ice packs can also help relieve inflammation.

Relieving or preventing constipation is important if you have hemorrhoids. This means drinking at least 6-8 glasses of water a day and increasing your dietary fiber – whole grains, vegetables, and fruits – and taking a stool softener or fiber supplement if necessary to eliminate straining and reduce pressure on hemorrhoids. Fiber is helpful for both constipation and diarrhea.

Infrequently, large or symptomatic hemorrhoids may need to be surgically removed. Our experts treat hemorrhoids using a number of techniques, including:

• Opening of acutely swollen external hemorrhoids. This may be done in the office and is only helpful if performed in the first couple of days after symptoms.
• Rubber band ligation – placing a rubber band around the bottom of the hemorrhoid inside the rectum, which cuts off blood flow to the hemorrhoid, causing it to slowly shrink and degenerate within a few days.
• Sclerotherapy – injecting a chemical solution around the blood vessel to shrink the hemorrhoid.
• Electrical, laser or infrared photo coagulation – using different sources of heat to destroy the hemorrhoid.
• Hemorrhoidectomy – removing hemorrhoids surgically.
• A new technique of stapling hemorrhoids may be appropriate with multiple internal hemorrhoids.

Following treatment for hemorrhoids, it is important to prevent recurrence by keeping stools soft so they pass without pressure and straining. Increased dietary fiber, exercise, and drinking 6-8 glasses of water a day can help reduce chances of a recurrence.