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How to Alleviate the Presence and Pain of Hemorrhoids: Michael Tarlowe, MD, PA: Proctologist

Hemorrhoids are common in both men and women. They affect about one in 20 Americans. About half of adults over 50 have hemorrhoids. Who is most likely to have hemorrhoids? You are more likely to get hemorrhoids if you strain during bowel movements and/or sit on the toilet for long periods of time. Here you will learn what hemorrhoids are, what their symptoms are, what causes them, how they are diagnosed, how they are treated, how they are prevented and when you should see a doctor.

What are hemorrhoids?

Hemorrhoids or 'piles' are lumps that form in and around the anus. They are very common. Hemorrhoids are sometimes described as “varicose veins” of the anus. They occur when there is a weakness in the side of the anal canal which leads to thickening of the lining and then the veins can enlarge and become hemorrhoids, causing symptoms such as bleeding, pain and discomfort.

Hemorrhoids can be just inside (internal hemorrhoids) or outside (external hemorrhoids) of the anus. Large internal hemorrhoids may protrude outside the anus (prolapse).

What are the symptoms of hemorrhoids?

Symptoms depend on the type of hemorrhoids:

External hemorrhoids, which are found under the skin around the anus, can include:

  • Irritation or itching around the anus region
  • Swelling around the anus
  • Pain or discomfort
  • Bleeding

Internal hemorrhoids, which are found inside the rectum. You usually can't see or feel them and they rarely cause discomfort. They can cause irritation when pushing when passing stool and can cause:

  • Painless bleeding during bowel movements and red blood on the toilet paper or in the toilet.
  • A hemorrhoid that passes through the anal opening (prolapsed or bulging hemorrhoid) causes pain and irritation.

Thrombosed hemorrhoids, which occur when blood pools in an external hemorrhoid and forms a clot (thrombus), can cause:

  • Severe pain
  • Inflammation
  • A hard lump near the anus

What are the causes of hemorrhoids?

Among its causes are:

  • Straining during bowel movements
  • Sitting on the toilet for long periods of time
  • Chronic constipation or diarrhea
  • A low fiber diet
  • Weakening of the supporting tissues in the anus and rectum that occurs with aging
  • The pregnancy
  • Often lifting heavy objects

How are hemorrhoids diagnosed?

Diagnosing hemorrhoids usually requires an examination of the anal canal to look for swollen blood vessels. Your doctor may perform one of the following tests:

  • A digital rectal exam, where your doctor puts on gloves and places a lubricated finger inside the anus to gently feel for any abnormalities. This will likely be uncomfortable, but it probably won't be painful.
  • A proctoscopy, in which your doctor examines the inside of the rectum with a proctoscope (a hollow tube with a tiny light at the end) to look for inflammation or other symptoms. Again, this may be uncomfortable, but it probably won't be painful.

How are hemorrhoids treated?

Since bleeding can be a symptom of the colon or rectum, a colonoscopy may be required before treating hemorrhoids.

Among home treatments, we recommend:

  • Take a warm bath or sitz bath several times a day in warm water for about 10 minutes
  • Use ice packs to reduce inflammation
  • Make sure you have smooth, regular bowel movements by eliminating foods that cause constipation, adding fiber to your diet, drinking plenty of fluids, and exercising regularly.
  • Spend less time in the bathroom
  • Try to have a bowel movement when you feel like it instead of holding it in

If your hemorrhoids do not respond to the above therapies, or are already very problematic, there are other treatment options, including:

Ligation with elastic band. Also called a band, which involves placing a very small elastic band around the base of the hemorrhoid inside the rectum. The band cuts off circulation and the hemorrhoid disappears in seven to 10 days. This leaves a scar that prevents further bleeding and prolapse. This is usually done in the office, but sometimes it is done in a surgery room.

What can you expect from the bands?:

  • Bleeding in seven to 10 days when the hemorrhoid falls out
  • Bleeding with bowel movements
  • A dull pain and fullness in the rectum: it is recommended that you apply an ice pack to help relieve this
  • If your pain increases, fever, and difficulty urinating appear, you should return to the hospital immediately to have the elastic band removed.
  • Avoid aspirin and non-steroidal pain relievers (ibuprofen-type pain pills) for 10 days
  • You can return to your daily activities immediately.

Sclerotherapy. This consists of injecting a chemical solution around the blood vessel to shrink the hemorrhoid. This causes inflammation and scarring. It is done in the office, but is more likely to work only temporarily. You can return to your daily activities immediately.

Hemorrhoidectomy. When hemorrhoids are severe, extensive, prolapsed, or incarcerated, they may require removal through a surgery known as hemorrhoidectomy. This is done under anesthesia. Because there is a risk of causing permanent damage to the sphincter, the muscle that controls bowel movements, this operation is only performed if absolutely necessary.

What can you expect from hemorrhoidectomy?:

  • You will experience a lot of discomfort from this procedure and will not be able to return to your usual activities for five to 10 days.
  • If you cannot urinate after the procedure, you should call your doctor.
  • Avoid aspirin and non-steroidal pain relievers (such as ibuprofen) for 10 days.
  • Warm baths will be relaxing.
  • The first few bowel movements may cause bleeding and pain. Narcotics will be needed for pain control and stool softeners.

Thrombosed external hemorrhoids. When an external hemorrhoid develops, it can be treated with excision or open cutting of the hemorrhoid or clot if it can be seen within the first 24 hours of pain. After that, the hemorrhoid will begin to disappear on its own and opening it will not help it heal faster. Warm baths are very useful for this.

Creams and Suppositories. Many doctors believe these can help, but they can also cause problems. The anal area prefers to be dry and because it is a very sensitive area, it can develop allergies to some preparations.

Fiber. A diet high in fiber will help you have smooth and regular bowel movements. Additionally, the best time to have a bowel movement is when your body feels like going; This will minimize the problems of hemorrhoids, fissures, itching and other common colon, rectal and anal problems. A high-fiber diet contains about 25 to 30 grams of fiber per day.

How to prevent hemorrhoids, especially from coming back?

There are lifestyle changes you can make to prevent hemorrhoids from coming back. These options help keep stool soft and increase volume, which will decrease pressure on the rectum and therefore relieve pressure on blood vessels.

  • Stay hydrated: Avoid constipation by drinking water constantly.
  • Increase your fiber intake: Examine your diet and see where you could eat more fruits and vegetables.
  • Exercise regularly – Stimulates intestinal function.
  • Go to the bathroom as soon as you feel the urge: Waiting for the urge to go away can cause the stool to dry out, which will increase pressure on the rectum

When should you consult the doctor?

If you bleed when you have a bowel movement or have hemorrhoids that don't improve after a week of home care, talk to your doctor. Don't assume that rectal bleeding is due to hemorrhoids, especially if you have changes in your bowel habits, or if your stools change color or consistency, or if you lose a lot of weight. Rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer.

It is also important to seek emergency care if you have large amounts of rectal bleeding, confusion, dizziness, or fainting.


"Because prevention is better than cure"

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