What Are Hemorrhoids?
Hemorrhoids (also called piles) are distended varicose veins in the anus. All veins are lined with valves that permit blood to flow in only one direction (back to the heart). Excess pressure on these valves can cause them to weaken and fail, allowing blood to flow in the wrong direction or to stagnate. The vein may engorge with blood, which, in the anus, results in a hemorrhoid.
Although hemorrhoids are often painless, the swollen wall of the vein is fragile and thus is prone to rupture and bleeding. Stagnant blood promotes formation of clots in the vein, which are typically painful and, in severe cases, may require surgery. Hemorrhoids usually affect people between the ages of 20 and 50 and are especially common in those who are constipated, pregnant, or obese, owing to increased pressure within the veins of the lower abdomen.
Who Gets Hemorrhoids?
Hemorrhoids are very common in both men and women. According to the National Institutes of Health (NIH), they affect about 75 percent of all people at some point in their lives. It's difficult to estimate the exact prevalence of hemorrhoids because many people use over-the-counter treatments and do not seek medical attention for the condition.
- Bright red blood on the toilet paper, the stool, or in the toilet bowl after a bowel movement.
- Pain, especially during bowel movements.
- Anal itching.
- Mucus discharge from the anus.
- Swelling or a hard lump near the anus area [H
Hemorrhoids usually do not lead to serious complications; however, minor complications can sometimes occur. A blood clot (thrombosis) may form in an external hemorrhoid, leading to increased swelling and pain—especially during bowel movements.
In some cases, an internal hemorrhoid swells and protrudes through the anal opening (called a prolapsed hemorrhoid). If a prolapsed hemorrhoid becomes trapped outside of the rectum, medical treatment usually is required. Infection also can occur as a result of hemorrhoids, causing the skin surrounding the anus to become inflamed and irritated.
- Straining during bowel movements is a primary cause. (A diet low in fiber can result in constipation, which in turn encourages the tendency to strain during bowel movements.)
- Pregnancy, childbirth, heavy lifting, and obesity increase the risk of hemorrhoids.
- Prolonged standing or sitting may be causes.
- Loss of muscle tone due to old age, an episiotomy, or rectal surgery can promote hemorrhoids.
- Digestive problems such as diarrhea and constipation can cause hemorrhoids.
- Excessive consumption of alcohol and caffeine increase risk
What If You Do Nothing?
Hemorrhoids are more of a nuisance than anything else and are rarely a serious risk to health. With proper care, pain or bleeding from an external hemorrhoid resolves itself very quickly in most cases. If you can withstand the pain and itching, the hemorrhoids may eventually diminish so living with them becomes tolerable.
But when you do notice the bleeding for the first time, you should get a doctor’s opinion. Probably it’s only a hemorrhoid, but in a very small number of cases, rectal bleeding may be the first sign of serious gastrointestinal disease, including cancer.
- Patient history and examination of the anus and rectum are necessary. A doctor may detect internal hemorrhoids with a special scope.
- Barium enema x-rays may be ordered.
- To rule out conditions other than hemorrhoids, other diagnostic tests may be performed, including sigmoidoscopy or colonoscopy.
- Wash the anal area gently but thoroughly after each bowel movement, using a soft tissue and warm water. To dry, dab the area with a soft cloth.
- For external hemorrhoids, apply an ice compress to help reduce inflammation and discomfort.
- Frequent warm baths or sitz baths can relieve mild symptoms of pain and itching.
- Anesthetic ointment and topical corticosteroids (such as hydrocortisone) may ease pain and swelling. Avoid over-use of hemorrhoid remedies such as Preparation H—prolonged use can be damaging to anal tissue.
- To help relieve pain use acetaminophen (one brand name: Tylenol), ibuprofen (one brand name: Motrin) or aspirin.
- An injection of a solution that turns the hemorrhoid to scar tissue may be used (sclerotherapy).
- Some hemorrhoids may be tied off using a rubber band (rubber band ligation).
- In severe cases surgical removal (hemorrhoidectomy) may be necessary.
- A high-fiber diet including fresh fruit, vegetables, and whole-grain breads and cereals is recommended. Consuming psyllium, a bulk-forming fiber supplement, can also increase your fiber intake. To prevent painful gas, cramping, bloating, or diarrhea, increase your fiber intake gradually
- Drink plenty of water to help ease bowel movements.
- Don’t strain during bowel movements or stay on the toilet longer than necessary.
- Avoid sitting or standing for long periods. Sit or lie down for brief periods whenever possible.
- If overweight, reduce your weight. Excess pounds increase pressure and cause hemorrhoids.
- Exercise regularly to improve circulation. Daily exercise helps prevent hemorrhoids from developing and aids in the shrinkage of existing hemorrhoids.
- Be careful when lifting heavy objects. Abdominal strain can increase pressure on the rectal-anal veins.
- Don’t take laxatives, except bulk-forming laxatives such as Metamucil or Fiberall. Other forms of laxatives can cause diarrhea, which can worsen hemorrhoids.
When To Call Your Doctor
- Any sign of rectal bleeding should be evaluated by a physician.
- If other symptoms do not improve with home treatment, see a doctor.
Robert Hurd, M.D., American Board of Internal Medicine and Professor of Endocrinology and Health Care Ethics, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network.