Hemorrhoids
Hemorrhoids are swollen veins in your anus and lower rectum. They can develop either inside the rectum (internal hemorrhoids) or on the outside of the anus (external hemorrhoids).
Almost three out of four adults will have hemorrhoids from time to time.Hemorrhoids can be caused by many things, but often the cause is unknown.
There are many effective treatments for hemorrhoids. Many people get relief by using home treatments and lifestyle changes.
Symptoms
Some signs and symptoms of hemorrhoids depend on the type of hemorrhoid.
External hemorrhoids
These are things that are located around your anus. Signs and symptoms might include: discomfort when you go to the bathroom, a discharge from your penis or female genitalia, or an itching sensation.
- You may be experiencing itching or irritation in your anal region.
- Pain or discomfort
- Swelling around your anus
- Bleeding
Internal hemorrhoids
Internal hemorrhoids are located inside the rectum. They are usually difficult to see or feel, and seldom cause discomfort. But straining or irritation when passing stool can cause them to swell and bleed.
- Bleeding during bowel movements is painless. You might see a small amount of red blood on toilet paper or in the toilet.
- A hemorrhoid that has prolapsed or protruded through the anus causes pain and irritation.
Thrombosed hemorrhoids
If blood accumulates in an external hemorrhoid and forms a clot, it can lead to:
- Severe pain
- Swelling
- Inflammation
- A hard lump near your anus
When to see a doctor
If you are having trouble with bowel movements or hemorrhoids, and they have not improved after a week of home care, please talk to your doctor.
Be sure to check for other causes of rectal bleeding before assuming it is due to hemorrhoids. This can include diseases such as colorectal cancer and anal cancer, even if your bowel habits or stools change.
If you have a lot of rectal bleeding, feeling lightheaded, or dizziness, go to the emergency room.
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Causes
The veins around your anus may stretch under pressure, and this may cause them to bulge or swell.This can lead to hemorrhoids, which are caused by increased pressure in the lower rectum.
- Straining during bowel movements
- You should not sit on the toilet for a long time.
- Having chronic diarrhea or constipation
- Being obese
- Being pregnant
- Having anal intercourse
- Eating a diet with few fiber sources
- Regular heavy lifting
Risk factors
As you get older, your risk of getting hemorrhoids increases. This is because the tissues that support the veins in your rectum and anus can weaken and stretch. It can also happen when you're pregnant, as the weight of the baby puts pressure on the anal region.
Complications
Hemorrhoids are rare but can cause complications, including:
- Anemia.If you have hemorrhoids, you may experience chronic blood loss, which can lead to anemia in which you don't have enough healthy red blood cells to transport oxygen to your cells.
- Strangulated hemorrhoid.If the blood supply to an internal hemorrhoid is cut off, the hemorrhoid may die and cause intense pain.
- Blood clot.Occasionally a clot can form in a hemorrhoid. If this happens, it can be very painful and sometimes a doctor needs to lance and drain the clot.
Prevention
To prevent hemorrhoids, you should keep your stools soft. This will make them pass easily and reduce the symptoms of hemorrhoids. Follow these tips to help you do this:
- Eat high-fiber foods.Eat more fruits, vegetables, and whole grains to help soften your stool and make it easier to pass. Eat these foods slowly to avoid problems with gas.
- Drink plenty of fluids to stay hydrated.Drink a lot of water and other liquids each day to keep your stools soft.
Consider fiber supplements.People don't usually get enough fiber in their diet. Studies have shown that taking over-the-counter supplements such as psyllium (Metamucil) or methylcellulose (Citrucel) can improve overall symptoms and bleeding from hemorrhoids.
If you are taking fiber supplements, drink at least eight glasses of water or other fluids every day. Otherwise the supplements may cause or worsen constipation.
- Don't strain.Straining when trying to pass a stool causes greater pressure in the veins near the rectum.
- Go as soon as you feel the urgeIf you wait to have a bowel movement and the urge goes away, your stool might be harder to pass because it has dried out.
- Exercise.Regular exercise can help prevent constipation and reduce pressure on your veins, which might cause hemorrhoids. In addition, staying active will help you lose excess weight, which could be contributing to your hemorrhoids.
- Avoid long periods of sitting.Sitting on the toilet for a long time can increase the pressure on the veins in your anus.
Diagnosis
Your doctor might be able to see external hemorrhoids. He or she might also examine your anal canal and rectum to diagnose internal hemorrhoids.
- Digital examination.Your doctor inserts a gloved finger into your rectum to feel for anything unusual. If they find something, they will remove it.
- Visual inspection.If your doctor suspects you have internal hemorrhoids, he or she might examine the lower portion of your colon and rectum with an anoscope or sigmoidoscope. This type of exam is done with a special type of telescope.
If your doctor thinks it is necessary, he or she might want to do a colonoscopy on you. This involves passing a long, thin tube through your anus and into your rectum to look for abnormalities.
- Based on your symptoms, it seems like you may have a different digestive system disease.
- You have things in your life that increase your risk of developing colorectal cancer.
- You are middle-aged and haven't had a recent colonoscopy because you are too old.
Treatment
Home remedies
Some home treatments can relieve the mild pain and swelling caused by hemorrhoids.
- Eat high-fiber foods.Eat more fruits, vegetables, and whole grains to soften your stool and make it thicker. This will help you avoid straining and worsen symptoms from hemorrhoids. Add fiber to your diet slowly to avoid problems with gas.
- Apply topical treatments.Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or use pads that contain witch hazel or a numbing agent.
- Soak your feet regularly in a warm bath or sitz bath.Wash your anus with warm water twice a day or use a sitz bath, which fits over the toilet.
- Take oral pain relievers.You can use over-the-counter painkillers (such as acetaminophen or aspirin) or ibuprofen to relieve your discomfort for a short time.
If you are experiencing hemorrhoid symptoms, try the following treatments: see your doctor in a week if you do not improve, or sooner if you have severe pain or bleeding.
Medications
If your hemorrhoids produce only mild discomfort, your doctor might suggest over-the-counter creams, ointments, suppositories, or pads. These products contain ingredients such as witch hazel or hydrocortisone and lidocaine which can temporarily relieve pain and itching.
Do not use an over-the-counter steroid cream for more than a week unless directed by your doctor because it can thin your skin.
External hemorrhoid thrombectomy
If a painful blood clot has formed within an external hemorrhoid, your doctor can remove the hemorrhoid using surgery. This procedure is done under local anesthesia and is most effective if it is done within 72 hours of developing the clot.
Minimally invasive procedures
If you are having persistent bleeding or severe hemorrhoids, your doctor might recommend one of the other minimally invasive procedures that are available without anesthesia.These treatments can be done in a doctor's office or other outpatient setting.
Rubber band ligation is a process that uses rubber bands to tie off blood vessels.Your doctor places a few tiny rubber bands around the base of an internal hemorrhoid to cut off its blood supply. This will cause the hemorrhoid to shrink and eventually fall off.
Hemorrhoid banding can be uncomfortable, but it rarely causes severe bleeding. Occasionally more serious complications can occur.
- Injection (sclerotherapy).Your doctor will inject a chemical solution into the hemorrhoid tissue to make it smaller. This might not be as effective as using a rubber band to seal the opening.
- The laser or bipolar treatment causes coagulation.Bleeding from internal hemorrhoids is treated with coagulation techniques. These methods use laser or infrared light or heat, which cause the hemorrhoids to harden and shrink. Coagulation usually has few side effects and causes little discomfort.
Surgical procedures
Some people with hemorrhoids may require surgery. However, if other measures haven't worked or you have large hemorrhoids your doctor may recommend one of the following:
Hemorrhoid removal (hemorrhoidectomy).Your surgeon may use one of several techniques to remove excessive tissue that causes bleeding. These procedures can be done with local anesthesia, combined with sedation or general anesthesia.
Hemorrhoidectomy is the most effective and complete way to treat severe or recurring hemorrhoids. Complications can include temporary difficulty emptying your bladder, which can lead to urinary tract infections. This complication occurs mainly after receiving spinal anesthesia.
After the surgery, most people experience some pain. Medications may relieve this pain. Alternatively, soaking in a warm bath might help.
Hemorrhoid stapling. This procedure, called stapled hemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. It is typically used only for internal hemorrhoids.
Stapling generally causes less pain than having a hemorrhoidectomy, but it has a greater risk of recurrence and rectal prolapse. In comparison, hemorrhoidectomy has been associated with a greater risk of recurrence and rectal protrusion, but it is less painful than stapling.
Complications can include urinary retention and pain, as well as a life-threatening blood infection (sepsis). Talk with your doctor about the best course of action for you.
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Making sure you are prepared for your appointment.
If you have signs or symptoms of hemorrhoids, see your regular doctor. If needed, your doctor might refer you to one or more specialists, including a doctor with expertise in the digestive system (gastroenterologist) or a colon and rectal surgeon. Treatment
Here are some things you can do to prepare for your appointment.
What you can do
Be aware of any restrictions that may be in place before your appointment. When you make your appointment, ask if there are any requirements that must be met in advance.
Make a list of:
- Your symptoms and how long you've noticed them
- Key personal information,The doctor will want to know about your usual bowel habits and diet, especially your intake of fiber.
- All medications, vitamins or supplements you take, including doses
- Questions to ask your doctor
Some questions you may want to ask your doctor if you have hemorrhoids include:
- What do you think may be the cause of my symptoms?
- How long will my condition last?
- Can I expect any complications from this condition?
- What would you recommend for treatment?
- If our first treatments don't work, what other options do we have?
- Will I need surgery? Why or why not?
- What else can I do to take care of myself?
- Can I manage my other medical problems while having hemorrhoids?
Do not hesitate to ask more questions.
What to expect from your doctor
Your doctor might ask you questions, including:
- How uncomfortable are your symptoms?
- What are your typical bowel habits?
- How much fiber does your diet contain?
- What can help improve your symptoms?
- What if anything seems to worsen your symptoms?
- Are any members of your family history of hemorrhoids or cancer of the colon rectum or anus?
- Have you had any changes in how often you go to the bathroom?
- During a bowel movement, have you noticed blood on the toilet paper or in your bowel movements?
What you can do in the meantime
Before your appointment, make sure to eat high-fiber foods and take an over-the-counter fiber supplement such as Metamucil or Citrucel. Drinking plenty of water can also help relieve symptoms.
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