Hemorroids - A Real Pain You Would Rather Avoid

What are hemorrhoids?

It is probably reasonable to assume that whoever coined the popular phrase “a pain in the butt” was a hemorrhoids sufferer.

Hemorrhoids, commonly known as piles, are dilated, swollen veins that bulge around the anus or inside the anus, and press on adjacent nerves. In a sense they are the counterpart of varicose veins, the unsightly dilated veins which are often seen in the legs of people who spent a great deal of time standing on their feet.

Hemorrhoids are called internal when they occur inside the anal canal, and external, when they occur at the anal opening.

Internal hemorrhoids are usually not painful unless they become ulcerated, infected or project outside through the anus. External hemorrhoids may be very painful, particularly if the blood inside them clots or when inflamed by a bacterial infection. They may also become partly damaged by the passage of hard stools and often bleed.

People at risk:

Hemorrhoids are known to be a very common condition. Hippocrates, a famous Greek physician who lived more than 2400 years ago, knew that they were dilated anal veins and recommended burning them away with hot-red irons, a rather crude version of electro-coagulation of today.

The frequency of hemorrhoids is higher among whites, people of higher socio- economic status, rural dwellers and pregnant women. The frequency is about the same between the sexes.

External hemorrhoids are seen more commonly in young and middle age adults, and the frequency increases with age.

Causes of hemorrhoids:

Hemorrhoids are caused by repeated increased pressure in the veins of the anus and rectum, as a result of either excessive straining to pass bowel movements or because of increased pressure on the veins of the inner pelvis, such as during pregnancy or delivery. They very rarely result from tumors of the abdomen or rectum.

Risk factors for getting hemorrhoids include: constipation, prolonged sitting, lack of erect posture, low intake of vegetables or fiber in diet, pregnancy, familial tendency, diarrhea – especially in heavy drinkers, liver disease, anal intercourse, episiotomy (surgical incision of the back wall of the vagina done in order to facilitate the delivery), and obesity.

Symptoms and diagnosis:

Symptoms of hemorrhoids include: rectal bleeding or spotting during or after bowel movements, pain while passing bowel movement, rectal tenderness, and a lump at the edge or inside the anus.

It may be a good idea not to try to diagnose by yourself whether or not you have hemorrhoids, but to have your doctor determine the proper diagnosis and whether or not a more severe condition is present.

One should definitely seek medical advise if there is severe pain, especially if it lasts for more than a week, a painful clot or hard lump in the hemorrhoid, there is rectal bleeding without bowel movement, or any evidence of infection.

Diagnostic tests (e.g. sigmoidoscopy, anoscopy, proctoscopy) usually include examination of the anal canal and terminal large bowel (colon) through telescopic devices that work using fiber optic technology and are called colonoscopes or anoscopes.

In most cases simple hemorrhoids recede spontaneously after 1-2 weeks, but the recurrence rate is quite high with 10-50 % of the afflicted experiencing another episode within a 5-year period.

Complications of hemorrhoids include thrombosis of hemorrhoids (blood clotting), infection, ulceration, abscess and rarely one can become anemic because of blood loss.

Preventive care:

Prevention is always the best approach. If one is at particular risk or wants to prevent a flare up of hemorrhoids, the following measures are recommended:

1. Drinking plenty of water or fluids, at least 2 quarts a day. This is particularly true for residents of Florida’s sunny climate.
2. Eating foods with good content of dietary fibers such as vegetables, whole grains, bran cereals, and fruits and/or add two-three tablespoons of bran per day.
3. Eating prunes or drinking prune juice.
4. Exercising regularly.
5. Passing a bowel movement as soon as the urge is felt. Failure to do so results in difficult to pass, drier and harder stools.
6. Abstaining from straining while having a bowel movement and not holding one’s breath while trying to pass a stool.
7. Keeping the anal area very clean by bathing it with warm water and mild soap.
8. Taking warm baths and/or using a sits bath with warm water (sitz bath devices fit over the toilet and are available in medical supply stores or some pharmacies).
9. Using moist towelettes or wet toilet paper, rather than irritating dry toilet paper.
10. Checking with a doctor whether to use over-the-counter products such as medical wipes, medicated suppositories that shrink hemorrhoids or reduce pain(e.g. Preparation H), and stool softeners (e.g., Colace, ExLax). Ice packs may help to reduce swelling of hemorrhoids. A helpful regimen for many hemorrhoids sufferers is to take a stool softener tablet in the evening, drink a full 8 oz. glass of water mixed with a teaspoon of a fiber supplement (e.g. Metamucil or Citrucel), and drink a tablespoon of mineral oil.
11. Local anesthetics (e.g. Lidocaine ointment 5%), or Hamamelis water(witch hazel).
12. Avoiding sitting for too long periods of time, including sitting too long on the toilet because it restricts blood flow around the anal area.
13. Losing weight if overweight.

Surgical treatment of hemorrhoids:

Most cases can be successfully medically treated. However, if conservative measures of self-care for hemorrhoids are not effective, a number of surgical procedures are available. Those include sclerotherapy (injecting a scarring solution around the veins), cryosurgery (freezing of the hemorrhoids), electro-coagulation (burning of the hemorrhoids by using laser light, electrical devices or infra-red light), ligation of the hemorrhoids (placing rubber bands on the base of the hemorrhoid, which then withers away) and hemorrhoidectomy (surgical removal usually done under general anesthesia).

In conclusion, hemorrhoids, although not a life-threatening disease, are a common and very annoying and uncomfortable condition that can be effectively treated. Simple preventive measures may be taken to avoid their occurrence and prevent recurrences.