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Hemorrhoids
(Piles)

Definition:
Hemorrhoids are swollen blood vessels in and around the anus and lower rectum. They stretch under pressure and are similar to varicose veins in the legs. Hemorrhoids are either internal or external.

Internal (inside) Hemorrhoids–develop inside the anus. They are painless and sometimes bleed a lot during bowel movements. They may also protrude during bowel movements. If they protrude from the anal opening and cannot be pushed back, they can cause severe pain.

External (outside) Hemorrhoids–develop under the skin around the anus and can easily be felt or seen as a lump. They bleed when broken by straining, rubbing, or scratching.

Causes:
The exact cause of hemorrhoids is unknown. The major contributing factor appears to be too much pressure on the veins in the rectum. If the pressure continues, the veins become enlarged and protrude.

Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
  • Straining when trying to pass a stool
  • Chronic constipation or diarrhea
  • Sitting on the toilet for long periods of time
  • Pressure on the veins from pregnancy and childbirth
  • Advancing age
  • Obesity
  • Family members with hemorrhoids
  • Chronic cough
  • Liver disease
  • Chronic use of enemas or laxatives
Symptoms:
In most cases, symptoms will go away within several days. Although many people have hemorrhoids, not all experience symptoms.

Common symptoms include:

  • Bleeding from the anus that may appear:
    • On the stool
    • On the toilet paper
    • In the toilet bowel
  • Anal itching and burning
  • Swelling and pain during bowel movements
  • Sensitive lumps of various sizes around the anus
Diagnosis:
The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor will examine the anus and rectum to look for swollen blood vessels and perform a digital rectal exam. This is accomplished by inserting a gloved, lubricated finger into the rectum to feel for abnormalities.

Bleeding from the rectum or blood in the stool can be a symptom of other digestive diseases or colon cancer. It is important to see a doctor if you have any rectal bleeding.

Treatment:
Initial medical treatment of hemorrhoids is aimed at relieving symptoms. Measures to reduce symptoms include:

Sitz Baths–sitting in plain, warm water 2-3 times a day for about 10 minutes each time

Ice Packs–putting cold packs on the anus for short durations to relieve pain and swelling

Medication–hemorrhoidal creams or suppositories applied to the affected area

High-fiber Diet–eating more whole fresh fruit, raw or cooked vegetables, and whole grains has been consistently shown to reduce symptoms of hemorrhoids, including bleeding. In contrast, spicy foods have been shown not to worsen the symptoms of hemorrhoids, so you do not need to avoid them.

Fluids–drinking 6-8 8-ounce glasses of nonalcoholic fluids daily to soften stools

If these treatments provide insufficient relief, one of several nonsurgical procedures may be used to shrink or destroy the hemorrhoidal tissue. These procedures, which are generally performed in a doctor’s office, include:

Rubber Band Ligation–a rubber band placed around the base of the hemorrhoid to cut off circulation and force the hemorrhoid to wither away within a few days

Sclerotherapy–a chemical solution is injected near the blood vessel to cause scarring and shrinkage of the hemorrhoid

Coagulation Therapy–the use of electricity (direct current electrotherapy), or laser or infrared light (photocoagulation) to shrink the hemorrhoidal tissue

If nonsurgical procedures are either not an option or fail to resolve the problem, surgical management is the final option:

Hemorrhoidectomy–permanent removal of hemorrhoids by cutting the hemorrhoidal tissue away. Some of the newest surgical treatments involve using stainless steel staples. While favored by many surgeons, there is some evidence that more traditional techniques produce more consistent and long-lasting relief.

Prevention:
The best way to prevent hemorrhoids is to keep stools soft so they pass easily. The following practices can help:
  • Eating a high fiber diet
  • Exercising regularly, especially walking.
  • Emptying bowels as soon as possible after the urge occurs
  • Avoiding the overuse of laxatives
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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