Hemorrhoids are swollen but normally present blood vessels in and
around the anus and lower rectum that stretch under pressure, similar
to varicose veins in the legs.
The increased pressure and swelling may result from straining to
move the bowel. Other contributing factors include pregnancy, heredity,
aging, and chronic constipation or diarrhea.
Hemorrhoids are either inside the anus (internal) or under the skin around the anus (external).
Many anorectal problems, including fissures, fistulae, abscesses, or
irritation and itching (pruritus ani), have similar symptoms and are
incorrectly referred to as hemorrhoids.
Hemorrhoids usually are not dangerous or life threatening. In most cases, hemorrhoidal symptoms will go away within a few days.
Although many people have hemorrhoids, not all experience symptoms.
The most common symptom of internal hemorrhoids is bright red blood
covering the stool, on toilet paper, or in the toilet bowl. However, an
internal hemorrhoid may protrude through the anus outside the body,
becoming irritated and painful. This is known as a protruding
hemorrhoid.
Symptoms of external hemorrhoids may include painful swelling or a
hard lump around the anus that results when a blood clot forms. This
condition is known as a thrombosed external hemorrhoid.
In addition, excessive straining, rubbing, or cleaning around the
anus may cause irritation with bleeding and/or itching, which may
produce a vicious cycle of symptoms. Draining mucus may also cause
itching.
Hemorrhoids are very common in men and women. About half of the
population have hemorrhoids by age 50. Hemorrhoids are also common
among pregnant women. The pressure of the fetus in the abdomen, as well
as hormonal changes, cause the hemorrhoidal vessels to enlarge. These
vessels are also placed under severe pressure during childbirth. For
most women, however, hemorrhoids caused by pregnancy are a temporary
problem.
A thorough evaluation and proper diagnosis by the doctor is
important any time bleeding from the rectum or blood in the stool lasts
more than a couple of days. Bleeding may also be a symptom of other
digestive diseases, including colorectal cancer.
The doctor will examine the anus and rectum to look for swollen
blood vessels that indicate hemorrhoids and will also perform a digital
rectal exam with a gloved, lubricated finger to feel for abnormalities.
Medical treatment of hemorrhoids initially is aimed at relieving symptoms. Measures to reduce symptoms include:
- Warm tub or sitz baths (bath in which one bathes sitting) several times a day in plain, warm water for about 10 minutes.
- Ice packs to help reduce swelling.
- Application of a hemorroidal cream or suppository to the affected area for a limited
time.
Prevention of the recurrence of hemorrhoids is aimed at changing
conditions associated with the pressure and straining of constipation.
Doctors will often recommend increasing fiber and fluids in the diet. Eating the right amount of fiber and drinking
six to eight glasses of fluid (not alcohol) result in softer, bulkier
stools. A softer stool makes emptying the bowels easier and lessens the
pressure on hemorrhoids caused by straining. Eliminating straining also
helps prevent the hemorrhoids from protruding.
Good sources of fiber are fruits, vegetables, and whole grains. In
addition, doctors may suggest a bulk stool softener or a fiber
supplement such as psyllium (Metamucil) or methylcellulose (Citrucel).
In some cases, hemorrhoids must be treated surgically. These methods
are used to shrink and destroy the hemorrhoidal tissue and are
performed under anesthesia. The doctor will preform the surgery during
an office or hospital visit.
