Hemorrhoids are the most common anal disorder. In fact, roughly half the population experiences hemorrhoids by age 50. Fortunately, this uncomfortable condition can be easily avoided and effectively treated.

Hemorrhoid Causes and Types

A hemorrhoid is a blood-filled vein in the lower rectum. Pressure on rectal vessels caused by constipation or heavy lifting can cause a vein to protrude. Standing, sitting, or resting on the toilet for a long time after a bowel movement, can also trigger the condition. Pregnant and obese women are at risk for hemorrhoids as well, because of uterine pressure on the rectum.

There are two types of hemorrhoids: internal and external. Internal hemorrhoids may only present themselves as traces of blood on toilet tissue. This happens when the straining caused by passing stool opens the vein and causes bleeding.

Internal hemorrhoids, which are pushed through the anal opening by intense straining, are called prolapsed internal hemorrhoids. These may cause a constant ache or itch. They also bleed.

External hemorrhoids develop near the anus and are covered by normal skin that has numerous pain receptors. If a blood clot develops in an external hemorrhoid, it becomes a hard sensitive lump. This is known as a thrombosed external hemorrhoid and is quite painful.

Although may people have hemorrhoids, not all people experience symptoms.

Hemorrhoid Diagnosis

As bleeding is the most common symptom of hemorrhoids, a thorough evaluation and proper diagnosis by a health care provider is important. A health care provider should examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and do a digital rectal exam to feel for abnormalities. A closer examination with an anoscope, a hollow, lighted tube is also useful for viewing the rectum.

To exclude other causes of bleeding, a colonoscopy may also be required.

Outpatient Treatment

Increased regularity of bowel movements and avoidance of constipation is a critical step in hemorrhoid prevention and relief. To keep stools soft, exercise regularly and eat plenty of fiber. Fiber-rich foods include fresh fruits and vegetables (preferably uncooked and unpeeled), whole-grain products, dried beans, peas and fruit. Using stool softeners or laxatives may also help.

Here are steps you can take to treat hemorrhoids at home:

• Take a warm sitz bath (a bath taken in a sitting posture) twice a day.

• Apply witch hazel soaks or ice packs to the hemorrhoid.

• Use topical medications or suppositories prescribed by your health care provider.

• Keep the area between the vagina and rectum (the perineum) clean. Try washing with warm water after a bowel movement.

• Use an inflatable seat cushion if sitting is painful.

• Sleep on your side to relieve pressure on rectal veins.

Surgical Treatment

In some cases, hemorrhoids are severe enough to require surgery and there are a number of surgical options. These methods are used to shrink and destroy the hemorrhoid tissue. Some of these surgeries may be performed in a doctor’s office while others are done in a hospital setting.

The most common type of hemorrhoid surgery, which is often done in a doctor’s office, is rubber band ligation. This process requires the use of an anoscope and instruments to place small rubber bands around the base of the hemorrhoid. A few days later, the hemorrhoid drops off and the bleeding subsides. In severe cases or in the case of thrombosed hemorrhoids, doctors can perform a hemorrhoidectomy, a surgical procedure that permanently removes the hemorrhoid. A procedure called US guided ligation or the stapling of the hemorrhoids can also be performed in a hospital setting under anesthesia.

Here Are Some Steps to Prevent Hemorrhoids

• Get regular exercise. This helps prevent constipation, which can lead to hemorrhoids.

• Drink plenty of water. Besides filling up on fiber, keeping well hydrated is another way to prevent constipation.

• Avoid long hours of sitting, standing or excessive lifting. This will relieve pressure on the rectal veins.

• Avoid food that irritates the digestive system. Milk and dairy products, chocolate, caffeine, alcohol can all cause irritation.

• Health care maintenance. Get regular checkups and colonoscopy evaluations as recommended so if symptoms appear you can seek advice quickly.

Dr. Myron Morse is a board-certified general surgeon with Columbus General Surgery.

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