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Hemorrhoids

Hemorrhoids are swollen veins in the lower rectum and anus. The anus is at the end of the rectum and is the opening through which bowel movements pass from your body. Hemorrhoids are a common problem, affecting about 40 percent of Americans. Another name for them is piles.

Hemorrhoids may be internal (forming from inside the rectum) or external. Internal hemorrhoids are often painless but they sometimes cause a lot of bleeding. The internal veins may stretch and even fall down (prolapse) through the anus to outside the body, so that they often can be felt outside of the body. The veins may then become irritated and painful. External hemorrhoids can be seen or felt easily around the anal opening. When the swollen veins are scratched or broken by straining, rubbing, or wiping, they sometimes bleed.

How do they occur?

We do not know for certain why some people form hemorrhoids, but they are associated with a number of situations. Hemorrhoids are more common in the presence of a low-fiber diet, excessive straining with a bowel movement, sitting too long on the toilet, coughing, sneezing, chronic diarrhea, obesity, injury to the anus, anal intercourse, increasing age, liver disease, pregnancy and constipation. In some situations there seems to be an inherited tendency, and sometimes they flare during periods of stress.

What are the symptoms?

Typical symptoms vary greatly, but can include itching, mild burning, and bleeding around the anus (for example, you might see bright red blood on toilet paper after wiping), swelling and tenderness around the anus, pain with bowel movements and painful lumps around the anus ranging in size from a pea to a walnut.

How are they treated?

• High-fiber diet/Activity: Eat more high-fiber foods, which can help prevent constipation. Good sources of fiber include fresh fruit, raw or cooked vegetables, especially asparagus, cabbage, carrots, corn and broccoli, and whole-grain cereals with bran, such as shredded wheat or bran flakes. Fiber-one Cereal, one-half cup daily can be a useful supplement to incorporate into your diet. Other cereals high in fiber include Raisin Bran or bran flakes.
• Fluids: Drink plenty of water. This helps to soften bowel movements so they are easier to pass. If necessary take a stool softener such as Haley's M-O, psyllium, Metamucil or Citrucel, or mineral oil. Exercise regularly to help prevent constipation. Avoid lifting heavy objects when your hemorrhoids are active.
• Sitz baths and cold packs: Sitting in lukewarm water two or thee times a day for 15 minutes cleans the anal area and may relieve discomfort. (If the bath water is too hot swelling around the anus will get worse.) Also, you might try putting a cloth-covered ice pack on the anus for 10 minutes four times a day.
• Medications: For mild discomfort your health care provider may prescribe a cream or ointment for the painful area. The cream may contain witch hazel, zinc oxide, or petroleum jelly. Your provider may also describe medicated suppositories to put inside the rectum.
• Procedures and surgeries: A number of procedures can be used to remove or shrink hemorrhoids. If you have protruding internal hemorrhoids, your health care provider can do a procedure called hemorrhoid banding. Your provider will put a tight band around the enlarged vein and either cut the hemorrhoid open, remove any blood clots, and let the vein heal or let the hemorrhoid dry up and fall off. This method is effective in most cases. Other methods include destroying the hemorrhoid with freezing, electrical or laser heat, or infrared light. For severe cases of hemorrhoids or for external hemorrhoids, a surgical procedure called a hemorrhoidectomy may be done, which is performed by a surgeon who surgically removes the tissue.

 

Specific over the counter medications that can be utilized?

Some products contain local anesthetic ingredients to stop pain, itching and burning. These ingredients include benzocaine, dibucaine, and pramoxine. These products are applied 3-6 times daily, depending on the specific ingredient in the product. Read the label for exact application directions. Products containing local anesthetics are only to be applied externally, since humans do not have nerve endings beyond the anal opening. You should not use your fingers or any other device (such as a plastic tube or ''pipe'') to place the products internally.

Protectants such as petrolatum (Vaseline), cocoa butter, hard fat, lanolin, mineral oil, glycerin and topical starch coat the skin. This relieves irritation and burning, protects inflamed skin and prevents drying of the skin.
Protectants may be applied after each bowel movement, following label directions.
Some products contain ingredients such as epinephrine and phenylephrine, which directly shrink blood vessels to reduce swelling. However, they must not be used if you have heart disease, hypertension, thyroid disease, diabetes or difficulty in urinating as a result of an enlarged prostate (unless dirtied by a physician).
Other ingredients include astringents and hydrocortisone. Astringents such as witch hazel relieve irritation and itching. Hydrocortisone in some hemorrhoid products can relieve anal itching as well.

 

This material does not cover all information and is not intended as a substitute for professional medical care.