Hemorrhoids

1 What are Hemorrhoids?

Hemorrhoids are swollen and inflamed vessels in the anus and rectum. They may result from straining during bowel movements or from increased pressure on these veins during pregnancy. Hemorrhoids may be located inside  the rectum (internal hemorrhoids or under  the skin around the anus (external hemorrhoids).

Hemorrhoids

Hemorrhoids are common ailments. By age 50, about half of adults have had to deal with the itching, discomfort and bleeding that can signal the presence of hemorrhoids. Fortunately, many effective options are available to treat hemorrhoids. Most people can get relief from symptoms by using home treatments and making lifestyle changes.

2 Symptoms

Signs and symptoms of hemorrhoids may include:

  • Painless bleeding during bowel movements — you might notice small amounts of bright red blood on your toilet tissue or in the toilet bowl
  • itching or irritation in your anal region
  • pain or discomfort
  • swelling around your anus
  • a lump near your anus, which may be sensitive or painful
  • Leakage of feces

Hemorrhoid symptoms usually depend on the location. Internal hemorrhoids lie inside the rectum. You usually can't see or feel these hemorrhoids, and they usually don't cause discomfort. But straining or irritation when passing stool can damage a hemorrhoid's delicate surface and cause it to bleed. Occasionally, straining can push an internal hemorrhoid through the anal opening. This is known as a protruding or prolapsed hemorrhoid and can cause pain and irritation.

External hemorrhoids are under the skin around your anus. When irritated, external hemorrhoids can itch or bleed. Sometimes blood may pool in an external hemorrhoid and form a clot (thrombus), resulting in severe pain, swelling and inflammation

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3 Causes

The veins around the anus tend to stretch under a certain amount of pressure and may bulge as well. Swollen veins or hemorrhoids can develop from a build up of pressure in the rectum.

The following factors may increase the build up of pressure:

  • straining during bowel movements,
  • sitting for a long period of time on a toilet,
  • chronic diarrhoea or constipation,
  • obesity,
  • pregnancy,
  • anal intercourse,
  • low-fiber diet.

Hemorrhoids are more likely to occur as one ages because the tissues that support the veins in the rectum and anus can weaken and stretch.

4 Making a Diagnosis

A doctor can diagnose external hemorrhoids simply by looking.

The following tests and procedures can be used to diagnose hemorrhoids:

  • examination of the anal canal and rectum for abnormalities,
  • visual inspection of the anal canal and rectum.

Because internal hemorrhoids are often too soft to be felt during a rectal examination, this examination can be done with an anoscope, proctoscope or sigmoidoscope.  

The doctor may also want to do a more extensive examination of the entire colon using a colonoscopy.

This procedure can be recommended: 

  • if signs and symptoms suggest that one can have another digestive system disease,
  • if there are risk factors for colorectal cancer,
  • if  one is older than the age of 50 and haven't had a recent colonoscopy.

5 Treatment

In most cases, treatment of hemorrhoids involves steps that an individual can take on their own, this include lifestyle changes. However, some cases may require medications or surgical procedures. If the hemorrhoids produce mild discomfort, the doctor may suggest over-the-counter creams, ointments suppositories or pads. If a blood clot within an external hemorrhoid, the doctor can remove the clot with a simple incision, which may provide prompt relief.

In case of persistent bleeding, the doctor may recommend another minimally invasive procedure. These treatments can be done in the doctor's office or other outpatient setting.

These treatments include

  • Rubber band ligation, which involves the doctor placing one or two tiny rubber bands around the the base of the internal hemorrhoid to cut off its circulation.
  • Injection or sclerotherapy, which involves the doctor injecting a chemical solution into the hemorrhoids in order to shrink it. 
  • Coagulation techniques use lasers or infrared light or heat. They cause small, bleeding, internal hemorrhoids to harden and shrivel.
  • Surgical procedures can also be incorporated into the treatment process. Hemorrhoid removal can be performed.
  • Hemorrhoidectomy is the most effective way to treat severe hemorrhoids.

Complications may include temporary difficulty emptying the bladder and urinary tract infections associated with this problem. Another procedure that can be performed is called hemorrhoid stapling or stapled hemorrhoidectomy. In this procedure, blood is blocked from flowing to hemorrhoid tissue. 

Compared with hemorrhoidectomy, stapling has been associated with a greater risk of recurrence and rectal prolapse, in which the  rectum protrude from the anus. Therefore, it is very advisable to talk with a doctor in order to choose the best option.

6 Prevention

The best way to prevent hemorrhoids is by keeping stool soft.

The following tips may be helpful:

  • Eating high-fiber foods such as fruits, vegetables and whole grains, this softens stool and increase its bulk.
  • One can also drink plenty of fluids, about six to eight glasses per day of water or any other fluid with the exception of alcohol.
  • One must avoid straining. Straining or holding the breath when trying to pass stool creates a greater in the veins of the lower rectum.
  • It is also important to go as soon as the urge to pass stool is felt.
  • Exercise can also be incorporated into he daily routine, it can help reduce the pressure on the veins,  which can occur with long periods of standing and sitting.
  • Sitting for long periods must be avoided as well, particularly on the toilet as this can increase the pressure on the veins in the anus.

7 Alternative and Homeopathic Remedies

Several alternative and homeopathic remedies exist for hemorrhoids.

One can relieve mild pain, swelling and inflammation of hemorrhoids with certain home remedies. Often these are the only treatments needed.

Applying an over-the-counter hemorrhoid cream containing cortisone or using pads containing with hazel or a numbing agent can be helpful.

It is also helpful to soak the anal region in plain warm water 10 - 15 minutes two to three times a day.

Taking oral pain relievers such as acetaminophen, aspirin or ibuprofen may be helpful as well.

Applying ice pack or cold compresses on the anus can relieve swelling.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with hemorrhoids.

An individual with hemorrhoids is always advised to keep their anal region clean.

Bathing or taking a shower a day to clean the skin around the anus gently with warm water.

It is not necessary to use soap as it may worsen the problem.Alcohol based perfumed wipes must also be avoided.

The area must further be dried gently with a hair dryer after bathing. The use of dry toilet paper should also be avoided.

To keep the anal region clean after bowel movement, most toilet paper or wet toilet paper that does not contain alcohol can be used.

9 Risks and Complications

The complication of hemorrhoids is a rarity.

But in some cases may include:

  • Chronic blood loss from hemorrhoids can lead to anaemia, a condition in which one does not have enough red blood cells to carry oxygen to their cells.
  • Another complication is a strangulated hemorrhoid which can cause extreme pain and lead to tissue death (gangrene).
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