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Hemorrhoids

What are hemorrhoids?

Hemorrhoids are enlarged blood vessels in the anal area that are covered by the lining of the rectum or anal skin. These natural structures are present from birth, and there are usually three internal and three external hemorrhoids. They may be located inside the anus (internal hemorrhoids) or outside the anus (external hemorrhoids).

Why do people get hemorrhoid trouble?

There is no easy answer to this question. While everyone has blood vessels in this area, not everyone develops hemorrhoid problems. The symptoms are caused by enlargement of the vessels, with downward slippage and stretching of the skin and anal lining.

Causes of symptomatic hemorrhoids may be constipation, diarrhea, straining to have bowel movements, prostate trouble in men, pregnancy in women, or chronic cough; all of which cause increased pressure in the abdomen. Prolonged sitting on the commode, postponing the urge to move the bowels, or heavy lifting may worsen symptoms as well.

They may be related in part to a diet without bulk food and roughage (such as bran, fresh fruit and fresh vegetables). There may be a hereditary factor in some cases, or, there may be no specific explanation at all. Some people develop symptoms from hemorrhoids for as yet undiscovered reasons.

How do hemorrhoids bother people?

Hemorrhoids can be troublesome in several ways. Internal hemorrhoids may cause painless bleeding, and/or may fall out of the anal canal, requiring a person to push them back up inside after bowel movements. External hemorrhoids may become swollen and painful. While these are not usually serious or life-threatening problems, bleeding, in particular, needs careful evaluation to see whether blood is coming from a hemorrhoid or from another problem higher up, such as a polyp, cancer, or inflammation of the bowel.

Should hemorrhoids always be treated?

Not necessarily. If symptoms are mild or infrequent, often no medical treatment is required. For more severe symptoms, the goals are relief of pain, and restoration of normal function. Bleeding should always be evaluated and usually should be treated, because of the possibility of camouflaging other bowel disease.

What type of treatments are used?

For mild or intermittent symptoms, usually sitz baths (soaking the hemorrhoid area in plain warm water, with no additives, for 20 minutes at a time, two to four times a day), supplemental fiber, and a medicated cream are all that is necessary. Avoiding prolonged sitting on the commode or standing will also improve symptoms.

For external hemorrhoids which develop painful clots (called "thrombosis"); these may resolve spontaneously or may be removed in the office, using a Novocain-type local anesthetic. Removal of the external hemorrhoid usually brings dramatic relief and also prevents the problem from returning in the same place in the future.

For people with symptomatic internal hemorrhoids alone, tiny rubber bands can be placed around the base of the hemorrhoids, causing them to shrink and fall off. Occasionally injection of a medicine (sclerosant) may be added to help shrink the vessels. This procedure is done in the office, and usually causes minimal discomfort. This treatment is well tolerated because there are fewer nerve endings inside the rectum.

For larger, more severe hemorrhoids (or mixed external and internal hemorrhoids), surgical removal of the hemorrhoids may be the simplest permanent solution. Surgical removal may involve either a conventional procedure (cutting off the hemorrhoids) or an alternative called a PPH (lifting and fixing the hemorrhoid internally). This does not require an overnight stay in the hospital.

What about other types of treatment for hemorrhoids?

Other therapies for hemorrhoids gain popularity from time to time, such as cryotherapy (freezing), infrared therapy, or laser therapy. These techniques don’t have the long-term relief of symptoms which the conventional treatments provide, are often actually more painful, and more complicated than necessary for simpler hemorrhoid problems.

Will hemorrhoids come back after treatment?

For the external hemorrhoid removal and rubber band methods, recurrences can occur, usually after several years. After surgical removal of hemorrhoids, it is rare for hemorrhoids to ever come back.