Hemorrhoids
Hemorrhoids
If the diagnosis is hemorrhoids, you basically have a problem with swollen veins in and around your anus and rectum. Prolonged sitting, constipation, and hard, dry stools that are difficult to pass are often to blame. Hemorrhoids are a common problem but, still, not simple to deal with, says Amnon Sonnenberg, M.D., gastroenterologist at the Department of Veterans Affairs Medical Center and professor of medicine in the division of gastroenterology at the University of New Mexico School of Medicine, both in Albuquerque. “There are two distinct kinds,” he says, “and they should be treated differently, depending on which kind you have.”
Least worrisome are internal hemorrhoids, which may cause blood to appear in the stool but are typically painless. If an internal hemorrhoid becomes big enough, however, it may protrude outside the body through the anus, becoming sensitive and painful as a result. Internal hemorrhoids are soft. The swelling of the anal rim makes it difficult to keep this area clean, which can cause itching and irritation. This is known as a protruding hemorrhoid.
External hemorrhoids on the outside of the anus are marked by painful swelling or a hard lump caused by a blood clot in the anal region. “This is called a thrombosed external hemorrhoid, and it can be acutely painful,” says Dr. Sonnenberg. “Frequently, the painful swelling of an external hemorrhoid subsides over a period of three to seven days. External skin is more sensitive than the internal lining of the anus, so external hemorrhoids are more painful.”
In some cases—with very large or recurring hemorrhoids, for example—medical techniques including surgery may be the best answer for the problem, Dr. Sonnenberg explains, but there are a number of things you can do to ease the discomfort at home. Here are some suggestions.
Try This First
Feast on fiber, followed with water. Eating a high-fiber diet with plenty of water may be the best thing you can do to both prevent and defeat hemorrhoids, says Juan Nogueras, M.D., colon and rectal surgeon at the Cleveland Clinic in Fort Lauderdale, Florida. Why? Because an unhealthy low-fiber diet leads to dry, hard stools, which can make going to the bathroom a straining experience. The strain, in turn, can aggravate (and even cause) hemorrhoids.
To add fiber to your diet, just make sure you eat plenty of fresh fruits and vegetables, whole grains, and beans—with the option of a psyllium supplement like Metamucil. If you haven’t been consuming a high-fiber diet, start gradually, to avoid problems with gas. Eat at least 15 grams of fiber daily and work up to a total of 25 to 30 grams daily, says Dr. Nogueras. In addition, try to drink at least eight cups of water or other fluids each day. (Caffeinated drinks don’t count since they actually deplete your body of fluids.) If you make fiber plus fluids a steady habit, your stools will become much softer and easier to pass. “It takes a lot of strain off your rectum,” he says.
Other Wise Ways
Move around and about. Daily exercise plays a vital part in minimizing hemorrhoid outbreaks, according to Dr. Nogueras. When you move around, you reduce the chance of constipation that can cause or irritate hemorrhoids, he says. Try to take a walk or participate in other physical activities at least once a day. Twenty minutes of activity is a good goal to shoot for, he suggests.
Travel to your tub. A good way to ease your symptoms is to take a sitz bath once or twice a day, says Dr. Sonnenberg. Fill your bathtub with three to four inches of warm water and sit in the water for 10 to 15 minutes. The warm water will alleviate pain, provide gentle cleansing, and help to relax your anal sphincter muscles and avoid problems caused by straining to pass stools.
Stop ascending the throne. Sitting on the toilet for long periods of time adds pressure on your anal veins and can therefore put extra pressure on your hemorrhoids and aggravate them, reports Dr. Nogueras. “I tell my patients to move the magazine rack out of the bathroom,” he says. If you get restless without something to read, that’s probably a good thing; it means you’ll spend less time on the toilet and come back when the urge is greater.
Have a pillow, not a doughnut. Many people with hemorrhoids favor inflatable doughnut cushions that enhance comfortable seating at home or the office. But Dr. Nogueras is opposed to them on the grounds that they really don’t help hemorrhoids. “It just puts additional pressure on the anus by spreading and stretching the surrounding area of the buttocks,” he says. “If you need additional cushioning, use a small pillow instead.”
Bewitch the problem. Witch hazel also relieves hemorrhoidal pain and itching, says James Duke, Ph.D., botanical consultant, author of The Green Pharmacy, and a former ethnobotanist with the U.S. Department of Agriculture who specializes in medicinal plants. Using the witch hazel available at pharmacies, make a compress by saturating some folded gauze or other soft, clean cloth. Apply it to the inflamed area for a minute or two until the pain eases, recommends Dr. Duke.
Paper things over. Wiping the area with scented toilet paper can severely agitate hemorrhoids, says Dr. Nogueras, even if you’re using the most expensive brand. Instead, stick with the plain stuff, with no chemical additives whatsoever. And for severe external hemorrhoids that are difficult to keep clean, wet the toilet paper with water to keep irritation to a minimum, he suggests. Make things even more soothing by moistening the paper with witch hazel.
Stop spicing up your life. Eating foods high in strong spices like red pepper and mustard can cause your hemorrhoids to flare up, says Andrew T. Weil, M.D., director of the program in integrative medicine and clinical professor of internal medicine at the University of Arizona College of Medicine in Tucson. Coffee, decaffeinated coffee, or alcohol can also make symptoms worse, as can tobacco. If you can’t eliminate these things completely, limit your use of them as much as possible, he suggests.
Take countermeasures. Many over-the-counter remedies are effective, according to experts. Stool softeners containing docusate sodium (Colace) serve to make bowel movements much easier, says Dr. Sonnenberg.
| Managing Your Meds The list of medications that cause constipation (and therefore aggravate any hemorrhoid problem) goes on for pages, says Juan Nogueras, M.D., colon and rectal surgeon at the Cleveland Clinic in Fort Lauderdale, Florida. Calcium channel blockers such as verapamil (Isoptin), various psychiatric medicines including tricyclic antidepressants like amitriptyline (Elavil) or lithium (Lithane), and medicines that affect thyroid function, like levothyroxine (Synthroid) are just a few. “Whenever you’re prescribed a new medication, it’s a good idea to ask your doctor if constipation is a side effect,” says Dr. Nogueras. Once you know, you can either ask about alternative medications or prepare for the added pressure on your hemorrhoids. You should also watch out for multivitamins and supplements that are high in iron, he says. “Iron can cause significant constipation.” |
Dr. Nogueras recommends suppositories, which help to lubricate the anal canal, thereby reducing the strain on your hemorrhoids.
One caveat: Avoid gels and lotions that promise to ease pain through topical anesthetics like benzocaine, warns Dr. Weil. “Use Preparation H instead,” he says.
Look to the East. If you’d like to try an alternative remedy, two traditional Chinese medicine remedies correct the imbalances that may cause hemorrhoids, says Dr. Weil. Eat an orange three times a day, or eat two bananas as soon as you wake up in the morning. Continue the remedy until your hemorrhoid is gone, he says.
