Hemorrhoids - Treatment of a common problem
If you're suffering from hemorrhoids, you've certainly got company. About 75 million Americans also have hemorrhoids -- swollen bunches of blood vessels, tissue, membrane, and skin that develop within the anal canal (externally) or in the rectum (internally). They can cause mild to severe burning, inflammation, and swelling.
How do hemorrhoids happen? A diet with too little fiber is usually the culprit. Combine that with too much sitting and too little exercise, and the result can be severely strained and weakened rectal tissue.
Though you can treat most hemorrhoidal conditions with simple diet changes, sometimes they are symptoms of more serious complications such as liver disease. So if your hemorrhoids linger after an attempt at self-treatment and a change in diet, see your doctor for a more complete evaluation of the problem.
Pronunciation
HEM-uh-roid
Synonyms
Detailed Description
Three major veins drain the anal area. In the process of passing a bowel movement, they expand (dilate). The more you need to strain to pass a stool, the more they expand. Over time, passing difficult and dry stools can swell and enlarge these veins. Essentially, they become varicose veins, and can be inside or outside the anus. Externally, they seem to be more painful, and internally, they have a tendency to bleed more often. Either way, these enlarged veins put pressure on surrounding nerves and create itchiness and discomfort.
Though they seem to have a genetic component and run in families, contributing factors such as excessive sitting (especially on the toilet for long periods), constipation, pregnancy, and being overweight are circumstances associated with hemorrhoid development.
In most cases, hemorrhoids are a minor inconvenience. The first line of defense is to change your diet so that your stools are softer and easier to pass. Without straining, hemorrhoids will most likely relax and the vein will shrink to its normal size.
In some cases, hemorrhoids cause a great deal more trouble than simple itching and irritation. They can become swollen and engorged with blood to the point that the pain is intolerable. Hemorrhoids can also bleed and become infected, bringing on anemia and other medical difficulties. In this case, surgery is in order. Your doctor can treat them with rubber-band ligation or a scarring agent.
How Common Are Hemorrhoids?
About 75 million Americans have hemorrhoids -- roughly one-third of the population. Hemorrhoids develop in an equal number of men and women and strike any age group, though they are slightly more common in older people because the blood vessels become thicker and less elastic with age. They are extremely rare in children under age 12.
Possible Underlying Causes
- Repeatedly spending a long time (more than four to five minutes) sitting on the toilet
- Straining during bowel movements or childbirth
- Passing a sharp object in the stool
- Accumulation of fecal "pockets" within the anal canal
- Liver disease (in rare cases)
Triggers of Hemorrhoids
Constipation is a major contributor to hemorrhoids. Dry, hard stools are more difficult to pass, and the more you need to strain to pass them, the more likely you are to develop or aggravate a hemorrhoid. Rarely, an underlying condition like colorectal cancer can cause the constipation itself. Contributing factors such as excessive sitting, pregnancy, and being overweight are also associated with hemorrhoids.
Drugs That Can Cause or Aggravate Hemorrhoids
Several drugs, including isosorbide mononitrate and succimer, may bring about hemorrhoids.
Diagnosing the Underlying Cause
There are two types of hemorrhoids: internal and external. External hemorrhoids are located outside the anal opening. These are easily seen and usually painful. Internal hemorrhoids are located inside the anal opening. They are not painful but tend to bleed more than external hemorrhoids.
Other medical conditions may resemble hemorrhoids. AV malformations, diverticulosis, rectal neoplasms, anal fissures, colitis, and proctitis can all cause rectal bleeding. If your hemorrhoids do not improve with self-treatment, or if you are concerned about your symptoms, seek the advice of your physician. He or she can perform a thorough physical examination (and diagnostic tests, if necessary) to rule out the possibility of a more serious medical problem.
Diagnostic Procedures
Your doctor will perform a medical history and physical exam, including a rectal exam. If needed, he or she will examine a hemorrhoid within the anus using anoscopy or sigmoidoscopy. Either procedure will involve the insertion of a thin tube into the anus. Anoscopy examines the anus and rectum, while sigmoidoscopy examines the rectum and sigmoid colon.
Goals of Treatment
Stools that cannot pass without strain often cause -- and aggravate -- hemorrhoids. To eliminate this problem, enhance your diet with fiber-filled foods such as grains, complex carbohydrates, fruits, and vegetables. The more moist and easily passable the stool, the less likely you will have to strain to defecate. Drink plenty of water (eight glasses a day at least) and use a fiber supplement.
Aside from changing your diet, the first line of defense in the treatment of hemorrhoids is to relieve the symptoms. Many products on the market can help relieve the itching and pain associated with hemorrhoids:
- Hemorrhoid pain relievers
- Itch/pain relievers -- also called counterirritants -- block the sting and itch of hemorrhoids by creating some of their own sting-cool-soothe distraction
- Sitz baths may be recommended to help relieve symptoms
- Corticosteroids relieve anal itching
Your doctor may treat severe hemorrhoids with injection of a sclerosing or scarring agent, rubber band ligation, or surgery.
Considerations for Women
Hemorrhoids are common in pregnancy. They rarely require treatment unless they are particularly painful.
Considerations for Older People
Hemorrhoids can cause blood loss, a particularly delicate condition for older people, and, rarely, iron-deficiency anemia. Hemorrhoids are particularly common in the older population because the veins begin to lose some of their elasticity with age.
Other, more serious, conditions that can cause rectal bleeding (such as cancer) are more common in older people. A doctor should evaluate any rectal bleeding.
Considerations for Children and Adolescents
Hemorrhoids are uncommon in very young children. Underlying causes of hemorrhoids may warrant medical investigation in younger patients. Consult with your child's doctor to rule out such causes as physical obstruction.
Preventing Hemorrhoids
- Don't strain. When you sit on the toilet, don't push too hard or for too long. Straining contributes to hemorrhoids.
- Get more exercise. Hemorrhoids are an occupational hazard of long-distance truck drivers, office workers, and others whose jobs require sitting for long periods. If you work in a chair, get up and walk around every hour or so. Regular exercise also helps prevent constipation.
- Watch out for constipation. Hemorrhoids are usually a side effect of constipation. If you suffer from this condition, follow the suggestions in constipation to help rid yourself of this annoying problem.
Herbs
- Witch hazel: cools and soothes hemorrhoids. It's the active ingredient in Tucks pads and other over-the-counter hemorrhoid treatments. [1] Apply it with cotton balls.
- Aloe vera gel: an astringent that soothes hemorrhoids. [2] If you have a plant, snip a leaf, slit it open, and scoop out a little gel. Apply it with a cotton ball.
Source
1, 2 Duke, J. The Green Pharmacy.. Emmaus, PA: Rodale Press, 1997.
Preventative Measures
Paying attention to your diet is the best way to prevent hemorrhoids. Drinking at least eight glasses of water a day and eating high-fiber, whole-grain, and complex-carbohydrate-rich meals will ensure that your digestion is even and balanced. You will strain less when eliminating softer stools. Stool softeners and bulk-forming laxatives can help relieve constipation. Avoid spending long periods of time (more than four to five minutes) sitting on the toilet. You will know you are drinking enough water if you have to urinate frequently.
Maintaining good hygiene is also important. Use soap and water after you defecate so that the bowel movement doesn't lead to infection.
Self-Care Measures
In addition to the above measures, these self-treatment steps can help reduce hemorrhoids and their discomfort:
- Try applying an ice pack. Ice helps shrink swollen, inflamed hemorrhoids. Place some ice in a plastic bag and wrap the bag in a cloth. Apply the pack for 15 minutes at a time, taking 15-minute breaks between applications.
- Take a bath. Warm baths and sitz baths are an age-old folk remedy for soothing hemorrhoids.
When to Call the Doctor
- If you notice any rectal bleeding
- If mucus discharge occurs
Websites & Organizations
American College of Obstetricians and Gynecologists (ACOG)
409 12th Street SW
Washington, DC 20024
Phone: 800-673-8444
American Dietetic Association
216 West Jackson Blvd., Ste. 800
Chicago, IL 60606-6995
Phone: 312-899-0040
American Digestive Health Foundations
7910 Woodmont Avenue, 7th Floor
Bethesda, MD 20814-3015
Phone: 301-654-2635
Fax: 301-654-1140
Email: dlee@gastro.org
American Society of Colon and Rectal Surgeons
85 W. Algonquin Road, Suite 550
Arlington Heights, IL 60005
Phone: 847-290-9184
Fax: 847-290-9203
American Thyroid Association
Endocrine-Metabolic Service
Walter Reed Army Medical Center
Washington, DC 20307-5001
Phone: 202-882-7717 or 800-542-6687
Fax: 202-882-7813
National Digestive Diseases Information
Box NDDIC
Bethesda, MD 20892
Phone: 301-468.6344
United Ostomy Association
36 Executive Park, Suite 120
Irvine, CA 92714
Phone: 800-826-0826 or 714-660-8624
Email: uoa@deltanet.com
Sources & Further Reading
Books
Balch, James F. and Balch, Phyllis A. Prescription for Nutritional Healing. Garden City Park, NY: Avery Publishing, 1997.
Fauci, Anthony J., et. al. Harrison's Principles of Internal Medicine, eds. New York: McGraw-Hill, 1998.
Hurst, J. Willis. Medicine for the Practicing Physician eds. Stamford, CT: Appleton & Lange 1996.
Murray, Michael T. Encyclopedia of Natural Medicine. Prima, 1998.
Noble, John. Primary Care Medicine ed. St. Louis: Mosby, 1996.
Physicians' Desk Reference. Montvale, NJ: Medical Economics Co., 1998.
Rakel, Robert E. Conn's Current Therapy eds. Philadelphia: W.B. Saunders, 1998.
Taylor, Robert B. Family Medicine: Principles and Practice. New York: Springer-Verlag, 1998.
Tierney, LM, McPhee, SJ, and Papadakis, MA. Current Medical Diagnosis and Treatment eds. Stamford, CT: Appleton & Lange, 1998.
Articles
Dennison, AR, Paraskevopoulos, JA, Kerrigan, DD, Shorthouse, AJ. "New Thoughts on the Aetiology of Haemorrhoids and the Development of Non-Operative Methods for their Management." Minerva Chir. 51(4):209-16. Apr 1996.
Dennison, AR, Paraskevopoulos, JA, Kerrigan, DD, Shorthouse, AJ. "Rubber Band Ligation of Hemorrhoids. Convenient and Economic Treatment." J Clin Gastroenterol. 23(1):50-2. Jul 1996.
Duke, J. Green Pharmacy. Rodale Press, Emmaus, PA, 1997
Janicke, DM, Pundt, MR. "Anorectal Disorders." Emerg Med Clin North Am. 14(4):757-88. Nov 1996.
Johanson, JF. "Association of Hemorrhoidal Disease with Diarrheal Disorders: Potential Pathogenic Relationship?" Dis Colon Rectum. 40(2):215-9; discussion 219-21. Feb 1997.
Metcalf, A. "Anorectal Disorders. Five Common Causes of Pain, Itching, and Bleeding." Postgrad Med. 98(5):81-4, 87-9, 92-4. Nov 1995.
Nagle, D, Rolandelli, RH. "Primary Care Office Management of Perianal and Anal Disease." Prim Care. 23(3):609-20. Sep 1996.
Newton, GD, Pray, WS, Popovich, NG. "New OTC Drugs and Devices: A Selected Review." J Am Pharm Assoc. NS36(2):108-116. Feb 1996.
Pfenninger, JL, Surrell, J. "Nonsurgical Treatment Options for Internal Hemorrhoids." Am Fam Physician. 52(3):821-34, 839-41. Sep 1, 1995.
Polglase, AL. "Haemorrhoids: A Clinical Update." Med J Aust. 167(2):85-8. Jul 21, 1997.
Sinclair, A. "Remedies for Common Family Ailments: 9. Haemorrhoids." Prof Care Mother Child. 5(6):161-2. 1995.
