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Hemorrhoids

The term hemorrhoids refers to a condition in which the veins
around the anus or lower rectum are swollen and inflamed.

Hemorrhoids may result from straining to move stool. Other
contributing factors include pregnancy, aging, chronic
constipation or diarrhea, and anal intercourse.

Hemorrhoids are either inside the anus (internal) or under the
skin around the anus (external).

What are the symptoms of hemorrhoids?
Many anorectal problems, including fissures, fistulae,
abscesses, or irritation and itching (pruritus ani), have similar
symptoms and are incorrectly referred to as hemorrhoids.

Hemorrhoids usually are not dangerous or life threatening. In
most cases, hemorrhoidal symptoms will go away within a few
days.

Although many people have hemorrhoids, not all experience
symptoms. The most common symptom of internal
hemorrhoids is bright red blood covering the stool, on toilet
paper, or in the toilet bowl. However, an internal hemorrhoid
may protrude through the anus outside the body, becoming
irritated and painful. This is known as a protruding
hemorrhoid.

Symptoms of external hemorrhoids may include painful
swelling or a hard lump around the anus that results when a
blood clot forms. This condition is known as a thrombosed
external hemorrhoid.

In addition, excessive straining, rubbing, or cleaning around
the anus may cause irritation with bleeding and/or itching,
which may produce a vicious cycle of symptoms. Draining
mucus may also cause itching.

How common are hemorrhoids?
Hemorrhoids are very common in both men and women.
About half of the population have hemorrhoids by age 50.
Hemorrhoids are also common among pregnant women. The
pressure of the fetus in the abdomen, as well as hormonal
changes, cause the hemorrhoidal vessels to enlarge. These
vessels are also placed under severe pressure during
childbirth. For most women, however, hemorrhoids caused by
pregnancy are a temporary problem.

How are hemorrhoids diagnosed?
A thorough evaluation and proper diagnosis by the doctor is
important any time bleeding from the rectum or blood in the
stool occurs. Bleeding may also be a symptom of other
digestive diseases, including colorectal cancer.

The doctor will examine the anus and rectum to look for
swollen blood vessels that indicate hemorrhoids and will also
perform a digital rectal exam with a gloved, lubricated finger
to feel for abnormalities.

Closer evaluation of the rectum for hemorrhoids requires an
exam with an anoscope, a hollow, lighted tube useful for
viewing internal hemorrhoids, or a proctoscope, useful for
more completely examining the entire rectum.

To rule out other causes of gastrointestinal bleeding, the
doctor may examine the rectum and lower colon (sigmoid)
with sigmoidoscopy or the entire colon with colonoscopy.
Sigmoidoscopy and colonoscopy are diagnostic procedures
that also involve the use of lighted, flexible tubes inserted
through the rectum.

What is the treatment?
Medical treatment of hemorrhoids is aimed initially at relieving
symptoms. Measures to reduce symptoms include

* tub baths several times a day in plain, warm water for
about 10 minutes
* application of a hemorroidal cream or suppository to the
affected area for a limited time

Preventing the recurrence of hemorrhoids will require relieving
the pressure and straining of constipation. Doctors will often
recommend increasing fiber and fluids in the diet. Eating the
right amount of fiber and drinking six to eight glasses of fluid
(not alcohol) result in softer, bulkier stools. A softer stool
makes emptying the bowels easier and lessens the pressure
on hemorrhoids caused by straining. Eliminating straining also
helps prevent the hemorrhoids from protruding.

Good sources of fiber are fruits, vegetables, and whole
grains. In addition, doctors may suggest a bulk stool softener
or a fiber supplement such as psyllium (Metamucil) or
methylcellulose (Citrucel).

In some cases, hemorrhoids must be treated endoscopically
or surgically. These methods are used to shrink and destroy
the hemorrhoidal tissue. The doctor will perform the
procedure during an office or hospital visit.

A number of methods may be used to remove or reduce the
size of internal hemorrhoids. These techniques include

* Rubber band ligation. A rubber band is placed around the
base of the hemorrhoid inside the rectum. The band cuts off
circulation, and the hemorrhoid withers away within a few
days.
* Sclerotherapy. A chemical solution is injected around the
blood vessel to shrink the hemorrhoid.
* Infrared coagulation. A special device is used to burn
hemorrhoidal tissue.
* Hemorrhoidectomy. Occasionally, extensive or severe
internal or external hemorrhoids may require removal by
surgery known as hemorrhoidectomy.

How are hemorrhoids prevented?
The best way to prevent hemorrhoids is to keep stools soft
so they pass easily, thus decreasing pressure and straining,
and to empty bowels as soon as possible after the urge
occurs. Exercise, including walking, and increased fiber in the
diet help reduce constipation and straining by producing
stools that are softer and easier to pass.

Content Source NIDDK.NIH

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