Hemorrhoids are the pillow-like cluster of veins underneath the mucus membranes lining your anus and the lowest part of your rectum. Using this definition, technically everyone has hemorrhoids. The condition called Hemorrhoids though is what happens when those veins swell up and either bleed, protrude, or cause pain and itching.
External vs Internal Hemorrhoids
There are two types of hemorrhoids: Internal (inside) and External (outside).
External or Thrombosed External Hemorrhoids develop around the skin of the verge or edge of the anus and are usually responsible for the pain and swelling. This is because External Hemorrhoids can cause the skin around the anus to swell and fill up with blood clot causing sudden and severe pain. A painful anal mass may appear suddenly and get worse during the first 48 hours. The pain generally lessens over the next few days. You may notice bleeding if the skin on top opens.
Internal hemorrhoids, on the other hand, form within the anus beneath the lining. Painless bleeding and protrusion during bowel movements are the most common symptoms. Bright red blood spots are seen on the toilet paper or drops of bright red blood are seen in the toilet bowl. However, an internal hemorrhoid can cause severe pain if it is completely prolapsed. This means it has slid out of the anal opening and cannot be pushed back inside.
If left untreated, Hemorrhoids can lead to anal discomfort, irritation, and itching called pruritus ani, where hemorrhoids protrude carrying with them small amounts of mucus and stool that can be quite irritating.
Causes of Hemorrhoids
The exact cause of hemorrhoids is unknown. A lot of pressure is put on human rectal veins due to our upright posture, which can potentially cause bulging. Hemorrhoids usually become a problem when a patient suffers from either diarrhea (loose or watery bowel movements) or constipation. It can also result from variability in consistency of bowel movements. Whether due to poor diet, pregnancy, or excessive sitting, this bowel irregularity can cause poor blood flow around the anus and rectum, causing these vessels to enlarge, bleed and protrude in an irritating and painful fashion.
Diagnosing Hemorrhoids
Hemorrhoids are very common. 3 out of 4 people suffer from hemorrhoids in their lifetime. It is important that symptoms are checked by a colon and rectal surgeon first before you try self-treatments. They will perform a thorough examination and recommend treatment. Mild symptoms can be relieved frequently without surgery. With nonsurgical treatment, pain and swelling usually decrease in two to seven days. The firm lump should recede within four to six weeks.
Common Treatment for Hemorrhoids
Treatment includes:
- Eating a high-fiber diet and taking over-the-counter fiber supplements (25-35 grams of fiber/day) to make stools soft, formed and bulky.
- Avoiding excessive straining to reduce the pressure on hemorrhoids and help prevent protrusion.
- Shortening time on the toilet to only 1 to 2 minutes to help prevent protrusion
- Drinking more water to help prevent hard stools and aid in healing
- Taking warm tub baths (sitz baths) for 10 to 20 minutes, a few times per day to help the healing process.
If there is evidence of microscopic bleeding, a colonoscopy may be performed in order to rule out colorectal polyps or colon cancer, especially if you are over 45.
Surgical Treatments for Hemorrhoids
Only 1 out of 10 patients need surgery, especially for large, bleeding, or painful hemorrhoids.
If pain from a thrombosed hemorrhoid is severe, your colorectal surgeon may decide to remove the hemorrhoid and/or clot with a small incision. These procedures can be done at your physician’s office or at the hospital under local anesthesia.
Rubber Band Ligation: This treatment works well on internal hemorrhoids that protrude during bowel movements. A small rubber band is placed over the hemorrhoid, cutting off its blood supply. The hemorrhoid and the band fall off in a few days. The wound usually heals in one to two weeks. Mild discomfort and bleeding may occur. This treatment needs to be repeated for complete treatment of the hemorrhoids depending on the size or if they return.
RUBBER BAND LIGATION OF INTERNAL HEMORRHOIDS:
- Bulging, bleeding, internal hemorrhoid
- Rubber band applied at the base of the hemorrhoid
- About seven days later, the banded hemorrhoid has fallen off, leaving a small scar at its base
Injection and Coagulation: This method can be used on internal hemorrhoids that do not protrude. A fat base liquid solution (commonly, Phenol 5%) is injected inside the internal hemorrhoid bags or bundles.
Both of above methods are fairly painless and cause the hemorrhoid to shrivel. Several treatments may be needed. This cannot be used for external hemorrhoids.
Hemorrhoidectomy: This is the most complete surgical method for removing extra tissue that causes bleeding and protrusion. It is done for both internal and external hemorrhoids under anesthesia using sutures. Depending on the case, hospitalization and a period of rest may be required.
Stapled Hemorrhoidectomy: This method employs a special stapling device under anesthesia to cut or shrink internal tissue but cannot be used for external hemorrhoids.
These procedures are generally more painful than rubber band ligation but are much more effective in removing hemorrhoids and preventing recurrence.
Hemorrhoids are a nuisance but with a little tweak in your diet and exercise can be gone before you know it. If you suffer from lingering problems, however, please consult a colorectal surgeon for treatment.
