Hemorrhoids

Hemorrhoids are swollen and inflamed veins around the anus or in the lower rectum. They may occur inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids). Straining during bowel movements or pregnancy causes increased pressure on these veins and contributes to the development of hemorrhoids. Hemorrhoids are a common problem affecting three out of four people and are frequently found amongst adults ages 45-to-65 and pregnant women, according to the National Institutes of Health. Although hemorrhoids can be painful, they are often not serious and can be treated with home remedies and lifestyle changes.

Symptoms

Hemorrhoid symptoms may vary depending on whether they are found externally or internally. External hemorrhoids, found under the skin, around the anus are often associated with itching and bleeding. Streaks of blood maybe seen on the toilet paper if excessive strain is used to pass a bowel movement. In addition, blood clots can form in an external hemorrhoid and may result in severe pain, swelling and inflammation. Internal hemorrhoids are found inside of the rectum and are usually not painful. These type of hemorrhoids are most are commonly associated with rectal bleeding. Bright red blood maybe found on the toilet paper or in the toilet bowl after having a normal bowel movement. Blood also may be visible on the surface of the stool. Other symptoms of internal hemorrhoids include:

• Itching
• Skin irritation
• Discomfort

Causes

Hemorrhoids occur as a result of elevated pressure on the veins in the rectal area. This increased pressure causes a pooling of blood and subsequent swelling in these veins. These swollen veins are stretched around the surrounding tissue and develop into hemorrhoids. Factors that contribute to this increased pressure and consequential swelling are:

• Sitting on the toilet for long periods of time
• Straining during bowel movements
• Chronic diarrhea or constipation
• Lack of fiber in the diet
• Pregnancy
• Obesity

Hemorrhoids may also develop with age as the connective tissue in the rectum and anus weakens.

Diagnosis

To diagnose hemorrhoids, the doctor will examine the anal canal and rectum. For external hemorrhoids, a digital rectal exam is performed where the doctor will insert a gloved and lubricated finger into your rectum. The doctor may also choose to use an anoscope, which is a hollow, lighted tube that is inserted a few inches into the anus. Since internal hemorrhoids maybe missed during a digital rectal exam, a doctor may use additional exams to assess the occurrence of hemorrhoids. These exams include:

• Proctoscopy: the insertion of a lubricated proctoscope ( a lighted, short, straight, rigid, hollow metal tube) into the rectum.
• Colonoscopy: the insertion of a colonscope (a flexible and lighted tube) through the anus, the rectum and the colon. 
• Sigmoidoscopy: similar to a colonoscopy, but uses a sigmoidoscope (a shorter tube) that is inserted into the rectum and the sigmoid colon.

Treatment

In most cases, hemorrhoids are treatable with simple dietary and lifestyle changes. Incorporating more fiber into a diet can soften the stool allowing it to pass with more ease and as a result reduce the pressure on hemorrhoids caused by straining. In addition, one can also take a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel). Bulk stool softeners such as Colace or Dulcolax are also available. However, these should not be used for more than a week unless otherwise indicated by a doctor.

Other lifestyle and dietary changes that may help relieve hemorrhoid symptoms include:

• Staying hydrated. Drink six to eight 8-ounce glasses of water or other nonalcoholic fluids daily.
• Soaking in a tub of warm water for ten minutes, several times a day.
• Exercising to prevent constipation.
• Applying ice packs or cold compresses on your anus to relieve swelling.
• Using moist towelettes (that do not contain perfume or alcohol) or wet toilet paper to help clean the anal area after a bowel movement.

Over-the-counter creams and suppositories may temporarily relieve the pain and itching of hemorrhoids. However, these treatments should only be used sparingly for a short time because extended use can damage the skin. Relief from hemorrhoid symptoms should occur within a few days of making the appropriate dietary and lifestyle changes.

(For tips on hemorrhoid prevention, read 7 Easy Tips On How To Prevent Hemorrhoids.)

If dietary and lifestyle changes do not ease hemorrhoid symptoms, then medical intervention may be necessary. Outpatient procedures can be performed in a doctor's office or a hospital. Outpatient treatments for internal hemorrhoids include the following:

• Rubber band ligation: A rubber band is placed at the base of a hemorrhoid, cutting off the circulation and causing the hemorrhoid to shrink.
• Sclerotherapy: A chemical solution is injected into the blood vessel in order to shrink the hemorrhoid.
• Infrared coagulation: Heat is utilized to shrink the hemorrhoid.
• Surgical Removal: Large external hemorrhoids that do not respond to the other treatments may be removed surgically.

Sources:

• NDDIC
• PubMed