Hemorrhoids

Basic Information

Hemorrhoids are small, abnormally dilated varicose veins of the anus and rectum. They begin as quite normal veins which help to pass the stool with ease. They are found at the rear of the rectal canal. There are two types of hemorrhoids: external and internal. Found inside the rectum, internal hemorrhoids protrude from the anus as they enlarge. External hemorrhoids however are outside the anus but skin covers the hemorrhoids going into the internal section and external hemorrhoids are covered by the colon lining (mucosa). Thrombosed or clotted external hemorrhoids can be very painful. The pain occurs from the swelling or inflammation when blood instead of flowing through the vein becomes clotted inside the vein. Sometimes there is blood if the clot tears open the skin, usually leaving some damage in the vein. Often there is bleeding as healing tries to occur by pushing out the clot .

Internal hemorrhoids do not have the covering of skin so the pain that is associated with external hemorrhoids is not present. There may be blood in passing the stool as there is blood with external hemorrhoids. Whenever there is blood from passing stools even if it is a small amount it is necessary to be certain to find the cause. Even if you suspect it is likely to come from hemorrhoids other causes should be ruled out. Hemorrhoids occur when there is an increase in pressure in the anorectal canal. Hemorrhoids are usually caused by straining when passing stools. The length of time you remain on the toilet increases your susceptibility to hemorrhoids. That is because of the pull of gravity at the veins

External hemorrhoids can be quite painful because of the inflammation and can be frightening if there is bleeding. Hemorrhoids occur nondiscriminately across the board. Adults and children are affected alike and heterosexual and gay men alike are prone to the disease. It is often assumed that gay men get hemorrhoids through anal sex and this can occur. But too many heterosexual males have hemorrhoids too and the most likely causes remain straining when having a bowel movement. Straining to bend down to lift objects or even a strong cough or sneeze can precipitate a case of hemorrhoids. It is usually difficult to pinpoint most causes. It is thought that half of the population in the U.S. has hemorrhoids at one period or another, some having repeated cases of hemorrhoids while others just suffering from one incidence.

Symptoms

Sometimes there are no symptoms and it is thought that if there is a lack of symptoms associated with the hemorrhoids that it is a normal condition. Sometimes when underwear is soiled anal itching and burning can occur. Perhaps the most common symptom is bleeding. Often the hemorrhoid sufferer will find some blood on the tissue after a bowel movement or notice a streak of blood in the stool but sometimes there may be blood in the toilet bowl. The blood in the bowl may look worse than it is as it takes just a small amount of blood to turn the water in the bowl red. An uncomfortable protrusion -- yet another symptom -- and pain is associated with external hemorrhoids.

Other symptoms which are not as usual are a difficulty in cleaning the anus if the patient has external hemorrhoids and a mucous discharge or feeling that you still have to void your stool with internal hemorrhoids.

Diagnosis/Treatment

Your health care provider should take a history of any bleeding, bowel movements, pain or swelling that you have experienced. By inspecting the rectum your health care provider can usually diagnose external hemorrhoids An anoscopy will be recommended for diagnosing internal hemorrhoids. To see the extent of hemorrhoid activity a phosphate enema will often be recommended.

There are several ways to treat hemorrhoids. Often they resolve on their own after a few weeks. Other cases require surgery. However the non-surgical approach is often the first step in treatment. Having a soft but formed stool is ideal and this can usually be achieved by taking stool lubricants such as colace to avoid irritating the hemorrhoids. Creams and ointments can lessen the discomfort and swelling. Topical creams and ointments containing hydrocortisone have proven effective. Preparation H has been a popular medication. For internal hemorrhoids a suppository may be more appropriate than a cream. A warm sitz bath will help relax your anus and control swelling. Tucks pads, especially applied when cold, protect against uncomfortable rubbing and will bring a modicum of relief, at least temporarily.

Diets high in fiber, especially plant fiber, are essential in softening the stool. Fiber supplements are available for those patients who do not normally have a lot of natural fiber in their diet.. But remember, drink plenty of water so that the fiber will remain wet and can act as the laxative needed to pass comfortably through a hemorrhoid that is inflamed. Avoid constipation even if it is painful to have a bowel movement because constipation will only make the bowel movement when it does come hard and unpliable.

Surgical removal of hemorrhoids is effective and lasting. In fact it is essentially the only treatment for removal of external hemorrhoids but it can be quite painful. This procedure is called a hemorrhoidectomy and is not recommended for mild cases. Laser surgery is an option that is considered less painful, usually without the scarring that can occur when under the knife.

If you have a thrombosed hemorrhoid you and your health care provider must decide whether surgery is the best option and it may well be an acute case. Usually it is advised that the hemorrhoid be completely removed instead of incised and drained because total removal removes the damaged vein as well as the clot.

Internal hemorrhoids can be treated in several ways:

• sclerotherapy (A caustic fluid is injected into each hemorrhoid one at a time making the blood sclerose or clot causing the hemorrhoids to shrivel and die.)
• rubber band ligation (A quarter-inch elastic band is dilated to three-eighths of an inch. The hemorrhoid is tied in the band and withdrawn then freed. Thus the hemorrhoid is ligated causing the hemorrhoid to die. This is an especially effective treatment for hemorrhoids that protrude. Sometimes hemorrhoids are a combination of external and internal and if this is the case with your hemorrhoids rubber band ligation for the internal section is usually indicated.)
• infrared photo coagulation (Infrared light or electricity clots off blood to the hemorrhoid and the hemorrhoid dies.)

It is usually recommended that hemorrhoids should be ligated only once every three weeks.

Except by hemorrhoidectomy (surgical removal) there is no guarantee that your case of hemorrhoids will not return. You must follow up with your health care provider for a number of weeks so that your treatment, any bleeding, status of your swelling and evaluation of your diet can be monitored.

If you are a gay male engaging in anal sexual activity you should speak frankly with your health care provider about the advisability and consequences of anal sex and hemorrhoids. It is often not necessary to stop anal sex altogether over time but irritation and bleeding can occur. You certainly will not be able to have anal sex until the anal area heals after treatment. This can generally take two weeks to a month. If you undergo a hemorrhoidectomy anal sex can usually resume within two months but very gently with a position of lying on your stomach to control swelling being the optimum position when having anal sex. Each case is different and you must discuss any return to anal sexual activity with your health care provider before resuming this sexual activity. Be certain you do not have specific medical problems or after-effects from treatment that would be deleterious to your health.

If you have hemorrhoids please contact your health care provider.