Dr. MJ Bazos MD,
What Are Hemorrhoids?
Hemorrhoids are normally present
but swollen blood vessels in and around the anus and lower rectum that stretch
under pressure, similar to varicose veins in the legs. The increased pressure
and swelling may result from straining to move the bowel. Other contributing
factors include pregnancy, heredity, aging, and chronic constipation or
diarrhea. Hemorrhoids are either inside the anus (internal) or under the skin
around the anus (external).
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
How Common Are
Hemorrhoids are very
common in 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
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 lasts more than a couple of days. 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
What Is the Treatment?
Medical treatment of hemorrhoids
initially is aimed at relieving symptoms.
Measures to reduce symptoms include:
- Warm tub or sitz baths several times a day in
plain, warm water for about 10 minutes.
- Ice packs to help reduce swelling.
- Application of a hemorroidal cream or suppository
to the affected area for a limited time.
Prevention of the
recurrence of hemorrhoids is aimed at changing conditions associated with 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.
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
surgically. These methods are used to shrink and destroy the hemorrhoidal tissue
and are performed under anesthesia. The doctor will perform the surgery during
an office or hospital visit.
of surgical 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.
- Techniques used to treat both internal and
external hemorrhoids include:
- Electrical or laser heat (laser coagulation) or
infrared light (infrared photo coagulation)—Both techniques use special
devices to burn hemorrhoidal tissue.
- Hemorrhoidectomy—Occasionally, extensive or
severe internal or external hemorrhoids may require removal by surgery known as
hemorrhoidectomy. This is the best method for permanent removal of hemorrhoids.
How Are Hemorrhoids
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. In addition, a person should not sit on the toilet for a long period of