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Hemorrhoids
What Are Hemorrhoids?
Hemorrhoids are swollen
but normally present 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).
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.
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
problem.
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 the rectum.
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.
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 surgically. These methods are used to shrink
and destroy the hemorrhoidal tissue and are performed under
anesthesia. The doctor will preform the surgery during an office
or hospital visit.
A number 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.
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.
National Digestive
Diseases Information Clearinghouse
2 Information
Way
Bethesda, MD 20892-3570
E-mail: nddic@info.niddk.nih.gov
NIH Publication
No. 95-3021
May 1994
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