Hemorrhoids…A Pain In The Butt
Anyone who has had to suffer from hemorrhoids knows what a pain in the butt they can be. Some medical conditions, like headaches or colds, are openly discussed among friends. But not hemorrhoids. When the commercials for hemorrhoid creams come across our TV screens, promising quick relief from the pain, itching, and burning of hemorrhoids, people either turn the channel or look around and act as if the commercial isn’t playing at all. Although hemorrhoids are a very common issue, the issue is very personal and people don’t want to share their struggle. Most people with hemorrhoids will opt for self-diagnosis and treatment at home, but they if you believe that you have hemorrhoids, you should discuss your concerns with your doctor sooner rather than later.
What are hemorrhoids and what are the symptoms?
Hemorrhoids, also called piles, are caused by swollen veins in the anus and rectum. The veins dilate as a response to pressure. Although hemorrhoids can be painless, it is not uncommon for this dilation causes irritation, pain and sometimes bleeding during and following a bowel movement.
Types Of Hemorrhoids
Hemorrhoids can be classified as internal or external.
Internal hemorrhoids are located in the anus, typically in the upper portion.
Hemorrhoids are further described by the degree in which they prolapse (protrude).
· Grade I are not prolapsed.
· Grade II hemorrhoids prolapse with straining (during a bowel movement) and return to normal without intervention.
· Grade III hemorrhoids are prolapsed and require intervention to be pushed to their normal position.
· Grade IV hemorrhoids are prolapsed and stay prolapsed even with attempted intervention.
External hemorrhoids are located in the lower and outer part of the anus. The raised area created may be normal in color, but will feel different. They may be lumpy, painful, or itchy. Irritation in the area could cause bleeding and may even lead to infection.
As the name suggests, those with mixed hemorrhoids have both internal and external hemorrhoids.
Who has a higher risk of hemorrhoids?
The elderly, obese, pregnant, those prone to constipation, and people taking anticoagulant or antiplatelet drugs such as Coumadin or heparin have a higher risk of developing hemorrhoids.
What are the causes of hemorrhoids?
Constipation is the primary cause of hemorrhoids. The increased pressure exerted while having a bowel movement increases the pressure in the veins of the anus and can lead to vessel weakness, swelling and irritation. Continued straining, over time, can lead to bleeding from the area.
Irritable Bowel Syndrome (IBS) is another cause of hemorrhoids. IBS is often associated with diarrhea, but IBS can also cause constipation. No matter the type, both diarrhea and constipation put an additional strain on the vessels of the anus.
Chronic venous insufficiency occurs when the blood does not flow properly and, due to improperly working valves in the veins, blood pools in extremities. With prolonged standing and sitting, blood not only pools in the legs and feet, but also in the vessels of the rectal area. This causes an increase in pressure in that area which leads to swelling, irritation and other symptoms. Smoking can make this worse as smoking is known to weaken the vessels. Obesity also increases the risk of chronic venous insufficiency and can a catalyst to developing hemorrhoids.
Pregnancy and central obesity can also lead to hemorrhoids. The hormonal and weight changes that occur during pregnancy are what leads to the development of hemorrhoids. The increased weight associated with pregnancy cause an increase in pressure of the blood vessels in the anus. Just as pregnancy is temporary, hemorrhoids caused during pregnancy are usually temporary.
When to call the doctor
If you see bright red blood from the rectum you should call the doctor immediately. Inability to have a bowel movement (large hemorrhoids can cause anal stricture) is also a warning sign and the doctor should be called.
How are hemorrhoids diagnosed?
Doctors make a definitive diagnosis of hemorrhoids based on symptoms and examination. During the office visit, the doctor may, using a gloved finger, feel for the bulging of hemorrhoids in the anus. If there is a history of rectal bleeding, the doctor may order further testing to visualize the colon (colonoscopy and/or sigmoidoscopy).
Treatment for hemorrhoids
Treatment for hemorrhoids varies depending on their type and severity (Grade). The primary goal of treatment is to decrease the inflammation, irritation, pain, bleeding or other symptoms. For low-grade hemorrhoids, surgical intervention is not the first choice for treatment.
Dietary and lifestyle changes are recommended for anyone with hemorrhoids. Increasing the amount of fiber in the diet can go a long way to easing the discomfort and aggravating the irritated area. Fiber is known to help ease the pain and strain of constipation. Combined with increasing water intake, a person with hemorrhoids can ease the pain of bowel movements, therefore decreasing the need to strain, increase pressure and worsening of existing hemorrhoid. Stool softeners or mild laxatives may also be prescribed.
Medications and treatments that could cause constipation or diarrhea are advised against. Over the counter and prescription creams, suppositories and wipes work to decrease inflammation, itching, and bleeding.
There are other, more involved, treatments that can be performed in the office or in surgery.
- Include rubber band ligation
- A band is tied to the base of the hemorrhoid, cutting off its blood supply; causing shrinkage. It will eventually fall off and be replaced by scar tissue.
- Outpatient procedure
- Used for internal hemorrhoids
- A liquid is injected into the blood vessels to cause shrinkage
- Used for mild hemorrhoids
- Rarely used
- Freezing the hemorrhoid
- Home or office procedure
- Surgical removal of the hemorrhoid
- Outpatient/surgery center procedure
- For large hemorrhoids (internal or external)
As hemorrhoids can be uncomfortable, inconvenient, and painful, which may not be of concern, they can become a concern due to bleeding and infection. It is important not to ignore hemorrhoids and to make lifestyle and dietary changes to prevent or reduce hemorrhoid symptoms. If hemorrhoids are expected, it is important to discuss this with your physician as dietary, lifestyle, and over-the-counter treatments may not be enough.