Central Indiana Proctology

Hemorrhoids

Hemorrhoids, or piles, are one of mankind's most common and nagging disorders. By themselves, hemorrhoids are rarely serious, but they can be extremely troublesome. In some instances, they may mask a more serious disorder, such as colon or rectal cancer. Therefore, hemorrhoids require the proper diagnosis and treatment by a physician. Hemorrhoids are dilated (enlarged) veins which occur in and around the anus and rectum. They may be external ( outside the anus) or internal and slip to the outside. In both of these instances, the hemorrhoids can be felt and seen as lumps or knots. Hemorrhoids also may remain inside the rectum and so cannot be felt or seen. These are called internal hemorrhoids.

What Causes Hemorrhoids?

A common cause of hemorrhoids is simply the standing position, in which all the blood above the rectum exerts pressure on the rectal and anal areas. Other conditions which contribute to hemorrhoids are: poor bowel habits, constipation, diarrhea, pregnancy, obesity, and especially frequent straining when having a bowel movement. However, some patients will have none of these conditions and still develop hemorrhoids

How Common Are Hemorrhoids?

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 the 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.

What Kinds of Hemorrhoids Are There?

External Hemorhoids - Just outside the anus, these small, soft pads are the same color as your skin. External hemorrhoids rarely cause pain unless they form a blood clot, or thrombose. Then they turn blue and may cause sudden, severe pain.

Internal Hemorrhoids - Internal hemorrhoids commonly occur in clusters around the anal canal wall and are usually painless. They may protrude or prolapse, from the anus when you strain and may disappear when you relax. Bright red or dull maroon in color, they may bleed or discharge mucus.

Other Anal Problems - Other problems may cause discomfort in the anal area. A fissure, an infected pathway, a crack in the anal canal's skin, may be painful and bleed. A fistula, an infected pathway, may develop as a abscess works its way from the inside the anal canal to the outside skin. It may be either painful or painless and usually causes a lot of drainage.

What Are the Complications?

Hemorrhoids can produce several uncomfortable, but non serious problems.

Thrombosis and Pain - A blood clot in the hemorrhoid may cause severe pain and usually demands immediate medical attention.

Bleeding - Hemorrhoids can ooze fresh red blood, whether located externally or internally. External hemorrhoids often cause dripping of blood from the anus while sitting on the toilet. The blood might also be seen as soiling of the underwear. Internal hemorrhoids that bleed may produce fresh blood in the stool.

Itching and Irritation - External hemorrhoids can be itchy, especially if the area is moist and irritated.

Do Hemorrhoids Cause Cancer ?

Hemorrhoids do not develop into cancer. However, both hemorrhoids and cancer can cause rectal bleeding. In fact, many disorders can be the cause of rectal bleeding. When rectal bleeding occurs in persons over age 30, and especially in those over age 50, it should be considered a serious problem until an exact diagnosis is made.

How Can I Feel Better?

Develop Good Bowel Habits - Everyone's system is different so don't push yourself to have a bowel movement every day. Don't stain on the toilet and don't put off the urge to go. Sit on the toilet only as long as necessary and don't read while you are there. Wipe gently with soft, white, unscented toilet paper.
Use Ice Packs - An ice pack applied to a thrombosed external hemorrhoid soon after it first appears can relieve the pain within a few minutes and reduce the clot within a few days. Use the ice for no more than a few minutes at a time, and stop using it altogether after a few hours.
Take Sitz Baths - Sit for a few minutes in about three inches of warm water for immediate relief of symptoms.
Laxatives - Laxatives and enemas can help ease constipation, but use them only on your doctor's advice.

Treatment

When hemorrhoids require treatment, the following general measures are recommended:

Conservative Treatment

Keep the anal area clean, using a mild soap and gentle dabbing after a bowel movement. Avoid vigorous rubbing of the area
Keep the anus and hemorrhoids as dry as possible, using talcum powder and a pad of soft tissue to absorb moisture.
Eat a diet high in fiber (bran) and roughage. Fiber and bran retain water in the stool, producing soft, bulky stools which are easier to pass and reduce the tendency to develop hemorrhoids.
Avoid straining when having a bowel movement.
When thrombosis, pain, and tenderness occur, a 10 to 20 minute hot tub bath two to four times daily brings heat to the area, provides relief from the pain, and promotes healing. This is called a hot Sitz bath.

What is Ligation?

A common method performed in our office of treating internal hemorrhoids is to use a small rubber band to tie off the base of the swollen vein. The blood circulation stops and the hemorrhoid then falls off. Repeat treatments are sometimes necessary.

How does Infrared Photocoagulation work?

Another treatment offered in the office is an infrared light source. It can be used to coagulate internal hemorrhoidal veins. Often, more than one treatment is necessary.

Will I Need Surgery?

Surgery is rarely recommended in treating hemorrhoids. It usually is reserved for:

Acute, painful clot (thrombosis) of hemorrhoids
Profusely or continuously bleeding hemorrhoids
Long standing, irreversible, and large hemorrhoids
When other treatment is unsuccessful

The physician evaluates each patient's case to determine the appropriate treatment.

What Happens During Surgery?

If surgery is required, then your doctor inserts a spoonlike instrument (retractor) into the anal canal, and removes the swollen hemorrhoid. To provide the drainage for fluid or mucus, the incision may be left open, or it may be stitched partially closed. Several hemorrhoids may be removed during your surgery.

After Surgery?

You will be taken to the recovery area, where a nurse monitors your heart rate and blood pressure. If you don't have extensive pain or difficulty with urination, you may be able to go home the same day. Otherwise, your doctor may ask you to stay a day or two in the hospital. For a short time, you may have gas cramps, nausea, or light bleeding. These should soon disappear.

During the next few days, you'll feel some discomfort and may have muscle spasms with bowel movements. You may fear the first bowel movement after surgery, but don't be afraid to push as hard as you usually do. Delaying your first bowel movement only makes it more difficult. Stool softerners, laxatives, bulk agents, and medication may be prescribed to relieve discomfort.

To Prevent Hemorrhoids

Eat plenty of insoluble fiber such as:

Whole grains, especially wheat bran, corn bran, and brown rice.
Vegatables, especially carrots, broccoli, and peas.
Fruits, especially apples, bananas, raisins, and pears.
Nuts and legumes, especially peanuts, lentils, and kidney beans.

to create regular, soft bowel movements.

Do not delay or try to prevent a bowel movement when the urge is present.

Exercise, especially aerobic, may help produce more regular bowel movements. .Drink plenty of liquids and eat regularly scheduled meals.

Keep the area around the anus clean and dry.