Hemorrhoids and their Treatment

HEMORRHOIDS OVERVIEW

Hemorrhoidal veins are a normal part of the circulation in the anal area.  Usually they are flat and cause no symptoms. When they become enlarged or swollen we then diagnose as having hemorrhoids. The most common symptoms of hemorrhoids are rectal bleeding, itching, and pain. Hemorrhoids can be external, you may be able to see or feel them around the outside of the anus, or they may be internal hidden, inside the rectum. Large internal hemorrhoids can protrude through the anus. Hemorrhoids are common, occurring in both men and women. Although hemorrhoids do not usually cause serious health problems, they can be annoying and uncomfortable.

Hemorrhoids can occur in anyone and without any predisposing factors. Hemorrhoids are more common in people with diarrhea, or constipation, and straining with bowel movements.  Women often develop hemorrhoids as a consequence of straining during childbirth.

HEMORRHOID SYMPTOMS

Symptoms of hemorrhoids can include the following:

  • Painless rectal bleeding
  • Anal itching or pain when the skin on or around the hemorrhoids are irritated
  • Tissue bulging around the anus
  • Leakage of feces or difficulty cleaning after a bowel movement
  • Anal pain if external hemorrhoids become clotted off.

Rectal bleeding is the most common symptom of hemorrhoids, not surprisingly since hemorrhoids are blood vessels.  Blood is usually bright red and seen in or after bowel movements and on the toilet paper.  The amount of blood is usually not excessive but even a small amount of blood in the toilet bowl can cause the water to appear bright red. There are many other and more serious causes of bleeding and any rectal bleeding should be brought to medical attention.

Itching can occur usually due to irritation of the skin over hemorrhoids.

Painful hemorrhoids can primarily occur when then become clotted off (thrombosed). Severe and acute discomfort may require urgent treatment.

HEMORRHOID DIAGNOSIS

External hemorrhoids can be diagnosed by visual inspection of the anal area.

Internal hemorrhoids required an instrument to inspect inside the rectum: anoscopy, flexible sigmoidoscopy, or colonoscopy.

INITIAL HEMORRHOID TREATMENT

Straining causes increased pressure in  the hemorrhoidal veins and contributes to swelling. Keeping the stools soft and avoiding straining can be accomplished with dietary changes or stool softeners/laxative.  Minimizing time sitting on the toilet will also reduce pressure.

Fiber supplements — Increasing fiber in your diet is one of the best ways to soften your stools. Fiber is found in fruits and vegetables. The recommended amount of dietary fiber is 20 to 35 grams per day.  Daily use of a bulk fiber supplement (Metamucil and others) can be used to achieve this fiber goal, if needed.

If increasing fiber is not sufficient to relieve constipation, laxatives can be used. Some laxatives that work by drawing water into the colon (osmotic laxatives) can be titrated to individualize dosing to achieve a comfortable frequency of bowel movements. Glycolax (Miralax) is not habit forming and is commonly recommended

Frequent bowel movements (diarrhea) is also associated with hemorrhoids. Finding the underlying reason for diarrhea and receiving appropriate treatment can reduce hemorrhoidal irritation.

Sitz bath, soaking the rectal area in warm water for 10 to 15 minutes two to three times daily can be soothing.  Do not add soap, bubble bath, or other additives in the water. Sitz baths work by improving blood flow and relaxing the sphincter muscle around the anus.

Ointments, creams, and suppositories are available to treat hemorrhoids, and many are available without a prescription. Pain-relieving creams and hydrocortisone rectal suppositories may help relieve pain, inflammation, and itching, at least temporarily.

MINIMALLY INVASIVE TREATMENT

Rubber band ligation is a quick outpatient procedure used to treat internal hemorrhoids. Rubber bands or rings are traditionally placed around the base of an internal hemorrhoid. As the blood supply is restricted, the hemorrhoid shrinks and degenerates over several days. The CRH O’Regan System is currently the preferred miminally invasive banding technique used at Ohio GI. During the brief and usually painless procedure, a small rubber band is placed around the tissue just above the hemorrhoid where there are few pain-sensitive nerve endings. Unlike traditional banding techniques that use a metal-toothed clamp to grasp the tissue, we use a gentle suction device, reducing the risk of pain and bleeding. The band cuts off the blood supply to the hemorrhoids causing them to shrink and fall off.

 

Infrared coagulation is also an outpatient treatment available for internal hemorrhoids.

HEMORRHOID SURGERY

Hemorrhoidectomy involves surgically removing excess hemorrhoidal tissue. It is successful in 95 percent of patients but can be painful and rarely associated with problems with the anal sphincter. Surgery is usually reserved for external hemorrhoids that are significantly symptomatic.