1. What are hemorrhoids?
Hemorrhoids are dilated veins, either within the rectum (internal hemorrhoids) or outside (external hemorrhoids) near the anus. Internal hemorrhoids are typically not painful, and external hemorrhoids tend to be more symptomatic. At least half of the population will have hemorrhoids by age 50.
2. What causes hemorrhoids?
Causes of hemorrhoids include the following:
Constipation
Pregnancy
Prolonged sitting
Advanced age
Diarrhea
Pelvic tumors
Anal intercourse
3. What are the symptoms of hemorrhoids?
Symptoms of hemorrhoids include:
• Anal itching
• Painless bleeding covering the stool, on the toilet paper after wiping or in the toilet
• Fecal leakage
• Pain when hemorrhoids are thrombosed or have a clot within them
4. How are hemorrhoids diagnosed?
Hemorrhoids are diagnosed by history and physical examination, which involves visual examination of the rectum and anus by a health-care provider. The rectum and anus will also be examined manually with a finger to feel for thrombosed hemorrhoids or masses. It is important that all causes of rectal bleeding are excluded, even though the hemorrhoids are a common cause. The health-care provider may suggest further evaluation with a sigmoidoscopy or colonoscopy to fully visualize the rectum and colon.
5. How are hemorrhoids treated?
Hemorrhoids can be treated conservatively with increasing dietary fiber, topical and oral medications or surgically. Oral treatment regimens along with dietary changes include increasing fiber to soften and add bulk to stools, and laxatives to improve constipation. Topical treatments comprise over-the-counter anti-itch creams and topical steroids. These should only be used for the shortest period of time (up to seven days) because of side effects, including skin irritation and thinning, respectively. Warm sitz baths, where the anal area is soaked in warm water for 10-15 minutes, can also help. This relaxes the anal sphincter and brings greater blood flow to the area.
If conservative measures fail, the individual may require surgical intervention, which consists of rubber band ligation, sclerotherapy, laser therapy, coagulation treatment or surgical removal of the hemorrhoids.
