Hemorrhoid is the medical term for the swelling that occurs in the veins surrounding the anus and the distal part of the rectum. There are two types of hemorrhoids. Internal hemorrhoids occur in the lower rectum, under the lining of the skin. These are usually painless, except during bowel movements or if they become prolapsed, which means that they come out of the anus and cannot be pushed back into the rectum. External hemorrhoids develop in the skin surrounding the anus. These are usually painless unless a clot forms within the vein. Hemorrhoids are very common. According to the National Digestive Diseases Information Clearinghouse, about 75 percent of people experience hemorrhoids at some point. Hemorrhoids can be treated in several ways. Most treatment strategies aim to decrease the swelling and inflammation of the veins, improve diet and nutrition to allow for soft bowel movements, and control pain. Surgery is another option in severe cases of hemorrhoids.
Causes
There are several factors that can contribute to inflammation of the blood vessels and the development of hemorrhoids. Though the exact cause remains unknown, increased pressure from pooling blood is thought to play a major role. According to the American Society of Colon & Rectal Surgeons, contributing factors include old age; chronic constipation or diarrhea; pregnancy, which increases the pressure upon the abdomen and the lower part of the body; and straining when having a bowel movement. Other factors include sitting on the toilet for long periods of time, which places excess pressure on the venous system of the rectum; nutritional deficiencies such as lack of stool-softening fiber in the diet; and overuse of laxatives and enemas, which interferes with the normal functions of the rectum. All these factors contribute to the stretching and dilation of the blood vessels which can then protrude from under the skin around the anus, forming a hemorrhoid.
Symptoms
The main symptoms of hemorrhoids are bleeding during bowel movements, with the presence of bright red blood in the toilet, on stool, or on the toilet paper upon wiping. Hemorrhoids can be incredibly uncomfortable, causing itching that can worsen with excessive straining or wiping. An external hemorrhoid that is thrombosed, or occluded with a clot, can be very painful, causing significant bleeding and forming a hard lump around the anus that is hard to push back in.
Initial Treatment
The initial treatment for hemorrhoids involves dietary and lifestyle modifications to help treat the symptoms. Increasing the amount of fiber in the diet helps with the passage of soft stools that do not cause inflammation or bleeding of hemorrhoids. Natural sources of fiber include whole brains and vegetables. Artificial over-the-counter fiber supplements can also help maintain regular bowel habits, decreasing the symptoms of hemorrhoids. Other strategies include increasing the intake of water to about six to eight 8-ounce glasses a day; sitting in the bath tub with warm water for a few minutes at a time; regular exercise to promote regular bowel health; and decreasing the amount of time sitting on the toilet and not straining during bowel movements. Anti-hemorrhoid cream, ointments and suppositories can temporarily relieve symptoms of itching and pain, and steroid suppositories can decrease the inflammation and swelling associated with hemorrhoids.
Surgical Treatment
These procedures include rubber band ligation, during which a doctor puts a medical rubber band around the hemorrhoid to cut off its blood supply, making it shrink; sclerotherapy, which is the use of a chemical solution that makes the hemorrhoid shrink; and infrared coagulation, which uses heat to shrink the vein. Surgery to remove the hemorrhoids, called hemorrhoidectomy, is usually reserved for large external hemorrhoids that do not respond to any of the other therapies. It may also be recommended if clots continue to form in external hemorrhoids and when there is persistent bleeding despite the use of other therapies.
