Hemorrhoids are collections of connective tissue, arteries and veins that can develop around your anus or inside your rectum. Hemorrhoidal symptoms range from the benign, such as itching, to the serious, such as bleeding or debilitating pain. Your doctor normally can treat your hemorrhoidal symptoms non-operatively. On rare occasions, surgery may be necessary. No matter how serious your symptoms are, always seek treatment from a colon and rectal specialist, a physician formerly known as a proctologist. Often, treament may include only conservative measures such as stool softeners and topical steroids such as betamethasone, a stong steroid preparation or other forms of topical steroids. In the severest forms, hemorrhoids may require an operative treatment.
Hemorrhoids can be external or internal, large or small. External hemorrhoids are located either inside or outside the anal canal. Internal hemorrhoids are located high in the anal canal, are more prone to bleeding and can produce a light anal discharge that triggers severe itching. When it comes to hemorrhoids, size does not always matter. Small hemorrhoids can cause big problems, and large hemorrhoids may cause no problems at all. What does matter is the severity of your symptoms.
Hemorrhoids sometimes can prolapse, or protrude outside the anal canal. Prolapsed hemorrhoids can be painful, but sometimes they recede without any treatment. When hemorrhoids enlarge and clot, a thrombotic hemorrhoid forms. Thrombotic hemorrhoids can be intensely painful and bleed as the swollen vein breaks through the skin. Non-thrombotic external hemorrhoids also can cause bleeding, pain or anal itching.
Most treatment for hemorrhoids begins with bulking your stool with fiber or synthetic bulking agents. Your doctor may advise that you eat more high-fiber foods such as vegetables, fruits, beans and legumes. Synthetic bulking agents are sold in the over-the-counter section of your pharmacy or market. These simple interventions help eliminate the trauma of hard stool irritating the anal area.
Topical steroids such as betamethasone, when applied as directed and supervised by your doctor, soothe the anal area by decreasing the inflammation. Prescription-strength ointments can provide rapid relief, but these medications must not be used over a long period of time because prolonged use can weaken or irritate the anal skin.
When minimal intervention measures fail, your physician may attempt more aggressive treatments such as surgical hemorrhoidectomy, or hemorrhoid removal; banding, a procedure in which doctors stop the hemorrhoidal blood flow with rubber bands; sclerotherapy, or injection therapy, which involves injecting the areas around the hemorrhoids with dilute phenol, a chemical solution; infrared coagulation, or coagulation therapy, in which your doctor heats the hemorrhoid with an infrared light to cut off its blood supply; or the procedure for prolapse and hemorrhoids, PPH, in which your doctor uses a stapling device to partially remove and reposition the hemorrhoidal tissue.
It is important to confirm that your symptoms are not caused by something more serious such as anal cancer. Benign problems such as an anal fissure can mimic hemorrhoidal symptoms, but the treatment is very different for a fissure. Do not fear seeking medical attention. A colon and rectal specialist can diagnose your problem quickly, gently and skillfully.
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