Hemorrhoids

What are hemorrhoids?

Hemorrhoids are normal cushions of tissue containing blood vessels in the lower rectum and around the anus. They are a normal part of the ability to control defecation which helps prevent any leakage of feces. Hemorrhoids affect more than half of the population at some point in their lives. They are one of the most common conditions that prompt people to visit their doctor.

In order to understand hemorrhoids, you have to understand the structure of the rectum and anus. Doctors call the area where feces exit the digestive system the anal canal. There exists a complicated set of muscles known as anal sphincters that control the release of feces through the anal canal. The hemorrhoids are located adjacent to the anal canal and fill with blood to help close the anal canal and prevent leakage. When the hemorrhoids become significantly enlarged, they protrude into the anal canal or appear on the outside of the anus.

Internal and external hemorrhoids

The position of the hemorrhoid determines the main classification described as either internal or external. Remember that the anus, or anal canal, is the opening, and the rectum is the final portion of the colon, or large intestine, that leads to this opening. Hemorrhoids can occur both above the anal canal (internal) or below the anal canal in the skin around the anus (external). However, they exhibit different symptoms depending on the location.

Although usually painless, there may be some pain associated with internal hemorrhoids if they become thrombosed (develop a blood clot inside) or prolapsed for long periods of time. (A prolapse is the falling down or slipping of a body part from its usual position.) After a bowel movement, rectal bleeding may be noticed. Bright red blood may appear on toilet paper or in the toilet. The stool itself may also appear discolored.

External hemorrhoids can be painful if thrombosed, but do not necessarily cause serious problems. The pain usually persists for only a few days. Swelling will usually subside in a few weeks. Hygiene is important when dealing with external hemorrhoids. Fecal matter must be kept from irritating the skin around the anus, which can cause more discomfort and itching.

Whether internal or external, thrombosed hemorrhoids occur when a blood clot forms inside the hemorrhoidal tissue. This is a very painful condition, but it usually resolves itself in a few days.

Symptoms of hemorrhoids

The symptoms of hemorrhoids depends on their location, but may include:

• red blood on toilet tissue, stool, or in the toilet bowl
• pain during bowel movements
• lumps near the anus
• anal pain while sitting
• anal itching

Causes of hemorrhoidal symptoms

Hemorrhoids are normal tissue occurring in all people. Hemorrhoids can become large, can bleed, and can become tender. There is no single cause for hemorrhoidal symptoms but some factors may play a part:

• chronic constipation with straining
• straining during bowel movements, and sitting on the toilet for long periods
• chronic diarrhea
• diet, especially one low in fiber, or dehydration

Sedentary lifestyles also seem to coincide with this condition.

Diagnosing hemorrhoids

A physical examination of the anus usually confirms a diagnosis of external hemorrhoids as they are easily visualized. A digital examination of the lower rectum can confirm the structure of muscles and often locate any polyps and/or tumors.

An anoscopy employs an endoscopic device with a light to examine the interior wall of the anal canal and the very lowest part of the rectum. For a more complete examination of the large intestine, a colonoscopy and flexible sigmoidoscopy can be utilized.

Barium enemas, which employ a contrast solution that is instilled into the rectum for x-ray imaging, may also be an option.

These examinations generally cause little discomfort.

Hemorrhoid medications

Medication for hemorrhoids is a major industry, but there is little proof that medications actually improve this condition. In some cases, they can relieve pain and swelling using a combination of anti-inflammatory agents and pain-killers. Sadly, reducing the recurrence of this condition is not that easy.

Non-surgical treatment of hemorrhoids

If a person's external hemorrhoids are not causing very much trouble in the way of pain or bleeding, they are usually observed with some dietary changes and supportive care. Internal hemorrhoids can be treated with rubber band ligation over a few weeks, or infrared coagulation.

Dietary changes and supportive care

Mild or moderate cases of hemorrhoids can usually be treated with good success by:

• adding fiber to the diet in the form of a fiber supplement
• increasing water intake, to avoid constipation and to soften the stools
• stool softeners can help with hard stools
• NSAIDS (nonsteroidal anti-inflammatory drugs) to treat pain

The combination of water and fiber makes stools soft and bulky, and therefore easier to pass through the anal canal. Patients are encouraged to avoid straining and forcing a bowel movement to happen.

The outcomes of these lifestyle changes usually work. However, it may take some time and patience for this course of action to yield results.

Rubber band ligation

Hemorrhoid ligation is the least invasive treatment available for hemorrhoids. The hemorrhoid is wrapped with a rubber band at the base of the protrusion, cutting off blood flow. This causes the hemorrhoid to shrink and eventually fall off, usually within a week. This procedure, which involves very little pain, can be performed on an outpatient basis.

Infrared coagulation

Coagulation therapy is another effective technique for removing hemorrhoids that are not too large. With this procedure a local anesthetic is applied followed by an infrared coagulation device that is brought in contact with the hemorrhoid. The protrusion is heated for a brief interval, causing tissue to be burned. The necrotic (dead) tissue then forms a scar inhibiting the flow of blood to the hemorrhoid.

However, there are a few disadvantages to this procedure:

• some bleeding will occur
• recovery time is a few days longer
• stool softeners need to be used to avoid straining (which could cause the scar
  to open)
• multiple areas cannot be treated at once; several treatments would be required

Surgical treatment of hemorrhoids

Hemorrhoid surgery is reserved for those people who do not respond to more conservative therapies. The important factor to consider is how much trouble the hemorrhoids are causing. Occassionally, hemorrhoids that become quite large, or bleed so much, will require surgery.